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Longitudinal Study of the Relationship Between Chemoradiation Therapy for Non–Small-Cell Lung Cancer and Patient Symptoms

Xin Shelley Wang, Diane L. Fairclough, Zhongxing Liao, Ritsuko Komaki, Joe Y. Chang, Gary M. Mobley, Charles S. Cleeland

From the Departments of Symptom Research and Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; and the Department of Preventive Medicine and Biometry, Colorado Health Outcomes Center, University of Colorado Health Science Center, Denver, CO

Address reprint requests to Xin Shelley Wang, MD, MPH, The University of Texas M.D. Anderson Cancer Center, Department of Symptom Research, 1515 Holcombe Blvd, Unit 221, Houston, TX 77030; e-mail: swang{at}mdanderson.org

PURPOSE: Cancer patients undergoing aggressive therapy suffer from multiple nonspecific treatment-related symptoms. The goal of this prospective study was to establish a profile of the development of different symptoms over the time of therapy and to examine symptom-related functional interference in patients with non–small-cell lung cancer (NSCLC) undergoing concurrent chemoradiation therapy (CXRT).

PATIENTS AND METHODS: Patients with locally advanced unresectable (stage II-IIIB) NSCLC were recruited for the study (N = 64). The M.D. Anderson Symptom Inventory (MDASI) was used to measure multiple symptoms before and weekly for 12 weeks after the start of CXRT. Mixed-effect growth curve models were used to estimate symptom development during CXRT.

RESULTS: Approximately 63% of patients suffered from moderate to severe levels of multiple symptoms by the end of CXRT. Symptom clusters with four development patterns appeared over the time of CXRT. With some variation between patients, all symptoms had a significant impact on the level of interference (all P < .001). Fatigue, distress, and sadness were the single strongest predictors of total symptom interference (each R² 0.49). Physical symptoms had greater impact on interference with function when they were moderate to severe, whereas affective symptoms had the largest effect on interference when they were mild to moderate.

CONCLUSION: Longitudinal analysis identified symptom clusters that have different development patterns in NSCLC patients receiving CXRT, providing a base for more accurate symptom management and suggesting the need for further study to identify potential mechanisms that might lead to better symptom control or prevention.

Supported in part by National Institutes of Health Grants No. R01 CA026582 and R21 CA109286.

Presented in part at the 12th Annual Conference of the International Society of Quality of Life, San Francisco, CA, October 10-12, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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