Of the 159 patients, the mean age was 63.12 ± 11.4 years, and 64.8% of all patients were female. The majority of the patients were married (76.7%), had completed high school or higher education (61.6%), lived with family (85.5%), diagnosed within five years (68.6%), had never smoked (78.0%), never smoked in the family history (73.6%), no secondhand smoke status (73.0%), had > NT$20000 monthly income level (59.8%), and were unemployed (79.2%). Most were diagnosed with stage IV (68.5%) with lung cancer and were receiving chemotherapy or radiotherapy (42.1%) as their treatment (Table 1).
Table 1
Participant Characteristics (N = 159)
Characteristic | n | % |
Age, mean ± SD (range) | 63.12 | ± 11.4 (37–88) |
Sex | | |
| Male | 56 | 35.2 |
Female | 103 | 64.8 |
Marital status | | |
| Married | 122 | 76.7 |
Single or widowed | 37 | 23.3 |
Education level | | |
| College or higher | 61 | 38.4 |
High school or lower | 98 | 61.6 |
Live with family | | |
| Yes | 136 | 85.5 |
No | 23 | 14.5 |
Duration of post-diagnosis | | |
| Diagnosed more than five years (before 2016) | 50 | 31.5 |
Diagnosed within five years (2017–2021) | 109 | 68.6 |
Smoking status | | |
| Never | 124 | 78.0 |
Former or current | 35 | 22.0 |
Family history | | |
| No | 117 | 73.6 |
Yes | 42 | 26.4 |
Second hand smoke status | | |
| No | 116 | 73.0 |
Yes | 43 | 27.0 |
Stage | | |
| I-III | 50 | 31.5 |
IV | 109 | 68.5 |
Monthly income level | | |
| ≥ NT$20000 | 95 | 59.8 |
≤ NT$20000 | 64 | 40.2 |
Occupational status | | |
| Yes | 33 | 20.78 |
No | 126 | 79.2 |
Treatment | | |
| NIL | 59 | 37.1 |
| Chemotherapy or radiotherapy | 67 | 42.1 |
| Chemotherapy and radiotherapy | 33 | 20.8 |
Table 2 showed the quality of life and lung cancer-related symptoms collected from QLQ-C30 and QLQ-LC13. The Global QOL score was 67.87 ± 22.24. The mean ± SD of five function scores was 82.14 ± 20.28 for physical function (PF), 82.29 ± 27.98 for role function (RF), 86.69 ± 21.26 for emotional function (EF), 84.28 ± 21.24 for cognitive function (CF), and 80.29 ± 27.55 for social function (SF). The top five highest score of lung cancer-related symptoms were insomnia (32.08 ± 36.72), dyspnea (24.53 ± 31.48), and fatigue (23.27 ± 27.04) in the nine symptoms from QLQ-C30 and coughing (23.06 ± 29.04) and dyspnea (19.92 ± 27.28) in the ten symptoms from QLQ-LC13.
Table 2
Patients' Quality of Life Score and Lung Cancer Symptom Scales (n = 159)
Characteristic | Item | Meana | SD |
Quality of life (QLQ-C30)a | | | |
| Global QOL | 2 | 67.87 | 22.24 |
| Physical Function | 5 | 82.14 | 20.28 |
| Role Function | 2 | 82.29 | 27.98 |
| Emotional Function | 4 | 86.69 | 21.26 |
| Cognitive Function | 2 | 84.28 | 21.24 |
| Social Function | 2 | 80.29 | 27.55 |
Symptom Burden | | | |
QLQ-C30 a | | | |
| Fatigue | 3 | 23.27 | 27.04 |
| Nausea and vomiting | 2 | 6.60 | 18.85 |
| Pain | 2 | 16.25 | 26.65 |
| Dyspnea | 1 | 24.53 | 31.48 |
| Insomnia | 1 | 32.08 | 36.72 |
| Appetite loss | 1 | 18.03 | 30.87 |
| Constipation | 1 | 13.42 | 27.07 |
| Diarrhoea | 1 | 14.47 | 26.13 |
| Financial difficulties | 1 | 9.64 | 24.40 |
QLQ-LC13 a | | | |
| Dyspnea | 3 | 19.92 | 27.28 |
| Coughing | 1 | 23.06 | 29.04 |
| Haemoptysis | 1 | 2.10 | 10.40 |
| Sore mouth | 1 | 11.11 | 25.62 |
| Dysphagia | 1 | 5.24 | 16.58 |
| Peripheral neuropathy | 1 | 14.05 | 24.42 |
| Alopecia | 1 | 17.61 | 31.56 |
| Pain in chest | 1 | 10.90 | 22.66 |
| Pain in arm or shoulder | 1 | 10.06 | 22.74 |
| Pain in other parts | 1 | 13.42 | 27.07 |
Abbreviations: |
QOL, quality of life; |
a Quality of life: the higher values indicate a higher level of functioning and quality of life; Symptom Burden: the higher values indicate more perceived health problems. |
Table 3 was the result of Pearson correlations between symptoms and quality of life variables. The global QOL had negative correlations with fatigue (r = − 0.49, P < 0.01), nausea and vomiting (r = − 0.029, P < 0.01), pain (r = − 0.36, P < 0 .01), dyspnea (r = − 0.34, P < 0.01), appetite loss (r = − 0.52, P < 0.01), constipation (r = − 0.28, P < 0.01), diarrhea (r = − 0.25, P < 0.01), financial difficulties (r = − 0.35, P < 0.01), dyspnea (r = − 0.44, P < 0.01), alopecia (r = − 0.17, P < 0.05), chest pain (r = − 0.37, P < 0.01), pain in the arm or shoulder (r = − 0.17, P < 0.05), and pain in other body parts (r = − 0.20, P < 0.05). In the other five function scores, the significant symptom variables were shown to be negatively correlated and the symptoms with the highest r were fatigue, pain, dyspnea, appetite loss, dyspnea, and chest pain.
