Assessment of baseline symptom burden in treatment-naïve patients with lung cancer: an observational study
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Patients with newly diagnosed lung cancer who have not yet begun treatment may already be experiencing major symptoms produced by their disease. Understanding the symptomatic effects of cancer treatment requires knowledge of pretreatment symptoms (both severity and interference with daily activities). We assessed pretreatment symptom severity, interference, and quality of life (QOL) in treatment-naïve patients with lung cancer and report factors that correlated with symptom severity.
This was a retrospective analysis of data collected at initial intake. Symptoms/interference were rated on the MD Anderson Symptom Inventory (MDASI) between 30 days prediagnosis and 45 days postdiagnosis. We examined symptom severity by disease stage and differences in severity by histology. Linear regression analyses identified significant predictors of severe pain and dyspnea.
Of 460 eligible patients, 256 (62%) had adenocarcinoma, 30 (7%) had small cell carcinoma, and 100 (24%) had squamous cell carcinoma; > 30% reported moderate-to-severe (rated ≥ 5, 0–10 scale) pretreatment symptoms. The most-severe were fatigue, disturbed sleep, distress, pain, dyspnea, sadness, and drowsiness. Symptoms affected work, enjoyment of life, and general activity (interference) and physical well-being (QOL) the most. Patients with advanced disease (n = 289, 63%) had more-severe symptoms. Cancer stage was associated with pain severity; both histology and cancer stage were associated with severe dyspnea.
One third of lung cancer patients were symptomatic at initial presentation. Quantification of pretreatment symptom burden can inform patient-specific palliative therapy and differentiate disease-related symptoms from treatment-related toxicities. Poorly controlled symptoms could negatively affect treatment adherence and therapeutic outcomes.
KeywordsLung cancer Symptoms Interference Patient-reported outcomes Quality of life
The authors acknowledge Jeanie F. Woodruff, BS, ELS, for editorial assistance. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 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.
Tito Mendoza: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, writing—original draft, and writing—review and editing
Kenneth Kehl: conceptualization, investigation, and writing—review and editing
Oluwatosin Bamidele: conceptualization, investigation, writing—original draft, and writing—review and editing
Loretta Williams: conceptualization, investigation, and writing—review and editing
Qiuling Shi: data curation, methodology, and writing—review and editing
Charles Cleeland: conceptualization, investigation, resources, supervision, writing—original draft, and writing—review and editing
George Simon: conceptualization, investigation, writing—original draft, and writing—review and editing
All research at The University of Texas MD Anderson Cancer Center is supported in part by the institution’s Cancer Center Support Grant, NCI P30 CA016672. The sponsors played no role in study design, in the collection, analysis, or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Compliance with ethical standards
The study was approved by our Institutional Review Board. As this was a retrospective review of deidentified data, the requirement for informed consent was waived.
Conflict of interest
The MD Anderson Symptom Inventory is copyrighted and licensed by The University of Texas MD Anderson Cancer Center and Charles S. Cleeland. The authors report no other conflicts of interest in this work.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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