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Lung Cancer. 2013 Aug;81(2):288-93. doi: 10.1016/j.lungcan.2013.03.008. Epub 2013 Apr 3.

Symptom burden and quality of life in advanced non-small cell lung cancer patients in France and Germany.

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Pfizer Oncology, New York, NY 10017, USA.



To assess patient reported symptom burden and impact on disease specific health related quality of life (HRQOL) in advanced non-small cell lung cancer (NSCLC) patients.


Patients with advanced (stage IIIB/IV) NSCLC in France (n = 613) and Germany (n = 600) were recruited into a multicenter, patient record-based cross-sectional study. Patient reported symptoms using the Lung Cancer Symptom Scale, which assesses fatigue, loss of appetite, shortness of breath, cough, pain and blood in sputum on a 0-100 visual analog scale. Disease specific and generic HRQOL were assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) and the EuroQol five-dimensional questionnaire (EQ-5D) respectively. A multivariate regression analysis was performed with total FACT-L score as the dependent variable and symptom scores as predictors. Age, gender, stage and performance status were used as control variables.


Majority of the patients were male (67%), Caucasian (93%) with an average age of 63 years. Fatigue, loss of appetite, shortness of breath, cough and pain were reported by ≥ 90% of patients. The mean health utility index score was found to be 0.58 and the mean general health status score was 58.0. Fatigue (β = -0.122; p < 0.001), loss of appetite (β = -0.170; p < 0.001), pain (β = -0.145; p < 0.001), shortness of breath (β = -0.118; p < 0.001) were found to be significant predictors of lung cancer specific quality of life as measured by the FACT-L total score.


Fatigue, loss of appetite, shortness of breath and pain have a significant negative impact on patient reported disease specific HRQOL in advanced NSCLC patients.


EQ-5D; FACT-L; LCSS; Lung cancer; Patient reported outcomes; Quality of life; Symptoms

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