Objective: Age-adjusted mortality rates for Lung Cancer remain the highest among all cancers. As the disease progresses, patients tend to experience an increase in the number and intensity of symptoms. In previous work, we employed factor analysis to determine the cluster of symptoms reported by lung cancer patients shortly after diagnosis. A cluster of symptoms, consisting of fatigue, weakness, nausea, vomiting, loss of appetite, weight loss, and altered taste was found. The current analysis extends that research to answer the following questions: Does this cluster of symptoms remain consistent several months after diagnosis? Do reports of individual symptoms remain stable over time? Does the level of the reported symptom severity remain stable? Do factors such as stage of cancer at the time of diagnosis, type of therapy being provided, and the patient’s age and gender predict symptom severity? Is the symptom cluster predictive of death? Design: This is a secondary analysis of an NIH funded panel study of older cancer patients who survived at least 3 months after diagnosis. Sample: 160 lung cancer patients (90 men, 70 women), 65-87 (mean=72) years old who participated in both wave 1 (within 6 weeks of diagnosis) and wave 2 (3 months after diagnosis) of the panel study. These patients were recruited into the study from 24 hospitals and cancer clinics in Michigan. Methods: After obtaining human subjects approval, patients were invited to participate in a panel study of the long-term impact of cancer and its treatment on older adults. Information came from two sources: 1) audits of medical records: cancer type, cancer stage, treatment; 2) panel interviews: patient reports of symptom presence and severity, patient age and gender. Findings: To confirm the consistency of the 7-item symptom cluster reported in both interviews, reliability analyses were run on the responses from both waves. The Kuder-Richardson version (KR-20) of the coefficient alpha yielded a value of .67 for wave 1 data and .68 for wave 2 data. In addition, all inter-item correlations were found to be positive, indicating a tendency for subjects to report these symptoms simultaneously. Severity scores (0=no symptom, 4=severe symptom) associated with each of the 7 symptoms in the cluster were compared between wave 1 and wave 2, yielding statistically significant correlations ranging between r=. 21 and r=. 36. Similarly, the correlation between the mean symptom severity scores (averaged over all 7 symptoms) of waves 1 and 2 was r=.36 (p<. 01), confirming a modest degree of test-retest reliability. While ANOVA revealed an overall decline in average reported symptoms between wave 1 and 2, none of the hypothesized between-subjects factors (age, gender, stage of cancer, or type of treatment) predicted variations in symptom counts or symptom severity at wave s1 or 2. After controlling for age and gender, the odds of dying within one year of the initial diagnosis were significantly related to the number of symptoms reported at both waves 1 and 2: adjusted odds ratios of 1.22 (p< .05) and 1.28 (p<. 05) indicate that the odds of dying increase by 22% and 28% respectively for each additional symptom reported at wave 1 or wave 2. Conclusions: Lung cancer patients report a cluster of symptoms (fatigue, weakness, nausea, vomiting, loss of appetite, weight loss, and altered taste) that exhibits a weak but consistent pattern over the first three months after diagnosis. While the overall severity of reported symptoms declines, symptoms reported at time of diagnosis are also significantly correlated to symptoms reported 3 months later, demonstrating stability over time. Age, gender, stage of cancer at diagnosis and type of treatment are not predictive of symptom severity or number of symptoms reported, but the reported symptoms do predict increased odds of dying after 3 months and within one year of the initial diagnosis. Implications: Lung cancer patients should be assessed for the presence or absence of the seven symptoms of fatigue, weakness, nausea, vomiting, loss of appetite, weight loss, and altered taste at the time of diagnosis. This same symptom constellation can be expected to remain stable over time, though of lower intensity. Symptoms in the cluster may also be used as a predictor of subsequent patient death. As such, they may give an important clue to the development of the clinical trajectory that can be expected.
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