Elsevier

Lung Cancer

Volume 71, Issue 1, January 2011, Pages 103-108
Lung Cancer

Health-related quality of life among early-stage, non-small cell, lung cancer survivors

https://doi.org/10.1016/j.lungcan.2010.04.011Get rights and content

Abstract

Background

Limited data are available about the physical and mental functioning of individuals diagnosed and treated for early-stage lung cancer. To develop post-treatment guidelines and targeted resources for the growing number of lung cancer survivors, clinically relevant information about longer term health-related quality of life (HQOL) is needed. The current study examines lung cancer survivors’ HQOL and identifies associations between HQOL and demographic, disease and medical risk factors.

Methods

A total of 359 individuals diagnosed and surgically treated for stage IA or IB non-small cell lung cancer completed a post-treatment survey via mail or telephone that included the SF-36v2 as well as questions regarding demographic and medical factors. To better understand the impact of lung cancer treatment, we examined age- and gender-adjusted differences in HQOL as compared to a demographically matched sample of older adults, most with a significant smoking history, who participated in a lung cancer screening trial. Risk factors for impairments in HQOL were also identified.

Results

Compared to the screening sample, lung cancer survivors reported lower physical health scores, but did not differ in terms of mental health status. Dyspnea and distressed mood were most associated with HQOL impairments.

Conclusions

Early-stage lung cancer survivors are likely to experience mild impairment in physical functioning. They may benefit from management of distressed mood and referral to physical activity and pulmonary rehabilitation programs to promote HQOL outcomes.

Introduction

In the United States, lung cancer is the second most prevalent cancer with about 219,440 new cases diagnosed annually [1]. Despite the generally poor prognosis, 5-year survival rates for individuals diagnosed with early-stage (IA and IB) non-small cell lung cancer (NSCLC) are 73% and 54%, respectively [2]. There are currently an estimated 360,000 survivors of lung cancer in the US, accounting for 4% of the total adult cancer survivor population [3]. Ongoing investigations of early detection and advances in targeted therapies and adjuvant multi-modality treatment hold increased hope for disease-free survival for this growing cohort of relatively understudied individuals diagnosed with early-stage lung malignancies [4].

To guide the long-term care of lung cancer survivors, information is needed regarding their health-related quality of life (HQOL), represented by patient reports of physical symptoms, functional abilities, psychological well-being, and social functioning. Previous studies have noted that post-treatment impairment in HQOL among lung cancer survivors persists throughout survivorship [5], [6], [7], [8], [9], [10], [11], [12], yet various methodological shortcomings of prior work limit the conclusions drawn to date. Prior studies have used relatively small samples and typically collected data either only within the first year after treatment or more than 5 years post-treatment [13]. Most important, few studies have compared lung cancer survivors’ HQOL to relevant comparison groups (for an exception, see Ref. [6]), limiting the ability to control for the confounding effects of smoking history or comorbid conditions (such as chronic lung disease) on HQOL outcomes. Additionally, there is a need to pay greater attention to the clinical importance of HQOL findings [14] and to identify risk factors for impairment in post-treatment HQOL [15] so that supportive care and rehabilitation interventions can be targeted to lung cancer survivors most in need of specialized follow-up care.

This study examines the HQOL of early-stage lung cancer survivors (1–6 years post-resection) who had undergone surgical resection as their primary treatment and remained disease-free. We examined demographic, medical, and psychological correlates of HQOL. In contrast to other cross-sectional studies that compared HQOL to the general population, we compared HQOL (SF-36v2) scores from lung cancer survivors with a comparison sample of older adults who had enrolled in a lung screening trial [16] and who had screened negative for lung cancer. Use of this matched comparison sample allowed us to better control for demographic, tobacco-related, and comorbidity variables that can influence the interpretation of HQOL outcomes.

Section snippets

Participants and procedure

Lung cancer survivors were identified from institutional clinical and research patient databases at Memorial Sloan-Kettering Cancer Center (MSKCC). Eligibility criteria were: diagnosis of primary stage IA or IB NSCLC between 1 and 6 years post-surgical resection with curative intent, no evidence of disease at time of recruitment, thoracic surgical oncologist's permission to contact the individual for study participation, no cognitive impairment likely to interfere with study participation (as

Participants

A total of 556 eligible individuals were identified from the thoracic surgery and institutional databases, 359 of whom provided informed consent (65% participation rate). Primary reasons for study nonparticipation were: passive refusal (n = 54), unable to be reached by telephone (n = 47), lack of interest (n = 23), wishing to avoid discussing cancer (n = 20) and feeling too poorly to participate (n = 10). Recruitment and data collection were conducted from September 2005 to July 2007. Those who completed

Discussion

This study makes several important contributions to clinical care and research focusing on post-treatment lung cancer survivors. In contrast to studies using general population norms, this study compares HQOL in lung cancer survivors with that of closely matched controls, thereby improving the interpretation of the specific impact of disease and treatment exposure. These analyses also build upon prior research [5], [6], [8] by examining correlates of HQOL and by interpreting results in terms of

Conclusions

These findings provide clinically useful information for physicians managing post-treatment care of early-stage, resected lung cancer survivors. While our finding that lung cancer survivors overall do not experience major deficits in HQOL is encouraging, multi-disciplinary post-treatment follow-up beyond the initial treatment phase is warranted as the presence of either ongoing dyspnea or depression is likely to be associated with clinically meaningful decrements in physical functioning for

Conflict of interest statement

The authors declare no financial or personal conflicts of interest with regard to the content of this work.

Funding

This research was supported by grants T32CA009461-25 and R03CA115212-02 from the National Cancer Institute and by the Byrne Fund. This publication also acknowledges P30 CA08748 which provides partial support for the Behavioral Research Methods Core.

Acknowledgements

We thank Claudia Henschke for her generosity in sharing data from a comparison sample of older adults enrolled in a lung cancer screening program (NY-ELCAP) and Mary McCabe for her review and comments on an earlier manuscript draft. We thank Melissa Ozim and Syncia Sabain for their assistance with data collection and management and the study participants for their valued contribution.

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