Knowledge Bank

Patients with advanced non-small cell lung cancer (NSCLC) report higher levels of depression and anxiety compared to patients with other cancer types. Patients with lung cancer also report high levels of physical symptoms, including dyspnea, cough, and pain. Patients with advanced NSCLC receive different types of cancer treatment depending on several physical characteristics. While chemotherapy has historically been the primary treatment option, advanced treatments with less physical side effects, such as immunotherapy and targeted therapy, have since been discovered. It was hypothesized that patients receiving advanced treatments would report lower psychological symptoms, including depression and anxiety, along with physical symptoms compared to those receiving chemotherapy after eight months into treatment. Studied were 211 patients with NSCLC treated at the Ohio State University Comprehensive Cancer Center (OSUCCC). Descriptively, the majority were Caucasian (93%), male (58%), and middle-aged (M=63 years). Patients completed the PHQ-9, GAD-7, and a physical symptom questionnaire at enrollment and 8 months later. Patients received chemotherapy (n= 36, 17%), immunotherapy (n= 42, 20%), targeted therapy (n=33), immunotherapy plus chemotherapy (n= 62, 29%). No treatment or unknown treatment received outside of the CCC occurred for (n= 38, 18%). Linear mixed models tested treatment group as a predictor of depression symptoms, anxiety symptoms, and physical symptoms from baseline to 8 months, controlling for baseline levels. Covariates were age, gender, education level, employment status, and income. Results showed that gender and time were significant predictors of depression symptoms in the model. Males reported more depressive symptoms compared to females, and overall depression decreased over the 8-month follow-up period. Age and time were significant predictors of anxiety symptoms in the model. Those that were younger reported more symptoms of anxiety, but overall anxiety decreased over the 8-month follow-up period. Employment and income level were significant predictors of physical symptoms in the model. Those that were unemployed reported more physical symptoms, along with individuals earning a household income < $15,000 - $50,000. The trajectories of depression symptoms, anxiety symptoms, and physical symptoms were different for the treatment groups over time. Age, gender, and employment were also significant predictors of the outcomes. In the clinical setting, all patients with advanced lung cancer should be provided with resources for psychological and physical support. Future studies should examine the impact of treatment type on further psychological and behavioral outcomes such as cancer-specific stress, self-care, and adherence behaviors.