Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients

Jacot, William; Colinet, Benoît; Bertrand, Delphine; Lacombe, Sandy; Bozonnat, Marie Cecile; Daurès, Jean‐Pierre; Pujol, Jean-Louis

doi:10.1093/annonc/mdn064

Cited by 95 publications

(91 citation statements)

References 25 publications

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“…Earlier publications that reported on the correlation between PS and QoL are ambiguous [18,22,23]. It could be, since we adjusted for fatigue, a variable which is identified as a strong potential confounder that the PS pales into insignificance.…”

Section: Discussionmentioning

confidence: 93%

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Pijls‐Johannesma

Houben

Boersma

et al. 2009

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer leads to a high incidence of severe, mostly esophageal, toxicity. The purpose of this study was to investigate the evolution of quality of life (QoL) in patients with lung cancer, selected for curative radiotherapy (RT) or chemo-RT. Methods: Seventy-five lung cancer patients completed a longitudinal the EORTC QLQ-C30 and LC13. Linear mixed regression models were fitted to investigate the impact of different factors on overall QoL. Results: Overall QoL decreased shortly after the end of RT (4 points, p = 0.19), but increased back to baseline within 3 months. Mean scores of role functioning (p = 0.018), cognitive functioning (p = 0.002), dyspnoea (EORTC QLQ-LC13; p = 0.043), dysphagia (p = 0.005) and hoarseness (p = 0.029), showed a significant worsening over time. Emotional functioning (p = 0.033) improved significantly over time. Severe esophagitis (Pgrade 2) was reported in only 12% of the patients. Next to maximal esophageal toxicity Pgrade 2 (p = .0.010), also tumor stage IIIA (p < 0.001), tumor stage IIIB (p = 0.003), gender (p = 0.042) and fatigue (p < 0.001) appeared to be significant predictors of QoL. Conclusion: High-dose radiotherapy or concurrent chemo-radiation in the treatment of lung cancer seems to be a well-tolerated treatment option with preservation of QoL. Lung cancer remains a major public health problem worldwide because of its high incidence, rapid progression, and poor outcome [1]. The majority of patients who develop lung cancer die of this disease within a year [2]. Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer is standard care for patients with locally advanced disease, i.e. stage III non-small cell lung cancer (NSCLC) or limited stage small cell lung carcinoma (LD-SCLC) [3,4].Combined concurrent modality treatment increases long-term survival, but at the expense of a higher incidence of severe esophagitis [5][6][7][8]. In order to allow proper balancing between expected benefits and drawbacks of aggressive therapy, knowledge of the effects of a given treatment on the quality of life (QoL) is needed.An optimal therapy could be defined as one that increases survival or provides benefit through reduction in cancer-related symptoms and improved QoL.To the best of our knowledge, in only one study, QoL assessment was performed in patients receiving high-dose radiotherapy for NSCLC [9]. No data are at present known on the influence of concurrent chemo-radiation on the QoL.Moreover, a broad Medline search using the terms ''QoL and SCLC" (December 2008) revealed only 15 studies of which none examined QoL after radiotherapy treatment.The purpose of this study was to investigate the evolution of QoL on NSCLC stages I-III and LD-SCLC patients, referred for hyperfractionated accelerated high-dose radiotherapy (RT) with or without concurrent chemotherapy, with curative intent. Since we hypothesized that QoL would be considerably influenced by esophageal...

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Section: Discussionmentioning

confidence: 93%

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Pijls‐Johannesma

Houben

Boersma

et al. 2009

Radiotherapy and Oncology

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“…In the study conducted by Jacot et al on a group of 301 patients with NSCLC this prevalence was estimated at 8% [10].…”

