Impact of symptom burden in post-surgical non-small cell lung cancer survivors |
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Authors: | Amy E Lowery Paul Krebs Elliot J Coups Marc B Feinstein Jack E Burkhalter Bernard J Park Jamie S Ostroff |
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Institution: | 1. School of Medicine, University of Pittsburgh, 5115 Centre Ave, Suite 140, Pittsburgh, PA, USA 2. Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA 3. Department of Population Health, NYU Langone Medical Center, New York, NY, USA 4. VA New York Harbor Healthcare System, New York, NY, USA 5. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA 6. Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA 7. Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, NJ, USA 8. Rutgers, The State University of New Jersey, New Brunswick, NJ, USA 9. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA 10. Department of Thoracic Surgery, Hackensack University Medical Center, Hackensack, NJ, USA
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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. |
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