Clinically Significant Distress and Physical Problems Detected on a Distress Thermometer are Associated With Survival Among Lung Cancer Patients

Background: The distress thermometer is a well-estab-lished screening tool to detect clinically significant distress in cancer patients. It is often administered in combination with the problem list, differentiating further between various (e.g., physical and emotional) sources of distress.Objective: The present study aimed to extend previous research on the association between distress and overall survival. A further exploratory analysis aimed to evaluate the predictive value of the problem list for overall survival.Methods: Patients (n = 323) with newly diagnosed lung cancer were recruited from a large cancer center. Patients were split into 2 groups, those with (distress thermometer score $5) and those without sig-nificant distress. The 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. 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 than pa-tients 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 associated with the overall survival time.Conclusions: 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 among disease stage, co-morbidity, and distress. Overall, results suggest that physical and emotional problems that arise from lung cancer may be useful to identify patients at risk of poor prognosis (on the basis of Kaplan-Meier estimator)

Automated summary

This study aimed to assess the association between psychological distress and survival time in cancer patients, and to explore the predictive value of a problem list. Results showed that patients with higher psychological distress had shorter survival time. Additionally, certain items from the problem list were negatively associated with survival time.