Mental state as a possible independent prognostic variable for survival in patients with advanced lung carcinoma.
BACKGROUND
Although psychologic factors have been reported to influence the progression of cancer, this theory remains controversial. A prospective study of patients with advanced lung carcinoma was performed to explore the influence of the patient's mental state on survival.


METHODS
The patient's mental state was assessed with the Tokyo University Egogram. In a preliminary study, the egograms of long-term survivors (survival > 3 years) with TNM Stage IIIB or Stage IV lung carcinoma were compared with the egograms of consecutive, newly diagnosed lung carcinoma patients (controls). Next, in a prospective study, 123 patients with nonsmall cell lung carcinoma and 56 patients with small cell lung carcinoma (Stage IIIB or Stage IV; Eastern Cooperative Oncology Group performance status of 0 or 1) completed the egogram. Based on the results of the preliminary study, the subjects in the prospective study were divided into Group A (Free Child [FC] >or= 50th percentile and Adapted Child [AC] < 50th percentile) and Group B (FC < 50 percentile or AC >or= 50 percentile). The survival of the two groups was compared. The Cox proportional hazards model was used to determine the joint effect of the patient's mental state and other prognostic factors.


RESULTS
In the preliminary study, the FC score of the long-term survivors was significantly higher and the AC score was significantly lower than those of the controls. In the prospective study, the survival of Group A was significantly longer than that of Group B both in the nonsmall cell lung carcinoma and small cell lung carcinoma patients (P = 0.002 and P = 0.005, respectively, by the log-rank test). Multivariate analysis demonstrated that after adjustment for clinical factors, being in Group A was a significant predictor of survival both in the nonsmall cell and small cell lung carcinoma patients.


CONCLUSIONS
The results of the current study demonstrate that the mental state of the patient as assessed by the egogram may have prognostic significance in patients with advanced lung carcinoma.
Department of Respiratory Medicine, Himeji National Hospital, Himeji-city, Japan. nkhr@meg.winknet.ne.jp
Yasuharu
Y
Nakahara
Yoshiro
Y
Mochizuki
Yoshihiro
Y
Miyamoto
Akira
A
Tanaka
Tetsuji
T
Kawamura
Shin
S
Sasaki
Yukiko
Y
Nakahara
Yoshitaka
Y
Katsura
D000368:Aged; D014408:Biomarkers, Tumor; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000473:pathology / Q000523:psychology*; D018288:Carcinoma, Small Cell / Q000097:blood / Q000473:pathology / Q000523:psychology*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008175:Lung Neoplasms / Q000097:blood / Q000473:pathology / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011581:Psychological Tests; D011795:Surveys and Questionnaires; D015996:Survival Rate
D014408:Biomarkers, Tumor; D006454:Hemoglobins; D007770:L-Lactate Dehydrogenase