Kemoterapi uygulanan akciğer kanserli hastalarda tedaviye yanıtın, yan etkilerin, yaşam kalitesinin ve yaşam süresinin değerlendirilmesi
Evaluation of treatment response, side effects, quality of life and survival in lung cancer patients who were given chemotherapy
Yazar: BURCU ÖZLEN
Danışman: PROF. OSMAN NURİ HATİPOĞLU
Trakya Üniversitesi / Tıp Fakültesi / Göğüs Hastalıkları ve Tüberküloz Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2007
Konu: Göğüs Hastalıkları = Chest Diseases

Özet:
Akciğer kanseri Dünya'da ve Türkiye'de en sık görülen kanser türlerinden biri olup mortalitesi çok yüksektir. Tanı ve tedavisindeki tüm gelişmelere rağmen sağkalımda çok fazla artış saptanamamıştır. Bu çalışmanın amacı kemoterapi uygulanan akciğer kanserli hastalarda tedaviye yanıtın, yan etkilerin, yaşam kalitesinin ve yaşam süresinin değerlendirilmesi ve hasta ve kanser cevabı arasındaki ilişkiyi ortaya koymaktır.Mart 2004-Eylül 2006 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Kliniğinde akciğer kanseri tanısı alan ve kemoterapi endikasyonu olan 166 hasta çalışmaya alındı. Çalışma prospektif gözlem çalışması olarak planlandı. Hastaların tedavi yanıtı, kemoterapi sonrası oluşan yan etkileri ve sağkalım süreleri gözlendi. Yaşam kaliteleri her kür öncesi Akciğer Kanseri Semptom Skalası ile değerlendirildi.Küçük hücreli dışı akciğer kanserinde ortalama yaşam süresi 315.6 ± 25.1, küçük hücreli akciğer kanserinde 414.8 ± 58.8 gün olarak bulundu (p>0.05). Küçük hücreli dışı akciğer kanserinde evre 3A'da sağkalımın (633.5 ± 102.8 gün) evre 3B (280.2 ± 34.6 gün) ve evre 4'e (283.9 ± 28.7 gün) göre anlamlı olarak daha iyi olduğu, küçük hücreli akciğer kanserinde sınırlı hastalıkta (550.9 ± 117.1 gün) yaygın hastalığa (322.2 ± 46.1 gün) göre sağkalımın anlamlı daha iyi olduğu saptandı (p<0.05).Tam veya kısmi yanıt oranı küçük hücreli akciğer kanserinde %46.3, küçük hücreli dışı akciğer kanserinde %26.4 olarak bulundu (p<0.05). Progresif hastalık görülme oranı ise küçük hücreli akciğer kanserinde %22 iken, küçük hücreli dışı akciğer kanserinde %46.4 idi (p<0.05).Tam yanıtı olan hastalarda ortalama yaşam süresi 421.5 ± 268.3 iken progresif hastalığı olanlarda 254.6 ± 195.7 gün olarak bulunmuştur (p<0.05).Küçük hücreli dışı akciğer kanserinde ortalama bazal yaşam kalitesi skoru 29.03 ± 19.72 iken küçük hücreli akciğer kanserinde 30.73 ± 22.66 idi (p>0.05)Düşük Karnofsky Performans skoru olanlarda ve ileri evre hastalarda yaşam kalitesi skorları daha kötü idi. Küçük hücreli dışı akciğer kanserinde kemoterapinin yaşam kalitesi üzerine olumlu bir etkisi gösterilemedi. Küçük hücreli akciğer kanserinde ise kemoterapinin yaşam kalitesi üzerine olumlu etkisinin olduğu ve özellikle 2. kür kemoterapi sonrası yaşam kalitesinde iyileşmeler ortaya çıktığı saptandı.Alopesi, halsizlik, bulantı-kusma, konstipasyon en sık görülen yan etkilerdi. Düşük hemoglobin ve albumin değeri, yüksek alkalen fosfotaz değeri, düşük performans durumu ve yaşam kalitesi sağkalımı olumsuz etkileyen prognostik faktörler olarak saptandı.Küçük hücreli dışı akciğer kanseri tanısıyla ?4 kür kemoterapi alan hastalarda ortalama yaşam süresi (394.2 ± 55.0) >4 kür alanlarla (397.5 ± 41.4) benzerdi (p>0.05).Tam yanıtı olan hastaların yaşam sürelerinin %10'nu hastanede geçirdiği saptanırken, progresif hastalığı olanların yaşam sürelerinin %20'sini hastanede geçirdikleri saptandı (p<0.001).Sonuç olarak bu çalışma küçük hücreli dışı akciğer kanserinde kemoterapinin yaşam kalitesine olumlu etkisinin olmadığını, küçük hücreli akciğer kanserinde ise kemoterapinin yaşam kalitesi üzerine olumlu etkisinin olduğunu, yaşam kalitesinin sağkalımı etkileyen prognostik faktörlerden biri olduğunu, Karnofsky Performans skorunun Akciğer Kanseri Semptom Skalası ile çok yakın ilişkili olduğunu ve küçük hücreli dışı akciğer kanserinde 4 kürden fazla verilen kemoterapinin yaşam süresi üzerine olumlu etkisinin olmadığını, kanserin evresinin ve kanserin kemoterapiye yanıtının yaşam süresi ile yakından ilişkili olduğunu göstermiştir.Anahtar Kelimeler: Akciğer kanseri, yaşam kalitesi, yaşam süresi

