Quality-adjusted Survival Analysis of CIC-therapy (CDDP+IFO+CPT-11+G-CSF) for stage IIIB and IV Non-small Cell Lung Cancer

Abstract

A quality-adjusted survival analysis allows one to make treatment comparisons that incorporate differences in QOL associated with various health states. In this analysis, we define as health states the periods of time patients spend: a) in hospital for chemotherapy (toxicity; TOX): b) on an outpatient basis (TWiST: Time without Symptom and Toxicity), and in hospital for conservative therapy (relapse; REL). Utility coefficients to reflect the value of these health states were expressed as u_t, u_w and u_r. If u_w were 1 and u_t and u_r were plotted less than 1, u_tTOX+u_wTWiST+u_rREL could be a quality-adjusted value relative to TWiST (CI-TWiST). One hundred ninety-six patients with a stage IIIB and N non-small cell lung cancer were included in 1986-96. One hundred seven patients were given a cisplatin-containing regimen in 1986-93, 38 patients received CIC-regimen (CDDP + IFO + CPT-11+ G-CSF) in 1994-96 and other 51 patients were treated with supportive care only. In the two years following start to treatment, the prognostic factors for Q-TWiST were investigated employing an automatic interaction detection. Chemotherapy contributed to Q-TWiST with the arbitrary utility coefficient values of u_t>u_r. CIC-regimen was a significant factor with the arbitrary utility co-efficient values of u_t≥0.8 and u_r≤0.7. CIC-regimen contributed to QOL marginally.