Functional and Patient-reported Outcomes at Diagnosis of Non-small Cell Lung Cancer

Abstract

Rationale Poor functional performance and high symptom burden are frequently observed in patients undergoing treatment for non-small cell lung cancer (NSCLC). Little is known about their health status initiation therapy. We investigated functional and patient-reported outcomes at diagnosis in patients with early-and advanced-stage NSCLC, and compared them to age-matched healthy individuals. Methods A cross-sectional study was conducted in newly diagnosed patients with early-stage (stage IA-IIIA) and advanced-stage (stage IIIB-IVB) NSCLC-before starting treatment-and healthy individuals. Functional outcome measures were maximal inspiratory pressure (MIP; MicroRPM), quadriceps muscle strength (QMS; microFET), handgrip strength (HGS; Jamar), short physical performance battery (SPPB), one-minute sit-to-stand test (1-MSTST), and six-minute walk distance (6MWD). Patient-reported outcome measures were modified Baecke questionnaire, physical activity scale for the elderly questionnaire (PASE), multidimensional fatigue inventory (MFI-20), modified Medical Research Council dyspnea questionnaire (mMRC), San Diego shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS), short-form health survey (SF-12), EuroQoL 5-dimensions (EQ-5D), and instrumental activities of daily living scale (IADLs). One-way ANOVAs and Kruskal-Wallis tests, followed by Tukey-Kramer or Steel-Dwass pairwise comparisons, were performed in JMP PRO 14.2.0 to explore differences between the three groups. Results We recruited 24 patients with early-stage NSCLC (70% male; age 66±9yrs; 33% COPD), 17 patients with advanced-stage NSCLC (65% male; age 64±7yrs; 6% COPD) and 18 healthy individuals (44% male; age 67±10yrs; 0% COPD). Patients with early-and advanced-stage NSCLC presented significant lower 1-MSTST (72%pred vs. 74%pred vs. 89%pred, p=0.010), 6MWD (97%pred vs. 106%pred vs. 128%pred, p<0.0001) and SF-12 mental component score (45 vs. 42 vs. 53, p=0.046) in comparison to healthy individuals. PASE and MFI-20 scores were significantly worse in patients with advanced-stage NSCLC than in healthy controls (56 vs. 108, p=0.005; 58 vs. 42, p=0.027). Compared to patients with early-stage NSCLC, patients with advanced-stage NSCLC had a significantly lower PASE score (88 vs. 56, p=0.049). Detailed results are presented in Table 1. Conclusion Patients with NSCLC scored lower on the 1-MSTST and SF-12 mental score at diagnosis compared to healthy individuals. Patients with advanced-stage NSCLC reported higher fatigue symptoms than healthy individuals, and lower self-reported physical activity levels than patients with early-stage NSCLC and healthy individuals. Although patients with NSCLC scored worse compared to healthy individuals, clinically relevant impairments were not found at diagnosis. To prevent a further decrease, it is important to implement individually tailored interventions to maintain their health status during and after treatment.