The Impact of Comorbidities, Neutrophil-to-lymphocyte Ratio, and Adverse Events on Quality of Life in Lung Cancer Patients Receiving EGFR-TKI Therapy

Abstract

Abstract Background Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are used as the standard first-line treatment for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, the impact of clinical factors, including comorbidities and treatment-related adverse events (AEs), on quality of life (QoL) was seldom investigated. Objective We aimed to investigate the association of comorbidities, AEs, and QoL in treatment-naïve advanced NSCLC patients receiving EGFR-TKI treatments. Methods A multi-center prospective observational study was conducted to evaluate QoL and AEs at baseline, the 2nd, 4th, 12th, and 24th week. Clinical characteristics, comorbidities, and pre-treatment laboratory data were recorded. QoL was assessed by using the summary score of the EORTC QLQ-C30 and the dermatology life quality index. The impact of comorbidities, neutrophil-to-lymphocyte ratio (NLR), and AEs on QoL was analyzed by generalized estimating equations. Results A total of 121 patients were enrolled. Diarrhea (p = 0.033), anorexia (p < 0.001), and NLR ≥ 4 (p = 0.017) were significantly associated with a QoL impairment. Among skin toxicities, acneiform rash (p = 0.002), pruritus (p = 0.002), visual analogue scale for pruritus (≥ 3 and < 7, p = 0.006; ≥7, p = 0.001) and pain (1–3, p = 0.041) were associated with a QoL impairment. No significant association was found between comorbidities and QoL changes. Conclusion Diarrhea, anorexia, skin pain, and pruritus may cause a deterioration in QoL. NLR may be a potential predictive factor for QoL impairment. Aggressive management and close monitoring are crucial to improve QoL in patients receiving EGFR-TKI therapy.