Abstract
Advanced lung cancer (aLC) is often accompanied by anxiety and/or depression and malnutrition risk. The above stated burdens have a huge influence on patients’ lives during the disease trajectory. Aim of this study was to assess the influence of depression and/or anxiety and malnutrition risk on overall survival (OS) in advanced lung cancer patients. This prospective trial was conducted at the Institute for Pulmonary Diseases of Vojvodina, Serbia. Patients with advanced lung cancer were included in this study regardless of lung cancer type and therapy regimen. Patients rated themselves on the Hospital Anxiety and Depression Scale (HADS). Malnutrition universal screening tool (MUST) was used for assessment of malnutrition risk. Univariate and multivariate analysis was performed in order to correlate the data. Out of total 134 patients, 76.9% were male and 23.1% female. Majority of patients were current smokers (58.2%), average age 61, with ECOG performance status 1 (79.9%) and diagnosed lung adenocarcinoma (48.5%). A psychiatric disorder was confirmed in 41.8% of patients (anxiety in 3.0%, depression in 19.4%, combined disorder in 19.4%). Malnutrition risk was observed in 35.0% of patients (low risk in 13.4%, high risk in 21.6%). Malnutrition risk was significantly related to education level (p=0.010) and age (p=0.040). Median OS of included patients was 17.8 months. We observed a significant relation between OS and psychiatric disorder (p=0.029) and OS and malnutrition risk (p=0.001). Median OS of patients without psychiatric disorders was 20.3, with depression 12.2 and with combined psychiatric disorders 13.9 months. Median OS of patients with low malnutrition risk was 20.6, for medium risk 12.3 and for high risk 13.2 months. Median OS of patients with any psychiatric disorder accompanied by increased malnutrition risk was 5.9 months (p=0.000). One-year survival was 71.7% in patients without burdens, 73.5% in patients with psychiatric disorder, 64.0% in patients with malnutrition risk and in 36.4% (p=0.018) in patients with combined burdens. Five-year survival was 5.7%, all these patients were without disorders. Depression and/or anxiety and malnutrition risk are present in large number of aLC patients and have great influence on not only quality of life but also overall survival. Effort should be done to implement easy-to-use screening tools in daily routine for early recognition of patients’ burdens and concerns which can improve comprehensive care of incurable lung cancer.
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