Quality of Life and Survival in the 2 Years After Surgery for Non–Small-Cell Lung Cancer

Kenny, Patricia; King, Madeleine; Viney, Rosalie; Boyer, Michael; Pollicino, Christine; McLean, Jocelyn; Fulham, Michael; McCaughan, Brian C.

doi:10.1200/jco.2006.07.7230

Cited by 171 publications

(173 citation statements)

References 16 publications

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“…29 To our knowledge, this is the first, and to date the only, analysis of QOL from a prospective, randomized, controlled trial of adjuvant chemotherapy in NSCLC. Our data show that overall QOL and functional domain scores are somewhat compromised after thoracotomy, particularly after pneumonectomy; this is presumably an effect of surgery (as recently detailed by Kenny et al 30 ), but scores improve fairly quickly in patients who are not receiving chemotherapy. As expected, adjuvant chemotherapy has an immediate negative impact on a number of aspects of QOL in individuals with NSCLC who have undergone resection with curative intent.…”

supporting

confidence: 70%

Quality-of-Life Outcomes for Adjuvant Chemotherapy in Early-Stage Non–Small-Cell Lung Cancer: Results From a Randomized Trial, JBR.10

Bezjak

Lee

Ding

et al. 2008

JCO

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A B S T R A C T PurposeAdjuvant chemotherapy for early stage non-small-cell lung cancer (NSCLC) is now the standard of care, but there is little information regarding its impact on quality of life (QOL). We report the QOL results of JBR.10, a North American, intergroup, randomized trial of adjuvant cisplatin and vinorelbine compared with observation in patients who have completely resected, stages IB to II NSCLC. Patients and MethodsQOL was assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and a trial-specific checklist at baseline and at weeks 5 and 9 for those who received chemotherapy and at follow-up months 3, 6, 9, 12, 18, 24, 30 and 36. A 10-point change in QOL scores from baseline was considered clinically significant. ResultsFour hundred eighty-two patients were randomly assigned on JBR.10. A total of 173 patients (82% of the expected) in the observation arm and 186 (85% of expected) in the chemotherapy arm completed baseline QOL assessments. The two groups were comparable, with low global QOL scores and significant symptom burden, especially pain and fatigue, after thoracotomy. Changes in QOL during chemotherapy were relatively modest; fatigue, nausea, and vomiting worsened, but there was a reduction in pain and no change in global QOL. Patients in the observation arm showed considerable improvements in QOL by 3 months. QOL, except for symptoms of sensory neuropathy and hearing loss, in those treated with chemotherapy returned to baseline by 9 months. ConclusionThe findings of this trial indicate that the negative effects of adjuvant chemotherapy on QOL appear to be temporary, and that improvements (with a return to baseline function) are likely in most patients.

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supporting

confidence: 70%

Quality-of-Life Outcomes for Adjuvant Chemotherapy in Early-Stage Non–Small-Cell Lung Cancer: Results From a Randomized Trial, JBR.10

Bezjak

Lee

Ding

et al. 2008

JCO

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“…Our previous analysis of quality of life after SRT revealed little deterioration, in marked contrast to the reported negative impact of quality of life postsurgery. 28,29 In our study, cytohistologic confirmation of malignancy was available only in 39% of patients, and this low percentage is not uncommon in trials that evaluate the management of suspected early NSCLC. 30 Similar findings were observed by Sawada et al in 1039 patients who underwent surgical resection for a diagnosis of lung cancer or suspected lung cancer and in whom routine investigations confirmed a histologic diagnosis of lung cancer in only 523 patients.…”

Section: Discussionmentioning

confidence: 80%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

163

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BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

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“…35 The finding that over one-half of participants had some fatigue is consistent with prior studies showing fatigue to be highly prevalent among cancer survivors.7 -12 , 20 Fatigue may persist for months or years after lung cancer resection despite no evidence of active cancer. 12,[16][17] These results also demonstrate the association between moderate/severe fatigue and impairment in daily functioning. One in four individuals with moderate/severe fatigue was functionally impaired (SR-KPS ≤ 70%).…”

Section: Discussionmentioning

confidence: 57%

“…12 Several studies show complete resolution of fatigue by 3-6 months after lung cancer surgery [13][14][15] , whereas other studies show fatigue persisting for months to years after treatment completion. 12,[16][17] Fatigue can be associated with depressed mood, dyspnea, as well as functional dependency and the inability to perform activities of daily living. 12, 18-20 Therefore, examining the prevalence, severity, and association of fatigue with other health outcomes is important for understanding quality of life among lung cancer survivors.…”

Section: Introductionmentioning

confidence: 99%

Fatigue And Functional Impairment In Early-Stage Non-Small Cell Lung Cancer Survivors

Hung¹,

Krebs²,

Coups³

et al. 2010

C22. Behavioral and Psychosocial Factors in Asthma, Chronic Obstructive Pulmonary Disease and Other Lung Diseases

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Context-Fatigue is the most common sequela among non-small cell lung cancer (NSCLC) survivors 1-6 years post-treatment and is associated with functional limitations.Objectives-This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors.Methods-Three-hundred fifty individuals diagnosed and surgically treated for Stage IA or IB NSCLC completed a survey that included the Brief Fatigue Inventory (BFI) to assess the prevalence and severity of fatigue. The Self-Reported Karnofsky Performance Scale (SR-KPS) was used as a measure of functional status and was compared with the severity of fatigue though chi-square analyses. Demographic, psychological, and medical correlates of fatigue were examined using logistic regression.Results-The prevalence of fatigue was 57%. Forty-one percent (n = 142) of participants had mild fatigue and 16.8% (n = 59) had moderate or severe fatigue (BFI ≥ 4). Among the individuals reporting moderate or severe fatigue, 23.7% (n=14) had significant functional impairment (SR-KPS ≤ 70%) compared to 2.8% (n =8) with mild or no fatigue (χ 2 = 58.1, p < 0.001). In the multivariate analysis, NSCLC survivors with pulmonary disease (OR = 2.28), depressive symptoms (OR = 6.99), and anxiety symptoms (OR = 2.31) were more likely to report experiencing clinically significant fatigue, while those who met physical activity guidelines (OR = 0.29) reported less fatigue.Discussion-Fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue includes the screening and management of anxious and depressive symptoms, and pulmonary disorders such as chronic obstructive pulmonary disease.

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Quality of Life and Survival in the 2 Years After Surgery for Non–Small-Cell Lung Cancer

Cited by 171 publications

References 16 publications

Quality-of-Life Outcomes for Adjuvant Chemotherapy in Early-Stage Non–Small-Cell Lung Cancer: Results From a Randomized Trial, JBR.10

Quality-of-Life Outcomes for Adjuvant Chemotherapy in Early-Stage Non–Small-Cell Lung Cancer: Results From a Randomized Trial, JBR.10

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Fatigue And Functional Impairment In Early-Stage Non-Small Cell Lung Cancer Survivors

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