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T.R. Mendoza
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MA 18 - Global Tobacco Control and Epidemiology II (ID 676)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:H. Kawai, Christian Klaus Manegold
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 511 + 512
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MA 18.08 - Assessment of Baseline Symptom Burden in Treatment-Naïve Patients with Lung Cancer (ID 10246)
16:30 - 16:35 | Author(s): T.R. Mendoza
- Abstract
- Presentation
Background:
While most cancer therapies are associated with toxicities, a major component of cancer treatment is to reduce cancer-related symptoms and impairment of function. Assessing how well this goal is achieved is dependent on accurate assessments of baseline symptoms prior to initiation of therapy. The objectives of this study were to describe the symptom burden of treatment-naïve lung cancer patients and to examine demographic and disease factors that correlate with symptom severity.
Method:
Symptom data from 460 treatment-naïve patients with lung cancer were obtained using the validated MD Anderson Symptom Inventory via a 0-10 numeric rating scale. Descriptive statistics were used to summarize patient demographic and clinical characteristics. Differences in symptom severity, symptom interference and quality of life by disease stage and histology were examined using either t-test or ANOVA. Multiple linear regression analysis was performed using age, gender, tumor stage and histology to determine significant predictors of pain and shortness of breath.
Result:
The most severe symptoms were fatigue, disturbed sleep, distress, pain, shortness of breath, sadness and drowsiness. About 62% of patients had at least one moderate to severe (rated 5 or greater) symptom, while 48% had at least one severe (rated 7 or greater) symptom. Disturbed sleep, distress, shortness of breath, sadness, and drowsiness were reported to be severe by at least 16% of the patients. As expected, patients with advanced stage had significantly more severe symptoms. Patients with small-cell carcinoma reported the most severe pain and shortness of breath. Multiple linear regression analysis showed that stage was a significant predictor of pain severity while controlling for histology, age and gender. Patients with advanced stage had a pain level that was 1.2 higher than patients with early stage disease (95% CI= 0.5 – 1.8, p<0.001. For shortness of breath, both histology and stage were significant predictors of severe levels while controlling for age and gender. Patients with advanced stage had a shortness of breath level that was 0.9 higher than patients with early stage disease (95% CI= 0.4 – 1.6, p<0.001). Patients with small cell carcinoma had a shortness of breath level that was 1.5 higher than those with adenocarcinoma (95% CI= 0.35 – 2.6, p<0.01).
Conclusion:
In conclusion, as much as 62% of treatment-naïve patients with lung cancer reported at least one moderate-to-severe symptoms prior to initiation of cancer therapy. This high burden suggests that symptoms should be assessed routinely and tracked in parallel with cancer treatment.
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-036 - Symptom Trajectories During Chemotherapy Predict Overall Survival in Patients with Advanced Non-Small Cell Lung Cancer (ID 9393)
09:00 - 09:00 | Author(s): T.R. Mendoza
- Abstract
Background:
Patient–reported symptoms have shown prognostic value for patients with advanced non-small-cell lung cancer (NSCLC). The value of persistently high levels of critical symptoms during chemotherapy for predicting survival is seldom addressed. We examined symptom trajectories during first 15 weeks of chemotherapy and their relations to 3-year overall survival (OS) in patients with advanced NSCLC.
Method:
Stage IIIB-IV NSCLC patients scheduled to receive either intravenous chemotherapy or the oral tyrosine kinase inhibitor erlotinib were enrolled in a multicenter longitudinal study. Patients rated 15 symptoms on the MD Anderson Symptom Inventory-Lung (MDASI-LC) before chemotherapy and weekly thereafter for 15 weeks, on 0-10 severity scales. Group-based trajectory analysis was used to categorize patients into groups according to the level and trajectory of symptom severity (either high or low) that patients experienced over time. The 3-year OS was compared between high/low groups via Kaplan-Meier analysis. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated by Cox regression modeling, with adjustment for demographic and clinical factors.
Result:
We analyzed data from 140 patients (90 died by end of study). High-severity trajectories of three symptoms (fatigue, shortness of breath (SOB), lack of appetite (LOA)) significantly predicted 3-year OS. Patients in the high-fatigue group (n=60) began with moderate fatigue (4.1±3.4) that increased significantly during weeks 1-4 of therapy (5.7±4.5 at week 4; estimated weekly change=0.33, p=0.0004) and remained at this level to week 15. Compared with patients in the low-fatigue group (mean=2.0±1.8, no significant change over time), high-fatigue patients had shorter OS (median=290 vs. 623 days, HR=2.3, 95%CI=1.4-3.8, p=0.001). The high-SOB group (n=62) maintained a moderate level of SOB (4.6±3.5) over 15 weeks and had lower 3-year OS rate than did patients in the low-SOB group (median=256 vs. 566 days; HR=2.7, 95%CI=1.6-4.4, p<0.0001). Compared with patients in the low-LOA group (n=66, mean=0.8±1.8, no change over time), high-LOA patients (n=74, mean=3.2±3.1, no change over time) had shorter OS (median=261 vs. 566 days, p=0.019). The prognostic value of LOA was insignificant after adjusting for other factors.
Conclusion:
Our results suggest that, through longitudinal patient-reported symptom profiling during chemotherapy, persistently high symptom burden can independently predict overall survival in patients with advanced NSCLC. Patients with persistently high symptoms should be targeted for alerts to providers about the need for symptom control during chemotherapy in routine care for advanced NSCLC. Such information could also be used as reference parameters for clinical trial/research design.
