Patient and clinician perspectives on adjuvant treatment in early-stage non-small cell lung cancer (NSCLC): Qualitative results

Despite advances in treatment options, little is known about patient and clinician perspectives on the benefits of adjuvant treatment in early-stage NSCLC. Qualitative interviews with patients and clinicians explored concepts related to adjuvant treatment benefit, including the value of prolonging survival. Patients with fully resected stage IB-IIIA NSCLC who had or had not received adjuvant treatment and treating oncologists, thoracic surgeons, and pulmonologists in 13 countries completed online interviews. Themes investigated were informed by a review of the literature and clinical data for comparator treatments and included NSCLC symptoms, expectations for adjuvant treatment, and desired outcomes. Fifty-eight patients (Asia Pacific n = 9, Europe n = 29, North America n = 10, South America n = 10) and 109 clinicians (Asia Pacific n = 30, Europe n = 54, Middle East n = 5, North America n = 10, South America n = 10) completed an interview. Mean patient age was 56 years. Most patients were female (n = 34, 59%) and had received adjuvant treatment for NSCLC (n = 32, 55%). Most clinicians were oncologists (n = 69, 63%) and 20% were female (n = 22). The most common desired treatment benefits related to survival. In the patient sample this included cure or remission (n = 27, 47%), avoiding disease spread (n = 11, 19%), and delaying recurrence (n = 6, 10%), while clinicians reported overall survival (OS) (n = 97, 89%), disease-free survival (DFS) (n = 78, 72%), and progression-free survival (n = 21, 19%). For adjuvant treatment-naïve patients, tolerability was an important treatment consideration (n = 7,27%). Clinician treatment decisions were influenced by treatment tolerability and quality of life (QoL) concerns (both n = 37, 34%), as well as reduced symptom burden (n = 22, 20%). Survival outcomes including OS and DFS were most frequently mentioned as desired benefits but were described differently by patients and clinicians. Treatment tolerability and QoL on treatment were also important considerations. Results will be used to inform the design of a quantitative study assessing the trade-offs participants are willing to make between OS, DFS and treatment risk.