The close link between anxiety and cluster symptoms in lung cancer patients during first-line chemotherapy: further data from a dedicated WALCE (Women Against Lung Cancer in Europe) survey

Abstract

Background: Lung cancer (LC) patients refer a simultaneous incidence of physical and psychosocial symptoms defined cluster symptoms (CS). Preliminary results currently under evaluation for publication showed an association between anxiety and chemotherapy induced nausea and vomiting (CINV). As among CINV predictors, anxiety is a modifiable factor, once having identified subjects at higher risk, this toxicity could be prevented. With this additional analysis of the survey we aimed to identify the factors associated with anxiety during chemotherapy in stage IV LC patients undergoing first-line treatment. Material and methods: The WALCE survey investigated in 11 Italian centers, at four consecutive evaluations (T0, T1, T2 and T3) and by means of a Numerical Rating Scale, the following items: anxiety, lack of self-confidence, fatigue, lack of appetite, pain, somnolence, dyspnea, general status, and lack of trust in treatments. Depending on the value assigned to the anxiety item, anxiety was categorized as absent (0), mild (1-3), moderate (4-7), severe (8-10). The evaluated items number was too high to be included in a multivariate model, thus factor analyses were run at each time point. The factor scores obtained were included as covariates (together with sex, age class and chemotherapy scheme) in the multivariate logistic ordinal models, run at T0, T1, T2 and T3 evaluating the risk factors for anxiety. Results: 188 patients completed the questionnaire at T0, 164 at T1, 138 at T2 and 101 at T3. The global incidence of anxiety was equal to 90%. The factor analyses showed that behind the considered variables, there were two latent factors composed by the same items at each evaluation: factor 1 (physical CS), composed by fatigue, somnolence, dyspnea and lack of self-confidence, and factor 2 (psychological CS), composed by lack of trust in treatments, general status and lack of appetite. Only physical CS was associated with an increased risk of pre-chemotherapy anxiety, while during chemotherapy, both physical and psychological CS seemed to exert an influence on anxiety development at T1, T2 and T3. Conclusions: To date, there is no clear cause-effect relationship between CS and anxiety, however, their linkage and simultaneous intensity growth is well demonstrated during chemotherapy. More attention should be paid to the detection of CS and anxiety in LC patients during first-line chemotherapy.