Exploring the value of routinely collected data on EQ-5D-5L and other electronic patient-reported outcome measures as prognostic factors in adults with advanced non-small cell lung cancer receiving immunotherapy

Abstract

Objective Investigate whether routinely collected electronic patient-reported outcome measures (ePROMs) add prognostic value to clinical and tumour characteristics for adults with advanced non-small cell lung cancer (NSCLC) receiving immunotherapy.Methods and analysis We retrospectively analysed data from adults with advanced NSCLC commencing immunotherapy between April 2019 and June 2022. Prognostic factors were ePROMs on quality of life (EuroQoL five-dimension five-level (EQ-5D-5L); EuroQoL Visual Analogue Scale (EQ-VAS)) and symptoms (patient-reported version of the Common Terminology Criteria for Adverse Events v5.0) completed at baseline and the first follow-up. We performed Cox proportional hazard regression for overall survival and time-to-progression as outcomes, and logistic regression for the onset of severe treatment toxicities (grade ≥3).Results We included 379 patients; 161 (42.5%) completed ePROMs at baseline. Median overall survival and time-to-progression were 13.5 months (95% CI 11.3 to 16.7) and 10.5 months (95% CI 8.8 to 13.7), respectively. 36 (9.5%) experienced severe treatment toxicities during follow-up. Patients with lower EQ-5D-5L utility scores (HR per 0.1 unit increase 0.84, 95% CI 0.74 to 0.95) and higher symptom burden (HR 1.11; 95% CI 1.04 to 1.19) had poorer overall survival. This was also true for those with decreased EQ-VAS and increased symptom burden between baseline and the first follow-up. Lastly, only decreased EQ-5D-5L utility scores between baseline and the first follow-up were associated with shorter time-to-progression.Conclusion ePROMs may add prognostic value to clinical and tumour characteristics for overall survival in adults with advanced NSCLC receiving immunotherapy.