Quality of Life at Diagnosis Predicts Survival in Patients With Lung Cancer

Lung cancer carries a substantial symptom burden, and a study published in Clinical Lung Cancer found that physical and emotional functioning scores within quality-of-life (QOL) questionnaires at diagnosis may help predict survival in patients with lung cancer.

“Patients with lung cancer experience a higher burden of symptoms associated with physical and psychosocial problems than those with other types of cancers,” the study authors wrote. “Considerable symptom burden has been noted in newly diagnosed advanced lung cancer, and inappropriate perceptions of this burden can hinder the adequate provision of patient-centered care and further decrease patients’ QOL.”

In cancer care, several health-related QOL surveys are commonly used, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Edmonton Symptom Assessment Scale, the McGill Quality of Life Questionnaire, and the Palliative Care Outcome Scale.

The EORTC QLQ-C30 has been researched as a prognostic factor in several cancer types, but prior research has often focused on the physical function aspects of the scale and left out emotional functioning measures, the authors wrote.

The current study aimed to assess the correlation between QOL as determined by the EORTC QLQ-C30 with survival in patients with lung cancer, factoring in both physical and emotional functioning measures and including possible confounding factors. The questionnaire includes 30 questions evaluating 5 functional scales (physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning) and 9 symptom scales (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties).

The multicenter study included data from 1297 patients with lung cancer across 7 medical centers of the Catholic University of Korea who were enrolled between December 2017 and December 2020. Basic demographic and disease data were collected, and QOL information was collected using the EORTC QLQ-C30 version 3.0 at diagnosis.

A multivariable analysis found that several factors were statistically significant independent predictors of survival: male sex, younger age, never smoker status, better performance status (ECOG 0-1), early-stage (stage I or II) disease at diagnosis, receiving treatment, higher physical functioning scores, and higher emotional functioning scores.

“Here we only analyzed functional scales with survival not including symptom scales even though survival may also be affected by symptom burden, because the aim of our study was to evaluate the association between functions and survival,” the authors noted.

In a subgroup analysis with patients stratified into early or advanced cancer at diagnosis, higher physical function scores and higher emotional function scores were both found to be positive prognostic factors for survival. Physical function was an independent prognostic factor in early stage lung cancer, and emotional functioning was a significant factor regardless of stage at diagnosis.

Additionally, some symptoms in the nine scales were associated with lower functioning. Fatigue, pain, insomnia, and financial difficulties all correlated with lower emotional function scores. Fatigue, pain, dyspnea, and financial difficulties correlated with lower physical function scores. Considering functioning scale scores were found to be predictive of survival, the authors highlight the importance of taking patient complaints about symptoms seriously to improve emotional and physical functioning when possible.

The study was limited because it only collected EORTC QLQ C-30 scores at diagnosis and did not conduct follow-up surveys. The patient population was also heterogeneous with varied treatment modalities, pathology types, and clinical stages, although clinical stage heterogeneity was addressed by the subgroup analysis.

While further prospective research is needed to overcome limitations and confirm the findings, the data suggest self-reported QOL may be predictive of survival in lung cancer.

“Our findings suggest that physical functioning and emotional functioning, as assessed by patients’ self-report, can both independently predict survival in patients with lung cancer regardless of clinical stages, and that identifying symptoms could help improve QOL among patients with lung cancer,” the authors concluded.

Reference

Hong YJ, Han S, Lim JU, et al. Association between quality of life questionnaire at diagnosis and survival in patients with lung cancer. Clin Lung Cancer. Published online March 20, 2023. doi:10.1016/j.cllc.2023.03.007