Does cigarette smoking have an impact on quality of life after diagnosis of lung cancer?

Abstract

INTRODUCTION: Quality of life (QOL) is an important outcome measure for patients with lung cancer. OBJECTIVE: This study assessed the impact of patterns of cigarette use on patientsi QOL as measured with the Lung Cancer Symptom Scale (LCSS). Our hypothesis is that those patients who are current smokers have worse QOL scores than those who never smoked, and former smokers will have scores that are dependent on length of time since smoking abstinence. METHODS: Since January 1, 1997, patients pathologically diagnosed with non-small-cell lung cancer (NSCLC) and patients with small-cell lung cancer (SCLC) were approached to participate in a prospective cohort study. Beginning in 1999, the LCSS has been included in the routine follow-up procedure. A total of 1506 living patients were eligible to complete the LCSS; 1028 patients (68%) who responded to their first follow-up questionnaires, including a QOL assessment, comprise the study population. Additional annual surveys are mailed to the patients. First contacts that included the LCSS were made with the patients at various times from their diagnosis date: 344/1028 (33%), 308/1028 (30%), 254/1028 (25%), and 122/1028 (12%), at 6 months, 1 year, 2 years, and 3 years, respectively. We excluded patients who received their first follow-up at 4 and 5 years due to small numbers. Baseline demographics were summarized utilizing descriptive statistics. To compare the differences in the adjusted LCSS items for the different groups, a multiple logistic regression model was used. The model adjusted the LCSS scores for age, sex, stage, and time of assessment. The total LCSS score and the individual items range from 0 (no symptoms or the best QOL score) up to 100 (maximal amount of symptoms or the worst score); a lo-point difference between groups was considered clinically significant. Two-sided P values of co.05 were considered statistically significant. RESULTS: Responders to the follow-up assessment were more likely to be earlier stage patients and never smokers. Unexpectedly, the nonresponders were younger than responders: 16% of the nonresponders versus 9% of the responders were aged ~50 years at diagnosis. Among the responders who completed the LCSS at the time of first followup assessment (n = 1028), the mean (SD) age was 65.2 (10.7) years, and 45%