Monitoring changes in quality of life in patients with lung cancer by using specialised questionnaires: implications for clinical practice.

BACKGROUND: Quality of life (QoL) in lung cancer patients is overlooked due to the severity of the disease. Changes in factors comprising QoL need further exploration to determine therapy targets. METHODS AND MATERIALS: QoL was assessed in 282 patients referred to a specialised centre in Greece for chemotherapy using three reliable scales: Functional Assessment of Cancer Therapy-Lung (FACT-L, Greek version 4), Short Form (SF-36) Health Survey and Hospital Anxiety and Depression Scale (HAD)S. RESULTS: Comparing QoL scores, it was observed that in comparison to the first chemotherapy, there was a statistically significant deterioration in patients' physical well-being (p < 0.0001) at the following chemotherapies. In contrast, there was a statistically significant improvement in patients' emotional well-being (p < 0.0001), mental health (p < 0.0001) and social functioning (p = 0.006) in the chemotherapies following the first. Observations deriving from survival analyses agree with literature findings: small cell lung cancer (SCLC) patients had significantly shorter survival than non-SLSC (NSCLC) patients, initial performance status was consistent with survival, radiotherapy improved survival, existence of metastases hindered survival, and the number of chemotherapies and QoL scores were positively correlated with survival. CONCLUSIONS: Although patients' physical functioning deteriorated after chemotherapy, their psychological state, mental health and social functioning improved in comparison with their first chemotherapy. This may be due to the fear of the unknown and the stress patients experience before their treatment. Regarding survival analysis results, it could be stated that the better QoL scores, the longer the survival. The findings underline the importance of psychological support after diagnosis and during the initiation of treatment. This may result in a better QoL, hence leading to prolongation of survival.

The impact of zoledronic acid therapy in survival of lung cancer patients with bone metastasis.

Bone metastases occur in 20-40% of patients with lung cancer. Recent studies demonstrate a direct antiproliferative effect of 3rd generation bisphosphonates (BPs) on lung tumors, which may influence the survival. Therefore, we examined the clinical impact of zoledronic acid (ZOL; Zometa), a 3rd generation BP, with a focus on the survival, time to progression and pain effect in lung cancer patients with bone metastases. Lung cancer patients (n = 144, Stage IV) with evidence of metastasis bone scan were included. Eighty-seven of 144 experienced bone pain and received ZOL, 4 mg i.v. every 21 days (Group A), whereas the other 57 patients received no ZOL (Group B). All patients were treated with a combination chemotherapy consisted of docetaxel 100 mg/m(2) and carboplatin AUC = 6. It was found that Group A had a statistically significant longer survival (p < 0.01) when compared to Group B. A statistically significant positive correlation was found between the number of cycles of therapy with ZOL and total patient survival (p < 0.01, Pearson correlation) and time to progression (p < 0.01). Pain effect of ZOL had no significant difference between the 2 groups of patients (p > 0.05). Urine N-telopeptide of type I collagen (NTx) levels decreased in patients with NTx < or = 29 nM BCE/mM creatinine at baseline after treatment with ZOL. The results of our study suggest that the addition of ZOL increases overall survival in lung cancer patients with bone metastases. The longer period of receiving ZOL, the better effect on survival and time to progression.