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Christine Weldon

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    MA19 - Looking at PROs in Greater Detail - What Patients Actually Want and Expect (ID 147)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA19.01 - Empirical Identification of Distress Clusters in Lung Cancer Patients (Now Available) (ID 2085)

      11:30 - 13:00  |  Author(s): Christine Weldon

      • Abstract
      • Presentation
      • Slides


      Screening for distress from the time of diagnosis is emerging as standard cancer care. Although there is heterogeneity in patients’ experience of distress, identification of subgroups of patients with unique distress profiles may inform interventions for distressed patients. Accordingly, we aimed to identify unique subgroups of patients based on their distress screening responses from a large sample of newly diagnosed lung cancer patients across two urban academic medical centers in Chicago, IL.


      Lung cancer patients (N=596) were screened for distress at their diagnostic visit between (2/22/16 – 8/14/18) with the Coleman Foundation “Patient Screening Questions for Supportive Care” tool; a 34-item screener that identifies patient needs across psychological, physical, family/caregiver, and treatment and care concerns. A Two-Step cluster analysis was conducted to identify natural clusters of patients based on similar responses to distress screening items.


      Cluster analysis results revealed a two-cluster outcome: “High Distress” (N=332) and “Low Distress” (N=264). The items that best distinguished High Distress patients from Low Distress patients were concerns about cancer stage/diagnosis, concerns about prognosis/long-term outcome, concerns about treatment options, and having higher average number of total concerns. Cancer stage at screening was not predictive of cluster membership. Demographic characteristics, descriptive statistics, and group difference tests for survey items by cluster and for the total sample are presented in Table 1.


      More than half of lung cancer patients were grouped as experiencing high distress on screening. While cancer stage was not predictive of high distress grouping, concerns about stage, treatment, and prognosis were most predictive of high distress cluster membership. An intervention to improve communication between providers and patients about these concerns may reduce distress.

      Table 1

      High Distress (N=332/55.7%)

      Low Distress (N=264/ 44.3%)

      Total Sample (N=596)





      M=65.75 (SD=9.95)

      M=66.25 (SD=9.71)

      M=65.97 (SD=9.84)

      F=.39 (p>.05)


      N=171 (51.5%)

      N=144 (54.5%)

      N=315 (52.9%)

      χ2=.55 (p>.05)


      χ2=30.83 (p<.01)


      N=124 (37.3%)

      N=154 (58.3%)

      N=278 (46.6%)


      African American

      N=161 (48.5%)

      N=72 (27.3%)

      N=233 (39.1%)



      N=47 (14.2%)

      N=38 (14.4%)

      N=85 (14.3%)


      Stage IV

      N=160 (48.2%)

      N=118 (44.7%)

      N=278 (46.6%)

      χ2=.72 (p>.05)

      Physical & Psychological Health

      Psychological Distress (PhQ-4)

      M=3.55 (SD=3.63)

      M=1.56 (SD=2.14)

      M=2.67 (SD=3.29)

      F=58.86 (p<.01)


      M=5.13 (SD=4.76)

      M=4.76 (SD=3.45)

      M=4.99 (SD=3.66)

      F=1.04 (p>.05)


      M=8.56 (SD=5.31)

      M=7.63 (SD=4.74)

      M=8.15 (SD=5.01)

      F=4.34 (p<.05)

      Physical Activity

      M=12.63 (SD=7.74)

      M=16.70 (SD=8.52)

      M=14.42 (SD=8.33)

      F=35.55 (p<.01)


      Practical Concerns


      N=8 (2.5%)

      N=2 (.8%)

      N=10 (1.7%)

      χ2=2.43 (p>.05)

      Food & Housing

      N=58 (17.8%)

      N=13 (5.0%)

      N=71 (12.2%)

      χ2=22.06 (p<.01)


      N=72 (22.0%)

      N=14 (5.4%)

      N=86 (14.7%)

      χ2=31.29 (p<.01)


      N=19 (5.9%)

      N=8 (3.1%)

      N=27 (4.7%)

      χ2=2.49 (p>.05)

      Paying for Medication

      N=79 (24.1%)

      N=35 (13.6%)

      N=114 (19.5%)

      χ2=10.19 (p<.01)

      Family/Caregiver Concerns


      N=46 (18.7%)

      N=18 (8.0%)

      N=64 (13.6%)

      χ2=11.58 (p<.01)


      N=51 (20.9%)

      N=24 (10.6%)

      N=75 (15.9%)

      χ2=9.37 (p<.01)


      N=23 (9.5%)

      N=8 (3.5%)

      N=31 (6.6%)

      χ2=6.91 (p<.01)

      Ability to have children

      N=8 (3.3%)

      N=2 (.9%)

      N=10 (2.1%)

      χ2=3.35 (p>.05)


      N=62 (25.6%)

      N=24 (10.5%)

      N=86 (N=18.3%)

      χ2=18.07 (p<.01)

      Treatment & Care Concerns

      Cancer Diagnosis & Stage

      N=303 (93.5%)

      N=8 (3.3%)

      N=311 (55.1%)


      Prognosis & Long-term Outcome

      N=312 (95.7%)

      N=37 (15.4%)

      N=349 (61.6%)

      χ2=378.04 (p<.01)

      Treatment Options

      N=246 (75.7%)

      N=11 (4.6%)

      N=257 (45.4%)

      χ2=282.43 (p<.01)

      Communicating treatment wishes

      N=165 (52.1%)

      N=7 (2.9%)

      N=172 (30.8%)

      χ2=155.09 (p<.01)

      Physical Health Concerns


      N=160 (64.3%)

      N=78 (35.5%)

