Prognostic factors for patients with inoperable non-small cell lung cancer, limited disease. The importance of patients' subjective experience of disease and psychosocial well-being

Abstract

In a prospective controlled clinical trial, 102 patients with inoperable non-small cell lung cancer (NSCLC), limited disease, stage II and III were treated with combination chemotherapy, cisplatin 70 mg/m2 i.v. on day one and etoposide 100 mg/m2 i.v. on day one, and etoposide 200 mg/m2 orally on days 2 and 3, or radiotherapy given in 15 fractions of 2.8 Gy with two anterior/posterior fields during a period of three weeks. The patients completed a validated self-administered questionnaire before the start of treatment that assessed their psychosocial well-being, disease-related symptoms, personal functioning, and everyday activity. These subjective variables were evaluated together with treatment modality, WHO performance status, weight loss, and stage of disease, with regard to their value in predicting survival. Univariate survival analyses were undertaken for each individual factor, median survival was calculated according to life-table analyses. A step-wise multiple regression analysis was used to measure the prognostic value of the various factors. In the univariate analysis, general symptoms (p = 0.0006) psycho-social well-being (p = 0.0002) and stage of disease (p = 0.007) were the best predictive factors. In the multiple regression analyses the subjective variables, general symptoms (p less than 0.01) and psychosocial well-being (p less than 0.05) were shown to have the best predictive value for the patients' survival.