Quality of life changes following treatment in patients with NSCLC: a systematic review and meta-analysis

Health-related quality of life (HRQoL) is central to treatment decisions. We conducted a meta-analysis to assess treatment effects on patient-reported HRQoL in non-small cell lung cancer (NSCLC).

We searched MEDLINE, Embase, PsycInfo and Scopus (January-May 2025) for studies reporting HRQoL in treated NSCLC patients. Article quality was assessed using CONSORT-PRO extension criteria, RoB 2 or ROBINS-I. We evaluated HRQoL changes from baseline to 4, 12, 24, 36 and 52 weeks post-treatment using standardised mean differences from baseline (SMDFB), pooled via a random-effects model.

Forty-seven articles (7518 participants) were included. Targeted therapies improved HRQoL, including dyspnoea ((4 w SMDFB 0·20 [95% CI 0·05 to 0·36], I2 = 38%), 12 w 0·35 [0·24 to 0·47], 24%)), and physical functioning (12 w 0·45 [0·03 to 0·86], 93%). Surgical patients experienced deteriorations in pain and dyspnoea symptoms ((24 w ΔPain -0·58 [-1·14 to -0·02], 98%), 52 w ΔDyspnoea (-0·68 [-1·05 to -0·31], 94%)). Chemotherapy was associated with small deteriorations in multiple HRQoL dimensions at four weeks (ΔFatigue (-0·14 [-0·26 to -0·01], 20%), ΔAppetite (-0·24 [-0·39 to -0·09], 14%), ΔFACT-Lung score (-0·19 [-0·38 to -0·01], 21%)). Exploratory analyses suggested immunotherapy improved multiple HRQoL domains (including ΔEmotional functioning (0·16 [0·08 to 0·23], 0%)), but worsened diarrhoea (-0·20 [-0·37 to -0·04], 66%).

HRQoL changes varied by treatment, with newer therapies potentially offering favourable profiles. This can help patients align treatment with their values, however interpretation is limited by the high risk of bias. We identified evidence gaps in HRQoL reporting and provide recommendations including appropriately addressing missing data.

We conducted a meta-analysis of 47 studies (7518 patients) to evaluate treatment effects on health-related quality of life (HRQoL) in non-small cell lung cancer. HRQoL changes varied by treatment, highlighting the potential of newer therapies to align outcomes with patient preferences. Targeted therapies improved dyspnoea and physical functioning; chemotherapy caused short-term HRQoL deteriorations in fatigue and appetite; and surgery resulted in worsenings in dyspnoea and pain symptoms in the longer term. Gaps in HRQoL reporting and missing data handling were identified, with recommendations provided to improve future studies.