Supportive Care in Cancer

, Volume 22, Issue 1, pp 181–187

The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study


    • Global Health Economics & Outcomes ResearchPfizer Inc
  • Adam Roughley
    • Adelphi Real World (Manchester)Adelphi Mill
  • Alex Rider
    • Adelphi Real World (Manchester)Adelphi Mill
  • Gavin Taylor-Stokes
    • Adelphi Real World (Manchester)Adelphi Mill
Original Article

DOI: 10.1007/s00520-013-1959-4

Cite this article as:
Iyer, S., Roughley, A., Rider, A. et al. Support Care Cancer (2014) 22: 181. doi:10.1007/s00520-013-1959-4



Disease symptom management in patients with advanced non-small cell lung cancer (NSCLC) is a critical aspect of therapy. The main objective of our study was to assess patient-reported outcomes and the degree of concordance between physician and patient perceptions of symptom severity in advanced NSCLC in the USA.


Patients with advanced (stage IIIB/IV) NSCLC (N = 450) were recruited in a nationwide (USA) lung cancer study. Patients and their oncologists completed patient and physician versions of the Lung Cancer Symptom Scale (LCSS). Patient-reported lung cancer-specific quality of life was assessed with the Functional Assessment of Cancer Therapy—Lung (FACT-L). Concordance was assessed using the kappa-statistic. Regression analysis was performed with FACT-L total score as the dependent variable and patient-reported LCSS symptom scores as predictors.


A high proportion of patients experienced lung cancer symptoms: fatigue (100 %), loss of appetite (97 %), shortness of breath (95 %), cough (93 %), pain (92 %), and blood in sputum (63 %). Concordance between physician and patients was lowest for loss of appetite (kappa 0.1701) and greatest for hemoptysis (kappa 0.4586). Loss of appetite (β = −0.204; p < 0.001), cough (β = −0.145; p < 0.01), pain (β = −0.265; p < 0.001), and shortness of breath (β = −0.145; p < 0.01) were found to be significant predictors of the quality of life.


Symptom burden in patients with advanced NSCLC is high and has a negative impact on the quality of life. Patient-reported outcomes data could help optimize disease outcomes and therapy management in NSCLC.


Non-small cell lung cancerSymptom burdenQuality of lifeConcordancePatient-reported outcomes

Copyright information

© Springer-Verlag Berlin Heidelberg 2013