Quality of life in lung cancer patients: As an important prognostic factor

doi:10.1016/S0169-5002(00)00179-3

Lung Cancer

Volume 31, Issues 2–3, March 2001, Pages 233-240

https://doi.org/10.1016/S0169-5002(00)00179-3 Get rights and content

Abstract

Given that lung cancer is one of the common cancers world-wide, the implications of focusing on quality of life as well as survival require to be understood. We have carried out a study of the relationship between survival and quality of life in patients with lung cancer comparing patients those who lived with those who died within 3 months. The design of the study allowed every patient in a defined geographical area with a potential diagnosis of lung cancer to be studied from first outpatient consultation till after a definitive treatment has been given. Quality of life was measured using three standard questionnaires: the Nottingham Health Profile (NHP), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ–C30) and its lung cancer supplementary questionnaire (QLQ–LC13) in addition to a study specific questionnaire collecting data on demographic, social, clinical and performance status. The contribution of quality of life in relation to survival adjusted for known prognostic factors was determined using Cox's proportional hazard model. In all 129 lung cancer patients were interviewed, and 96 patients were alive at 3-months follow-up. Only 90 of 96 patients alive at 3-months follow-up were assessable. Descriptive analyses showed that those who were dead had more perceived health problems, greater level of symptoms and significant lower physical and role functioning and global quality of life at presentation. On the other hand, univariate analyses showed that patients’ aggregate scores on the NHP, the functioning scores, and global quality of life scores alone were significant predictors of survival (P<0.03, P<0.04, P<0.04, respectively ). The multivariate analyses showed that pre-diagnosis global quality of life was the most significant predictor of the length of survival even after adjusting for known prognostic factors (age, P<0.04; extent of disease, P<0.03; global quality of life, P<0.02), while performance status, sex and weight loss were not. This study confirmed that pre-diagnosis quality of life was a significant predictor of survival. Indeed, pre-diagnosis quality of life should be considered as a clinical status which has to be established by physicians before treatment starts as it is such an important predictor of survival.

Introduction

Lung cancer is well known as an important public health problem because of its high incidence [1], rapid progression [2], and poor outcome [3]. Thus, measuring quality of life has become an important endpoint of current clinical trials and other studies of lung cancer care.

Despite much attention, uncertainty about choice of instruments, study design and analysis in measuring quality of life remains [4], [5]. Our review of literature indicates that studies of quality of life have demonstrated harm from much of the treatment offered as well as benefit. Thus, quality of life should become one of the main outcome measures in clinical trials and treatment evaluations [6]. However, findings from more recent studies clearly suggest that effective systematic treatment in selected lung cancer patients can improve both survival and quality of life [7], [8], [9].

We have been fortunate in carrying out this study in area of high incidence of lung cancer in greater Glasgow where we had access to potential cases of lung cancer coming to outpatient clinics for diagnosis. This paper presents data from a prospective study of quality of life in lung cancer patients where quality of life was assessed pre-diagnosis drawn from a general population as opposed to the selected samples who are entered into clinical trials. The paper reports on the importance of quality of life as a prognostic factor of duration of survival.

Section snippets

Study design

A population-based study of quality of life in patients with lung cancer was conducted during 1 complete calendar year in the northern sector of Glasgow, Scotland. The population of the study area was 169 016 and the average annual number of incident of lung cancer was ∼150 cases. The intention was to interview all new lung cancer patients attending the chest clinic of a large teaching and district general hospital (Stobhill NHS Trust). All 167 general practitioners (GPs) in the defined area

Results

Based on data obtained from the local cancer registry there were 133 lung cancer patients registered from the Stobhill Hospital catchment area during the study period. Of these, 129 (97%) patients were interviewed and the remaining four patients were missed.

Discussion

The findings of this study clearly suggest that the pre-diagnosis quality of life is an important prognostic factor of the length of survival. This is one of the most striking findings in quality of life studies of survival in lung cancer patients.

Ruckdeschel et al. [16] in a series of quality of life studies using the Functional Living Index-Cancer (FLI-C) reported that the total baseline quality of life score (aggregate score on the FLI-C) alongside performance status, weight loss and stage

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Citation Excerpt :
Rehabilitation services may also need to be remotely-delivered to overcome barriers in access, uptake, and completion [102], particularly during global viral (e.g., COVID-19) pandemics that require social distancing. Additional novel and important contributions of our study are: 1) inclusion of patients who underwent radio/-ablation therapy for stage I lung cancer, a growing patient population given advances in radio/-ablation techniques and often excluded from studies that examined posttreatment lung cancer survivorship issues; 2) focus on individual functional impairments and symptoms that are potentially modifiable with identified effect sizes that have been suggested to be clinically meaningful in patients with lung cancer [80], met multiple statistical significance thresholds, and therefore should be targeted in interventions to improve the HRQL of lung cancer survivors following curative intent therapy; 3) comorbidities defined individually (and not combined as a total sum), which has important implications in the clinical setting to improve control of specific comorbidities (e.g., OSA); 4) HRQL defined with a highly prognostic measure [55–58]; and 5) being (to the best of our knowledge) among the first study to identify factors that explain most (>50%) of the variance in HRQL, enhancing clinical translation. Despite a thorough list of factors examined, we did not have information on spirituality [103] or stigma [104], important factors associated with HRQL in patients with lung cancer; or disease-/progression-free survival, an important patient-relevant (and clinical) endpoint [105].
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Quality of life in lung cancer patients: As an important prognostic factor

Abstract

Introduction

Section snippets

Study design

Results

Discussion

Lung Cancer

Eur. J. Cancer

J. Chronic Dis.

Lung Cancer

Estimation of the worldwide incidence of 18 major cancers in 1985

Int. J. Cancer

Lung cancer: recent changes and expectations of improvements

Semin. Oncol.

Quality of life

Quality of life in lung cancer patients: a review of literature from 1970–1995

Chest

Triplet chemotherapy combinations with new agents: is there a rationale?

Semin. Oncol.

New chemotherapeutic agents prolong survival and improve quality of life in non-small cell lung cancer: a review of the literature and future directions

Clin. Cancer Res.

Relationship between quality of life and clinical outcomes in advanced non-small cell lung cancer: best supportive care (BSC) versus BSC plus chemotherapy

Lung Cancer

The Nottingham Health Profile user's manual