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Predictors of the multidimensional symptom experience of lung cancer patients receiving chemotherapy

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Abstract

Purpose

Few studies have examined interindividual variability in the symptom experience of lung cancer patients. We aimed to identify the most prevalent, severe, and distressing symptoms, and risk factors associated with increased symptom burden.

Methods

Lung cancer patients (n = 145) reported occurrence, severity, and distress for 38 symptoms on the Memorial Symptom Assessment Scale 1 week after chemotherapy. Using multidimensional subscales, risk factors for higher global distress, physical, and psychological symptoms were evaluated using simultaneous linear regression.

Results

Mean age was 64.0 years and 56.6% were female. Mean Karnofsky Performance Status score was 79.1 (SD 14.6) and mean Self-Administered Comorbidity Questionnaire score was 7.3 (SD 3.9). The most distressing and prevalent symptom was fatigue. Problems with sexual interest/activity had the highest mean severity rating. Patients with lower functional status (p = 0.001) and higher comorbidity (p = 0.02) reported higher global distress. Similarly, lower functional status (p = 0.003) and higher comorbidity (p = 0.04) were associated with a higher physical symptom burden along with lower body mass index (p = 0.02). Higher psychology symptom burden was associated with lower functional status (p = 0.01), younger age (p = 0.02), non-metastatic disease (p = 0.03), higher number of prior treatments (p = 0.04), and income (p = 0.03).

Conclusions

Fatigue was the most distressing and prevalent symptom among lung cancer patients receiving chemotherapy. Lower functional status was associated with a higher burden of global distress, physical, and psychological symptoms. Younger age and non-metastatic disease were additional risk factors for increased psychological symptoms. Together, these risk factors can help clinicians identify lung cancer patients at increased need for aggressive symptom management.

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Acknowledgements

This work was supported by the National Cancer Institute [R01CA134900 and K05CA168960] and the National Institute on Aging [T32AG000212]. Dr. Miaskowski is an American Cancer Society Clinical Research Professor.

Role of the funder

Neither the National Cancer Institute, National Institute on Aging, nor the American Cancer Society had a role in the design or conduct of the study.

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Authors and Affiliations

  1. Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, 505 Parnassus Ave, Mailbox 1270, San Francisco, CA, 94143, USA

    Melisa L. Wong

  2. Department of Physiological Nursing, School of Nursing, University of California San Francisco, 2 Koret Way-N631Y, San Francisco, CA, 94143, USA

    Steven M. Paul & Christine Miaskowski

  3. Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way-N339B, San Francisco, CA, 94143, USA

    Bruce A. Cooper

  4. Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA

    Laura B. Dunn

  5. Department of Nursing, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1168, New York, NY, 10029, USA

    Marilyn J. Hammer

  6. School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA

    Yvette P. Conley

  7. School of Nursing, Yale University, PO Box 27399, West Haven, CT, 06516, USA

    Fay Wright

  8. Department of Oral & Maxillofacial Surgery, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA, 94122, USA

    Jon D. Levine

  9. Division of Geriatrics, Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, 4150 Clement (181G), San Francisco, CA, 94121, USA

    Louise C. Walter

  10. Department of Nursing, Mount Sinai Hospital and Mount Sinai Queens, One Gustave L. Levy Place, Box 1068, New York, NY, 10029, USA

    Frances Cartwright

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  1. Melisa L. Wong
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  2. Steven M. Paul
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  3. Bruce A. Cooper
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  8. Jon D. Levine
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  9. Louise C. Walter
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  10. Frances Cartwright
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  11. Christine Miaskowski
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Correspondence to Christine Miaskowski.

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Wong, M.L., Paul, S.M., Cooper, B.A. et al. Predictors of the multidimensional symptom experience of lung cancer patients receiving chemotherapy. Support Care Cancer 25, 1931–1939 (2017). https://doi.org/10.1007/s00520-017-3593-z

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