Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer

Abstract

Objective Dose delays and reductions in chemotherapy due to hematologic toxicities are common among patients with advanced non-small-cell lung cancer (NSCLC). However, limited data exist on behavioral or psychological predictors of chemotherapy adherence. The goal of this study was to explore the frequency and clinical predictors of infusion dose delays and reductions in this patient population. Methods Fifty patients newly diagnosed with advanced NSCLC of high performance status (ECOG PS=0-1) completed baseline assessments on quality of life (FACT-L) and mood (HADS) within eight weeks of diagnosis. Participants were followed prospectively for six months. Chemotherapy dosing data came from medical chart review. Results All patients received chemotherapy during the course of the study, beginning with either a platinum-based doublet (74%), an oral epidermal growth factor receptor-tyrosine kinase inhibitor (14%), or a parenteral single agent (12%). Forty percent (N=20) of patients had either a dose delay (38%) and/or reduction (16%) in their scheduled infusions. Fisher’s exact tests showed that patients who experienced neutropenia, smoked at the time of diagnosis, or reported heightened baseline anxiety were significantly more likely to experience dose delays or reductions. There were no associations between chemotherapy adherence and patient demographics, performance status, or quality of life. Conclusion In this sample, over one-third of patients with advanced NSCLC experienced either a dose delay or reduction in prescribed chemotherapy regimens. Behavioral and psychological factors, such as tobacco use and anxiety symptoms, appear to play an important role in chemotherapy adherence, though further study is required to confirm these findings.

Survivors at Higher Risk for Adverse Late Outcomes Due to Psychosocial and Behavioral Risk Factors

“…For example, one study found that after controlling for neutropenia, smoking and elevated anxiety were significant predictors of chemotherapy dose delays and reductions in patients with advanced nonsmall cell lung cancer (53). Other studies have found that untreated depression increases noncompliance with difficult and complex chemotherapy and radiation treatment regimens (54,55).…”

Trajectories and predictors of state and trait anxiety in patients receiving chemotherapy for breast and colorectal cancer: Results from a longitudinal study

“…Anxiety in patients with cancer is a topic of great importance: previous research shows that this particular emotion is not only extremely common in this patient group (Burgess et al, 2005;Lewis et al, 2014), but it also has far-reaching effects on symptom experiences during treatment (Lockefeer and Vries, 2013;Saevarsdottir et al, 2010;Whitford and Olver, 2012), treatment compliance (Greer et al, 2008), patient outcomes such as experienced side-effects (Van Esch et al, 2011), and even survivorship (García-Torres and Alós, 2014). A useful theoretical framework for researching anxiety throughout the course of cancer treatment is Spielberger's anxiety model (Spielberger, 1989;Spielberger et al, 1983), which differentiates between state and trait anxiety.…”

Depression and anxiety symptoms following cancer diagnosis: a cross-sectional study

“…Cancer location (Massie, 2004) and pain are also important factors associated with depression (Laird, Boyd, Colvin, & Fallon, 2009) and anxiety (Velikova et al, 1995). Both depression and anxiety can postpone treatment and decrease its acceptance and adherence in cancer patients (Colleoni et al, 2000;Greer, Pirl, Park, Lynch, & Temel, 2008).…”