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Screening for Emotional Distress in Older Patients With Lung Cancer

Screening for Emotional Distress in Older Patients With Lung Cancer

An estimated 219,440 new cases of lung cancer were expected in 2009, accounting for about 15% of cancer diagnoses.[1] Most cancer-related deaths in both men and women are attributable to lung cancer, which represents about 28% of all cancer deaths. Lung cancer patients are often older, with approximately 60% of cancer diagnoses and 70% of cancer mortality occurring in those over the age of 65 years.[2]

The two major types of lung cancer are non–small-cell lung cancer (NSCLC), representing 80% to 85% of all lung cancers, and small-cell lung cancer (SCLC), which represents 15% to 20%. Surgery is the primary treatment modality for early stage I and II NSCLC. If NSCLC is diagnosed at a later stage, radiation is used for control and chemotherapy is used for advanced and metastatic disease. Limited SCLC disease is treated with chemotherapy and radiation, whereas more extensive disease is treated with chemotherapy alone.[3]

Older adults are more likely to have concurrent diseases (eg, diabetes, chronic obstructive pulmonary disease, heart disease, arthritis, hypertension) which can exacerbate complications from cancer[4] and reduce treatment tolerance and life expectancy.[5] Although the relative survival rate for older lung cancer survivors is increasing, largely as a result of improvements in surgical treatments and combined therapies (eg, surgery, radiation, chemotherapy, and targeted biological therapies), older lung cancer patients may suffer from severe psychological distress.

Psychological distress, particularly depression and anxiety, has been well documented in adults diagnosed with cancer[6] but prevalence rates for distress vary by type of cancer. Prevalence rates of up to 43.5% for lung cancer patients have been reported,[7] and rates of 41% have been found for older adults.[8] It is clear that older lung cancer patients are at risk for developing severe psychological distress—distress that is often unrecognized or untreated.

Psychological distress is an important problem in cancer survivorship because it significantly influences cancer recovery and quality of life (QOL).[9] Symptoms of depression, for example, are associated with decreased compliance with adjuvant therapy and a variety of cognitive and functional impairments.[6] Psychological distress has been linked to decreased immune function,[10] response to chemotherapy observed by tumor size,[10] and when severe and persistent, to long-term survival.[11] Psychological distress in older cancer survivors can increase treatment-related side effects and decrease abilities to manage their symptoms, adding to the burden of the illness.[12] Untreated psychological distress has been linked to suicide in older adults, with the rates of suicide in cancer patients twice that of the general population.[13]

People with lung cancer are acknowledged to have more unmet needs and greater distress than people with other cancers. In part, this is because there is no effective method for early detection and the majority of people with lung cancer are diagnosed with advanced disease. Patients report both physical and psychological symptoms across the disease course.

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