Dyspnea in Patients with Stage IV Non-Small Cell Lung Cancer: A Population-Based Analysis of Disease Burden and Patterns of Care

Abstract

<h3>Purpose/Objective(s)</h3> Patients with metastatic non-small cell lung cancer (NSCLC) experience significant morbidity because of their disease burden. Dyspnea is a predominant symptom, with a reported prevalence of up to 70% in lung cancer patients. The objective of this study was to determine factors associated with a high dyspnea score based on the Edmonton Symptom Assessment System (ESAS), as well as resultant patterns of intervention and factors correlated to treatment receipt. <h3>Materials/Methods</h3> Using health services administrative data, we conducted a population-based study of all patients diagnosed with metastatic NSCLC treated from January 2007 to September 2018 in the province of Ontario. Exclusion criteria consists of patient age <18 less than 6 months of follow up without death, no ESAS evaluations completed, or if they had another cancer diagnosis 5 years preceding or following their NSCLC diagnosis. The primary outcome of interest was the prevalence of high dyspnea scores, defined as at least a single ESAS score of ≥4 at any time. Differences in baseline characteristic between high dyspnea and low dyspnea score cohorts were assessed by Student's t-test and chi-square test for continuous and categorical covariates, respectively. P-values less than 0.05 were considered to be statistically significant. <h3>Results</h3> The initial study cohort included 13,159 patients diagnosed with metastatic NSCLC who completed at least one ESAS survey. Of these, 9,434 (71.7%) reported a high dyspnea score. Compared to patients who did not report high dyspnea scores, those who reported a high dyspnea score were more likely to complete a greater number of ESAS surveys, be male, have a higher Elixhauser-Comorbidity Index () score, and receive subsequent systemic therapy after diagnosis. Multivariable regression identified older patients to be less likely to undergo pleurodesis. Thoracentesis was less common for patients living in rural and non-major urban areas, lower income areas. Receipt of thoracic radiotherapy was less common for older patients, females, those with ECI ≥4, patients living in urban areas, and those with later year of. Finally, palliative care referrals were less frequent for patients with ECI ≥4, residence outside of major urban areas, and lower income areas. <h3>Conclusion</h3> Dyspnea is a prevalent symptom amongst patients with metastatic NSCLC. Most patients reporting significant dyspnea received intervention, the most common being palliative care. Subpopulations of patients with high dyspnea scores were identified in which receipt of thoracic radiotherapy and thoracentesis were less likely, suggesting inequities in access to care that require further evaluation.