Characteristics of long-term lung cancer survivors.

PR-17

Background. People who survive beyond five years after a lung cancer diagnosis have been referred to as long-term lung cancer (LTLC) survivors. There currently is limited information about the health status, health behaviors, and quality of life (QoL) of LTLC survivors. In our multiple-dimension study, comprehensive models were explored under a conceptual model of Wilson and Cleary ⁽¹⁾ to capture the most important survival predictors. Our framework encompasses the following five dimensions: health and QoL (e.g., comorbid conditions and spiritual well-being), health-related behaviors (e.g., smoking status and physical activity level), disease and treatment related factors (e.g., adverse effects and disease recurrence), host related factors (e.g., genotypes of oxidative pathways), tumor related factors (e.g., histology and markers of cell proliferation and apoptosis), as well as demographic variables. Methods. We conducted a matched multivariate analysis to assess predictors for longer survival and better QoL. We sequentially modeled from each study dimension and then to higher order dimensions. LTLC survivors (n=150) were matched to patients who survived less than 2 years (n=150) by known survival predictors including age at diagnosis, gender, tumor cell type, TNM stage, and number of primary lung cancers. Results . Under disease dimension, patients with any progression or recurrence were almost 3 times more likely to die within 2 years than those without progression or recurrence; under treatment dimension, those who had surgery were only 33% as likely to die within 2 years as those without surgery; under physical functioning dimension, patients who reported being "unable to do work or could only do light work" were at a 2.7-5.8 fold higher probability of dying within 2 years than those who were fully active; and under host susceptibility dimension, patients with a GSTM1 positive allele (indicative of a higher anti-oxidative function) were 4 times less likely to die within 2 years than those with a null type. Summary. In this initial analysis, we have shown the importance of all five dimensions, with varying magnitude. New knowledge gained from our study may help lung cancer survivors, their healthcare providers, and their caregivers by providing evidence for establishing clinical recommendations to enhance their long-term survival and health-related QoL. (This study is supported by NIH grants CA77118, CA80127, CA84354, and CA115857.) 1. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. JAMA 1995; 273:59-65