Format

Send to

Choose Destination
Support Care Cancer. 2015 Dec;23(12):3455-63. doi: 10.1007/s00520-015-2699-4. Epub 2015 Mar 21.

What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer.

Author information

1
Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA. thomas.leblanc@duke.edu.
2
Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC, USA. thomas.leblanc@duke.edu.
3
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
4
Department of Bioinformatics and Biostatistics, Duke University Medical Center, 2400 Pratt Street, Suite 9000, Durham, NC, 27705, USA.
5
Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC, USA.

Abstract

PURPOSE:

Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool.

METHODS:

Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS).

RESULTS:

Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007).

CONCLUSIONS:

Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.

KEYWORDS:

Carcinoma; Non-small-cell lung; Palliative care; Patient outcome assessment; Symptom assessment

PMID:
25791391
DOI:
10.1007/s00520-015-2699-4
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center