Quality Of Life In Lung Cancer Patients Research Articles

Abstract 3707: Baseline quality of life and genetic determinants and the impact on five-year lung cancer survival

Abstract Patient-reported health-related quality of life (QOL) is an important part of a cancer patient's treatment plan and has been linked to overall cancer survival. We aimed to identify the impact of QOL and potential genetic factors on five-year lung cancer survival using a lung cancer patient cohort from MD Anderson Cancer Center. QOL data was obtained from the SF-12 questionnaire. Patient responses were used to calculate Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, with a lower score indicating a worse QOL. Mean baseline QOL scores were calculated for demographic factors in 7,135 patients, and individuals with a college degree (PCS = 42.0, compared to less than a high school degree PCS = 35.1, P<0.0001), current alcohol drinkers (PCS = 42.0, compared to never drinkers PCS = 37.3, P<0.0001), and those with no significant medical history (PCS = 40.8, compared to a significant history PCS = 38.4, P<0.0001) reported an improved PCS. Individuals greater than 70 years old (MCS = 47.8, compared to those less than 50 MCS = 45.2, P<0.0001), with a college degree (MCS = 48.0, compared to less than a high school degree MCS = 45.2, P<0.0001), Asian Pacific Islanders (MCS = 48.5, compared to whites MCS = 46.3, P = 0.033), and current alcohol drinkers (MCS = 47.4, compared to never drinkers MCS = 45.9, P<0.0001) reported a better MCS. We then analyzed the association between baseline QOL and lung cancer survival using survival data obtained from MD Anderson Tumor Registry. A PCS or MCS score less than 50 was associated with an increased risk of five-year mortality (HR = 1.20, 95% CI: 1.08-1.33, P = 0.001; HR = 1.13, 95%CI: 1.03-1.24, P = 0.008, respectively) and there was a significant difference between median survival time (MST) (PCS≥50 MST = 30.42 months, PCS<50 MST = 20.70 months, Plog-rank<0.0001) (MCS≥50 MST = 26.12 months, MCS<50 MST = 20.17 months, Plog-rank<0.0001). Finally, using a subset of the study population (N = 588), we completed a preliminary analysis of 218 single nucleotide polymorphisms (SNPs) in the p38 MAPK signaling pathway, activated in response to cellular and environmental stress, as a potential genetic determinant of QOL and five-year lung cancer survival. Using a score of 50 as the cut-off, twenty-five SNPs were associated with PCS, twenty-three SNPs were associated with MCS, and 28 SNPs were associated with five-year lung cancer survival (P<0.05). Individuals with at least one variant allele of rs2715815 in MAP2K6 showed a decreased risk of poor PCS and MCS score (OR = 0.49, 95% CI = 0.26-0.90, P = 0.022; OR = 0.41, 95% CI = 0.22-0.76, P = 0.005, respectively). At least one variant allele of FASLG: rs5030772 was associated with a decreased risk of poor MCS score (OR = 0.51, 95% CI = 0.27-0.96, P = 0.038) and a decreased risk of lung cancer death (HR = 0.68, 95% CI = 0.46-1.00, P = 0.049). These findings suggest that baseline QOL in lung cancer patients as well as genetic determinants may impact lung cancer survival. Citation Format: Jeanne A. Pierzynski, Michelle A. Hildebrandt, Yuanqing Ye, Jack A. Roth, Xifeng Wu. Baseline quality of life and genetic determinants and the impact on five-year lung cancer survival. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3707. doi:10.1158/1538-7445.AM2015-3707

Effects of Walking on Quality of Life Among Lung Cancer Patients: A Longitudinal Study.

