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

Physical Impact

The physical implications of a diagnosis and subsequent late- and long-term adverse events of treatment have been documented in the literature to negatively impact QOL.[5,36,38] The physical domains of QOL have received attention in postoperative patients: impaired pulmonary function (forced expiratory volume in 1 second < 70% predicted), diminished exercise capacity, and restrictions in physical activity. These changes in physical functioning may persist into survivorship.[5,36] Survivors of lung cancer undergo a heavy burden of illness[5] and often experience physical symptoms such as pain, fatigue, dyspnea, and cough.[51]

Cancer-related Pain

Cancer-related pain is a frequent and distressing symptoms reported among those with lung cancer. It is also the most common cause of disability and is associated with depression, anxiety, and sleep disturbances.[46] Uncontrolled cancer-related pain has major implications on QOL; therefore, interventions for pain control should be incorporated into posttreatment care plans.[46,52] Despite the known high frequency and clinical relevance, up to 45% of patients have inadequate pain control and 40% of 5-year survivors report cancer pain.[49] The results of a cohort study have indicated that a genetic predisposition to pain severity may be present that aids in the identification of survivors of lung cancer who have the highest risk for morbidity and poor QOL.[49] Chronic pain is the most common complication following surgery and was the most commonly reported problem among survivors of lung cancer.[5] A mild but chronic pain following lung surgery is known as postthoracotomy pain syndrome and is seen in as much as 80% of patients. Pain lasted for approximately 4 years in 30% of patients.[5]


Fatigue is the most commonly reported symptom among survivors of lung cancer, affecting up to 90% of survivors.[53] The medical literature shows that fatigue in patients with lung cancer is correlated with dyspnea, depressed mood, and anxiety. Contributing factors of fatigue include comorbidities, pain, psychological distress, sleep disturbances, and changes in breathing capacity.[5,53] Therefore, a comprehensive approach to the treatment of fatigue, particularly for patients with lung cancer, should include screening and management of anxious and depressive symptoms as well as pulmonary disorders.[53]

Fatigue is described as a persistent lack of energy that can impair daily functioning and mood. It is debilitating sequela affects all aspects of life. Persistent fatigue can negatively affect QOL by disrupting the ability to perform activities of daily living. Fatigue can linger and impair functioning for 1 to 7 years after treatment completion.[14] Guidelines for screening for fatigue with appropriate assessments are included in the National Comprehensive Cancer Network cancerrelated fatigue algorithm for all patients with cancer, including cancer of the lung.[54]


Dyspnea is labored, difficult breathing or "shortness of breath" and is often associated with lung cancer. Dyspnea may also be associated with other respiratory conditions such as asthma, chronic obstructive pulmonary disease, or emphysema. Dyspnea was correlated with increasing fatigue, pain, insomnia, and appetite loss. The perceptions of symptoms of a survivor of lung cancer are influential to QOL, implying that monitoring respiratory symptoms is important for those undergoing surgical procedures and/or radiation therapy.[55,56] In addition, in the presence of dyspnea, physical, cognitive, and emotional functions were found to be significantly lower.[5]


Cough is a common symptom of lung cancer and may persist throughout the course of the disease and into survivorship. Persistent cough can interfere with speech, eating, and sleeping, thus impacting the QOL domains.[57] Recognizing these common symptoms and intervening early may decrease unnecessary suffering and lead to improvements in the QOL of patients with lung cancer.