The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study

Support Care Cancer. 2014 Jan;22(1):181-7. doi: 10.1007/s00520-013-1959-4. Epub 2013 Sep 12.


Purpose: Disease symptom management in patients with advanced non-small cell lung cancer (NSCLC) is a critical aspect of therapy. The main objective of our study was to assess patient-reported outcomes and the degree of concordance between physician and patient perceptions of symptom severity in advanced NSCLC in the USA.

Methods: Patients with advanced (stage IIIB/IV) NSCLC (N = 450) were recruited in a nationwide (USA) lung cancer study. Patients and their oncologists completed patient and physician versions of the Lung Cancer Symptom Scale (LCSS). Patient-reported lung cancer-specific quality of life was assessed with the Functional Assessment of Cancer Therapy--Lung (FACT-L). Concordance was assessed using the kappa-statistic. Regression analysis was performed with FACT-L total score as the dependent variable and patient-reported LCSS symptom scores as predictors.

Results: A high proportion of patients experienced lung cancer symptoms: fatigue (100 %), loss of appetite (97 %), shortness of breath (95 %), cough (93 %), pain (92 %), and blood in sputum (63 %). Concordance between physician and patients was lowest for loss of appetite (kappa 0.1701) and greatest for hemoptysis (kappa 0.4586). Loss of appetite (β = -0.204; p < 0.001), cough (β = -0.145; p < 0.01), pain (β = -0.265; p < 0.001), and shortness of breath (β = -0.145; p < 0.01) were found to be significant predictors of the quality of life.

Conclusions: Symptom burden in patients with advanced NSCLC is high and has a negative impact on the quality of life. Patient-reported outcomes data could help optimize disease outcomes and therapy management in NSCLC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / psychology*
  • Cost of Illness
  • Cough / etiology
  • Cross-Sectional Studies
  • Fatigue / etiology
  • Female
  • Humans
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / psychology*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pain / etiology
  • Palliative Care
  • Physicians / psychology
  • Quality of Life
  • Self Report
  • Symptom Assessment / methods
  • Symptom Assessment / statistics & numerical data
  • United States