Advanced NSCLC: Assess Early for Functional Disability

Sharon Worcester

May 18, 2021

More than a third of adults with advanced non–small cell lung cancer (NSCLC) have moderate to severe functional disability around the time of diagnosis and initiation of treatment, findings from a prospective cohort of patients suggest.

"This is the most important time to intervene, because we know we have such a short amount of time" with these patients, commented first author Carolyn J. Presley, MD, MHS, a thoracic oncologist at the Ohio State University Comprehensive Cancer Center, Columbus, Ohio.

The majority of patients with advanced lung cancer will die, a fact that underscores the importance of addressing functional disability in newly diagnosed patients, said Presley, who is also co-director of the Cancer and Aging Resiliency (CARE) Clinic.

The high rates of disability observed in the study highlight the need for early assessment and intervention in this population ― especially given the apparent association between modifiable psychological symptoms and disability, the investigators say.

This is "a high stakes period of time" for preventing functional decline and disability from loss of strength and mobility and from other symptoms, including anxiety and depression, she added.

The study findings were published online May 3 in the Journal of Clinical Oncology.

For this study, Presley and colleagues used the EuroQol-5D-5L questionnaire to assess baseline functional disability in usual activities, mobility, and self-care in 173 patients newly diagnosed with stage IV NSCLC who were enrolled at diagnosis into the ongoing Beating Lung Cancer in Ohio study.

The mean age of the cohort members was 63.3 years; 56% were men; 83% had Eastern Cooperative Oncology Group (ECOG) performance score of 0–1; and 41% had brain metastases.

Patients were classified as having none to slight disability or moderate to severe disability. Classifications were based on total functional status scores.

"We found almost 40% of patients had disability at baseline," Presley said. She noted that prevalence was high regardless of age, sex, or comorbidities.

Moderate to severe disability was observed in usual activities in 37.6% of patients, in mobility in 26.6%, and in self-care in 5.2% of patients.

Depressive and/or anxiety symptoms ranged from none to severe and were the only characteristic associated with increased odds of baseline disability (adjusted odds ratio, 1.26), the authors report.

Patients with poorer performance status and those with depressive symptoms also had higher odds of moderate to severe mobility disability, compared with those who had none to slight disability, they note.

"This study did not find a significant association between older age and functional disability. However, as the geriatric oncology population grows exponentially, assessing disability and risk factors can identify patients in need of interventions to reduce morbidity and mortality," the researchers comment.

"Currently, clinicians have limited research findings to inform adults about their risk of experiencing worsening disability from lung cancer treatments, especially new treatments such as targeted therapies (oral tyrosine kinase inhibitors), immune checkpoint inhibitors, or combinations of chemotherapy plus immune checkpoint inhibitors," they add.

The current study represents a starting point for closing these knowledge gaps for patients of all ages, they say.

Interventions Not Regularly Implemented

They also note that interventions to prevent disability are currently not regularly implemented into routine cancer care for patients with stage IV NSCLC, even though such interventions "may also improve depression, anxiety, and cancer-specific stress.

"Importantly, psychologic symptoms are modifiable risk factors for which interventions exist, which could improve resiliency and prevent functional decline for patients with cancer...even if cancer treatment is ineffective or even discontinued," they write.

The findings fill "a huge knowledge gap" with respect to understanding functional status among adults with newly diagnosed advanced NSCLC, Presley said.

"This study highlights the data we needed to now go and intervene in a meaningful way," she said.

J Clin Oncol. Published online May 3, 2021. Abstract

Sharon Worcester is a reporter for MDedge News, part of the Medscape Professional Network.

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