2023-06-11 15:24:55
Why is this important?
In France, bronchial cancer is the 2e cancer in terms of frequency in men and the 3e in the woman. It is most often a cancer occurring in the elderly, the median age at diagnosis is 67 years for men and 65 years for women. The vital prognosis of this cancer is poor with a net standardized survival at 5 years of only 17%. However, this 5-year survival varies according to the stage of the disease (55% for localized disease, 4% for metastatic disease). Net survival, although low, tends to increase with new therapies. While studies have explored quality of life in the first months post-treatment, longer-term data are scarcer.
Methodology
This French study compared the quality of life 5 years after a diagnosis of lung cancer between individuals aged 70 and over and younger individuals. The diagnosis of lung cancer was made between January 2010 and December 2011.
Factors associated with a poor prognosis in terms of quality of life were also investigated in both groups. Data are from patients who participated in the VICAN5 survey [2].
Principle results
Of the 4,174 participants in the VICAN5 survey, 371 had lung cancer (60.8% male, 90.1% non-small cell lung cancer – no difference between the two age groups). The mean age at diagnosis was 56.1 years. Five years after diagnosis, 21.3% of the individuals included were ≥70 years old. The percentage of males was higher in the older group of subjects. Compared to younger people, older people were less likely to be embarrassed by their appearance or discriminated against because of their cancer, but they were more likely than younger people to experience negative consequences related to their cancer.es to their cancer, in particular they mentioned having less strength and having more difficulty enjoying life.
Compared to the general population of the same age, 67% of participants had an impaired physical quality of life and 28% an impaired mental quality of life. Physical and mental quality of life was significantly more impaired in patients <70 years old compared to older patients.
Five years after diagnosis, the oldest were more likely to receive continuous systemic treatment, to have a high comorbidity score at diagnosis and a Performance Status 0 or 1, be undernourished and complain of severe hearing loss since diagnosis. Older people were less likely than younger people to use complementary medicines, to be anxious or have an impaired mental quality of life, to suffer from fatigue or suspected neuropathic pain, and to report cancer-related sequelae . They were also less afraid of recurrences than the younger ones.
Of the 311 patients who had data concerning their treatments, 77.5% had undergone a first surgery and 41.8% had progressive cancer with no difference for these two subjects between the two age groups.
In the over 70s, in multivariate analysis, only feeling embarrassed by one’s appearance and suspicion of neuropathic pain were independently associated with impaired physical quality of life. Also in multivariate analysis, impairment of mental quality of life was independently associated with a PTGI score (Post-Traumatique Growth Inventory) low and suspicion of neuropathic pain.
In the under 70s, in multivariate analysis, impaired physical quality of life was independently associated with male sex, metastatic stage of cancer, presumed neuropathic pain, presence of serious side effects, and difficulty breathing at rest in the last 7 days. Impaired mental quality of life was independently associated with male gender, impaired ECOG-PS, and suspected or confirmed anxiety.
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