Evaluating Quality of Life in Thoracic Malignancy Trials: A scoping review on ESMO-MCBS Quality of Life Checklist Adherence and Concordance With Progression-Free and Overall Survival

Quality of life (QOL) is a key endpoint in oncology, complementing overall survival (OS) and progression-free survival (PFS). In thoracic malignancies with high symptom burden and treatment toxicity, evaluating how QOL is measured, reported, and related to clinical outcomes is essential for patient-centered care. We conducted a scoping review of phase III RCTs in thoracic malignancies published 2019-2023. Eligible trials included QOL assessment using European Organisation for Research and Treatment of Cancer (EORTC) instruments. For each QOL domain, we recorded whether a significant benefit was reported in favor of the experimental arm, whether an OS or PFS benefit was reported, and whether these benefits occurred together. Trials were also evaluated for meeting ESMO-MCBS QOL checklist criteria. Thirty-nine trials met inclusion criteria. Differences in global health/QOL and disease-related symptoms (coughing, chest pain) were reported in over 80% of trials, whereas treatment-related symptoms (neuropathy, sore mouth) in fewer than 60%. Less than 25% of trials reported concordant QOL and OS benefit, and up to one-third reported concordant QOL and PFS benefit. Almost 70% reported a PFS benefit, yet many lacked a corresponding QOL benefit, particularly in functional domains. Seven trials (17.9%) had QOL results eligible for integration into the final score following the ESMO-MCBS QOL checklist. In phase III RCTs of thoracic malignancies, concurrent gains in OS/PFS and QOL are rarely observed. Moreover, QOL endpoints infrequently meet criteria for integration into formal clinical benefit frameworks. Improved QOL reporting is needed to ensure QOL data meaningfully inform patient-centered care. • In phase III RCTs, QOL endpoints are commonly included but inconsistently analyzed • Concordance between PFS/OS and QOL is limited, underscoring the need to evaluate all • QOL outcomes infrequently qualify for formal clinical benefit frameworks • More complete and standardized reporting of QOL results is needed