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Quality of Life of Long-Term Survivors of Non–Small-Cell Lung Cancer

From the School of Nursing, Departments of Surgery and Medicine, and Integrated Substance Abuse Program, University of California Los Angeles, Los Angeles; School of Nursing, California State University, Los Angeles; and School of Nursing, University of California San Francisco, San Francisco, CA.

Address reprint requests to Linda Sarna, DNSc, School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, Box 956918, Factor 4-262, Los Angeles, CA 90095-6918; email: lsarna{at}sonnet .ucla.edu.

PURPOSE: To describe the quality of life (QOL) among survivors of non–small-cell lung cancer (NSCLC).

PATIENTS AND METHODS: One hundred forty-two 5-year minimum self-reported disease-free survivors of NSCLC completed QOL instruments (QOL-Survivor and Medical Outcomes Study 36-Item Short Form [SF-36]) and assessments of emotional distress (Center for Epidemiologic Studies Depression Scale [CES-D]), comorbid disease, and tobacco use. Pulmonary function was assessed with a hand-held spirometer. Multivariate regression methods were used on total QOL-Survivor scores and physical (PC) and mental (MC) component scores of the SF-36.

RESULTS: The majority (71%) of survivors described themselves as hopeful, and 50% viewed the cancer experience as contributing to positive life changes (QOL-Survivor). Comorbidity was common (60% one condition); 22% had distressed mood (CES-D 16). Most were former smokers (76%); 13% continued to smoke. Half had moderate/severe pulmonary distress (forced expired volume in 1 second [FEV₁] < 70% of predicted). Regression models including the set of variables (age, sex, living alone, education, smoking status, pulmonary function category, distressed mood, time since diagnosis, and comorbidity) accounted for 37%, 48%, and 29% in the QOL-total, MC, and PC scores, respectively. Primary predictors of lower QOL scores were white ethnicity and distressed mood (CES-D 16) (34% of the variance explained). The primary predictor of lower MC scores was distressed mood (R² = 0.45). Lower PC scores were associated with older age, living alone, FEV₁ less than 70% of predicted, distressed mood, time since diagnosis, and more comorbid diseases (R² = 0.28).

CONCLUSION: These findings provide the first description of the QOL of long-term survivors of lung cancer. Risk factors for poorer QOL are strongly linked to distressed mood, which is a potential target for intervention.

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