Abstract
PurposeThe purpose of this study is to investigate changes over time in quality of life (QoL) in incurable lung cancer patients and the impact of determinants like molecular alterations (MA).MethodsIn a prospective, longitudinal, multicentric study, we assessed QoL, symptom burden, psychological distress, unmet needs, and prognostic understanding of patients diagnosed with incurable lung cancer at the time of the diagnosis (T0) and after 3 (T1), 6 (T2) and 12 months (T3) using validated questionnaires like FACT-L, National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), PHQ-4, SCNS-SF-34, and SEIQoL.ResultsTwo hundred seventeen patients were enrolled, 22 (10%) with reported MA. QoL scores improved over time, with a significant trend for DT, PHQ-4, and SCNS-SF-34. Significant determinants for stable or improving scores over time were survival > 6 months, performance status at the time of diagnosis, and presence of MA. Patients with MA showed better QoL scores (FACT-L at T1 104.4 vs 86.3; at T2 107.5 vs 90.0; at T3 100.9 vs 92.8) and lower psychological distress (NCCN DT at T1 3.3 vs 5; at T2 2.7 vs 4.5; at T3 3.7 vs 4.5; PHQ-4 at T1 2.3 vs 4.1; at T2 1.7 vs 3.6; at T3 2.2 vs 3.6), but also a worsening of the scores at 1 year and a higher percentage of inaccurate prognostic understanding (27 vs 17%) compared to patients without MA.ConclusionPatients with tumors harboring MA are at risk of QoL deterioration during the course of the disease. Physicians should adapt their communication strategies in order to maintain or improve QoL.
Highlights
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death worldwide [1]
We used data from patients diagnosed with incurable lung cancer who participated in our prospective study, expanding our first timepoint evaluation [20] with further assessments at 3, 6, and 12 months
Scores are rated as normal (0–2), mild (3–5), moderate (6–8), or severe (9–12) depression and anxiety
Summary
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death worldwide [1]. Patients with lung cancer have been shown to experience reduced quality of life. QoL is determined by the prognosis and the treatments of the underlying disease, as well as by psychological distress such as anxiety and depression [6] and by sociodemographic characteristics [7]. Previous studies have explored determinants of QoL in patients with advanced cancer using different validated questionnaires. They have identified older age, good Eastern Cooperative Oncology Group (ECOG) performance status (PS) and survival longer than 6 months as strong factors associated with better QoL [7, 9, 10]. Older patients and men have shown better physical and emotional functioning
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