Results Summary

What was the research about?

Patients with advanced lung cancer have important choices to make about chemotherapy. Chemotherapy is a treatment that uses medicines to stop the growth of cancer cells. The side effects of medicines used in chemotherapy differ. Some medicines may be hard for patients to tolerate for long periods of time. Patients’ treatment preferences can change over time.

The research team talked to patients before, during, and after chemotherapy to see whether they changed their views on

  • What treatment results they prefer: longer life, improved well-being, or a mix of both
  • How long they would be willing to tolerate specific side effects
  • Which side effects they would most like to avoid

The research team looked at data from all patients who had more than one interview. They reported how patients changed their answers from their first to their last interview.

What were the results?

After having chemotherapy, 47 percent of patients changed their preferences about treatment results. Of patients who first said that treatment success was longer life, 80 percent changed their definition of success to include improved well-being.

The number of patients willing to put up with chemotherapy side effects for years, rather than months, decreased after treatment. Among all patients, 36 percent decreased how long they would put up with side effects from “years” to “months” compared with 24 percent of patients who increased how long they would put up with side effects from “months” to “years”.

Before treatment, patients ranked shortness of breath, bleeding, and fatigue as the side effects they would most like to avoid. After treatment, more ranked fatigue as the side effect to avoid, followed by shortness of breath and bleeding.

Who was in the study?

This study included 235 patients with lung cancer receiving care from nine cancer centers in Nebraska, North Dakota, Kansas, and Florida. Of these, 95 percent were white, and 5 percent were other races. The average age was 68, and 55 percent were men.

What did the research team do?

The research team interviewed patients before, during, and after chemotherapy. They asked patients what treatment results they prefer: longer life, improved well-being, or a mix of both. In addition, they asked patients how long they would be willing to put up with treatment side effects. Finally, patients ranked a list of chemotherapy side effects to see which ones they would most like to avoid. The research team looked at whether patient responses were different before and after treatment.

Patients, family members, patient advocates, and cancer doctors and nurses helped design the study.

What were the limits of the study?

Most patients in this study were white and over age 60. The results may be different for patients of other backgrounds.

How can people use the results?

This study found that patients often change treatment preferences after starting chemotherapy. Doctors may want to ask patients about what matters most to them both before and after starting treatment.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers requested extensive edits because of difficulties understanding the language in the report and insufficient detail of the methods used. The researchers made several efforts to correct language and restructure the report to make it more readable.
  • Reviewers identified a number of standard reporting elements for clinical trials, including eligibility criteria, allocation concealment, and detailed intervention information, that the report did not describe adequately. The researchers expanded their presentation of the study methods. However, the reviewers were not completely satisfied with the researchers’ responsiveness to their concerns.
  • Reviewers questioned the choice to complete more than 200 qualitative interviews, then create categorical variables from those qualitative data, as part of the methods for Aim 1. The researchers explained that the interviews had quantitative and qualitative components, and the qualitative questions were actually limited to the patients defining their understanding of treatment success.

Conflict of Interest Disclosures

Project Information

KM Islam, MBBS, PhD
University of Nebraska Medical Center
Patient-Defined Treatment Success and Preferences in Stage IV Lung Cancer Patients

Key Dates

May 2013
September 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 25, 2023