The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer

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Geerse, OP
Brandenbarg, D
Kerstjens, HAM
Berendsen, AJ
Duijts, SFA
Burger, H
Holtman, GA
Hoekstra-Weebers, JEHM
Hiltermann, TJN
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Introduction: The use of patient-reported outcome measures is increasingly advocated to support high-quality cancer care. We therefore investigated the added value of the Distress Thermometer (DT) when combined with known predictors to assess one-year survival in patients with lung cancer. Methods: All patients had newly diagnosed or recurrent lung cancer, started systemic treatment, and participated in the intervention arm of a previously published randomised controlled trial. A Cox proportional hazards model was fitted based on five selected known predictors for survival. The DT-score was added to this model and contrasted to models including the EORTC-QLQ-C30 global QoL score (quality of life) or the HADS total score (symptoms of anxiety and depression). Model performance was evaluated through improvement in the -2 log likelihood, Harrell's C-statistic, and a risk classification. Results: In total, 110 patients were included in the analysis of whom 97 patients accurately completed the DT. Patients with a DT score ≥5 (N = 51) had a lower QoL, more symptoms of anxiety and depression, and a shorter median survival time (7.6 months vs 10.0 months; P = 0.02) than patients with a DT score <5 (N = 46). Addition of the DT resulted in a significant improvement in the accuracy of the model to predict one-year survival (P < 0.001) and the discriminatory value (C-statistic) marginally improved from 0.69 to 0.71. The proportion of patients correctly classified as high risk (≥85% risk of dying within one year) increased from 8% to 28%. Similar model performance was observed when combining the selected predictors with QoL and symptoms of anxiety or depression. Conclusions: Use of the DT allows clinicians to better identify patients with lung cancer at risk for poor outcomes, to further explore sources of distress, and subsequently personalize care accordingly.

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Lung Cancer

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© 2019 The Author(s). Published by Elsevier B.V. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Geerse, OP; Brandenbarg, D; Kerstjens, HAM; Berendsen, AJ; Duijts, SFA; Burger, H; Holtman, GA; Hoekstra-Weebers, JEHM; Hiltermann, TJN, The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer, Lung Cancer, 2019, 130, pp. 101-107