Mohan Anant, Singh P, Kumar S, Mohan C, Pathak A K, Pandey R M, Guleria R
Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Asian Pac J Cancer Prev. 2008 Oct-Dec;9(4):557-62.
Quality of life (QOL), and pulmonary and nutritional parameters are important outcome measures during treatment of lung cancer; however, the effect of chemotherapy on these factors and their relationship with clinical response is unclear.
Patients with non-small cell lung cancer (NSCLC) were evaluated for symptom profile, nutritional status (using anthropometry), pulmonary functions by spirometry and six minute walk distance (6 MWD), and QOL using the WHO-QOL Bref 26 questionnaire, before and after chemotherapy.
Forty-four patients were studied (mean (SD) age, 55 (10) years, 75% males). The majority (98%) had stage III or IV disease and 72% were current / ex-smokers with median pack-years of 27.0 (range, 0.5-90). Some 61% had a Karnofsky Performance Scale (KPS) 70 or 80. The commonest symptoms were coughing, dyspnea, chest pain, anorexia and fever (79%, 72%, 68%, 57% and 40%, respectively). The mean (SD) 6 MWD was 322.5 (132.6) meters. The mean (SD) percentage forced vital capacity (FVC %), and forced expiratory volume in one second (FEV1 %) were 64.7 (18.8) and 57.8 (19.4), respectively. The mean (SD) QOL scores for the physical, psychological, social, and environmental domains were 52.9 (20.5), 56.1 (17.9), 64.5 (21.8), 57.1 (16.6), respectively. Fourteen patients (32%) responded to chemotherapy. Non-responders had significantly higher baseline occurrence of fever, anorexia, and weight loss, higher pack-years of smoking and poorer KPS compared to responders. Overall, chemotherapy caused significant decline in the frequency of coughing, dyspnea, chest pain, fever, anorexia, weight loss, and improvement in hemoglobin and albumin levels. There was no significant improvement in pulmonary functions, nutritional status, or QOL scores after treatment.
Lung cancer patients have a poor QOL. Although chemotherapy provides significant symptomatic benefit, this does not translate into similar benefit in respiratory and nutritional status or QOL. Patients with constitutional symptoms, higher smoking burden, and poor KPS are less likely to respond to chemotherapy. Management of NSCLC must include strategies to improve various aspects of QOL, nutritional status and pulmonary reserve to achieve comprehensive benefit.
生活质量（QOL）、肺部及营养参数是肺癌治疗期间重要的疗效指标；然而，化疗对这些因素的影响及其与临床反应的关系尚不清楚。
对非小细胞肺癌（NSCLC）患者在化疗前后进行症状评估、营养状况（采用人体测量法）、通过肺量计测定肺功能及六分钟步行距离（6MWD），并使用世界卫生组织生活质量简表26问卷评估生活质量。
共研究了44例患者（平均（标准差）年龄55（10）岁，75%为男性）。大多数（98%）患者为Ⅲ期或Ⅳ期疾病，72%为现吸烟者/既往吸烟者，中位吸烟包年数为27.0（范围0.5 - 90）。约61%的患者卡氏功能状态评分（KPS）为70或80。最常见的症状为咳嗽、呼吸困难、胸痛、厌食和发热（分别为79%、72%、68%、57%和40%）。平均（标准差）6MWD为322.5（132.6）米。平均（标准差）用力肺活量（FVC%）和一秒用力呼气量（FEV1%）分别为64.7（18.8）和57.8（19.4）。身体、心理、社会和环境领域的平均（标准差）生活质量评分分别为52.9（20.5）、56.1（17.9）、64.5（21.8）、57.1（16.6）。14例患者（32%）对化疗有反应。与有反应者相比，无反应者发热、厌食和体重减轻的基线发生率显著更高，吸烟包年数更多，KPS更差。总体而言，化疗使咳嗽、呼吸困难、胸痛、发热、厌食、体重减轻的频率显著下降，血红蛋白和白蛋白水平有所改善。治疗后肺功能、营养状况或生活质量评分无显著改善。
肺癌患者生活质量较差。虽然化疗能带来显著的症状改善，但在呼吸和营养状况或生活质量方面并未转化为类似的益处。有全身症状、吸烟负担较重且KPS较差的患者对化疗反应较差。NSCLC的管理必须包括改善生活质量、营养状况和肺储备各方面的策略，以实现综合获益。
