MA19.02 Psychological Distress in Never, Ex, Current, and Passive Smokers Diagnosed with Lung Cancer - Analyses from the EnRICH Program

Abstract

Lung cancer is associated with greater psychological distress than any other cancer. In Australia, the prevalence of anxiety and depression in those with lung cancer is nearly 30% higher than the average of other major cancers. More than 50% of patients experience distress, anxiety and/or depression, resulting in diminished quality of life (QoL), and a fourfold increase in likelihood of suicide than the general population. Lung cancer stigma, arising from presumption about tobacco exposure and associated smoking stigma, contributes to high levels of distress. A national survey found that more than a third (35%) of Australians believe those living with lung cancer “have only themselves to blame” and almost 40% indicated, before expressing concern, the first question they would ask someone diagnosed with lung cancer is whether they smoked. This stigma makes lung cancer patients reluctant to seek psychosocial support and reduces their sense of entitlement to care and empathy. However, approximately one fifth (21%) are life-long never-smokers. This study aimed to describe differences in levels of psychological distress in never-and ever-smokers enrolled in the Sydney Catalyst EnRICH Program, a prospective clinical cohort of patients with lung cancer in New South Wales, Australia. Measures: EnRICH incorporates patient-reported outcome measures (PROMs) that assess dimensions of anxiety, depression, emotional function, and psychological distress, namely, the: (i) EORTC QLQ-C30; and (ii) NCCN Distress Thermometer. Sample: All patients with newly diagnosed lung cancer presenting to study hospitals are eligible for the EnRICH cohort. Consenting patients who completed PROMs comprise the sample for the current analyses. Statistical Methods: Subscales of the QLQ-C30 reflecting overall QoL and emotional function, and scores on the NCCN Distress Thermometer, were compared between patient groups by smoking status. Groups were combined into never-smokers (never, passive) and ever-smokers (ex, current) for analyses. Mean differences and 95% confidence intervals were computed. Among 205 patients who completed PROMs (69% of consenting patients), there were 52 never-smokers, 5 passive-smokers, 161 ex-smokers and 52 current-smokers at the time of diagnosis. Emotional function was worse in never-smokers (ever=75.3, never=63.2, difference=12.1 points 95%CI 2.4-21.7). There were no differences in other subscales. Although numbers are small, passive-smokers had the lowest mean scores for emotional-, role-, and social-functioning (Figure 1). Distress thermometer scores were 1.2 points worse in never-smokers [95%CI (0.56-1.8)]. Never-smokers had worse emotional function and higher distress than other lung cancer patients. If confirmed in larger studies, additional supportive care services may improve outcomes for these patients.