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Prognostic value of patient-reported symptom interference in patients with late-stage lung cancer

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Abstract

Purpose

Patient-reported outcomes (PROs) have been found to be significant predictors of clinical outcomes such as overall survival (OS), but the effect of demographic and clinical factors on the prognostic ability of PROs is less understood. Several PROs derived from the 12-item Short-Form Health Survey (SF-12) and M. D. Anderson Symptom Inventory (MDASI) were investigated for association with OS, with adjustments for other factors, including performance status.

Methods

A retrospective analysis was performed on data from 90 patients with stage IV non-small cell lung cancer. Several baseline PROs were added to a base Cox proportional hazards model to examine the marginal significance and improvement in model fit attributable to the PRO: mean MDASI symptom interference level; mean MDASI symptom severity level for five selected symptoms; SF-12 physical and mental component summaries; and the SF-12 general health item. Bootstrap resampling was used to assess the robustness of the findings.

Results

The MDASI mean interference level had a significant effect on OS (p = 0.007) when the model was not adjusted for interactions with other prognostic factors. Further exploration suggested the significance was due to an interaction with performance status (p = 0.001). The MDASI mean symptom severity level and the SF-12 physical component summary, mental component summary, and general health item did not have a significant effect on OS.

Conclusions

Symptom interference adds prognostic information for OS in advanced lung cancer patients with poor performance status, even when demographic and clinical prognostic factors are accounted for.

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Abbreviations

ECOG PS:

Eastern Cooperative Oncology Group performance status

EORTC:

European Organisation for Research and Treatment of Cancer

HR:

Hazard ratio

MDASI:

M. D. Anderson Symptom Inventory

NSCLC:

Non-small cell lung cancer

PRO:

Patient-reported outcome

SF-12:

12-item Short-Form Health Survey

SF-36:

36-item Short-Form Health Survey

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Acknowledgments

The authors acknowledge the editorial support of Bryan F. Tutt, MA, ELS, of the Department of Scientific Publications at MD Anderson, and Jeanie F. Woodruff, BS, ELS, of the Department of Symptom Research at MD Anderson. This project was supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant, Award Number CA016672, and by Award Number CA026582 from the National Cancer Institute to Charles Cleeland, PhD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health..

Conflict of interest

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Author information

Author notes

  1. Valen E. Johnson

    Present address: Department of Statistics, Texas A&M University, 525K Blocker, 3143 TAMU, College Station, TX, 77843-3143, USA

Authors and Affiliations

  1. Department of Mathematics and Statistics, Kennesaw State University, Kennesaw, Georgia

    Bradley J. Barney

  2. Department of Symptom Research (Unit 1450), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX, 77030, USA

    Xin Shelley Wang, Charles S. Cleeland & Tito R. Mendoza

  3. Department of Thoracic/Head and Neck Medical Oncology (Unit 432), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Charles Lu

  4. Department of Radiation Oncology (Unit 97), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Zhongxing Liao

  5. Department of Biostatistics (Unit 1411), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Valen E. Johnson

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  1. Bradley J. Barney
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Correspondence to Tito R. Mendoza.

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Barney, B.J., Wang, X.S., Lu, C. et al. Prognostic value of patient-reported symptom interference in patients with late-stage lung cancer. Qual Life Res 22, 2143–2150 (2013). https://doi.org/10.1007/s11136-013-0356-2

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