Time-dependent Patient-reported Outcomes as Predictors of Patient Survival of Lung Cancer

Abstract

Background: Patient-reported outcomes (PROs) can be used to accurately and directly gauge patients’ disease-related symptoms. Aim: The purpose of this study was to investigate the association between PROs and survival periods among patients with lung cancer considering time-varying covariates. Methods: A total of 86 patients with confirmed diagnoses of lung cancer were recruited, and a prospective study design was adopted. PROs were collected five times for each patient: before treatment and 6, 12, 24, and 48 weeks after treatment. The results were analyzed using time-dependent Cox regression. Results: Average follow-up duration was 14.3 months; 75 participants died over the course of the follow-up period and 11 survived. The median survival period was 15.0 months (range: 0.6–49.7 months). Bivariate time-dependent Cox regression indicated that the basic attribute variables of significance were cancer diagnosis, stage of cancer, pretreatment pneumonia, and type of treatment. The significant PRO variables were sleep disorders, anxiety, depression, weight loss, chest tightness, and ease of breathing. Thus, we analyzed the predictive power of these 11 variables. Multivariate time-dependent Cox regression revealed that only stage four lung cancer (hazard ratio [HR] = 7.33, p = .029) and weight loss (HR = 0.76, p = .006) were significant. Conclusion: Sleep disorders, anxiety, depression, chest tightness, and ease of breathing in PROs were associated with the survival periods of lung cancer patients; however, controlling for time, stages, and other PROs revealed that weight loss is the only independent factor associated with lung cancer patient survival.