Assessment of the psychosocial and economic impact according to sex in non-small cell lung cancer patients: an exploratory longitudinal study

Abstract

Background: Little is known about the impact of sex on lung cancer patients from the psychological, economic and social perspectives. This study was designed to explore the psychosocial and economic impact according to sex of metastatic non-small cell lung cancer (mNSCLC) in patients and caregivers.

Methods: Exploratory study of two cohorts of patients starting first-line treatment for mNSCLC. The following questionnaires were administered at baseline, 4 months later and following the first and second disease progression: APGAR, relationship impact scale, DUKE-UNC scale, economic impact in patients and caregiver, and Zarit scale. It was planned to include 1250 patients to get an 80% possibility of detecting as significant (p < 0.05) effect sizes less than 0.19 between men and women. Univariate comparisons were made between the tests applied to men and women. Overall survival was estimated with Kaplan-Meier method. Cox analyses were done to estimate hazard ratios (HRs) with 95% CI.

Results: 333 patients were included. Most families reported to continue being functional despite the lung cancer diagnosis. Regardless of sex, they did not perceive changes in their partner relationship. Most patients felt their social support was normal. Roughly 25% of people reported a worsening in their economic situation, without remarkable differences by sex. Statistically significant differences were found between both groups regarding the caregiver's relationship to the patient (more parents were the caregiver in females than in males, p < 0.0001) and the caregiver's employment situation (more employed caregivers in females) (p < 0.0001). Most caregivers of both sexes considered that taking care of their relative did not pose a significant burden.

Conclusions: This study provides a preliminary insight into sex-related characteristics in the management of advanced NSCLC and its impact on the emotional, social and economic burden of patients and their caregivers, and recall the high priority of researching in cancer from a sex perspective. Nevertheless, due to the low recruitment rate and the relevant loss of patients during the follow-up, it was difficult to find differences by sex.

Trial registration: ClinicalTrials.gov identifier: NCT02336061.

Ethics committee: Comité Ético de Investigación Clínica del Hospital Clínic de Barcelona, Spain. Reference number: HCB/2014/0705.

Keywords: Carcinoma; Caregivers; Non-small-cell lung; Sex characteristics.

Conflict of interest statement

Dr. Angel Artal has nothing to declare. Dr. Dolores Isla has nothing to declare. Dr. Enric Carcereny has nothing to declare. Dr. Juan Coves reports personal fees from boehringer ingelheim, personal fees from BMS, personal fees from Roche, personal fees from ASTRAZENECA, personal fees from NOVARTIS, personal fees from MSD, personal fees from LILLY, outside the submitted work; Dr. Enriqueta Felip reports personal fees from ABBVIE, personal fees from ASTRA ZENECA, personal fees from BERGENBIO, personal fees from BLUE PRINT MEDICINES, personal fees from BOEHRINGER INGELHEIM, personal fees from BRISTOL-MYERS SQUIBB, personal fees from CELGENE, personal fees from ELI LILLY, personal fees from GUARDANT HEALTH, personal fees from JANSSEN, personal fees from MEDSCAPE, personal fees from MERCK KGaA, personal fees from MERCK SHARP & DOHME, personal fees from NOVARTIS, personal fees from PFIZER, personal fees from priME ONCOLOGY, personal fees from ROCHE, personal fees from SAMSUNG, personal fees from TAKEDA, personal fees from TOUCHTIME, outside the submitted work; and Board: Grífols (Independent Member). Dr. Javier De castro reports other from ASTRA ZENECA, other from BOEHRINGER INGELHEIM, other from BRISTOL MYERS SQUIBB, other from MERCK SHARP AND DOHME, other from HOFFMANN ROCHE, other from TAKEDA, other from NOVARTIS, other from PFIZER, outside the submitted work. Dr. Jose Luis Gonzalez Larriba has nothing to declare. Dr. Jordi Remon reports other from MSD, other from BOEHRINGER, other from PFIZER, personal fees and other from OSE IMMUNOTHERAPEUTICS, other from BMS, other from ASTRAZENECA, other from ROCHE, outside the submitted work. Dr. Manuel Domine reports personal fees from Abbvie, personal fees from Astra-Zeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from MSD, personal fees from Pfizer, personal fees from Roche, outside the submitted work. Dr. Margarita Majem reports grants from ROCHE, during the conduct of the study; personal fees from ROCHE, grants from BMS, personal fees from MSD, personal fees and other from ASTRA ZENECA, outside the submitted work; Dr. Nuria Viñolas reports grants from Roche, during the conduct of the study; personal fees from Roche, other from BMS, personal fees from Pfizer, other from Boeringher ingelheim, personal fees and other from Lilly, other from Astra zeneca, outside the submitted work. Dr. Pilar Garrido reports grants from ROCHE, during the conduct of the study; other from MSD, personal fees and other from BMS, personal fees and other from BOERINGHER INGELHEIM, personal fees and other from PFIZER, personal fees and other from NOVARTIS, other from LILLY, other from GUARDANT HEALTH, other from ABBVIE, personal fees and other from ASTRA ZENECA, other from SYSMEX, other from BLUE PRINT, other from TAKEDA, personal fees from GILEAD, personal fees from ROVI, personal fees and other from ROCHE, outside the submitted work. Dr. Pilar Lianes has nothing to declare. Dr..Rosario Garcia Campelo reports grants from Roche, during the conduct of the study; personal fees and other from Roche, personal fees and other from BMS, personal fees and other from MSD, personal fees and other from PFIZER, personal fees and other from LILLY, personal fees and other from ASTRA ZENECA, personal fees and other from TAKEDA, personal fees from NOVARTIS, personal fees and other from BOERINGHER INGELHEIM, outside the submitted work.

Figures

Fig. 1

Survival by sex