Walking is typically the preferred form of physical activity among lung cancer patients. Physical activity can promote and maintain the health of such patients. We examined how walking affected the quality of life (QOL) of lung cancer patients, evaluating the factors that predicted changes in walking during a 6-months study. This study involved a longitudinal and correlational design, and the instruments comprised the Godin Leisure-Time Exercise Questionnaire, the Functional Assessment of Cancer Therapy-Lung Cancer, and social support and self-efficacy scales. In total, 107 patients were evaluated for 6 months; the results indicated that the patients completed approximately 217 to 282 minutes of walking per week. The data demonstrated that the frequency of walking exercise decreased or stopped among 36% patients during the 6-month study. A generalized estimating equation analysis indicated significant differences between the Functional Assessment of Cancer Therapy-Lung Cancer scores and levels of physical and functional well-being among the lung cancer patients who did and did not engage in walking. Social support, self-efficacy, and patient treatment status can be used to predict the change in walking among lung cancer patients. Patient QOL can be improved by engaging in walking exercise for 6 months. Regarding lung cancer patients, social support and self-efficacy are the key factors in maintaining walking exercise. Integrating psychological strategies may be required to strengthen the positive effects of walking exercise on the QOL of lung cancer patients.

Abstract 5045: Genetic and social determinants of quality of life in lung cancer patients

Abstract Patient reported health-related quality of life (QOL) has been recognized as a major component of the overall well-being of cancer patients, with links to prognosis and other endpoints. We aimed to identify determinants of baseline QOL by investigating the relationship between patient characteristics, genetic factors, and baseline QOL in lung cancer patients. We included 7,135 newly diagnosed and previously untreated lung cancer patients. Patient reported data from the SF-12 questionnaire was used to calculate baseline Physical Component Summary (PCS) and Mental Component Summary (MCS), with lower scores indicating a worse quality of life. We observed that the mean PCS (38.82) and MCS (46.22) scores were reduced in the lung cancer population when compared to the general population which was normalized to 50. We observed a significant trend for decreasing mean PCS and MCS from never, former, to current smokers (PCS Ptrend<0.0001; MCS Ptrend<0.0001) and a similar significant increasing trend of mean PCS/MCS was seen for education from no high school through college (PCS Ptrend<0.0001; MCS Ptrend<0.0001). When compared to never smokers, current smokers were at an increased risk of reporting a poor PCS (OR: 1.51, 95%CI: 1.18-1.94, P=1.0x10-3). Compared to individuals with less than a high school degree, those with a high school (OR: 0.76, 95%CI: 0.61-0.94, P=1.0x10-2) or college degree (OR: 0.48, 95%CI: 0.38-0.62, P<0.001) had a decreased risk of a poor PCS. A similar relationship was seen for MCS. As cancer stage increased the mean PCS and MCS score decreased (PCS Ptrend<0.0001; MCS Ptrend<0.0001). Further, we analyzed 218 single nucleotide polymorphisms (SNPs) in the p38 MAPK signaling pathway, a key mediator of response to cellular and environmental stress, as genetic determinants of QOL in a subset of the study population (N=588). Using the median PCS/MCS score as the cut-off, twenty SNPs were statistically significantly associated with PCS and 26 SNPs were associated with MCS (P<0.05). In the PCS analysis, there was a 3.47-fold (95%CI, 1.75-6.88, P=3.5x10-4) increased risk of reporting a low PCS score in individuals with at least one variant of MAP2K6: rs12600726. At least one variant allele of rs7207011 in MAP2K4 was associated with a lower score for both PCS and MCS (PCS: OR=0.10, 95%CI, 0.01-0.87, P=3.7x10-2; MCS: OR=0.09, 95%CI, 0.01-0.80, P=3.0x10-2). A gene-based analysis identified MEF2D and MAP3K5 as a significant contributor to PCS, but not MCS. Furthermore, MAP2K6 was identified as a significant contributor to both PCS and MCS. Validation for these results is underway. Taken together these findings suggest that multiple factors can contribute to QOL in lung cancer patients. Citation Format: Jeanne A. Pierzynski, Michelle Hildebrandt, Yuanqing Ye, Alma Rodriguez, Xifeng Wu. Genetic and social determinants of quality of life in lung cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5045. doi:10.1158/1538-7445.AM2014-5045

Quality of life of lung cancer patients receiving outpatient chemotherapy.

