title: What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer.
abstract: OBJECTIVE
  Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool.
  
  
  METHODS
  Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS).
  
  
  RESULTS
  Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007).
  
  
  CONCLUSIONS
  Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.
authors: Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA. thomas.leblanc@duke.edu.|Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC, USA. thomas.leblanc@duke.edu.
authors: Thomas W
authors: TW
authors: LeBlanc
authors: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors: Myles
authors: M
authors: Nickolich
authors: Department of Bioinformatics and Biostatistics, Duke University Medical Center, 2400 Pratt Street, Suite 9000, Durham, NC, 27705, USA.
authors: Christel N
authors: CN
authors: Rushing
authors: Department of Bioinformatics and Biostatistics, Duke University Medical Center, 2400 Pratt Street, Suite 9000, Durham, NC, 27705, USA.
authors: Gregory P
authors: GP
authors: Samsa
authors: Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC, USA.
authors: Susan C
authors: SC
authors: Locke
authors: Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC, USA.
authors: Amy P
authors: AP
authors: Abernethy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D020407:Internet; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D015995:Prevalence; D011788:Quality of Life; D057566:Self Report; D063189:Symptom Assessment / Q000379:methods*
keywords: Carcinoma; Non-small-cell lung; Palliative care; Patient outcome assessment; Symptom assessment