title: The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study.
abstract: OBJECTIVE
  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.
authors.affiliation: Global Health Economics & Outcomes Research, Pfizer Inc, 235, E 42nd Street, New York, NY, 10017, USA, shrividya.iyer@pfizer.com.
authors.forename: Shrividya
authors.initials: S
authors.lastname: Iyer
authors.forename: Adam
authors.initials: A
authors.lastname: Roughley
authors.forename: Alex
authors.initials: A
authors.lastname: Rider
authors.forename: Gavin
authors.initials: G
authors.lastname: Taylor-Stokes
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000523:psychology*; D017281:Cost of Illness; D003371:Cough / Q000209:etiology; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology; D010166:Palliative Care; D010820:Physicians / Q000523:psychology; D011788:Quality of Life; D057566:Self Report; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D014481:United States
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