Time-dependent Patient-reported Outcomes As Predictors Of Survival In Patients With Lung Cancer: A Prospective Study

Abstract

Background: The importance of patient-reported outcomes (PROs) has been increasingly recognized in cancer care. No study has investigated how changes in PROs after completion of cancer treatment affect survival.

Objective: To investigate the predictive value of patient characteristics, including PROs, for cancer survival.

Methods: A total of 86 patients with a confirmed diagnosis of lung cancer were recruited. Data on PROs including sleep disturbance, anxiety, depression, fatigue, nausea, pain, weight loss, cough, good appetite, chest tightness, and ease of breathing were collected through self-reported questionnaires at 5 time points for each patient: before treatment and 6, 12, 24, and 48 weeks after treatment.

Results: Bivariate time-dependent Cox regression revealed the following variables to be significant: small-cell, stage IV lung cancer; pretreatment pneumonia; treatment type; and several PRO variables, including sleep disturbance (hazard ratio [HR] = 1.10, P < .001), anxiety (HR = 1.15, P < .001), depression (HR = 1.11, P < .001), weight loss (HR = 0.71, P < .001), chest tightness (HR = 0.83, P = .029), and ease of breathing (HR = 0.62, P < .001). Multivariable time-dependent Cox regression revealed that only stage IV (HR = 7.33, P = .029) and weight loss (HR = 0.76, P = .006) were significant variables associated with survival.

Conclusions: Patient-reported weight loss was independently associated with shortened survival in patients with lung cancer.