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

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.