Seven-year quality of life assessment in lung cancer

Abstract

9531 Background: After decades of efforts on reducing lung cancer incidence and mortality, we are now challenged by the lack of understanding of the health conditions and quality of life (QOL) among the survivors. Methods: We evaluated 2,005 consecutive primary lung cancer patients diagnosed 1999- 2006. Two validated patient-reported assessments, the Lung Cancer Symptom Scale and Linear Analogue Self-Assessment, were used to measure overall QOL, pain, fatigue, appetite, symptoms, physical-, emotional-, mental-, and spiritual well-being, social activity/support, and financial/legal concerns. Cross-sectional and longitudinal analyses were performed. Assessments were translated onto a 0–100 (worst to best) scale, and a normative range was defined as 80.0±10.0 established in healthy individuals. Four QOL groups were defined: norm (70.0–90.0), above-norm (>90), below-norm (60.0–70.0), and poor (<60). Adjusted QOL was calculated by multiple regression models with variables at baseline (age, sex, ethnicity, marital status, years of education, employment status, smoking history, body weight, histology and stage, and comorbidities) and at each time a QOL questionnaire was answered (performance status, surgery, chemotherapy, and radiotherapy, weight change, and current tobacco use). Results: A total of 5,289 QOL questionnaires were answered by 2,005 patients from 6-month to 7-year post diagnosis. The mean (SD) overall QOL was 73.0 (23.2), ranging 70.8–76.0 across the 7 years, with and without covariates. Frequent pain and physical well-being were consistently below norm, fatigue scored as poor for all years, and shortness of breath was below norm between 6 months and year-4 and declined to poor thereafter. Longitudinally following patients in the four groups based on their initial overall QOL score, survivors stayed in the same QOL group throughout years, except those who started in the poor group (mean score 41.2) improved gradually to a mean score of 64.7 at year-5 although still below norm. Conclusions: This study describes health-related QOL by prospectively following a large lung cancer cohort. Modifiable contributors to poor QOL need to be identified and interventions should be designed to improve patients’ QOL in conjunction with prolonged survival. Supported by NIH grants CA77118, CA80127, and CA84354. No significant financial relationships to disclose.