Quality of survival: a new concept framework to assess the quality of prolonged life in cancer

ABSTRACT

Background: Improved cancer care means that more patients are surviving longer, but there is a need to examine how well patients survive. We conducted an exploratory analysis of a new conceptual framework termed ‘quality of survival’ (QoS) that delineates the quality of patients’ experience.

Methods: This project included an electronic database search to investigate the survivorship landscape and to create a visual QoS map and semi-structured interviews with patients (n = 35), clinicians (n = 40), and payers (n = 7) to support the QoS map. QoS was discussed in the context of two tumor types, metastatic non-small cell lung cancer and metastatic melanoma.

Results: Despite increased long-term survival, no specific definition of QoS exists. Patients reported many impacts that affect QoS, clinicians viewed QoS as relevant to treatment decisions, and payers felt it could help communicate different aspects relevant to the patient. Four interconnected QoS dimensions were developed (quality of life, survival, side effects, and economic impact), which vary in importance along the care continuum.

Conclusion: QoS is a patient-centric concept that could help decision-making and patient communication. The QoS map could provide a framework to monitor patient experience and help patients frame what treatment attribute is most important to them at any point in the cancer continuum.

KEYWORDS:

• Melanoma
• non-small cell lung cancer
• quality of life
• survival
• quality of survival

Acknowledgments

The authors wish to acknowledge Lauren Walrath, formerly at Bristol-Myers Squibb, and Jessica Costello, Laura Grant, Rebecca Hall, Louise Heron, Rhianna Miles, and Nicola Williamson at Adelphi Values for their work in the design, collection, and interpretation of evidence. Bristol-Myers Squibb, the study sponsor, was involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication. Lesley Fallowfield, DPhil, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Declaration of interest

The Lead & Corresponding author, Lesley Fallowfield, DBE, BSc, DPhil, FMedSci has the following UK Disclosures: Research Funding: Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffmann-La Roche, Roche UK, Sanofi/pH Associates; Consulting or Advisory Role: Amgen; Honoraria: Amgen, Bristol-Myers Squibb, Bayer, Hoffmann-La Roche, Roche UK, Sanofi, TEVA; Speakers Bureau: Amgen, Hoffmann-La Roche, Roche UK. Coauthor, Eric Nadler, MD, MPP, has the following USA Disclosures: Speakers Bureau: Genentech, GlaxoSmithKline, Lilly, Pfizer. CoauthorIsabelle Gilloteau, MSc, MPH, Bristol-Myers Squibb, Princeton, NJ, USA (affiliation at the time of this research) has the following disclosure: Stock or Other Ownership: at the time of this research, Bristol-Myers Squibb; Employment: at the time of this research, Bristol-Myers Squibb. Coauthor Maire Greaney, BSc, Adelphi Values, Cheshire, has the following UK Disclosures: Consulting or Advisory Role: Adelphi Values. Coauthor Adam Gater, MSc, Adelphi Values, Cheshire, has the following UK Disclosure: Consulting or Advisory Role: Adelphi Values. Coauthor Lucinda Orsini, DPM, MPH, Bristol-Myers Squibb, Princeton, NJ, USA (affiliation at the time of this research) has the following disclosure: Stock or Other Ownership: at the time of this research, Bristol-Myers Squibb; Employment: at the time of this research Bristol-Myers Squibb. Coauthor Milayna Subar, MD, Bristol-Myers Squibb, Princeton, NJ, USA (affiliation at the time of this research) has the following disclosures: Employment: at the time of this research, Bristol-Myers Squibb. Coauthor: Gary H. Lyman, MD, MPH, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, has the following USA Disclosure: Research Funding: Amgen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Professional medical writing assistance was provided by Mark Palangio and professional editing assistance was provided by Karin McGlynn, and was funded by Bristol-Myers Squibb.

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Additional information

Funding

Adelphi Values received funding from Bristol-Myers Squibb for conducting the study on which this report is based. Professional medical writing assistance was provided by Mark Palangio and professional editing assistance was provided by Karin McGlynn at StemScientific, an Ashfield Company, and was funded by Bristol-Myers Squibb.