Study Shows Profile of At-Risk Elderly Lung Cancer Patients

EAST LANSING, Michigan—A profile for elderly lung cancer patients at high risk of having major cancer-related losses in physical functioning has emerged from a Michigan State University study.

The impact of lung cancer in the elderly is likely to be more severe in patients who have a higher prior level of physical functioning, higher symptom severity, and, to a lesser degree, younger age, said principal investigator Barbara Given, PhD, RN, of the School of Nursing. “Early recognition by physicians and other health care professionals of this at-risk group would be important in planning for supportive care to enhance quality of life for these patients,” Dr. Given said.

The study included 129 lung cancer patients between the ages of 65 and 87 (average, 72). Patient interviews were conducted 4 to 6 weeks after surgery or 2 to 4 weeks after subsequent initial radiation therapy or chemotherapy.

Physical functioning was measured using a 10-item subscale from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Symptom severity was measured with the Symptom Experience Scale, which elicited information on 32 symptoms.

To determine comorbidity, patients were asked to choose from a list of 13 common comorbid conditions. Prior physical functioning was taken from patient recall of a period approximately 3 months before their diagnosis. Disease stage and treatment were culled from the patients’ medical records.

“The most consistent theme observed was that fatigue almost universally was the most frequently reported symptom,” Dr. Given said. The six most commonly reported symptoms, as shown in the Table, and their severity did not differ significantly across the various treatment categories, stages of disease, or by patient sex (J Symptom Pain Manage 19:249-256, 2000).

In this study, younger patients and those reporting higher levels of prior physical functioning or higher symptom severities showed greater losses in physical functioning. Older patients generally had lower baseline levels of physical functioning and therefore experienced smaller losses in physical functioning.

Comorbidity did not play a significant role in predicting loss of physical functioning, nor were there any significant differences in loss of physical functioning according to stage of disease, type of treatment, or patient sex.

Dr. Given’s co-authors were Margot E. Kurtz, PhD, Department of Family and Community Medicine; J.C. Kurtz, PhD, Department of Mathematics; Manfred Stommel, PhD, College of Nursing; and Charles W. Given, PhD, Department of Family Practice.