Quality of Life in NSCLC Survivors - A Multicenter Cross-Sectional Study

Introduction: The objective was to assess quality of life (QoL) in lung cancer survivors, compare it to the general population, and identify factors associated with global QoL, physical functioning, emotional functioning, fatigue, pain, and dyspnea. Methods: Data from NSCLC patients who had survived 1 year or longer after diagnosis were collected cross-sectionally in a multicenter study. QoL was assessed with the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the lung cancer module QLQ-LC13 across different clinical subgroups and compared to age-and sex-standardized general population reference values. Multivariable linear regression analyses were performed to test the associations of patient-, tumor-, and treatment-related factors with the six primary QoL scales. Results: Six hundred fifty-seven NSCLC patients participated in the study with a median time since diagnosis of 3.7 years (range, 1.0-21.2 years). Compared to the age-and sex-standardized general population, clinically meaningful differences in the QoL detriment were found on almost all domains: lung cancer survivors had clinically relevant poorer global QoL (10 points, p < 0.001). Whereas in 12 months or longer treatment-free patients this detriment was small (8.3), it was higher in patients currently in treatment (16.0). Regarding functioning and symptom scales, respective detriments were largest for dyspnea (41 points), role function (33 points), fatigue (27 points), social function (27 points), physical function (24 points), and insomnia (21 points) observed across all subgroups. The main factor associated with poorer QoL in all primary QoL scales was mental distress (beta vertical bar 19-31 vertical bar, all p < 0.001). Detriments in QoL across multiple primary QoL scales were also observed with current treatment (beta vertical bar 8-12 vertical bar, p < 0.01), respiratory comorbidity (beta vertical bar 4-5 vertical bar, p < 0.01), and living on a disability pension (beta vertical bar 10-11 vertical bar, p < 0.01). The main factor associated with better QoL in almost all primary QoL scales was higher physical activity (beta vertical bar 10-20 vertical bar, p < 0.001). Better QoL was also observed in patients with high income (beta vertical bar 10-14 vertical bar, p < 0.01). Conclusions: Lung cancer survivors experience both functional restrictions and symptoms that persist long term after active treatment ends. This substantiates the importance of providing long-term supportive care. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.