An increasing number of cancer patients receive outpatient chemotherapy as an alternative to inpatient chemotherapy. The aim of this study was to investigate whether quality of life (QOL) during outpatient chemotherapy was better than QOL prior to hospital discharge, and to explore possible related factors prior to hospital discharge that affected the QOL of lung cancer patients who received outpatient chemotherapy. Lung cancer inpatients who were scheduled for outpatient chemotherapy were assessed two times (prior to hospital discharge and during outpatient chemotherapy) using the Functional Assessment of Cancer Therapy-Lung and Hospital Anxiety and Depression Scale. A total of 40 patients completed all assessments, both prior to hospital discharge and during outpatient chemotherapy. In the present study, QOL during outpatient chemotherapy was not significantly different when compared with the QOL prior to hospital discharge, and predictors prior to hospital discharge for a better QOL of patients during outpatient chemotherapy included better social, emotional and physical well-being. These results suggest that medical staff, in particular those involved in outpatient chemotherapy, need to recognize social and emotional as well as physical well-being prior to hospital discharge, regardless of cancer-related factors and the personal characteristics of the patients.

The Relationships between Stigma, Distress, and Quality of Life in Patients with Lung Cancer

Purpose: The aim of this study was to investigate the relationships between stigma, distress, and quality of life (QOL) in patients with lung cancer. Methods: The subjects of the study were 123 lung cancer patients who visited the outpatient department of S hospital in Seoul from July 21st to August 29th, 2011. To measure stigma, distress, and QOL, Cataldo Lung Cancer Stigma Scale, Hospital Anxiety and Depression Scale (HADS), and EORTC QLQ-C30 (Quality of Life Questionnaire, Core 30) were used in this study. The col lected data were analyzed using frequency, average, t-test, ANOVA, and Pearson correlation with SPSS WIN 19.0. Results: Stigma showed positive correlations with anxiety, depression, and symptom (r = .37, p < .001; r = .44, p < .001; r = .23 p = .012), while it showed negative correlations with global QOL and function (r = -.26, p = .003; r = -.40, p < .001). Anxiety and depression also positively correlated with symptoms (r = .43, p < .001; r = .58, p < .001) while anxiety and depression negatively correlated with global QOL (r = -.40, p < .001; r = -.56, p < .001) and function (r = -.64, p < .001; r = -.66, p < .001). Conclusion: The findings of the study demonstrated that lung cancer patients experienced stigma and distress that had a negative influence on the subjects’ QOL. Thus the study’s findings can be useful in developing psychosocial nursing strategies to improve QOL of lung cancer patients in the future.

Efficacy of perioperative administration of long-acting bronchodilator on postoperative pulmonary function and quality of life in lung cancer patients with chronic obstructive pulmonary disease. Preliminary results of a randomized control study

Long-acting bronchodilators are recommended as a first-line treatment for chronic obstructive pulmonary disease (COPD), although their effects for postoperative lung cancer patients with COPD are still not well known. A prospective randomized trial was used to examine the efficacy of bronchodilators on postoperative pulmonary function and quality of life (QOL). Twenty lung cancer patients with COPD who had lobectomies were randomized. A control group (n = 10) did not receive bronchodilators. An experimental group (n = 10) received tiotropium and salmeterol. Patients were divided into two COPD grades: stage I COPD and stage II-III COPD. Results for pulmonary function, 6-minute walking test, and the St. George's Respiratory Questionnaire (SGRQ) were compared. Diaphragmatic motion on dynamic magnetic resonance imaging was also analyzed. The patient demographics were similar in the two groups. Except for pulmonary function results at 2 weeks, no other parameters were significantly different. However, in stage II-III COPD, forced expiratory volume in 1 second, forced vital capacity, inspiratory capacity, the total score of the SGRQ, and diaphragmatic motion in the experimental group (n = 5) were significantly better than those in the control group (n = 4) at various time points (all P < 0.05). The daily inhalation of bronchodilators was effective for maintaining the respiratory function and QOL in lung cancer patients with moderate to severe COPD.

Clinician perceptions of care difficulty and quality of life for lung cancer patients: Results from the ECOG SOAPP study (E2Z02).

