title: Lung carcinoma symptoms--an independent predictor of survival and an important mediator of African-American disparity in survival.
abstract: BACKGROUND
  The extent of disease in patients with lung carcinoma is reflected morphologically by stage and pathophysiologically by sign/symptoms. This study evaluates the associations between symptoms and stage, the independent impact of symptoms on survival, predictors of symptoms, and the extent to which symptoms mediate survival disparities.
  
  
  METHODS
  Data from 1154 patients with lung carcinoma were collected from the authors' tumor registry and by abstraction of medical records. Associations were evaluated by logistic and Cox regression analyses.
  
  
  RESULTS
  Symptomatic diagnoses were associated with advanced disease stage (odds ratio [OR], 4.53; 95% confidence interval [95%CI], 3.17-6.48). Hoarseness, hemoptysis, dyspnea, noncardiac chest pain, extrathoracic pain, neurologic symptoms, weight loss, and weakness/fatigue (adverse symptoms) were associated independently with relatively higher/advanced stage and/or reduced survival. Adverse symptoms (> or = 1 vs. 0) predicted reduced survival independently of stage and other prognosticators (hazard ratio [HR], 1.84; 95%CI, 1.52-2.21). Independent predictors of adverse symptoms included gender (OR(male vs. female), 1.50; 95%CI, 1.11-2.01), race/ethnicity (OR(black vs. white), 1.62; 95%CI, 1.18-2.21), and marital status (OR(spouseless vs. not), 1.79; 95%CI 1.31-2.45). The hazard ratios (HR; black vs white), univariate, adjusted for stage, and adjusted for stage and adverse symptoms, was 1.206 (95%CI, 1.05-1.38), 1.165 (95%CI, 1.01-1.34), and 1.075 (95%CI, 0.94-1.26), respectively. Adverse symptoms explained 43% of race/ethnic survival disparity beyond stage.
  
  
  CONCLUSIONS
  Symptoms were associated with disease stage, yet both were important, independent predictors of survival; and symptoms explained an important amount of race/ethnic disparity in the survival of patients with lung carcinoma. Symptomatology needs to be incorporated into cancer clinical trials and into outcomes and disparities research.
authors.affiliation: Josephine Ford Cancer Center, Henry Ford Health System, Detroit, Michigan 48202-3450, USA. mtammem1@hfhs.org
authors.forename: C Martin
authors.initials: CM
authors.lastname: Tammemagi
authors.forename: Christine
authors.initials: C
authors.lastname: Neslund-Dudas
authors.forename: Michael
authors.initials: M
authors.lastname: Simoff
authors.forename: Paul
authors.initials: P
authors.lastname: Kvale
mesh_terms: D001741:Black or African American; D005006:Ethnicity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D017533:Marital Status; D011379:Prognosis; D012959:Socioeconomic Factors