Symptom trajectories during chemotherapy in patients with non-small cell lung cancer (NSCLC) and the function of prolonging low dose dexamethasone in promoting enhanced recovery after chemotherapy.

BACKGROUND

Lung cancer, mainly non-small cell lung cancer (NSCLC), is one of the leading causes of death worldwide. Currently, chemotherapy is still the most significant treatment strategy for NSCLC. However, scant attention has been paid in previous studies to those patients who often experience various symptoms and discomfort during chemotherapy treatment cycles.

METHODS

This study included 127 NSCLC patients who completed an EORTC QLQ-C30 questionnaire and specifically designed symptom diary. Chi-square test, factor analysis, Pearson correlation coefficient and hierarchical cluster analysis were used to perform multivariate analysis.

RESULTS

We identified the top five most-frequent symptoms within the chemotherapy cycle which included fatigue, insomnia, cough and sputum, appetite loss and hypodipsia. These symptoms were at a moderate level on chemotherapy treatment days 3-7, and were then reduced to a stable and lower level in the following two weeks. A statistically significant difference in adverse events (AEs) was found between 54 patients who received dexamethasone (treatment group) and the control group: fatigue (risk ratio [RR]: 1.48; 95% confidence interval [CI]: 1.120-1.961; p = 0.006), insomnia (RR: 1.34; 95% CI: 1.016-1.778; p = 0.038), cough and sputum (RR: 2.00; 95% CI: 1.484-2.695; p < 0.001), appetite loss (RR: 1.28; 95% CI: 0.959-1.696; p = 0.095). In total, 62 patients completed the EORTC QLQ-C30 scale. The functioning scales of the treatment group were higher than the control population within positive effect sizes (ES: 0.1-0.8). Apart from diarrhea scales, most symptom scales were lower than the control group within negative effect sizes (ES: 0.1-0.9).

CONCLUSIONS

In this study we identified the top five most frequent post-chemotherapy AEs in a chemotherapy treatment cycle and found that dexamethasone was well tolerated by NSCLC patients who received platinum-based chemotherapy and substantially alleviated the symptom burden and improved the health-related quality of life (HRQOL) of patients.