Premium
Mental state as a possible independent prognostic variable for survival in patients with advanced lung carcinoma
Author(s) -
Nakahara Yasuharu,
Mochizuki Yoshiro,
Miyamoto Yoshihiro,
Tanaka Akira,
Kawamura Tetsuji,
Sasaki Shin,
Nakahara Yukiko,
Katsura Yoshitaka
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10608
Subject(s) - medicine , prospective cohort study , stage (stratigraphy) , proportional hazards model , carcinoma , lung cancer , percentile , lung , oncology , gastroenterology , paleontology , statistics , mathematics , biology
BACKGROUND Although psychologic factors have been reported to influence the progression of cancer, this theory remains controversial. A prospective study of patients with advanced lung carcinoma was performed to explore the influence of the patient's mental state on survival. METHODS The patient's mental state was assessed with the Tokyo University Egogram. In a preliminary study, the egograms of long‐term survivors (survival > 3 years) with TNM Stage IIIB or Stage IV lung carcinoma were compared with the egograms of consecutive, newly diagnosed lung carcinoma patients (controls). Next, in a prospective study, 123 patients with nonsmall cell lung carcinoma and 56 patients with small cell lung carcinoma (Stage IIIB or Stage IV; Eastern Cooperative Oncology Group performance status of 0 or 1) completed the egogram. Based on the results of the preliminary study, the subjects in the prospective study were divided into Group A (Free Child [FC] ≥ 50th percentile and Adapted Child [AC] < 50th percentile) and Group B (FC < 50 percentile or AC ≥ 50 percentile). The survival of the two groups was compared. The Cox proportional hazards model was used to determine the joint effect of the patient's mental state and other prognostic factors. RESULTS In the preliminary study, the FC score of the long‐term survivors was significantly higher and the AC score was significantly lower than those of the controls. In the prospective study, the survival of Group A was significantly longer than that of Group B both in the nonsmall cell lung carcinoma and small cell lung carcinoma patients ( P = 0.002 and P = 0.005, respectively, by the log‐rank test). Multivariate analysis demonstrated that after adjustment for clinical factors, being in Group A was a significant predictor of survival both in the nonsmall cell and small cell lung carcinoma patients. CONCLUSIONS The results of the current study demonstrate that the mental state of the patient as assessed by the egogram may have prognostic significance in patients with advanced lung carcinoma. Cancer 2002;94:3006–15. © 2002 American Cancer Society. DOI 10.1002/cncr.10608