PURPOSE: Quality of life (QOL), pulmonary and nutritional assessments are important outcome measures during treatment of lung cancer; however, the effect of chemotherapy on these parameters and their relationship with clinical response is unclear.
METHODS: Patients with Non-small cell lung cancer (NSCLC) were evaluated for symptom profile, nutritional status (using anthropometry), pulmonary functions by spirometry and six minute walk distance (6 MWD), and QOL using the WHO-QOL Bref 26 questionnaire, before and after chemotherapy.
RESULTS: Forty-four patients were studied (Mean (SD) age, 55 (10) years, 75% males). Majority (98%) had stage III and IV disease. 72% were current / ex-smokers with median pack-years of 16.8 (range, 0-90). 61% had Karnofsky Performance Scale (KPS) 70 or 80. The commonest symptoms were cough, dyspnea, chest pain, anorexia and fever (79%, 72%, 68%, 57%, and 40% respectively). The mean (SD) 6 MWD was 322.5 (132.6) meters. The mean (SD) percentage forced vital capacity (FVC %), and forced expiratory volume in one second (FEV1 %) were 64.67 (18.79) and 57.76 (19.42) respectively. The mean (SD) QOL scores for the physical, psychological, social, and environmental domains were 52.9 (20.5), 56.1 (17.9), 64.5 (21.8), 57.1 (16.6), respectively. Fourteen patients (32%) responded to chemotherapy. Non-responders had significantly higher baseline occurrence of fever, anorexia, and weight loss, higher pack-years of smoking and poorer KPS compared to responders. Overall, chemotherapy caused significant decline in the frequency of cough, dyspnea, chest pain, fever, anorexia, weight loss, and improvement in hemoglobin and albumin levels. There was no significant improvement in pulmonary functions, nutritional status, or QOL scores after treatment.
CONCLUSION: Lung cancer patients have a poor QOL. Although chemotherapy provides significant symptomatic benefit, this does not translate into similar benefit in respiratory and nutritional status or QOL. Patients with constitutional symptoms, higher smoking burden, and poor KPS are less likely to respond to chemotherapy.
CLINICAL IMPLICATIONS: Management of NSCLC must include strategies to improve various aspects of QOL, nutritional status and pulmonary reserve to achieve comprehensive benefit.
DISCLOSURE: Anant Mohan, None.