Survivorship Issues for Patients With Lung Cancer

Christie L. Pratt Pozo, DHSc; Mary Ann A. Morgan, PhD; Jhanelle E. Gray, MD


Cancer Control. 2014;21(1):40-50. 

In This Article

Quality of Life

QOL is defined as a multidimensional construct that encompasses social, physical, cognitive, and psychological domains.[12,36,37] Health-related QOL domains include pain, fatigue, depression, physical functioning ailments, and distress. Several generic and diseasespecific instruments have been developed and widely used in research to assess QOL domains.[5,36,38–47] The concept of QOL has become an important end point for treatment and clinical trial evaluation, and it has been used as an independent prognostic predictor for survivors of lung cancer.[13,36] The main factors that play a role in QOL for survivors of lung cancer are discussed below.

Surgery, Radiation, and Chemotherapy

For patients with lung cancer, QOL has been examined as a construct in terms of treatment modalities. Surgical resection among patients with early-stage lung cancer offers the best chance for long-term survival.[48] Although resection offers the best survival outcomes, research indicates that this modality can have implications on QOL. Studies examining the short- and longterm impact of surgical resection found that postthoracotomy pain, functional limitations due to reduced lung capacity, fatigue, persistent cough, and dyspnea can persist and can negatively impact QOL.[40,42] Pain, fatigue, and dyspnea are common after pulmonary resection and can persist in the long-term for patients.[7,39] Kenny et al[39] found that approximately one-half of patients still experience increased dyspnea, fatigue, and role functioning relative to their preoperative levels. Ostroff et al[38] examined the health-related QOL of survivors of early-stage lung cancer 1 to 6 years postresection and concluded that posttreatment follow-up to identify depression and dyspnea was warranted. Similar results were found in studies by Ozturk et al[41] and Lagerwaard et al[44] among survivors of lung cancer who had undergone radiation. In addition, changes in pulmonary functioning and the occurrence of clinical pneumonitis are documented adverse events of radiation therapy.[5] Many patients with lung cancer undergo chemotherapy both in the adjuvant setting and as a single modality. Chemotherapy agents have known toxicities and cause physical aberrations, cardiopulmonary toxicities, and neuropathy.[5] Although some of these symptoms subside after treatment, many have long-term or late effects that can impact wellbeing. For patients with lung cancer who remain on maintenance therapeutics and anticancer biologics, these effects may be persistent and may impede relief. Symptom management guidelines for patients with lung cancer[10] have been developed that address pain, dyspnea, cough, depression, fatigue, and many other symptoms or complications that may occur as a result of treatment, as well as disease progression.

Although most cancer survivors benefit from QOL comparable with that of the general population, approximately 20% of survivors experience compromised QOL due to the residual effects of their cancer diagnosis and treatment.[21] This proportion may be even greater among survivors of lung cancer who frequently undergo toxic multimodality and multiple lines of aggressive treatment. Survivors of lung cancer do not experience the same life expectancy and QOL relative to other cancer diagnoses.[5,49] This population often experiences other comorbidities that can profoundly impact the physical, psychosocial, and emotional aspects of well-being.[24,36] These adverse psychological and physical symptoms faced by cancer survivors may also have the potential for increased mortality rates.[14]

Patient Age

Age is another compounding factor that can impact QOL. Approximately 68% of lung cancer diagnoses are among those aged 65 years and older.[22,50] The late effects and long-term issues among patients are often compounded by the effects of normal aging and increased comorbidities.[21] Bellury et al[22] proposed the use of a conceptual model that takes into account the normal aging process and how aging further impacts the related problems of cancer survivors. Due to the nature of lung cancer, a need exists for increased interventions with this subgroup at elevated risk for poor QOL.[5,49]