Analysis of the psychological impact of cancer-related symptoms on patients with non-small cell lung cancer

Psychooncology. 2017 Jun;26(6):755-762. doi: 10.1002/pon.4071. Epub 2016 Jan 20.


Background: Patients with non-small cell lung cancer (NSCLC) experience adverse physical symptoms because of cancer, cancer treatment, and comorbidities. The relations among Cancer-Related Symptoms, Functional Impairment, and Psychological Symptoms in patients with NSCLC is not well understood.

Methods: Retrospective analysis of patient-reported symptoms with the 38-item Patient Care Monitor survey, collected in routine clinical care for 1138 patients with NSCLC at eight US community oncology practices. Study sample was randomly split, and structural equation models examined the direct and mediated effects of Cancer-Related Symptoms and Functional Impairment on symptoms of acute distress (Distress) and depression (Despair) in the training sample. The training model was cross validated in testing sample. Results are presented for the full model using the entire sample.

Results: Patients were 48.3% female, with mean age of 66.0 years. The most common comorbidities were anemia (60.8%) and respiratory disease (24.5%). Severity of Cancer-Related Symptoms was strongly and positively related to Functional Impairment and Psychological Symptoms in both training and testing models. The modeled effect of Functional Impairment on Distress and Despair was significant in the overall model using the total sample, and significant or near-significant in the training and testing models. The mediated effect of Cancer-Related Symptoms by Functional Impairment tended to be weaker than its direct modeled effect on Distress and Despair.

Conclusions: Despite prior research suggesting that Functional Impairment plays a larger role than symptom burden in depression in NSCLC, the independent modeled effects of Functional Impairment were no greater than the direct modeled effects of Cancer-Related Symptoms. Copyright © 2016 John Wiley & Sons, Ltd.

Keywords: cancer physical symptoms; functional impairment because of cancer; non-small cell lung cancer; oncology patient reported outcomes; psychological distress in cancer.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung / physiopathology
  • Carcinoma, Non-Small-Cell Lung / psychology*
  • Carcinoma, Non-Small-Cell Lung / therapy
  • Comorbidity
  • Depression / epidemiology*
  • Female
  • Health Surveys
  • Humans
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / psychology*
  • Lung Neoplasms / therapy
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stress, Psychological / epidemiology*