A randomised assessment of the use of a quality of life questionnaire with or without intervention in patients attending a thoracic cancer clinic

Our plain-English summary of A randomised assessment of the use of a quality of life questionnaire with or without intervention in patients attending a thoracic cancer clinic, by K. Nimako, B. Ayite, K. Priest, et al (European Journal of Cancer Care, 2017).

The study

• Authors: K. Nimako, B. Ayite, K. Priest, J. Severn, H.M. Fries, R. Gunapala, J. Bhosle, S. Popat, M. O'Brien
• Journal: European Journal of Cancer Care
• Published: 2017;26(4)
• Type of article: Randomized trial
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The study examined the impact of using a quality of life (QoL) questionnaire during a clinic to identify QoL issues and to improve QoL. 138 patients were randomised (1:1:1) to either (1) an Intervention group that completed the European Organisation for Research and Treatment of Cancer-Core Quality of Life Questionnaire and Lung Cancer Module (EORTC QLQ-C30 and LC13) at baseline and received feedback during a clinic, (2) an Attention group that completed the questionnaire at baseline without feedback and (3) a Control group that did not complete the questionnaire. All patients completed the same questionnaire 6 weeks later and a contact diary during the study period. There was a significant difference between the Intervention and Control groups for the mean number of QoL issues identified at baseline (4.69 vs. 2.81, P = 0.006) and the mean number of actions taken (4.41 vs. 2.46, P = 0.004). At 6 weeks, there was no difference between the groups in global QoL (Intervention vs. Control group, P = 0.596; Attention vs. Control, P = 0.973). The results suggest that the completion of the EORTC QLQ-C30 LC13 with feedback improves communication and increases the number of QoL issues identified and actions taken. However, the intervention does not impact on QoL per se. Clinicaltrials.gov: NCT01213745.

© 2015 John Wiley & Sons Ltd.

In plain English

In this randomised trial at the Royal Marsden Hospital, UK, 138 patients with non-small cell lung cancer, small cell lung cancer or mesothelioma who had completed treatment and had none planned within 6 weeks were split into three groups. In the Intervention group (45), patients completed a quality of life questionnaire (EORTC QLQ-C30 and lung cancer module LC13), which the doctor used during the visit. In the Attention group (47), patients completed it but the doctor did not see it. The Control group (46) did not complete it before the visit; all groups completed it at 6 weeks. Doctors identified more problems in the Intervention group than in the Control group (mean 4.69 vs. 2.81, P = 0.006) and took more actions (mean 4.41 vs. 2.46, P = 0.004). At 6 weeks there was no statistically significant difference between the groups in overall quality of life or in contacts with health professionals. The authors concluded that questionnaires improve communication but that the study gave no evidence of better quality of life. Mesothelioma patients were not analysed separately, and asbestos exposure was not studied.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Randomised controlled trial with three arms (1:1:1): Intervention, Attention and Control
• Who was studied: 138 of 201 eligible patients with thoracic cancer (non-small cell lung cancer, small cell lung cancer or mesothelioma) attending the Royal Marsden Hospital thoracic cancer clinic, UK. Patients had completed treatment, with no limit on the time since treatment, and could have no treatment planned within 6 weeks. There were 45 in the Intervention group, 47 in the Attention group and 46 in the Control group. Table 1 lists 23 with mesothelioma (22 epitheloid, 1 sarcomatoid). Recruitment dates are not given.
• Exposure: This was not an asbestos exposure study. The intervention was completion of the EORTC QLQ-C30 and LC13 questionnaires on paper before the consultation, with the doctor giving feedback and using the questionnaire during the consultation. The Attention group completed the questionnaire without the doctor seeing it. The Control group did not complete it at baseline. All groups completed it at 6 weeks.
• Main results:
  • Mean number of quality of life issues identified at the baseline visit: 4.69 in the Intervention group vs. 2.81 in the Control group, P = 0.006
  • No significant difference between the Attention and Control groups in issues identified (mean 3.03 vs. 2.81, P = 0.434)
  • Mean number of actions taken at baseline: 4.41 in the Intervention group vs. 2.46 in the Control group, P = 0.004. Attention vs. Control: 2.57 vs. 2.46, P = 0.605
  • All participants, including the Control group, completed the questionnaire at 6 weeks.
  • No significant difference in global quality of life at 6 weeks: Intervention vs. Control mean 63.1% vs. 65%, P = 0.596; Attention vs. Control mean 65.4% vs. 65.5%, P = 0.973
  • No significant change from baseline to 6 weeks in global quality of life, functional scales or symptom scales within the Intervention or Attention groups
  • No significant difference in the number of contacts with health care professionals during the 6 weeks (Intervention vs. Control P = 0.293; Attention vs. Control P = 0.403)
  • 131 of 138 participants (95%) completed the 6-week questionnaire; seven were lost to follow-up
• The authors' conclusion: The authors concluded that using questionnaires improves communication between patients and their doctor but that the study did not provide evidence of improved quality of life. They said robust evidence of benefit is needed before such questionnaires become established in routine care.
• Limitations the authors state:
  • Contamination could not be excluded: doctors knew patients were in the study, and Control patients knew the study's aims, so the effect of the intervention may have been underestimated.
  • The same questionnaire was used both as the intervention and as the outcome measure. The authors considered familiarity unlikely to be a significant problem.
  • Questionnaire results were given to doctors unsummarised and without graphics; a better data format might have improved interpretability.
  • Consultations were verified against the GP letter rather than recordings, and doctors do not always document everything discussed.
  • The 6-week time frame may have been too short to see a change in quality of life.
  • The questionnaire was given at only one time point.
  • There was no protocol guiding what action to take for each issue identified.
  • The study was not powered to detect differences in secondary endpoints.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Quality of Life, Lung Cancer.

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