Healthcare Policy and Outcomes

Annals of Surgical Oncology

, Volume 20, Issue 6, pp 1788-1797

First online:

Longitudinal Changes in Function, Symptom Burden, and Quality of Life in Patients with Early-Stage Lung Cancer

  • Marianna KoczywasAffiliated withMedical Oncology and Therapeutics Research, City of Hope
  • , Anna Cathy WilliamsAffiliated withNursing Research & Education,Department of Population Sciences, City of Hope
  • , Mihaela CristeaAffiliated withMedical Oncology and Therapeutics Research, City of Hope
  • , Karen ReckampAffiliated withMedical Oncology and Therapeutics Research, City of Hope
  • , Frederic W. Grannis Jr.Affiliated withThoracic Surgery, City of Hope
  • , Brian L. TiepAffiliated withPulmonary Critical Care, Department of Respiratory Diseases, City of Hope
  • , Gwen UmanAffiliated withVital Research
  • , Betty FerrellAffiliated withNursing Research & Education,Department of Population Sciences, City of Hope Email author 

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Emerging evidence supports the integration of palliative care concurrently with disease-focused care in patients with serious illnesses, such as lung cancer. This paper describes how longitudinal changes in physical function, symptom burden, and QOL of patients with early-stage non-small cell lung cancer (NSCLC) informed the development of an interdisciplinary, tailored palliative care intervention.


Patients with early stage (I-IIIB) NSCLC were accrued into the usual care phase (Phase 1) of an NCI-funded Program Project Grant. Baseline and longitudinal (up to 52 weeks post-accrual) physical function, symptoms, and QOL were assessed in the thoracic ambulatory clinics of one NCI-designated Comprehensive Cancer Center. Outcome measures included geriatric assessments, psychological distress, symptoms, and QOL. The association between disease stage (I–II vs. III) and longitudinal changes in these domains was evaluated.


A total of 103 patients were accrued. Stage I–II patients were significantly more likely to complete the study (p = 0.005). The stages (I–II vs. III) were equivalent at baseline on all demographic variables, clinical, and functional status. Physical function fluctuated longitudinally and was higher at 6 and 24 weeks than at baseline and 12 weeks. There was a longitudinal decrease in total number of symptoms (p < 0.001). Physical and social/family QOL fluctuated longitudinally (p < 0.001 and p = 0.016, respectively).


Patients with early-stage NSCLC report a significant longitudinal decrease in physical QOL, and fluctuations in objective and subjective measures of physical function over time were observed regardless of disease stage category. An interdisciplinary palliative care intervention is currently being tested to decrease symptom burden and improve QOL.