9102 Background: Emerging evidence suggests that lung cancer patients experience disparities in medical care compared to other cancer patients. This may be due to providers' perceptions that lung cancer patients are more difficult to care for and have a poorer quality of life (QOL). Methods: Participants included clinicians treating breast (n = 1543), colorectal (n = 717), prostate (n = 320), and lung (n = 522) cancer patients enrolled in the Eastern Cooperative Oncology Group (ECOG) study of Symptom Outcomes and Practice Patterns (SOAPP; Protocol E2Z02). Data included clinicians' written responses to questions about patient QOL and difficulty of care. Analyses focused on repeated measures (baseline and 28-35 day follow-up) analysis of covariance (ANCOVA) with planned comparisons for reports of lung cancer v. other cancer (breast, prostate, and colorectal) patients. Results: After controlling for relevant patient factors (sex, race/ethnicity, current status/stage of disease, metastatic sites, performance status, weight loss, current treatment, number of moderate/severe symptoms) and institution type, clinicians reported greater difficulty in care for lung cancer patients compared to other cancer patients (p < .01). After adding patients' baseline reports of QOL as a covariate (in addition to the above factors), clinicians also estimated a lower QOL for lung cancer patients (p < .001). Conclusions: Even after controlling for a number of relevant patient and disease factors, clinicians reported higher difficulty of care and lower QOL for lung cancer patients compared to patients with other common solid tumors. These data generate the hypothesis that providers have more pessimistic attitudes about lung cancer care, which could lead to disparities in treatment. Further research is needed to confirm these findings and explore potential explanations for these clinician perceptions related to lung cancer patients. No significant financial relationships to disclose.

Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy

The diagnosis of lung cancer in the advanced stage of illness, the poor prognosis associated with the disease, and the side effects of chemotherapy all have an impact on various dimensions of quality of life (QoL). The purpose of the research The current study was designed to describe the QoL and symptom distress of lung cancer patients undergoing chemotherapy and to explore the relationships between demographic/treatment-related characteristics and QoL. Methods and sample The sample consisted of 154 lung cancer patients undergoing chemotherapy. The symptom experiences and QoL of lung cancer patients undergoing chemotherapy were evaluated using the Memorial Symptom Assessment Scale and Quality of Life Index – Cancer Version. Results The lung cancer patients had low QoL scores. The scores on the Health and Functioning subscale were the lowest (20.33 ± 5.59), while those of the Family subscale were the highest (27.66 ± 2.77). The most common physical symptoms experienced by lung cancer patients were lack of energy, coughing, pain, lack of appetite, and nausea, while the psychological symptoms were feeling nervous, difficulty sleeping, feeling sad, and worrying. There was a negative relationship between the symptom distress and quality of life scores (r = −0.45; p < 0.000). Females and those with low income levels and performance status experienced greater symptom distress. Conclusions Lung cancer patients receiving chemotherapy suffer many limitations due to the symptoms and disruptions to their QoL, arising from both the disease process and its treatment. Lung cancer patients need to be assessed regularly and supported.

A psychometric analysis of quality of life tools in lung cancer patients who smoke

