Time-dependent Patient-reported Outcomes As Predictors of the Survival of Patients With Lung Cancer

Abstract

Background: The importance of patient-reported outcomes (PROs) has been increasingly recognized in cancer care. No study has investigated how changes in PROs after completion of cancer treatment affect survival. Objective: To investigate the predictive value of patient characteristics, including PROs, for cancer survival. Methods: A total of 86 patients with a confirmed diagnosis of lung cancer were recruited. Data on PROs including sleep disturbance, anxiety, depression, fatigue, nausea, pain, weight loss, cough, good appetite, chest tightness, and ease of breathing were collected through self-reported questionnaires at 5 time points for each patient: before treatment and 6, 12, 24, and 48 weeks after treatment. Results: Bivariate time-dependent Cox regression revealed the following variables to be significant: small-cell, stage IV lung cancer; pretreatment pneumonia; treatment type; and several PRO variables, including sleep disturbance (hazard ratio [HR] = 1.10, P < .001), anxiety (HR = 1.15, P < .001), depression (HR = 1.11, P < .001), weight loss (HR = 0.71, P < .001), chest tightness (HR = 0.83, P = .029), and ease of breathing (HR = 0.62, P < .001). Multivariable time-dependent Cox regression revealed that only stage IV (HR = 7.33, P = .029) and weight loss (HR = 0.76, P = .006) were significant variables associated with survival. Conclusions: Patient-reported weight loss was independently associated with shortened survival in patients with lung cancer. Implications for Practice: Health care professionals should closely monitor the PROs of patients with lung cancer. In cases of self-reported weight loss, further investigation and appropriate interventions are necessary. What is Foundational: Patient-reported weight loss has been recognized in our research as a modifiable risk factor in lung cancer survival. PROs have potential predictive value in cancer survival.