Psychosocial distress in patients with driver-mutant lung cancer.
Authors: Head Lia , Yun Nicole , Basu Sanjib , Rynar Lauren , Feldman Jill Elizabeth , Batus Marta , Bonomi Philip D. , Jelinek Michael J. , Fidler Mary J. 
Published: June 2021

e24125 Background: Project PRIORITY, a collaborative research study between The EGFR Resisters and the LUNGevity Foundation, found that 29% of United States respondents had clinical depression. While tyrosine kinase inhibitors (TKI) prolong lives, the impact of an oncogene driven lung cancer diagnosis on emotional well-being is not well studied nor are resource utilization and potential contributing factors to psychosocial distress. Methods: Our primary objective was to study cancer related distress in patients (pts) with newly diagnosed oncogene driver lung cancer. The secondary objective was to correlate distress with neutrophil to lymphocyte ratio (NLR) and body mass index loss (BMI) as a surrogate for cancer cachexia/precachexia to gauge the relationship to psychosocial distress. We retrospectively reviewed pts treated with TKI between 1/1/2008 and 2/1/2021. Sample size was based on estimates of depression in this population. A diagnosis of depression or anxiety was defined by documentation in the visit problem list, and active symptoms were based on progress note documentation. Depression and anxiety were recorded at 6 time points from diagnosis to progression on TKI, and their associations with treatment toxicities, progression free survival (PFS) and overall survival (OS) were assessed. Association with serial BMI and NLR were assessed using longitudinal statistical models. Results: We studied 78 pts: 71.8% female, 62.8% Caucasian, 15.4% African American, 15.6% Hispanic/LatinX, and 11.5% Asian. 94.9% had an EGFR mutation, and 5.1% had an ALK mutation. Prevalence of depression at diagnosis and progression was 11.5% and 25%, with anxiety prevalence 28.2% and 40.6%, respectively. Of these pts, 22.2% had active depression symptoms and 54.5% had active anxiety symptoms at diagnosis, although symptoms were not addressed in 33.3% and 22.7%, respectively. At progression, 68.8% had active depression symptoms and 46.2% had active anxiety symptoms, but symptoms were not addressed in 6.3% and 26.9%, respectively. At diagnosis and progression, 24.4% and 35.9%, respectively, were on treatment for anxiety and/or depression. Social work and psychology evaluated 12.8% and 10.3% of all pts at diagnosis and 10.9% and 17.2% at progression. NLR > 3.5 and > 5 were not associated with depression or anxiety. A more rapid longitudinal decrease in BMI was associated with depression. Grade ≥3 toxicities were not associated with depression or anxiety. Shorter PFS and OS were associated with higher rates of depression, but not anxiety. Conclusions: In this retrospective study of an ethnically diverse patient group at an academic medical center, we found a prevalence of depression and anxiety consistent with the Project PRIORITY findings. We saw an association between depression and more rapid weight loss but did not see correlation with NLR. Prospective evaluation with accurate documentation is needed to better address these questions in future studies.