Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX, 77030, USA.
Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 112, Houston, TX, 77030, USA.
Support Care Cancer. 2019 Sep;27(9):3439-3447. doi: 10.1007/s00520-018-4632-0. Epub 2019 Jan 19.
Patients with newly diagnosed lung cancer who have not yet begun treatment may already be experiencing major symptoms produced by their disease. Understanding the symptomatic effects of cancer treatment requires knowledge of pretreatment symptoms (both severity and interference with daily activities). We assessed pretreatment symptom severity, interference, and quality of life (QOL) in treatment-naïve patients with lung cancer and report factors that correlated with symptom severity.
This was a retrospective analysis of data collected at initial intake. Symptoms/interference were rated on the MD Anderson Symptom Inventory (MDASI) between 30 days prediagnosis and 45 days postdiagnosis. We examined symptom severity by disease stage and differences in severity by histology. Linear regression analyses identified significant predictors of severe pain and dyspnea.
Of 460 eligible patients, 256 (62%) had adenocarcinoma, 30 (7%) had small cell carcinoma, and 100 (24%) had squamous cell carcinoma; > 30% reported moderate-to-severe (rated ≥ 5, 0-10 scale) pretreatment symptoms. The most-severe were fatigue, disturbed sleep, distress, pain, dyspnea, sadness, and drowsiness. Symptoms affected work, enjoyment of life, and general activity (interference) and physical well-being (QOL) the most. Patients with advanced disease (n = 289, 63%) had more-severe symptoms. Cancer stage was associated with pain severity; both histology and cancer stage were associated with severe dyspnea.
One third of lung cancer patients were symptomatic at initial presentation. Quantification of pretreatment symptom burden can inform patient-specific palliative therapy and differentiate disease-related symptoms from treatment-related toxicities. Poorly controlled symptoms could negatively affect treatment adherence and therapeutic outcomes.
尚未开始治疗的新诊断肺癌患者可能已经出现由疾病引起的主要症状。了解癌症治疗的症状影响需要了解治疗前症状（包括严重程度和对日常活动的干扰）。我们评估了未经治疗的肺癌患者的治疗前症状严重程度、干扰和生活质量（QOL），并报告了与症状严重程度相关的因素。
这是对初始摄入时收集的数据进行的回顾性分析。在诊断前 30 天至诊断后 45 天期间，使用 MD 安德森症状量表（MDASI）对症状/干扰进行评分。我们根据疾病阶段检查症状严重程度，并根据组织学检查差异检查严重程度差异。线性回归分析确定了严重疼痛和呼吸困难的显著预测因子。
在 460 名合格患者中，256 名（62%）患有腺癌，30 名（7%）患有小细胞癌，100 名（24%）患有鳞状细胞癌；>30%的患者报告有中度至重度（评分为≥5，0-10 分）的治疗前症状。最严重的是疲劳、睡眠障碍、痛苦、疼痛、呼吸困难、悲伤和嗜睡。症状最影响工作、生活享受和一般活动（干扰）以及身体健康（QOL）。患有晚期疾病的患者（n=289，63%）症状更严重。癌症分期与疼痛严重程度相关；组织学和癌症分期均与严重呼吸困难相关。
三分之一的肺癌患者在初始就诊时出现症状。治疗前症状负担的量化可以为患者特定的姑息治疗提供信息，并区分与疾病相关的症状与与治疗相关的毒性。控制不佳的症状可能会对治疗依从性和治疗结果产生负面影响。
