Functional Trajectories and Resilience Among Adults With Advanced Lung Cancer

Carolyn J Presley; Nicole A Arrato; Peter G Shields; David P Carbone; Melisa L Wong; Jason Benedict; Sarah A Reisinger; Ling Han; Thomas M Gill; Heather Allore; Barbara L Andersen; Sarah Janse

doi:10.1016/j.jtocrr.2022.100334

Functional Trajectories and Resilience Among Adults With Advanced Lung Cancer

JTO Clin Res Rep. 2022 May 17;3(6):100334. doi: 10.1016/j.jtocrr.2022.100334. eCollection 2022 Jun.

Authors

Affiliations

¹ Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
² Department of Psychology, The Ohio State University, Columbus, Ohio.
³ Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California.
⁴ Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.
⁵ Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.
⁶ Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

Abstract

Introduction: To evaluate whether and the degree to which patients with advanced NSCLC (aNSCLC) receiving lung cancer treatments will experience functional disability or have resilience and to identify characteristics associated with functional disability.

Methods: We evaluated longitudinal data of patients with aNSCLC receiving treatment in the Beating Lung Cancer in Ohio prospective cohort study. Disability versus resilience in functional status (usual activities, mobility, and self-care) was measured monthly for 8 months using the EuroQol-5D-5L. Data captured included baseline demographics (Eastern Cooperative Oncology Group performance status), comorbidities, cancer and depressive symptoms (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7 scale), and cancer stress (impact of events). Group-based latent class trajectory modeling was used to determine clinically distinct functional disability trajectories jointly with attrition probability (death or withdrawal) in the study period.

Results: Among 207 participants, the mean age was 63.5 years (range: 34-92 y), 58.9% were male, 6.8% were African American or Black, 73.3% were former smokers, and 35% resided in rural areas. At baseline, participants had adenocarcinoma histological subtype (74.9%), 40.3% had brain metastases, and 46.1% had bone metastases. Participants received chemotherapy plus immunotherapy (46.9%), immunotherapy single agent (21.7%), targeted treatments (18.8%), or no treatment (12.6%). Three distinct functional trajectory groups were identified, as follows: none/mild (n = 79, 38.2%), moderate (n = 99, 47.8%), and severe disability (n = 29, 14.0%). Characteristics associated with severe disability included baseline Eastern Cooperative Oncology Group performance status greater than 1, worse dyspnea and pain, and higher Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale scores. At month 8, 95 participants (45.9%) displayed resilience, 11 (5.3%) experienced functional decline, and 69 (33.3%) were deceased.

Conclusions: We identified three distinct functional trajectories among patients with aNSCLC. Risk stratification tools and targeted interventions designed to target these three groups are needed to improve functional resilience and prevent disability.

Keywords: Disability; Functional status; Immunotherapy; Lung cancer; Targeted kinase inhibitors.

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States