Table 3
The relationship between symptom burden and quality of life (n = 159)
| | Global QOL | Physical Function | Role Function | Emotional Function | Cognitive Function | Social Function |
QLQ-C30 | | | | | | | |
| Fatigue | | -0.49** | -0.56** | -0.66** | -0.29** | -0.24** | -0.52** |
| Nausea and vomiting | | -0.29** | -0.19* | -0.35** | -0.19* | -0.02 | -0.21** |
| Pain | | -0.36** | -0.31** | -0.41** | -0.17* | -0.29** | -0.34** |
| Dyspnea | | -0.34** | -0.48** | -0.40** | -0.07 | -0.27** | -0.38** |
| Insomnia | | -0.05 | -0.11 | -0.15 | -0.25** | -0.22** | -0.12 |
| Appetite loss | | -0.52** | -0.42** | -0.52** | -0.22** | -0.33** | -0.46** |
| Constipation | | -0.28** | -0.31** | -0.29** | -0.05 | -0.17* | -0.25** |
| Diarrhoea | | -0.25** | -0.18* | -0.22** | -0.09 | -0.16* | -0.11 |
| Financial difficulties | | -0.35** | -0.35** | -0.52** | -0.01 | -0.32** | -0.44** |
QLQ-LC13 | | | | | | | |
| Dyspnea | | -0.44** | -0.65** | -0.61** | -0.15 | -0.27** | -0.51** |
| Coughing | | -0.14 | -0.23** | -0.13 | -0.11 | -0.01 | -0.21** |
| Haemoptysis | | -0.03 | -0.08 | 0.01 | 0.04 | 0.02 | -0.09 |
| Sore mouth | | -0.12 | -0.19* | -0.18* | -0.06 | -0.10 | -0.22** |
| Dysphagia | | -0.01 | -0.11 | -0.16* | -0.02 | -0.10 | -0.20* |
| Peripheral neuropathy | | -0.09 | -0.06 | -0.14 | 0.08 | -0.08 | -0.26** |
| Alopecia | | -0.17* | -0.06 | -0.05 | 0.07 | -0.09 | -0.14 |
| Pain in chest | | -0.37** | -0.31** | -0.29** | -0.22** | -0.26** | -0.30** |
| Pain in arm or shoulder | | -0.17* | -0.09 | -0.14 | -0.02 | − .180* | -0.16* |
| Pain in other parts | | -0.20* | -0.17* | -0.31** | -0.06 | -0.27** | -0.30** |
∗P < 0.05; ∗∗P < 0 .01. |
Abbreviations: QOL, quality of life; |
In Table 4, the stepwise multiple regression analysis revealed that the predictors of global QOL were appetite loss, fatigue, pain in arm or shoulder, dyspnea, and alopecia, which accounted for 40% of the variance and the β from − 0.15 to -0.32 (F = 22.02, P < 0.001), appetite loss was the highest effected factor for 27% of the variance. The variables of dyspnea, fatigue, constipation, age, and sore mouth were the predictors of physical function which accounted for 54% of the variance and the β from − 0.11 to -0.45 (F = 37.82, P < 0.001. The predictors of role function were fatigue, dyspnea, financial difficulties, appetite loss, secondhand smoke status, constipation, and smoking status, which accounted for 60% of the variance and the β from − 0.12 to -0.35 (F = 35.38, P < 0.001). The significant factors of emotional function were fatigue, Insomnia, RT and CT treatment, which accounted for just 13% of the variance and the β from − 0.17 to -0.26 (F = 9.03, P < 0.001). The variables of appetite loss, financial difficulties, life with family, income level, insomnia, education level, and dyspnea were significant with the cognitive function, which accounted for 23% of the variance and the β from − 0.15 to -0.24 (F = 7.90, P < 0.001). The predictors of social function were fatigue, dyspnea, peripheral neuropathy, appetite loss, RT and CT treatment, which accounted for 45% of the variance and the β from − 0.16 to -0.26 (F = 26.40, P < 0.001). In these five function models, the symptoms of dyspnea, fatigue, fatigue, appetite loss, fatigue had accounted for the higher variance (R2 change), individually (Fig. 1).
