Search

Background Quality of life (QOL) is one of the major outcomes to reflect lung cancer patients' general condition. However, the individually physical and psychological differences may affect and cause different types of QOL trajectories. The aims of this study were to (1) explore the potential types of QOL trajectories in advanced lung cancer patients during the first 6 month of diagnosis, and (2) identify factors related to each type of the QOL trajectories. Methods A prospective longitudinal study was conducted in a medical center in Taiwan. A total of 170 newly diagnosed non-operable lung cancer patients were recruited and completed 4 assessments during pre-treatment and 1, 3, 6 months from receiving treatments (T1-4, respectively). QOL trajectory was measured by the overall QOL item from the EORTC QLQ-C30. Physical function and symptoms, depression, uncertainty (about illness) land self-efficacy (level of confidence) in coping with cancer were assessed and analyzed as potential related factors of each QOL trajectory. We used Latent Class Growth Analysis (LCGA) to identify the types of QOL trajectory and their related factors. Results Three types of QOL trajectories were identified. The first type of QOL type covered 41.8% of patients which represented a “declining form moderate level of QOL to lower QOL and then back to moderate levels of QOL “. The second type of QOL covered 19.6% of patients and represented “the relatively higher level of QOL declined to relatively lower level of QOL and then steadily back to moderate QOL“. The third type of QOL covered 39.6% of patients and represented “steadily moderate level of QOL“. The factors significantly related to the first type of QOL trajectory were physical function, pain, poor appetite, uncertainty, and self efficacy; pain, uncertainty and self-efficacy were related to the second type of QOL trajectory; and depression and uncertainty were related to the third type of QOL trajectory. Conclusion Based on the QOL trajectories and identified factors, the timely and tailoring interventions should be developed, applied to and tested for their clinical effectiveness in enhancing advanced lung cancer patients' QOL during the most distressful first 6 months of having lung cancer. Acknowledge This study is supported by National Health Research Institute (NHRI) in Taiwan. Disclosure All authors have declared no conflicts of interest.

Background There is controversy regarding palliative chemotherapy for large cell neuroendocrine carcinoma (LCNEC). We evaluated whether advanced LCNEC should be treated similarly as small-cell lung cancer (SCLC) or non-small-cell lung cancer (NSCLC). Methods The clinical reports and tumor specimens of 45 consecutive patients who were diagnosed with advanced LCNEC were reviewed. They were divided into SCLC (n = 11) and NSCLC regimen groups (n = 34) according to first-line chemotherapeutic regimens. Results Most patients were male (96%) and smokers (93%) with a median age of 64 years. Neuroendocrine differentiation was established in 42 (93%) tumors by immunohistochemical analyses. Regarding the efficacy of first-line chemotherapy in the SCLC and NSCLC regimen group, the response rates were 72.7% and 50% (P = 0.19), and the median progression-free survival times were 6.1 and 4.9 months (P = 0.41), respectively. The difference in overall survival between the two treatment groups was 7.3 months (16.5 versus 9.2 months, P = 0.10). There was also a contrasting difference in the type and efficacy of salvage chemotherapeutic regimens between the two groups: salvage regimens with irinotecan, platinum, or taxanes were commonly used with relatively high objective responses in the SCLC regimen group, whereas frequently used agents in the NSCLC regimen group such as pemetrexed, gefitinib, or erlotinib were associated with no objective response. Conclusions Regarding palliative chemotherapy, advanced LCNEC should be treated similarly as SCLC rather than NSCLC.

Background Crizotinib is an ALK inhibitor indicated in the US for advanced ALK-positive NSCLC. Visual effects reported by patients treated with crizotinib were characterized using the Visual Symptom Assessment Questionnaire (VSAQ). Methods Patients with previously treated, advanced ALK-positive NSCLC were administered 250 mg BID crizotinib in an ongoing phase II study (PROFILE1005, NCT00932451; Pfizer). Patients completed the VSAQ at day 1 of each 21-day cycle and at the end of treatment. The VSAQ has a recall period of 3 weeks and consists of seven questions assessing presence, frequency, timing, duration and degree of bother of visual effects and their impact on activities of daily living (ADL). The visual effects assessed included appearance of overlapping shadows/after images, flashing lights and streamers/strings/floaters, difficulty adapting to lights and seeing at night. Patients rated degree of bother on a 5-point scale ranging from ‘not at all’ to ‘extremely’. The impact on ADL was measured using a 10-point scale (0: no effect; 10: completely prevented ADL). Frequency analyses were carried out. Results As of 1 June 2011, visual effects as identified by VSAQ were reported by 63% (114 of 182) of patients at cycle 2 (C2), 57% at C3 (85 of 149), 52% at C4 (64 of 123) and 41% at C5 (46 of 112). The most commonly experienced visual events were appearance of flashing lights (C2: 81%; C3: 82%; C4: 84%; C5: 76%), streamers/strings/floaters (C2: 83%; C3: 78%; C4: 81%; C5: 87%) and overlapping shadows/after images (C2: 70%; C3: 77%; C4: 87%; C5: 84%). Most patients reported each event to last ≤1 minute (C2: 61%; C3: 71%; C4: 77%; C5: 70%). Majority of patients reported event frequency at each cycle of Conclusions Visual effects identified by VSAQ in patients treated with crizotinib were frequent, but were reported to be transient with no or minimal impact on ADL.