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. 2013 Oct;22(8):2143-50.
doi: 10.1007/s11136-013-0356-2. Epub 2013 Jan 31.

Prognostic value of patient-reported symptom interference in patients with late-stage lung cancer

Bradley J Barney  1 , Xin Shelley Wang, Charles Lu, Zhongxing Liao, Valen E Johnson, Charles S Cleeland, Tito R Mendoza
Affiliations

Prognostic value of patient-reported symptom interference in patients with late-stage lung cancer

Bradley J Barney et al. Qual Life Res. 2013 Oct.

Abstract

Purpose: Patient-reported outcomes (PROs) have been found to be significant predictors of clinical outcomes such as overall survival (OS), but the effect of demographic and clinical factors on the prognostic ability of PROs is less understood. Several PROs derived from the 12-item Short-Form Health Survey (SF-12) and M. D. Anderson Symptom Inventory (MDASI) were investigated for association with OS, with adjustments for other factors, including performance status.

Methods: A retrospective analysis was performed on data from 90 patients with stage IV non-small cell lung cancer. Several baseline PROs were added to a base Cox proportional hazards model to examine the marginal significance and improvement in model fit attributable to the PRO: mean MDASI symptom interference level; mean MDASI symptom severity level for five selected symptoms; SF-12 physical and mental component summaries; and the SF-12 general health item. Bootstrap resampling was used to assess the robustness of the findings.

Results: The MDASI mean interference level had a significant effect on OS (p = 0.007) when the model was not adjusted for interactions with other prognostic factors. Further exploration suggested the significance was due to an interaction with performance status (p = 0.001). The MDASI mean symptom severity level and the SF-12 physical component summary, mental component summary, and general health item did not have a significant effect on OS.

Conclusions: Symptom interference adds prognostic information for OS in advanced lung cancer patients with poor performance status, even when demographic and clinical prognostic factors are accounted for.

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Figures

Fig. 1
Fig. 1
Estimated overall survival curves for two “average” patients with stage IV NSCLC who differ at baseline only by ECOG PS group membership
Fig. 2
Fig. 2
Estimates and 95% confidence intervals of the adjusted HR associated with a one-point increase in mean MDASI symptom interference level, by ECOG PS stratum; HR > 1 indicates difference in survival
See this image and copyright information in PMC

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