Impact of symptom burden in post-surgical non-small cell lung cancer survivors

Abstract

Purpose: Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors.

Methods: A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden.

Results: Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54).

Conclusions: Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.

Fig. 1

ROC curve using a SR-KPS cutpoint of 1. ROC results (plotting sensitivity as a function of 1-specificity). Optimal cutoff values in the ROC curve for degree of symptom burden and functional limitation (using Self-Reported Karnofsky Performance Scale [SR-KPS]) in (n =183) NSCLC survivors. The area under the curve (AUC) was 0.63. The diagonal line corresponds to the ROC curve produced by random prediction

Fig. 2

ROC curve using a SR-KPS cutpoint of 2. ROC results (plotting sensitivity as a function of 1-specificity). Optimal cutoff values in the ROC curve for degree of symptom burden and functional limitation (using Self-Reported Karnofsky Performance Scale [SR-KPS]) in (n =183) NSCLC survivors. The area under the curve (AUC) was 0.75. The diagonal line corresponds to the ROC curve produced by random prediction