Lung cancer is the leading cause of cancer death for both men and women in the United States. Patient quality of life (QOL) prior to cancer treatment is known to be a strong predictor of survival and toleration of treatment toxicities. A lung cancer patient's self-assessment of QOL is highly valued among clinicians as it guides treatment-related decisions and impacts clinical outcomes. Smokers are known to report a lower QOL. Limited research has been conducted on QOL outcomes in lung cancer patients who continue to smoke. To assess QOL, a reliable and valid QOL measure specific to lung cancer is required. The functional assessment of cancer therapy-lung cancer (FACT-L) and lung cancer symptom scale (LCSS) are instruments that specifically examine QOL among lung cancer patients. The LCSS is a focused QOL instrument that includes physical and functional domains of QOL and disease symptomatology. The FACT-L is a broader QOL instrument that includes physical, functional, social and emotional domains and disease symptomatology. Both are psychometrically valid and are widely used in the literature, but have not been exclusively evaluated in smokers. Furthermore, there is no ‘gold standard’ instrument since there has never been a correlation study to compare estimates of reliability and validity between these instruments. The purpose of this study is to report the internal consistency and convergence validity of the FACT-L and the LCSS among newly diagnosed lung cancer patients who smoke. This data were collected and analyzed from a larger study examining smoking behavior among newly diagnosed lung cancer patients ( n = 51). Descriptive statistics were calculated on the FACT-L and LCSS scores, internal consistency was assessed by estimating Cronbach's alpha coefficients, and Pearson correlation coefficients were estimated between the two scales. Internal consistency coefficients demonstrated good reliability for both scales, and the two instruments demonstrated a strong correlation, suggesting good convergence validity. Either of these instruments are appropriate measures for QOL in lung cancer patients who smoke. Given the conceptual difference between the two instruments, it is important to carefully consider the research aims when selecting the appropriate QOL measurement instrument.

What symptom and functional dimensions can be predictors for global ratings of overall quality of life in lung cancer patients?

This study explores what dimensions of a health-related quality of life (HRQOL) questionnaire predict global ratings of overall quality of life (QOL) in lung cancer patients in assessments by patients and significant others, respectively. The analyses were based on dyadic assessments from lung cancer patients and their significant others. A subset of scales and items from the Swedish version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 and the lung-cancer-specific module, LC-13, was selected. Using multiple regression procedures, the relative importance of different symptoms and of functional impairments in predicting overall QOL was examined. The multiple regressions revealed that emotional functioning and fatigue were the only significant predictors of overall QOL for both the patients and the significant others' assessments. In addition, physical functioning was found to be another predictor in the significant others' assessments. The results emphasize that it is essential to consider both emotional functioning and fatigue as important areas for overall QOL in lung cancer patients.

Quality of life in lung cancer patients: impact of baseline clinical profile and respiratory status

As cure is attainable in very few cases of lung cancer, the imperative issue is to make quality of life (QOL) as good as possible as part of the palliative care package. The aim of this paper was to evaluate the baseline QOL of lung cancer patients and observe its association with various clinical parameters and overall respiratory status. A total of 101 patients were administered the European Organization for Research and Treatment of Cancer core quality of life (EORTC QLQ-C30, version 3) questionnaire. Clinical profile and measures of respiratory status, including spirometry, measures of dyspnoea, and 6-min walk test, were recorded. Higher Karnofsky Performance Status (KPS) significantly correlated with better global health status (P < 0.001) and healthy level of functioning (P < 0.001). The cumulative symptom burden was significantly associated with global QOL (P = 0.01) and physical, role and cognitive function scales (P < 0.05). All dyspnoea measures negatively correlated with global QOL and functioning scales. Spirometric indices showed a positive correlation with all functional scales (P < 0.05) except social. In conclusion, lung cancer patients have unsatisfactory QOL, with the global health status and physical functions being most affected. Number of symptoms, KPS, dyspnoea and spirometry significantly affect QOL.

Factors affecting the quality of life in lung cancer patients measured by EORTC QLQ questionnaire

To evaluate the quality of life (QoL) of lung cancer patients and to investigate the differences in QoL with respect to social and medical characteristics. Structured questionnaires (EORTC QLQ-C30 and QLQ-LC13) were used in 106 consecutive lung cancer patients for data collection during January 1, 2002 to December 31, 2002. The t test and one-way analysis of variance (ANOVA) were used to compare the differences in QoL at a 5% level of significance. The QoL of lung cancer patients were worse than reference value. The QoL of young, male and married patient groups was better than that in old, female and single groups. The QoL in patients with lower education or income was worse than that in patients with high education and income. Small cell lung cancer patients showed poorer QoL than non-small cell lung cancer patients did. The locally advanced or metastatic patients had worse QoL. All the kinds of treatments could worsen the QoL, however, the patients receiving surgical treatment had best QoL. The results suggest that the establishment of QoL judgment standard in Chinese lung cancer patients might be useful for clinicians, researchers and policy-makers.