Effect of Change in Symptoms, Respiratory Status, Nutritional Profile and Quality of Life on Response to Treatment for Advanced Non-small Cell Lung Cancer


Introduction: Quality of life (QOL), and pulmonary and nutritional parameters are important outcomemeasures during treatment of lung cancer; however, the effect of chemotherapy on these factors and theirrelationship with clinical response is unclear.
Methods: Patients with non-small cell lung cancer (NSCLC) wereevaluated for symptom profile, nutritional status (using anthropometry), pulmonary functions by spirometryand six minute walk distance (6 MWD), and QOL using the WHO-QOL Bref 26 questionnaire, before and afterchemotherapy.
Results: Forty-four patients were studied (mean (SD) age, 55 (10) years, 75% males). The majority(98%) had stage III or IV disease and 72% were current / ex-smokers with median pack-years of 27.0 (range,0.5-90). Some 61% had a Karnofsky Performance Scale (KPS) 70 or 80. The commonest symptoms were coughing,dyspnea, chest pain, anorexia and fever (79%, 72%, 68%, 57% and 40%, respectively). The mean (SD) 6 MWDwas 322.5 (132.6) meters. The mean (SD) percentage forced vital capacity (FVC %), and forced expiratoryvolume in one second (FEV1 %) were 64.7 (18.8) and 57.8 (19.4), respectively. The mean (SD) QOL scores forthe 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 significantlyhigher baseline occurrence of fever, anorexia, and weight loss, higher pack-years of smoking and poorer KPScompared to responders. Overall, chemotherapy caused significant decline in the frequency of coughing, dyspnea,chest pain, fever, anorexia, weight loss, and improvement in hemoglobin and albumin levels. There was nosignificant improvement in pulmonary functions, nutritional status, or QOL scores after treatment.
Conclusions:Lung cancer patients have a poor QOL. Although chemotherapy provides significant symptomatic benefit, thisdoes not translate into similar benefit in respiratory and nutritional status or QOL. Patients with constitutionalsymptoms, higher smoking burden, and poor KPS are less likely to respond to chemotherapy. Management ofNSCLC must include strategies to improve various aspects of QOL, nutritional status and pulmonary reserveto achieve comprehensive benefit.