Predictors of the multidimensional symptom experience of lung cancer patients receiving chemotherapy.
Few studies have examined interindividual variability in the symptom experience of lung cancer patients. We aimed to identify the most prevalent, severe, and distressing symptoms, and risk factors associated with increased symptom burden.



Lung cancer patients (n = 145) reported occurrence, severity, and distress for 38 symptoms on the Memorial Symptom Assessment Scale 1 week after chemotherapy. Using multidimensional subscales, risk factors for higher global distress, physical, and psychological symptoms were evaluated using simultaneous linear regression.



Mean age was 64.0 years and 56.6% were female. Mean Karnofsky Performance Status score was 79.1 (SD 14.6) and mean Self-Administered Comorbidity Questionnaire score was 7.3 (SD 3.9). The most distressing and prevalent symptom was fatigue. Problems with sexual interest/activity had the highest mean severity rating. Patients with lower functional status (p = 0.001) and higher comorbidity (p = 0.02) reported higher global distress. Similarly, lower functional status (p = 0.003) and higher comorbidity (p = 0.04) were associated with a higher physical symptom burden along with lower body mass index (p = 0.02). Higher psychology symptom burden was associated with lower functional status (p = 0.01), younger age (p = 0.02), non-metastatic disease (p = 0.03), higher number of prior treatments (p = 0.04), and income (p = 0.03).



Fatigue was the most distressing and prevalent symptom among lung cancer patients receiving chemotherapy. Lower functional status was associated with a higher burden of global distress, physical, and psychological symptoms. Younger age and non-metastatic disease were additional risk factors for increased psychological symptoms. Together, these risk factors can help clinicians identify lung cancer patients at increased need for aggressive symptom management.
Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, 505 Parnassus Ave, Mailbox 1270, San Francisco, CA, 94143, USA.
Melisa L
ML
Wong
Department of Physiological Nursing, School of Nursing, University of California San Francisco, 2 Koret Way-N631Y, San Francisco, CA, 94143, USA.
Steven M
SM
Paul
Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way-N339B, San Francisco, CA, 94143, USA.
Bruce A
BA
Cooper
Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA.
Laura B
LB
Dunn
Department of Nursing, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1168, New York, NY, 10029, USA.
Marilyn J
MJ
Hammer
School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.
Yvette P
YP
Conley
School of Nursing, Yale University, PO Box 27399, West Haven, CT, 06516, USA.
Fay
F
Wright
Department of Oral & Maxillofacial Surgery, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA, 94122, USA.
Jon D
JD
Levine
Division of Geriatrics, Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, 4150 Clement (181G), San Francisco, CA, 94121, USA.
Louise C
LC
Walter
Department of Nursing, Mount Sinai Hospital and Mount Sinai Queens, One Gustave L. Levy Place, Box 1068, New York, NY, 10029, USA.
Frances
F
Cartwright
Department of Physiological Nursing, School of Nursing, University of California San Francisco, 2 Koret Way-N631Y, San Francisco, CA, 94143, USA. chris.miaskowski@ucsf.edu.
Christine
C
Miaskowski
D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
Chemotherapy; Distress; Fatigue; Lung cancer; Multiple symptoms; Symptom burden