Impact of Quality of Life on Prognosis of Metastatic Non-Small Cell Lung Cancer: Is It Correlated to the Chemotherapy Regimen Used?

Abstract

Introduction: Interactions between cancer genesis, sleep quality and patient’s humor engage complex pathophysiological pathways. However, the outcome of various indicators of quality of life (Qol) after chemotherapy in non small cells lung cancer (NSCLC) and also their prognostic impact remain understudied. The objective of this study was to analyze the Qol, sleep quality and anxio-depressive disorder in advanced NSCLC patients put on chemotherapy. We aimed also to demonstrate the correlation between the Qol and overall survival (OS) of the cohort. Methods: In this monocentric prospective study, we included all patients with metastatic NSCLC, put on chemotherapy regimen from January to December 2018. We assessed the Qol, the sleep quality and disturbances of humor through dedicated questionnaires in Arabic Tunisian dialectal version. Concerning the outcome, the study mentioned the response to chemotherapy and the overall survival. The point date was on December 31st 2019. Results: Seventy one male patients were included. Their mean age was 62.17 years. Adenocarcinoma was the most frequent histologic type (58%) and then was squamous cell carcinoma (25%). When analyzing QLQ-C30, we found a significant correlation between the global Qol coefficient and the coefficient of performances, an inversely proportional correlation with the coefficient of symptoms. Analysis of PSQI score had shown a poor sleep quality in 55% of patients after chemotherapy. A depressive humor was detected in 21 patients (30%) and an anxious humor in 24 patients (34%). Twenty six patients (37%) had a tumor regression after 1st line of chemotherapy. Mean OS was 317 days (IC = 95% [292-377], margin of error of 20 days) with extremes from 1.6 months to 21 months. One year survival rate was 44%. Statistical analysis had shown a closely comparable OS in our patients, whatever was the chemotherapy regimen. OS was correlated to Performance Status, response to chemotherapy, good sleep quality and high levels of performance dimensions. Multivariate analysis found poor sleep quality and tumor progression after chemotherapy as independent predictive factors of mortality. Conclusions: Considering our results, we highlight the important decline of Qol in NSCLC patients, affecting several dimensions, whatever was the molecules of chemotherapy used. This decline would be predictive of a poor prognosis.