title: Levels of symptom burden during chemotherapy for advanced lung cancer: differences between public hospitals and a tertiary cancer center.
abstract: OBJECTIVE
  We compared risk factors for high disease- and treatment-related symptom burden over 15 weeks of therapy in medically underserved patients with advanced non-small-cell lung cancer and in patients treated at a tertiary cancer center.
  
  
  METHODS
  We monitored symptom severity weekly during chemotherapy. Patients were recruited from a tertiary cancer center (n=101) and three public hospitals treating the medically underserved (n=80). We used a composite symptom-severity score and group-based trajectory analysis to form two groups: one with consistently more severe symptoms and another with less severe symptoms. We examined predictors of group membership.
  
  
  RESULTS
  Seventy percent of the sample (n=126) reported low symptom-severity levels that decreased during therapy; 30% (n=55) had consistently severe symptoms throughout the study. In multivariate analysis, patients with good performance status being treated in public hospitals were significantly more likely than patients treated at the tertiary cancer center to be in the high-symptom group (odds ratio, 5.6; 95% CI, 2.1 to 14.6; P = .001) and to report significantly higher symptom interference (P = .001). Other univariate predictors of high-symptom group membership included variables associated with being medically underserved (eg, having less education, being single, and being nonwhite). No group differences by ethnicity were observed in the public hospitals. Medically underserved patients were less likely to receive adequate pain management.
  
  
  CONCLUSIONS
  Patients with advanced lung cancer and good performance status treated at public hospitals were more likely than those treated at a tertiary cancer center to experience substantial symptoms during chemotherapy.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. ccleeland@mdanderson.org
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: Xin Shelley
authors.initials: XS
authors.lastname: Wang
authors.forename: Jeanie F
authors.initials: JF
authors.lastname: Woodruff
authors.forename: Guadalupe R
authors.initials: GR
authors.lastname: Palos
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Richman
authors.forename: Arlene
authors.initials: A
authors.lastname: Nazario
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Lynch
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.forename: Gary M
authors.initials: GM
authors.lastname: Mobley
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D017281:Cost of Illness; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents