Simplified Graded Baseline Symptom Assessment in Patients With Lung Cancer Undergoing First-Line Chemotherapy: Correlations and Prognostic Role in a Resource-Constrained Setting

Abstract

Purpose There are limited data from developing countries on graded baseline symptom (BS) assessment in lung cancer. This prospective study aimed to assess the prognostic role of BS and correlation of BS with comorbidity, demographic, and investigation profiles in a cohort of 238 patients with lung cancer undergoing first-line chemotherapy over a 15-month period. Methods The Medical Research Council (MRC) scale was used to assess dyspnea, whereas the visual analog scale (VAS; score of 1 to 10) was used to assess anorexia, fatigue, chest pain, and cough. Weight loss (WL) was noted as percentage of pre-illness baseline. All patients received histology-guided platinum doublet chemotherapy. Outcomes assessed were overall survival (OS) and radiologic responses by RECIST. Results Significant correlations (Spearman ρ) were noted for fatigue and anorexia with all other BSs. Dyspnea differed significantly among groups on the basis of either the simplified comorbidity score or Charlson comorbidity index. Median OS was 287 days (95% CI, 232 to 342 days). OS was significantly higher for anorexia VAS score less than 4 (388 v 229 days for VAS score ≥ 4), fatigue VAS score less than 3 (388 v 213 days for VAS score ≥ 3), WL less than 5% (410 v 259 days for WL ≥ 5%), and MRC dyspnea grade less than 3 (377 v 187 days for MRC grade ≥ 3). On univariable Cox proportional hazards analysis, worse OS was noted for all BSs, stage, and performance status, but on multivariable analysis, only fatigue (hazard ratio [HR], 1.21), Eastern Cooperative Oncology Group performance status ≥ 2 (HR, 1.57), and stage IV disease (HR, 1.61) were significant. Nonresponders (stable disease and progressive disease [PD]) had a higher percentage of WL and higher mean VAS scores for cough, chest pain, anorexia, and fatigue. On multivariable logistic regression analysis, PD was associated with fatigue and percentage of WL. Conclusion BSs are prognostic for patients with lung cancer on first-line chemotherapy. Fatigue is prognostic for worse OS and PD. Comorbidity and investigation profiles do not correlate with either OS or response rates.