A nationwide clinical trial is underway to evaluate the health-related quality of life (QoL) trajectory of young Hodgkin lymphoma patients undergoing treatment. This initiative signals a move towards making QoL measurements more accessible and interpretable for both cancer patients and their physicians, complementing traditional clinical measures such as relapse rates and overall survival.
Improved Outcomes with Immuno-Oncology and QoL
The integration of an immuno-oncologic agent, specifically brentuximab vedotin, into a multidrug chemotherapy regimen has demonstrated clinical advantages over standard chemotherapy. A study published in the New England Journal of Medicine showed not only superior clinical outcomes but also fewer adverse effects on patients' QoL, as detailed in the Journal of Clinical Oncology. According to Susan Parsons, M.D., MRP, providers are actively seeking methods to maintain survival rates while minimizing the long-term toxicities associated with front-line therapies, thus improving the survivorship experience.
Assessing Quality of Life in Clinical Trials
In the study, patients were randomized to receive either the standard multidrug chemotherapy regimen alone or in combination with brentuximab vedotin, an anti-CD30 antibody-drug conjugate. Previous trials had indicated a potential increased risk of peripheral neuropathy with brentuximab vedotin. To assess QoL, two concise, targeted questionnaires were administered, focusing on the impact of neuropathy and overall quality of life. AnnaLynn Williams, Ph.D., noted the "extraordinarily high participation" rates across almost all time points, underscoring the feasibility and significance of incorporating patient-reported outcomes in nationwide clinical trials.
Integrating Patient Experience into Drug Approval
The research team is currently working with the National Cancer Institute (NCI) and the U.S. Food and Drug Administration (FDA) to explore how to incorporate patient experience into the drug approval process across all age groups. Parsons emphasizes that while complex, this integration represents the future of cancer treatment evaluation.
The Shift in Focus: Beyond Survival
Historically, the primary focus was on patient survival. However, the conversation has evolved to consider the cost of treatment and how to improve the overall patient experience. New measurement systems, developed through National Institutes of Health (NIH) initiatives, enable efficient and precise QoL assessments. Parsons argues that there is now no reason not to utilize these tools in clinical trials and practice.
Standardizing QoL Measurement
Significant progress has been made in standardizing QoL measurement tools, largely due to initiatives like the Patient-Reported Outcomes Measurement Information System (PROMIS). These tools are designed to be brief, with some questionnaires taking only one to two minutes to complete. When PROMIS tools were introduced in clinical settings, concerns about workflow disruption and patient dissatisfaction were unfounded. Instead, the measures were scored immediately and used to inform patient care.
Addressing Missing Data
Researchers are actively working to streamline data collection to minimize missing data, which can introduce bias. Electronic data capture and multimodal data collection systems are being explored to improve data quality. Parsons stresses the importance of focusing on specific quality-of-life questions relevant to the trial and the drugs being studied, rather than conducting massive descriptive studies.
Improving Patient Care Through QoL Metrics
The inclusion of QoL metrics in clinical trials allows for a comparison of treatment options based on patient-defined metrics, ultimately providing greater choice for individual patients and their clinicians. By providing clinicians with a broader understanding of what patients experience during treatment, anticipatory guidance can be offered, helping patients better prepare for the challenges ahead.
The Importance of Long-Term QoL
Williams highlights that Hodgkin lymphoma's high survival rates make QoL assessments even more critical. When survival gains between experimental and standard treatments are marginal, QoL and toxicity profiles can help guide treatment decisions. Studies have shown that long-term survivors of Hodgkin lymphoma often experience persistent fatigue and diminished quality of life. Longitudinal studies, like the latest one, provide a more complete picture of the patient experience from diagnosis through treatment and survivorship.
Streamlining Data Collection for Better Insights
According to Williams, the response rates in the latest study were above 90% for the initial time points, demonstrating the feasibility of including QoL measurements in clinical trials. The researchers learned that thoughtful timing of data collection, such as aligning it with clinic visits, can further improve participation rates. The study's success in embedding QoL measurements into drug trials was made possible by support from organizations like the Leukemia & Lymphoma Society, the NCI, and the Seagen Corporation.
