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Graded baseline symptom (BS) assessment in lung cancer (LC) patients (pts) undergoing first line chemotherapy (CTx) – correlations and prognostic role

Date

20 Dec 2015

Session

Poster presentation 2

Presenters

Navneet Singh

Citation

Annals of Oncology (2015) 26 (suppl_9): 125-147. 10.1093/annonc/mdv532

Authors

N. Singh, S.S. Potsangbam, A.N. Aggarwal, D. Behera

Author affiliations

  • Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), 160012 - Chandigarh/IN
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Aim/Background

There is limited data from developing countries on graded BS assessment in LC. This prospective study aimed to assess prognostic role & correlation of BS with comorbidity, demographic & investigation profiles in a cohort of 238 newly diagnosed LC pts on CTx over a 15 month period.

Methods

MRC scale was used for dyspnea; Visual Analogue Scale (VAS; 1-10) for anorexia, fatigue, chest pain & cough. Weight loss (WL) was noted as % of pre-illness baseline. Comorbidity was assessed by Simplified Comorbidity Score (SCS) & Charlson Comorbidity Index (CCI). All pts received standard histology guided platinum doublet CTx. Outcomes noted were overall survival (OS) & radiological responses (RRs) by RECIST.

Results

Majority had advanced disease (IIIB = 33.6%; IV = 42.4%). Distribution of histology was 39.9% SqCC, 32.8% ADC, 19.7% SCLC & of performance status (PS) was 63% ECOG = 0-1, 30.7% ECOG = 2. Significant correlations [Spearman's (Rho)] were noted for fatigue & anorexia with all other BS (Table).

Correlations of baseline symptoms and comorbidity

%WeightLoss Anorexia Fatigue SCS CCI
Anorexia 0.495; p < 0.001
Fatigue 0.310; p < 0.001 0.603; p < 0.001
Dyspnea 0.102; p = 0.116 0.343; p < 0.001 0.327; p < 0.001 0.161; p = 0.013 0.225; p < 0.001
Cough 0.166; p = 0.010 0.256; p < 0.001 0.363; p < 0.001 0.094; p = 0.148 0.170; p = 0.009
Chest Pain 0.211; p = 0.001 0.301; p < 0.001 0.333; p < 0.001 0.058; p = 0.375 −0.028; p = 0.669
Hemoglobin −0.170; p = 0.008 −0.133; p = 0.041 −0.006; p = 0.929 −0.154; p = 0.017 −0.048; p = 0.460
HbA1C 0.055; p = 0.540 0.030; p = 0.738 0.093; p = 0.295 0.455; p < 0.001 0.456; p < 0.001
FVC% −0.191; p = 0.017 −0.275; p = 0.001 −0.324; p < 0.001 −0.005; p = 0.956 −0.238; p = 0.003
FEV1% −0.208; p = 0.010 −0.313; p < 0.001 −0.262; p = 0.001 −0.152; p = 0.059 −0.387; p < 0.001
SCS 0.114; p = 0.080 0.148; p = 0.022 0.107; p = 0.098
CCI 0.019; p = 0.775 0.075; p = 0.247 −0.017; p = 0.795 0.474; p < 0.001
Age −0.036; p = 0.577 −0.085; p = 0.192 −0.142; p = 0.029 0.293; p < 0.001 0.205; p = 0.001
Smoking Index 0.015; p = 0.839 0.156; p = 0.029 0.096; p = 0.183 0.344; p < 0.001 0.091; p = 0.206
KPS −0.264; p < 0.001 −0.444; p < 0.001 −0.391; p < 0.001 −0.078; p = 0.233 −0.103; p = 0.111
ECOG-PS 0.249; p < 0.001 0.403; p < 0.001 0.374; p < 0.001 0.053; p = 0.413 0.078; p = 0.229

HbA1C = Glycated hemoglobin, KPS = Karnofsky PS

FVC% = Forced Vital Capacity as percentage of predicted

FEV1% = Forced Expiratory Volume 1st second as percentage of predicted

Dyspnea was only BS that differed between SCS ≤ 9 vs. SCS > 9 and between CCI = 0, CCI = 1 & CCI ≥ 2 groups. Median OS was 287 days (95% CI = 232-342). OS was significantly higher for anorexia VAS < 4 (388 vs. 229 for VAS ≥ 4), fatigue VAS < 3 (388 vs. 213 for VAS ≥ 3), WL < 5% (410 vs. 259 for WL ≥ 5%), dyspnea MRC < 3 (377 vs. 187 for MRC ≥ 3). On univariate Cox PH analysis, worse OS was noted for all BS, stage, PS, albumin, FEV1%, FVC% but on multivariate, only fatigue (HR = 1.21), ECOG PS ≥ 2 (HR = 1.57) & stage IV disease (HR = 1.61) were significant. Compared to pts with CR + PR, pts with SD + PD had higher %WL (7.4% vs 6.1%) & mean VAS scores for cough, chest pain, anorexia & fatigue. On multivariate logistic regression analysis, PD was associated with fatigue (OR = 1.49) & %WL (OR = 1.11) but not gender, histology, PS, stage, albumin or hemoglobin.

Conclusions

BS are prognostic for LC pts on 1st line CTx. Fatigue is prognostic for worse OS & PD. Comorbidity & investigations do not correlate with either OS or RR.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.

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