The Close Link between Anxiety and Cluster Symptoms in Lung Cancer Patients during First-Line Chemotherapy

Background: Lung cancer (LC) patients report simultaneous incidence of physical and psychosocial symptoms defined cluster symptoms (CS). As among chemotherapy induced nausea and vomiting (CINV) predictors, anxiety is a modifiable factor. The aim of this study was to investigate the link between anxiety development and CS in stage IV LC patients during first-line chemotherapy. Methods: This is an additional analysis using data from previously published WALCE survey. Several items (anxiety, lack of self-confidence, fatigue, lack of appetite, pain, somnolence, dyspnea, general status, lack of trust in treatments) were investigated at four timepoints (T0-T3) using a Numerical Rating Scale. Factor analyses were run and factor scores included (together with sex, age class and chemotherapy scheme) in multivariate logistic ordinal models at each time points in order to evaluate risk factors for anxiety. Results: Factor analyses showed two latent factors composed by the same items at each evaluation: physical CS (fatigue, somnolence, dyspnea, lack of self-confidence) and psychological CS (lack of trust in treatments, general status, lack of appetite). Physical CS was associated with an increased pre-chemotherapy anxiety risk, while during chemotherapy, both physical and psychological CS seemed to exert an influence on anxiety development. Conclusions: A close link between anxiety and CS in LC patients is evident. More attention should be paid to the detection of CS and anxiety in LC patients during first-line chemotherapy, in order to early detect high-risk patients and implement preventive actions.