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Clinicians perceive poorer quality of life in patients with lung cancer
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Clinicians were found to be more pessimistic about the quality of life of their patients with lung cancer compared with patients with other solid tumors, according to study results published in the Journal of Thoracic Oncology.
The differences persisted after researchers controlled for such variables as stage, performance status and patient-reported outcomes.
“Clinicians who treat lung cancer often encounter late-stage diagnoses, poor outcomes, treatment toxicities, multiple comorbidities, behavioral risk factors and complicated symptom burdens,” Heidi A. Hamann, PhD, of the University of Texas Southwestern Medical Center, and colleagues wrote. “On the basis of this complexity, clinicians might consider their individual lung patients to be more difficult to treat, have poorer quality of life and have more troubling symptoms compared with their patients with other solid tumors.”
However, few studies have evaluated clinician assessments of patients with lung cancer compared with other patient groups.
Researchers evaluated secondary analyses from the ECOG Symptom Outcomes and Practice Patterns study, including clinician ratings of 3,106 solid tumor patients with lung, breast, colon and prostate cancers.
Univariate analyses examined patterns of disease-specific perceptions. Multivariable analyses assessed whether disease-specific differences persisted after covariate inclusion.
According to study results, clinicians rated patients with lung cancer as more difficult to treat than patients with other solid tumors, with poorer quality of life and higher symptom reports. After covariates were adjusted, the odds of clinicians perceiving lower quality of life for their patients with lung cancer were 3.6 times higher than for patients with other solid tumors (OR=3.6; 95% CI, 2-6.6).
In addition, the odds of clinicians perceiving weight difficulties for their patients with lung cancer were 3.2 times higher (OR=3.2; 95% CI, 1.7-6). No other outcome evaluated in multivariable models showed significant differences between lung cancer and other cancers.
“Associations between smoking and lung cancer may affect clinicians’ views, both through possible perceptions of blame and anticipated treatment nonadherence associated with behavioral risk factors,” Hamann and colleagues wrote. “Given that a subset of findings suggests that features of nihilism do persist, further exploration of this issue is needed.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Hongbin Chen, MD, PhD
Each year, lung cancer causes more deaths than breast, prostate and colorectal cancers combined. Most lung cancer patients have advanced disease when they are diagnosed, and treatment is usually palliative rather than curative. With that in mind, this study provides empirical data to suggest the so-called “therapeutic nihilism” among clinicians who treat lung cancer patients.
Most of the clinicians in this study are community-based practitioners, who treat the majority of cancer patients in this country, as compared to academic-based practitioners. Nevertheless, the poorer ratings of lung cancer patients’ quality of life and symptoms versus other major solid tumors by clinicians seem to correspond to the self-reported outcomes by patients in this study. So is it pessimistic attitude or just realistic perception? Our lung cancer patients deserve fair treatment and better outcomes.
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