Section: Discussionmentioning

confidence: 97%

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Zarzecka

Kubicki²,

Kozielski³

2013

Advances in Respiratory Medicine

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Introduction: It is known from clinical practice that data concerning plasma sodium concentration and its influence on patient prognosis are underestimated. The aim of this study was the evaluation of the prevalence and influence of hyponatraemia on prognosis in patients with lung diseases, particularly with lung cancer. Material and methods: Retrospective analysis of data obtained from a single Pulmonary Department was performed. A total of 449 patients divided in two groups, were analysed. The first group consisted of all lung cancer patients (n = 290) hospitalized in the analysed period. The second group included patients with hyponatraemia but without diagnosed lung cancer (n = 159). The prevalence of hyponatraemia, including severity (mild, moderate or severe), was evaluated. Histological types of lung cancer as well as comorbidities were taken into account. Results: Hyponatraemia was found in 46.9% of patients with lung cancer, including mild (serum sodium 135-130 mEq/L), moderate (129-125 mEq/L) and severe hyponatraemia (< 125 mEq/L) in 66.9%, 25% and 8.1, respectively. In patients without lung cancer and with recognized hyponatraemia, mild, moderate and severe hyponatraemia were found in 81.8%, 13.2% and 5%, respectively (mainly in obstructive and interstitial lung diseases). Hyponatraemia was observed in 52.6% of patients with non-small cell lung cancer (NSCLC) and in 45.2% of patients with small cell lung cancer (SCLC). There was no statistical significance in prevalence of hyponatraemia between histological types of lung cancer. In patients with lung cancer and hyponatraemia compared to patients with lung cancer but without hyponatraemia, a significant increase of in-hospital mortality was found (28.7% vs. 7.8%, respectively) p < 0.001. Conclusions: Hyponatraemia was a common abnormality found in approximately 50% of lung cancer patients. Hyponatraemia was a significant prognostic factor associated with poor prognosis.

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“…was identified as a negative prognostic factor in both univariate and multivariate analyses in two of three studies of nonsmall cell lung cancer [16,18,19], two studies of renal cell carcinoma [20,21], and in separate studies of gastric cancer [22,23] and non-Hodgkin's lymphoma [24]. Three large studies explored the prognostic role of hyponatremia at hospital admission ( Table 2).…”

Section: Rationale For Diagnosis and Management Of Hyponatremia In Camentioning

confidence: 99%

Diagnosis and Management of Hyponatremia in Cancer Patients

Castillo

Vincent

Justice³

2012

The Oncologist

209

201

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Hyponatremia, a common electrolyte abnormality in oncology practice, may be a negative prognostic factor in cancer patients based on a systematic analysis of published studies. The largest body of evidence comes from small-cell lung cancer (SCLC), for which hyponatremia was identified as an independent risk factor for poor outcome in six of 13 studies. Hyponatremia in the cancer patient is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH), which develops more frequently with SCLC than with other malignancies. SIADH may be driven by ectopic production of arginine vasopressin (AVP) by tumors or by effects of anticancer and palliative medications on AVP production or action. Other factors may cause hypovolemic hyponatremia, including diarrhea and vomiting caused by cancer therapy. Hyponatremia may be detected on routine laboratory testing before or during cancer treatment or may be suggested by the presence of mostly neurological symptoms. Treatment depends on several factors, including symptom severity, onset timing, and extracellular volume status. Appropriate diagnosis is important because treatment differs by etiology, and choosing the wrong approach can worsen the electrolyte abnormality. When hyponatremia is caused by SIADH, hypertonic saline is indicated for acute, symptomatic cases, whereas fluid restriction is recommended to achieve a slower rate of correction for chronic asymptomatic hyponatremia. Pharmacological therapy may be necessary when fluid restriction is insufficient. The orally active, selective AVP receptor 2 (V 2 )-receptor antagonist tolvaptan provides a mechanism-based option for correcting hyponatremia caused by SIADH or other conditions with inappropriate AVP elevations. By blocking AVP effects in the renal collecting duct, tolvaptan promotes aquaresis, leading to a controlled increase in serum sodium levels. The Oncologist 2012;17:756 -765

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Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients

Abstract: In this extended validation population, the SCS is more informative than the CCI in predicting NSCLC patient outcome as the former is also more disease specific. Combination of both SCS comorbidity score and LSCC QoL yields a more accurate information that conventional analysis of PS.

Cited by 95 publications

References 25 publications

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Diagnosis and Management of Hyponatremia in Cancer Patients

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