Long-Term Lung Cancer Survivors Report Good Quality of Life in First-of-its-Kind Study

New research at UCLA's Jonsson Cancer Center provides the first comprehensive examination of quality-of-life issues faced by long-term lung cancer survivors.

The findings, published in the July 1 issue of the Journal of Clinical Oncology (http://www.jco.org ), could help healthcare providers develop more effective rehabilitation programs for long-term lung cancer survivors. The findings also will better prepare patients and their families to cope with the non-medical challenges of daily life.

Rehabilitation for lung cancer patients traditionally has focused on remedying or managing physical problems. But the UCLA study strongly suggests that emotional quality of life factors also must be addressed.

Lead author Linda Sarna, a nurse-researcher at UCLA's Jonsson Cancer Center and a professor at the UCLA School of Nursing, said two findings surprised the research team: More than 50 percent of long-term lung cancer survivors--patients in remission for five or more years--said they have good quality of life despite decreased lung function caused by lung cancer surgery and a history of smoking. And in survivors who reported relatively poor quality of life, depression affected the quality of their lives more significantly than any physical challenges.

"We expected that the lung cancer survivors' emotional quality of life would be lower than long-term survivors of other cancers because they often face more life-long physical challenges, including significant breathing difficulties when they've had all or part of a lung removed. They also face problems due to many years of smoking, so we thought the physical challenges would very negatively affect their moods and sense of optimism," Sarna said. "Survivors also deal with a variety of medical conditions aside from the cancer. Some of these conditions most likely are due to a history of tobacco use, and some are merely part of the aging process."

Sarna and her colleagues found that 50 percent of the 142 lung cancer survivors they studied said having cancer had helped them view their lives more positively, and 71 percent of the group described themselves as "hopeful" about the future.

About 50 percent of the survivors had moderate to severe limitations in lung function because their lung capacity had diminished by about 30 percent. Working harder to breathe may have affected their physical quality of life but overall, it did not affect their emotional state of mind or outlook on life.

Among the survivors who reported poorer quality of life, researchers found that depression--not the significantly reduced breathing capacity--had the greatest impact on the survivors' quality of life.

Dr. Donald Tashkin, a UCLA pulmonologist and co-author of the study, said that impaired lung function "was not nearly as important a predictor of poorer quality of life as depression."

Tashkin said this suggests that long-term survivors of lung cancer "can significantly offset the negative impact of their limited ability to breathe by working to overcome depression" instead of trying to physically manage or improve their lung capacity.

Although the American Cancer Society estimates that 169,400 Americans will be diagnosed with lung cancer this year, lung cancer survivorship is an understudied field because the disease has a very poor prognosis. Several studies have examined short-term quality of life after lung cancer surgery, but no major studies previously have evaluated long-term survivorship and quality of life in long-term survivors, Sarna said.

"There are about nine million cancer survivors in the United States, but there has been almost no information on the experiences of lung cancer survivors," Sarna said. "Most of the research on quality of life in lung cancer patients has focused on end-of-life aspects because survival rates are very bleak. Only 15 percent of all patients live longer than five years. But lung cancer is the most common cancer in the United States, so 15 percent could translate into more than 100,000 people diagnosed within the past 10 years."

Sarna and her colleagues conducted the study through interviews, asking the survivors questions about their emotional, spiritual and physical quality of life. Emotional quality of life measures moods, anxiety and depression, while spiritual quality of life measures optimism and opinions about life's meaning. Physical quality of life measures physical challenges.

Overall, the long-term survivors' quality of life was as high or higher than that of other cancer survivors. The long-term survivors had better emotional quality of life than people with chronic lung disease and mentally, they were as healthy as other cancer survivors. However, their physical quality of life was slightly worse than other people with cancer or other lung diseases, Sarna said.

The study also hinted that gender, ethnic and cultural differences may affect long-term survivors' quality of life, but these findings warrant further study, Sarna said.

Men and women in the study reported similar overall quality of life, but women had better spiritual quality of life than men. White ethnicity was linked with poorer overall quality of life among men and women.

"The good news is that people do survive lung cancer," Sarna said. "With all of the current studies of new treatments and ways to improve early detection of lung cancer, hopefully there will be many more lung cancer survivors in the future. Our study will help healthcare professionals start tailoring effective recovery programs for those survivors."