      N=238 (50.7%)

      χ2=38.77 (p<.01)


      N=86 (43.4%)

      N=41 (20.0%)

      N=127 (31.5%)

      χ2=25.63 (p<.01)


      N=47 (27.0%)

      N=17 (8.5%)

      N=64 (17.1%)

      χ2=22.68 (p<.01)


      N=22 (13.3%)

      N=4 (2.1%)

      N=26 (7.2%)

      χ2=16.72 (p<.01)


      N=66 (33.7%)

      N=16 (8.1%)

      N=82 (20.8%)

      χ2=39.15 (p<.01)


      N=137 (59.3%)

      N=58 (27.4%)

      N=195 (44.0%)

      χ2=45.79 (p<.01)


      N=46 (26.1%)

      N=12 (6.0%)

      N=58 (15.5%)

      χ2=28.79 (p<.01)


      N=49 (27.1%)

      N=18 (9.1%)

      N=67 (17.7%)

      χ2=21.01 (p<.01)

      Mouth Sores

      N=24 (14.5%)

      N=13 (6.6%)

      N=37 (10.2%)

      χ2=6.18 (p<.05)

      Dry Mouth

      N=116 (53.2%)

      N=51 (24.5%)

      N=167 (39.2%)

      χ2=36.76 (p<.01)

      Swollen Arms or Legs

      N=76 (39.6%)

      N=21 (10.5%)

      N=97 (24.7%)

      χ2=44.49 (p<.01)

      Feeling full quickly or swollen abdomen

      N=57 (32.0%)

      N=18 (9.2%)

      N=75 (20.1%)

      χ2=30.35 (p<.01)

      Sexual Intimacy or Functioning

      N=54 (28.3%)

      N=17 (8.4%)

      N=71 (18.0%)

      χ2=23.37 (p<.01)

      Dry/Itchy or Blistered Skin

      N=94 (46.3%)

      N=43 (20.7%)

      N=137 (33.3%)

      χ2=30.37 (p<.01)

      Tingling in hands/feet

      N=84 (43.5%)

      N=33 (16.8%)

      N=117 (30.1%)

      χ2=32.93 (p<.01)


      N=31 (19.35)

      N=14 (7.2%)

      N=45 (12.7%)

      χ2=11.52 (p<.01)

      Use of Alcohol or Drugs

      N=3 (2.0%)

      N=1 (.5%)

      N=4 (1.2%)

      χ2=1.59 (p>.05)

      Total # of Concerns

      M=7.84 (SD=3.71)

      M=2.53 (SD=2.47)


      F=400.82 (p<.01)

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    P2.10 - Prevention and Tobacco Control (ID 176)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Prevention and Tobacco Control
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.10-08 - Association Between Smoking and Anxiety/Depression in Respiratory Tract Cancers (Now Available) (ID 1803)

      10:15 - 18:15  |  Author(s): Christine Weldon

      • Abstract
      • Slides


      Several studies have shown that depression can reduce patients’ immune and endocrine functions. The prevalence of depression and anxiety is the highest among respiratory tract cancers, which in turn has a negative impact on treatment outcomes. Interestingly, patients with lung cancer have the highest rates of depression when compared to those with other types of cancers. We believe one possible reason for this is that they may suffer from the stigma that lung cancer is self-induced by smoking. Society has shifted perspectives greatly on how smoking is viewed. From widely disseminated anti-smoking ads to increased political campaigns and regulations to ban smoking in public spaces, lung cancer has now become almost synonymous with a disease of smoking. In this study, we analyzed the association between PHQ-4 scores and smoking status in lung and head and neck cancer patients.


      Medical records for 395 lung and head and neck cancer patients (never smokers=83, former smokers=142, and current smokers=170) at University of Illinois Hospital were assessed using the validated Patient Health Questionnaire (PHQ-4) scale, a four-item health questionnaire that measures anxiety and depression. Patient data from the two-year time May 2016 to Aug 2018 was matched for important demographics like age, race, sex, and cancer diagnosis.Multivariate analyses examined correlations between PHQ-4 score, smoking status (based on CDC definitions), and other characteristics including: insurance, pain level, fatigue level, level of physical concern, level of physical activity,


      Being a current smoker demonstrated a very strong correlation with elevated anxiety and depression levels (p = 0.0003), while being a former smoker did not have the same effect. Insurance also had a significant positive correlation, with Medicaid patients having the highest average PHQ-4 score (p = 0.02). As expected, pain, fatigue, physical concerns, and physical activity scores were also highly correlated with depression and anxiety with p < 0.0001 for all of these measures. A multivariate model adjusting for the most salient patient parameters affecting PHQ-4 distress scores was generated and found that being a smoker had a significant increase on PHQ-4 score of on average 0.84 points over non-smokers (p = 0.03). In this model, pain, fatigue, and physical concerns also had increases of 0.14, 0.22, and 0.25 respectively in PHQ-4 scores (p = 0.0046, p < 0.0001, and p < 0.0001).


      Our findings show that there is a correlation between smoking status, and PHQ-4 scores in lung and head and neck cancer patients. Distress and anxiety can interfere with a patient’s ability to effectively cope with cancer, its physical symptoms, and its treatment. Thus, screening for anxiety and depression, identifying it, and referring patients to smoking cessation clinics and other supportive services is an integral part of cancer treatment. Since lung and head and neck cancers are associated with smoking, patients feel that their smoking is the culprit of the disease, and this in turn can lead to self-inflicted stigma. We are currently investigating whether higher PHQ-4 scores in lung and head and neck cancer patients are correlated with higher levels of perceived cancer-related stigma.

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