# The Association Between Health‐Related Quality of Life Scores and Clinical Outcomes for People Living With Lung Cancer: An Australian Registry Cohort Study Using Patient‐Reported Outcomes to Drive Value‐Based Healthcare

## TL;DR

This study explores how patient-reported quality of life and experiences relate to clinical outcomes and costs in lung cancer care in Australia, supporting value-based healthcare.

## Contribution

The study introduces a VBHC dashboard integrating HRQL, patient experience, clinical quality, and cost data for lung cancer care.

## Key findings

- HRQL was associated with cancer stage, performance status, comorbidities, and treatment adherence.
- Earlier stage disease correlated with better HRQL and survival, despite higher costs in advanced stages.
- A VBHC dashboard was developed to support health service performance review and patient-centered care.

## Abstract

Improving patient‐centered outcomes is a core aim of value‐based healthcare (VBHC). Integrating patient‐reported outcome and experience measures (PROMs/PREMs) into clinical quality registries may provide insight into health‐related quality of life (HRQL) and variation in care. We piloted PROMs/PREMs collection in an Australian Lung Cancer Registry to evaluate associations between HRQL, clinical outcomes and treatment value.

Individuals newly diagnosed with lung cancer across five metropolitan health services were invited to complete electronic PROMs (EORTC QLQ‐C30 and QLQ‐LC29) and PREMs at baseline and follow‐up. Preference‐based utilities (QLU‐C10D) and quality‐adjusted life‐years (QALYs) were derived and linked with registry clinical data. Stage‐specific Australian health system cost estimates for guideline concordant treatment (GCT) provided context for value‐based reporting. Multivariable regression examined associations between HRQL and clinical variables.

Baseline PROMs/PREMs were completed by 241/490 (49%) participants. HRQL was associated with cancer stage, ECOG performance status ≥ 2, comorbidities, weight loss, and receipt of GCT (p = 0.041). HRQL remained stable among ongoing respondents over time. Estimated health system costs increased with advancing stage, while earlier stage disease was associated with better HRQL and survival. A registry‐level VBHC dashboard integrating HRQL, patient experience, clinical quality indicators and cost context was developed to support health service performance review.

PROMs/PREMs linked with clinical and cost data provided meaningful insight into patient‐centered outcomes and drivers of value in lung cancer care. This VBHC framework highlights the importance of early diagnosis and access to evidence‐based treatment and offers a scalable approach to support patient‐centered quality improvement at the health system level.

Linking patient‐reported outcomes and experiences with clinical and cost data reveals key drivers of value in lung cancer care, empowering earlier diagnosis, equitable access, and patient‐centered quality improvement.