Patient-Reported and End-of-Life Outcomes Among Adults with Oncogene-Driven Lung Cancer in a Clinical Trial of Early Integrated Palliative Care: A Secondary Analysis (F415C)

1.Distinguish the quality of life, symptom experience, illness understanding and end-of-life outcomes of patients with oncogene-driven NSCLC from those of patients with wild-type NSCLC in order to identify differences in the experience of patients who benefit from highly effective therapy in the setting of life-limiting cancer compared to patients who receive chemotherapy.2.Translate the findings of this analysis into opportunities to tailor palliative care for patients with life-limiting cancer who benefit from highly effective cancer-directed therapy. Targeted therapy has revolutionized treatment for patients with oncogene-driven non-small cell lung cancer (NSCLC), though data are lacking on patient-reported and end-of-life (EOL) care outcomes in this population. The goal of this study was to compare quality of life (QOL), symptoms, illness understanding and EOL care between patients with oncogene-driven versus wild-type NSCLC. In this secondary analysis of a randomized controlled trial of early integrated palliative and oncology care in patients with advanced NSCLC, we compared change in QOL and symptoms (per the Functional Assessment in Cancer Treatment [FACT]-General and Lung Cancer Subscale [LCS]) over 24 weeks among patients with oncogene-driven versus wild-type NSCLC using linear mixed effects models adjusted for receipt of palliative care. We also compared patients’ self-reported prognostic understanding and decedents’ EOL health care utilization using logistic regression. Compared to individuals with wild-type NSCLC, patients with oncogene-driven NSCLC reported significantly greater improvements in QOL (B=4.84; 95% CI 1.70, 7.99 for FACT-General) and symptoms (B=1.28; 95% CI 0.29, 2.26 for LCS) over time, independent of palliative care. Patients with oncogene-driven NSCLC were less likely to discuss prognosis with their clinicians (OR 3.49; p=0.016 for reporting "never” or "rarely” discussed prognosis), more likely to report that their treatment was curative (OR 2.24; p=0.05), and more likely to receive chemotherapy in the last 14 days of life (OR 5.33; p=0.036) than patients with wild-type NSCLC. Patients with oncogene-driven NSCLC experience marked improvements in QOL and symptoms relative to those with wild-type NSCLC, likely due to disease control by targeted therapy. They are also less likely to discuss their prognosis with oncology clinicians, which may contribute to intensive EOL treatment.