WCLC Researchers Focus on Multifaceted Lung Cancer Treatment Toxicities

Beyond the physical effects, lung cancer and its treatment can exact a financial and emotional toll on patients, according to several sessions, posters, and abstracts at the 2024 World Conference on Lung Cancer (WCLC), held September 7-10, 2024, in San Diego, California. The WCLC agenda was filled with these reminders that the exciting advances in therapy require a continued focus on how they are impacting the patients who receive them.

The WCLC agenda was filled with reminders that the exciting advances in therapy require a continued focus on how they are impacting the patients who receive them. | Image Credit: © Christina Mattina

Financial Toxicity

A session held Tuesday, September 10, focused on the effects of financial toxicity, clinical communication, and the needs of patients and caregivers. Financial toxicity is defined by the National Cancer Institute as “the phenomenon of adverse financial effects of cancer treatment,”¹ and according to presenter David Pottinger, MD, of the University of Alabama at Birmingham, there’s a growing recognition of how it impacts patient well-being. He and colleagues surveyed their institution’s patients with lung cancer from 2017-2023 on 2 measures of financial hardship, and their findings were concerning.²

More than half (52%) of the patients reported concerns about having enough savings, retirement funding, or assets to cover their treatment costs, and minoritized and younger patients reported worse financial toxicity than White or older patients. “This does convey an elevated risk of worse health outcomes on patients, so this certainly warrants further investigation,” Pottinger said.

Another presenter, Anne-Marie Baird, PhD, of Lung Cancer Europe, discussed findings from a literature review and online survey on how the financial toxicity of lung cancer impacts all spheres of life.³ Of the 2 in 3 participants who reported financial difficulties, 82.1% considered these difficulties a barrier to treatment and care, and 88.4% reported negative effects on at least 1 aspect of their life, like mental health (67.5%) or social activities (59.0%). Among participants with or without financial difficulties, 26.5% said they made decisions that negatively affected their self-care for financial reasons.

“We need to be screening for financial toxicity as part of the care pathway, we need to do better at assisting accessing supports, and we also need to work on increasing sick benefits for patients as well,” Baird closed. In a Q&A panel, she noted that after these findings were brought to the attention of the European Union parliament, some hospitals have done away with car parking charges for patients.

Time Toxicity

It’s not just patients’ wallets that can be strained by their treatment regimens—it also takes up their time. Recent research has begun to define time toxicity as the time spent coordinating and receiving care—and any associated adverse effects or tests—and investigators note that this time burden can be substantial.⁴

Research presented at the 2024 WCLC by Amanda Herrmann, MD, of the University of California San Diego, aimed to quantify the time toxicity of clinical trial participation by patients with lung cancer.⁵ Herrmann and colleagues found that total time toxicity, as measured with time toxicity units calculated retrospectively for published clinical trials, is increasing over time, with a significantly greater burden in phase 1 to 3 studies published between 2015 and 2024 compared with 2005 to 2014.

“As clinical investigators, we need to pay greater attention to time toxicity when designing clinical trials, and we propose that we do that by objectively quantifying time in this setting,” Herrmann said.

Sexual Well-Being

An underrecognized sphere of life affected by a lung cancer diagnosis or therapy course is sexual health, according to research presented at the 2024 WCLC. For instance, Aylen Vanessa Ospina-Serrano, MD, MSc, of Hospital Universitario Puerta de Hierro Majadahonda, presented results from the LUDICAS study of sexual dysfunction in Spanish patients with lung cancer.⁶ Among 448 patients from 24 hospitals, 63.4% reported sexual dysfunction after starting cancer treatment, and 88.4% agreed that it was important for their clinicians to assess this dysfunction.

In an education session on advanced cancer survivorship, Laila Agrawal, MD, of Norton Cancer Institute, presented tips on how the attendees can assess their patients’ sexual health, including normalizing these discussions, using standardized questions, and reassuring that these concerns are experienced by many other patients.⁷ Once a concern is identified, the clinician can recommend basic interventions or refer the patient to a specialist like a gynecologist, urologist, hormone therapy specialist, or pelvic floor physical therapist.

Agrawal emphasized the role of the bio-psycho-social framework, in which sexual health can be affected by a variety of physiological, social, and personal factors such as fatigue, shortness of breath, body image, and fear of recurrence. As was clear throughout the conference, lung cancer affects far more than the lungs, and health care providers need to see the whole patient in order to successfully treat them.

References

1. Financial toxicity and cancer treatment (PDQ)–health professional version. National Cancer Institute. Updated May 29, 2024. Accessed September 16, 2024. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq

2. Pottinger DL, Olisakwe S, Williams C, et al.Paying the price: how lung cancer care impacts wallets and well-being. Presented at: 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. Accessed September 16, 2024. https://cattendee.abstractsonline.com/meeting/20598/Session/160

3. Villalòn D, Aguarón A, O’Sullivan M, et al. The financial toxicity of lung cancer impacts all spheres of life. Presented at: 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. Accessed September 16, 2024. https://cattendee.abstractsonline.com/meeting/20598/Session/160

4. Gupta A, Eisenhauer EA, Booth CM. The time toxicity of cancer treatment. J Clin Oncol. 2022;40(15):1611-1615. doi:10.1200/JCO.21.02810

5. Herrmann A, Bazhenova L, Jain S. TIME TOX lung: retrospectively quantifying the time toxicity of lung cancer clinical trials. Presented at: 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. Accessed September 16, 2024. https://cattendee.abstractsonline.com/meeting/20598/Session/160

6. Ospina Serrano AV, Azkona E, Guillén Sentís P, et al. Characterization of sexual dysfunction in patients with lung cancer undergoing oncological management: results from the LUDICAS study. Presented at: 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. Accessed September 17, 2024. https://cattendee.abstractsonline.com/meeting/20598/Session/167

7. Agarwal S. Sexual health. Presented at: 2024 World Conference on Lung Cancer; September 10, 2024; San Diego, CA. Accessed September 17, 2024. https://cattendee.abstractsonline.com/meeting/20598/Session/66