Abstract
Objective: The distress thermometer (DT) is a well-established screening tool to detect clinically significant distress in cancer patients. It is often administered in combination with the problem list (PL), differentiating further between various (e.g., physical and emotional) sources of distress. The present study aimed to extend previous research on the association between distress and overall survival. Further exploratory analysis aimed to evaluate the predictive value of the PL for overall survival.
Methods: Patients (n=323) with newly diagnosed lung cancer were recruited from a large cancer center. Patients were split into two groups, those with (DT score ≥5) and those without significant distress. Overall survival time was illustrated by a Kaplan Meier curve and compared with a log rank test. Univariable Cox proportional hazard models were built to control the association of distress with overall survival for age, gender, disease stage,comorbidity and their interaction terms. A multiple linear regression was used to investigate the association of the items from the problem list with survival time.
Results: Patients with significant distress had a shorter survival time compared to patients without significant distress (25 vs. 43 months). Regression analysis revealed more problems with both "bathing and dressing" and "eating", as well as absence of "diarrhea" and increased "nervousness" to negatively impact overall survival time.
Conclusion: Our results show that estimation of the survival function using cancer-related distress is possible. However, when using Cox regression, distress shows no significant value for survival as a predictor. Moreover, our study did not reveal an interaction effect between disease stage, comorbidity, and distress. Overall, results suggest that physical and emotional problems that arise from lung cancer may be useful to identify patients at risk for poor prognosis.
Schulze, Jan Ben