Effects of CALM intervention on neutrophil-to-lymphocyte ratio (NLR), fear of cancer recurrence and quality of life in patients with lung cancer

Abstract

Purpose This study aims to evaluate the effects of managing cancer and living meaningfully (CALM) intervention on the neutrophil-to-lymphocyte ratio (NLR), fear of cancer recurrence, quality of life and general distress in lung cancer patients and to explore whether there is a correlation between the NLR, fear of cancer recurrence, general distress and quality of life. Methods Eighty lung cancer patients with clinical range scores (≥13 points) on the FCRI severity subscale were recruited and randomly assigned to the CALM group or usual care (UC). The NLR was recorded before and after treatment. The Fear of Cancer Recurrence Inventory (FCRI), Quality of Life Questionnaire Core 30 (QLQ-C30) and Depression-Anxiety-Stress Scale (DASS-21) were used to evaluate patients at baseline (T0), immediately after treatment (T1), and at 2 (T2) and 4 (T3) months. Results Compared with the UC group, the NLR was significantly different before and after CALM intervention (z=-5.498; P=0.000). There were significant differences in the scores of QLQ, FCR and general distress (referring to depression and anxiety) before and after the T1, T2 and T3 interventions (F=220.30, F=315.20, F=290.10, respectively; P<0.001). The NLR in lung cancer patients was negatively correlated with QOL both before (r=-0.763; P<0.0001) and after the intervention (r=-0.810, P<0.0001). FCR and general distress were negatively correlated with the QOL scores in the CALM group (T0: r=-0.726, r=-0.776, respectively; P<0.0001; T1: r=-0.664, r=-0.647, respectively; P<0.0001; T2: r=-0.678, r=-0.695, respectively; P < 0.0001; T3: r=-0.511, P = 0.0008; r=-0.650, P<0.0001). Conclusion The CALM intervention can effectively reduce the NLR, alleviate the recurrence fear and general distress symptoms and improve the quality of life in lung cancer patients. Meanwhile, the NLR, fear of cancer recurrence and general distress were negatively correlated with quality of life. This indicates that the NLR can be used as a marker of the efficacy of the CALM intervention.