Identifying Potential Risk Factors for Increased Distress in Lung Cancer Patients Receiving Radiotherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 120; no. 2; p. e385
• Main Authors: Loving, B., Oyeniyi, J.F., Qu, L., Grills, I.S., Stevens, C.W., Stromberg, J.S.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2024
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2024.07.855

Previous studies have reported that lung cancer patients often experience high levels of emotional distress at the initiation and continuation of care. However, factors contributing to this elevated distress have not been extensively studied. This study evaluates various potential risk factors that influence NCCN distress thermometer (DT) scores in lung cancer patients at radiotherapy consultation. From 2016 to 2020, we conducted a retrospective analysis of lung cancer patients treated with radiotherapy (RT) at our multi-site institution. The study involved collecting baseline and post-treatment NCCN DT scores, alongside baseline ICD-10 codes for mental health diagnoses (MHD). As a departmental standard, we refer patients with an NCCN DT score of 4 or higher to social work for supportive care. Additional variables included area deprivation index (ADI), Charleson Comorbidity Index (CCI), patient demographics, pulmonary rehabilitation referral prior to RT, oxygen requirement prior to RT, smoking status, and SBRT vs longer fractionated regimens. Both linear and logistic univariate (UVA) and multivariable (MVA) analyses were conducted, both with a backward stepwise selection procedure that iteratively removing the least significant variables based on P values, with a significance level of alpha = 0.10 for inclusion. Of 523 patients in the initial database query, 394 (75.3%) patients remained after exclusion of patients who were missing NCCN DT scores. Two-hundred and eight (52.8%) patients received SBRT. In our patient cohort, 260 (66%) were ≥ 70 years old and 223 (57%) were female. The median NCCN pre-treatment NCCN DT score was 3 (0-10). Linear regression MVA showed female sex (p<0.001), referral to pulmonary rehabilitation (p = 0.045), and current smoker (p = 0.018) significantly increased DT scores as did ADI above the mean (p = 0.001) and CCI≥3 (p<0.001). The logistic regression MVA showed that females had 1.7 times higher odds of being referred to social work for scoring at or above 4 on the NCCN DT compared to males (p = 0.016), and patients who were <70 years old had 1.7 times higher odds (p = 0.012) compared to patients ≥70. Female patients and those younger than 70 exhibited notably higher levels of distress, as reflected in increased NCCN DT scores and greater likelihood of requiring social work referral. Furthermore, socioeconomic deprivation, as indicated by a higher ADI, a greater burden of comorbidities, measured by CCI scores, and current smokers were found to contribute to elevated distress. These results can inform future prospective research aimed at establishing pre-treatment screening protocols for lung cancer patients at elevated risk of distress. Early identification and intervention for these individuals may lead to enhanced quality of life, reduced distress levels, and potentially better treatment adherence during radiotherapy.