Health-Related Quality of Life in Iraqi Patients with Advanced NSCLC and Coexisting COPD Following Systemic Therapy: A Multicenter Cross-Sectional Study

Akram Hasan Kareem; Samer Imad Mohammed; Ahmed Abdali Shihad

doi:10.31557/APJCC.2026.11.5.759

Authors

Akram Hasan Kareem Department of Clinical Pharmacy, Al-Diwaniyah Health Directorate, Qadisiyah, Iraq.
Samer Imad Mohammed Faculty member- Department of Clinical Pharmacy -College of Pharmacy- University of Baghdad – Baghdad – Iraq.
Ahmed Abdali Shihad Oncology Department, Diwaniyah Teaching Hospital, Qadisiyah, Iraq.

DOI:

https://doi.org/10.31557/APJCC.2026.11.5.759

Keywords:

NSCLC, COPD, Quality of life, Immunotherapy, Real-world.

Abstract

Introduction: Coexisting chronic obstructive pulmonary disease (COPD) may exacerbate respiratory symptoms and impair functional status in patients with advanced non–small cell lung cancer (NSCLC). However, comparative real-world data evaluating health-related quality of life (HRQOL) across systemic treatment modalities in this comorbid population remain limited. To evaluate HRQOL among patients with advanced NSCLC and COPD receiving systemic therapy in routine clinical practice and to compare outcomes across chemotherapy, pembrolizumab, and atezolizumab groups.

Materials and Methods: This multicenter real-world cross-sectional study was conducted at two oncology centers in Iraq. Patients with stage IV NSCLC and documented COPD who completed six cycles of systemic therapy were included. HRQOL was assessed using the EORTC QLQ-LC13 questionnaire after treatment completion. Pulmonary function (FEV1%) was measured post-treatment at the same time point. Statistical analyses included ANOVA with Bonferroni correction, effect size estimation (η²), multivariable linear regression adjusting for age, sex, FEV1%, smoking status, and PD-L1 expression.

Results: A total of 120 patients were analyzed. Significant differences in HRQOL symptom scores were observed across treatment groups, with chemotherapy generally associated with higher symptom burden. Effect size analysis demonstrated large to very large differences across most domains. In multivariable analysis, pembrolizumab remained associated with lower symptom scores across most domains, while atezolizumab showed variable associations after adjustment. No statistically significant differences in post-treatment FEV1% were observed between groups (p = 0.094), despite numerically higher values in the immunotherapy groups. Hepatic parameters showed some differences between groups but without consistent clinical patterns.

Conclusions: In this cross-sectional real-world study, treatment modality was associated with differences in HRQOL outcomes among patients with advanced NSCLC and COPD. These findings should be interpreted with caution due to the cross-sectional design, potential selection bias related to inclusion of patients completing six treatment cycles, and the absence of baseline HRQOL assessment.