Characteristics and patient-reported outcomes of long-term lung cancer survivors

Abstract

Background: Due to advances in screening and treatment of lung cancer, there has been increased interest in long-term lung cancer survivors (LTLCS). The aim of this study was to evaluate the prevalence, characteristics and patient-reported outcomes (PROs) of LTLCS. Material and Methods: Cross-sectional study that included patients diagnosed with primary lung cancer between Jan/2012 and Dec/2016 whose overall survival was greater than 5 years. A self-administered questionnaire was applied, including EORTC QLQ-C30, PHQ-4 and two open questions regarding quality of life (QoL) and suggestions for improvements. Factors potentially related to QoL were analysed. Results: Of 767 lung cancer patients, 158 (20.6%) were LTLCS and LTLCS' proportion increased yearly. Most patients were diagnosed at early stages (66.2%) but 8.9% were at stage IV. During follow-up, 77.1% quitted smoking, 31.8% had disease progression/ relapse and 15.2% developed other tumours. Of all living LTLCS, 100 (85%) patients answered the PROs questionnaire. The median global health score was 66.67 [50-83], social function had the best score and emotional function the worst. Pain and fatigue were the symptoms with the worst impact on QoL. PHQ-4 identified mental distress in 36% and patients with a lower QoL were more likely to present anxiety (35.3% vs. 9.4%, p=0.007) or depression (27.9% vs. 3%, p=0.006). In the open questions, patients reported pain (17%), lack of familiar/financial support (16%), dyspnoea (14%), depression (8%), concern for the future (8%) and limitations performing daily activities (8%) as the aspects with most impact in QoL. The most suggested measures were improvement of care provided by health institutions (25%) and better social support (16%). Conclusion: Prevalence of LTLCS is increasing and survivors may experience a high prevalence of anxiety and depression as well as high disease burden affecting QoL. Therefore, it's important to provide a multidisciplinary continuous patient-centred care and a careful follow-up.