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Prognostic value of symptom burden for overall survival in patients receiving chemotherapy for advanced nonsmall cell lung cancer
Cancer, 10/26/09

Wang XS et al. – An increased risk for shorter survival was indicated by moderate to severe coughing at baseline or by increased fatigue or shortness of breath during the first chemotherapy cycle in patients with advanced NSCLC. Although cross-validation is needed, these data suggest that an individual patient's symptom severity scores, quickly obtainable in the clinic, might contribute clinically useful information for treatment planning for that patient.

Methods

94 patients with advanced NSCLC and an Eastern Cooperative Oncology Group performance status (PS) of 0 to 2
Patients who qualified for chemotherapy rated symptom severity using M. D. Anderson Symptom Inventory before and after their first chemotherapy cycle
Prognostic values of baseline symptoms and changes in symptom severity examined by Cox proportional hazards models

Results

In multivariate analysis, controlled for demographic and other factors, baseline coughing rated ≥ 4 independently predicted significantly higher risk for shorter survival
Patients with coughing ≥ 4 and a PS of 2 were more likely to have shorter survival than patients with coughing < 4 and a PS of 0 to 1
1-point or greater increase in severity of fatigue , shortness of breath, or poor appetite from baseline to end of first chemotherapy cycle was also found independently associated with higher risk for poor survival

Exclusive Author Commentary
Xin Shelley Wang, MD, MPH , 10/28/09

This report strengthens the evidence that symptom report predicts survival, especially in advanced disease, and suggests that symptom assessment should be a part of routine cancer care and research in these patients.

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