Impact of cancer treatment on physical functioning, symptoms and health-related quality of life in patients with non-small cell lung cancer: A longitudinal observational study

Abstract

Background: Treatments for non-small cell lung cancer (NSCLC) may negatively affect health status. This study aimed to (i) quantify the impact of different treatments on physical functioning, symptoms, and health-related quality of life (HRQoL) in patients with NSCLC, and (ii) compare these with a one-time assessment in ageand sex-matched healthy individuals. Methods: A multicenter longitudinal observational study assessed patients at diagnosis and 12-15 weeks after treatment initiation. Healthy individuals underwent the same assessments, including peripheral and respiratory muscle strength, functional exercise capacity (6-min walk distance (6MWD), 1-min sit-to-stand (1MSTS)), objectively measured physical activity (PA), and patient-reported outcomes on symptoms and HRQoL. Results: Seventy-six patients (66 +/- 9 years; 65 % male) and 46 healthy individuals (64 +/- 10 years; 59 % male) were included. At diagnosis, patients scored significantly worse than healthy individuals across most outcomes. Twelve weeks, post-surgery (n = 41), patients showed significant worsening of 1MSTS (- 2 +/- 4 reps, p = 0.03), 6MWD (-24 +/- 59 m, p = 0.008), self-efficacy for PA, dyspnea, physical wellbeing, and lung cancer-specific symptoms (p < 0.05). Declines were more pronounced with (neo-)adjuvant therapy. Systemic chemotherapy (n = 16) worsened self-efficacy to perform PA (p = 0.03), while radiotherapy (n = 5) reduced self-reported PA (p < 0.05) and increased fatigue (p = 0.04), but improved mental wellbeing (p = 0.03). All treatment groups showed significantly lower PA post-treatment compared to healthy individuals. Conclusion: At diagnosis, patients with NSCLC had worse physical functioning, symptoms, and HRQoL than healthy individuals. Treatment for NSCLC further deteriorated these outcomes, with patients exhibiting significantly lower physical activity compared to healthy individuals. These findings highlight the need for implementation of rehabilitation programs in NSCLC care. Trial registration: registered on ClinicalTrials.gov (NCT02493114)