Patients’ Attitudes and Physicians’ Perceptions Toward Maintenance Therapy for Advanced Non–Small-cell Lung Cancer: A Multicenter Italian Survey

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Abstract

Introduction

Pemetrexed maintenance therapy (MT) after induction with platinum-based chemotherapy has recently become a common treatment strategy for advanced nonsquamous non–small-cell lung cancer (NSCLC). However, the benefits of MT should be weighed with consideration of the patients’ perceptions and preferences. The aim of the present study was to evaluate patients’ attitudes toward MT and to describe physicians’ awareness of their patients’ inclinations.

Materials and Methods

We administered a 12-question anonymous survey and the Distress Thermometer Questionnaire to patients with advanced or recurrent nonsquamous NSCLC. The survey was also distributed to the referring physicians.

Results

From December 2014 to July 2015, 92 patients and 37 physicians were enrolled. All 92 patients completed the questionnaire at T0 (before starting chemotherapy) and 56.5% also did so at T1 (after completion of induction). The physicians completed the survey only at T0. Most patients had a positive attitude toward MT at both T0 (78.9%) and T1 (86.5%), and 100% of the physicians thought their patients would be in favor of MT. The physicians believed that their patients’ attitudes toward MT would decrease proportionally with the reduction in the magnitude of the overall survival increase and expected benefits. The decrease expected by the physicians was much greater than that reported by the patients. This was especially true for an overall survival increase as small as 1 month (51.9% of patients accepting MT vs. 13.5% supposed by physicians) or when the only treatment benefit was radiologic tumor stabilization (69.3% of patients accepting MT vs. 37.8% supposed by physicians).

Conclusion

NSCLC patients have a generally positive attitude toward MT, which is not directly proportional to the expected benefits and greater than the attitude expected by physicians.

Micro-Abstract

One question is how long patients with advanced non–small-cell lung cancer wish to receive therapy. The perceptions of > 100 patients and physicians were analyzed to compare different prognostic conditions. The patients’ attitudes were generally positive and not directly linked to the expected benefits, suggesting that other factors in conjunction with the clinical assessment, such as the doctor–patient relationship, should be considered to understand patients’ motivations.

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