Table 4
Results for multivariable regression analyses for quality of life (n = 159) Abbreviations: QOL, quality of life; RT, Radiotherapy; CT, Chemotherapy; SE, Standard Error
Quality of life Model | B | SE | β | t | p | Adjusted R2 | R2 Change | |
Global QOL model | | | | | | | | |
| Appetite loss | -0.23 | 0.05 | -0.32 | -4.38 | < 0.001 | 0.27 | 0.27 | |
| Fatigue | -0.19 | 0.06 | -0.23 | -2.95 | 0.004 | 0.34 | 0.07 | |
| Pain in arm or shoulder | -0.15 | 0.06 | -0.15 | -2.45 | 0.016 | 0.36 | 0.03 | |
| Dyspnea | -0.15 | 0.06 | -0.18 | -2.50 | 0.013 | 0.38 | 0.02 | |
| Alopecia | -0.11 | 0.04 | -0.15 | -2.42 | 0.017 | 0.40 | 0.02 | |
Physical Function model | | | | | | | | |
| Dyspnea | -0.33 | 0.05 | -0.45 | -6.94 | < 0.001 | 0.42 | 0.42 | |
| Fatigue | -0.23 | 0.05 | -0.31 | -4.74 | < 0.001 | 0.49 | 0.07 | |
| Constipation | -0.13 | 0.04 | -0.17 | -3.11 | 0.002 | 0.51 | 0.02 | |
| Age | -0.30 | 0.10 | -0.17 | -3.05 | 0.003 | 0.53 | 0.03 | |
| Sore mouth | -0.09 | 0.04 | -0.11 | -1.98 | 0.049 | 0.54 | 0.01 | |
Role Function model | | | | | | | | |
| Fatigue | -0.36 | 0.07 | -0.35 | -5.33 | < 0.001 | 0.43 | 0.43 | |
| Dyspnea | -0.26 | 0.06 | -0.26 | -4.05 | < 0.001 | 0.52 | 0.10 | |
| Financial difficulties | -0.27 | 0.07 | -0.24 | -3.92 | < 0.001 | 0.55 | 0.03 | |
| Appetite loss | -0.10 | 0.06 | -0.11 | -1.67 | 0.097 | 0.57 | 0.02 | |
| Second hand smoke status yes (versus no) | 7.47 | 3.25 | 0.12 | 2.30 | 0.023 | 0.58 | 0.01 | |
| Constipation | -0.14 | 0.06 | -0.14 | -2.49 | 0.014 | 0.59 | 0.01 | |
| Smoking status former or current (versus never) | 8.08 | 3.50 | 0.12 | 2.31 | 0.022 | 0.60 | 0.01 | |
Emotional Function model | | | | | | | | |
| Fatigue | -0.21 | 0.06 | -0.26 | -3.46 | 0.001 | 0.08 | 0.09 | |
| Insomnia | -0.13 | 0.04 | -0.22 | -2.84 | 0.005 | 0.11 | 0.04 | |
| RT and CT (versus Nil) | 8.76 | 3.93 | 0.17 | 2.23 | 0.027 | 0.13 | 0.03 | |
Cognitive Function model | | | | | | | | |
| Appetite loss | -0.11 | 0.06 | -0.15 | -1.90 | 0.059 | 0.10 | 0.11 | |
| Financial difficulties | -0.21 | 0.07 | -0.24 | -3.06 | 0.003 | 0.14 | 0.05 | |
| Live with family no (versus yes) | -9.91 | 4.31 | -0.16 | -2.30 | 0.023 | 0.16 | 0.03 | |
| Income level < 20000 (versus ≥ 20000) | 8.15 | 3.18 | 0.19 | 2.56 | 0.011 | 0.18 | 0.02 | |
| Insomnia | -0.09 | 0.04 | -0.16 | -2.26 | 0.025 | 0.20 | 0.02 | |
| High school or lower (versus College or higher) | -6.50 | 3.19 | -0.15 | -2.04 | 0.043 | 0.22 | 0.02 | |
| Dyspnea | -0.11 | 0.05 | -0.16 | -2.04 | 0.043 | 0.23 | 0.02 | |
Social Function model | | | | | | | | |
| Fatigue | -0.27 | 0.08 | -0.26 | -3.52 | 0.001 | 0.27 | 0.27 | |
| Dyspnea | -0.27 | 0.07 | -0.26 | -3.73 | < 0.001 | 0.35 | 0.08 | |
| Peripheral neuropathy | -0.27 | 0.07 | -0.24 | -3.99 | < 0.001 | 0.39 | 0.05 | |
| Appetite loss | -0.19 | 0.06 | -0.21 | -3.07 | 0.003 | 0.42 | 0.03 | |
| RT and CT (versus Nil) | -10.53 | 4.03 | -0.16 | -2.61 | 0.010 | 0.45 | 0.02 | |