Abstract:
Lung cancer is the most common cancer in the world and Turkey and has a high mortality rate. In spite of developments in the diagnosis and treatment of lung cancer, survival stay unchanged. The aim of this study was to evaluate the treatment response, side effects, quality of life and survival in lung cancer patients and establish the relationship between patient and cancer response.166 lung cancer patients who were given chemotherapy in Trakya University Chest Department between March 2004-September 2006 were enrolled into the study. This study designed as prospective observational study. Patients? treatment response, side effects after chemotherapy and survival time were observed. Quality of life were analyzed with Lung Cancer Symptom Scale before each course.Average survival time was 315.6 ± 25.1 days in non small cell lung cancer, 414.8 ± 58.8 days in small cell lung cancer (p>0.05). A highly significant better survival was observed in stage 3A patients (633.5 ± 102.8 days) compared with stage 3B (280.2 ± 34.6 days) and stage 4 (283.9 ± 28.7 days) in non-small cell lung cancer and in limited disease of small cell lung cancer (550.9 ± 117.1 days) compared with common disease (322.2 ± 46.1 days) (p<0.05).Complete or partial response was shown in 46.3% of small cell lung cancer patients and 26.4% of non small cell lung cancer patients (p<0.05). Progressive disease was shown in 22% of small cell lung cancer patients and 46.4% of non small cell lung cancer patients (p<0.05).We found the avarage survival time 421.5 ± 268.3 days in patients with complete response and 254.6 ± 195.7 days in patients with progressive disease (p<0.05).In non small cell lung cancer avarage basal quality of life score was 29.03 ± 19.72, and 30.73 ± 22.66 in small cell lung cancer (p>0.05).A worse quality of life scores determined in patients with low Karnofsky Performance status and advanced disease. We could not demonstrate the improvement in quality of life with chemotherapy in non-small cell lung cancer. But in small cell lung cancer significant improvement in quality of life was shown especially after second course chemotherapy.Common side effects of chemotherapy were alopecia, asthenia, nausea-vomiting and constipation. Low levels of hemoglobin and albumin, high levels of alkalen phosphatase, poor performance status and quality of life scores were determined as prognostic factors on survival.Avarage survival time was same in patients who were given ?4 (394.2 ± 55.0) and >4 (397.5 ± 41.4) course chemotherapy in non small cell lung cancer (p>0.05).Patients with complete response stayed in hospital 10% of their survival time while patients with progressive disease stayed in hospital 20% (p<0.001)As a conclusion, we showed that chemotherapy didn?t improve the quality of life in non-small cell lung cancer, but improved in small cell lung cancer and quality of life was found as one of the prognostic factors that effects survival. Also we showed that Karnofsky performance status had a close relationship between Lung Cancer Symtom Scale, >4 course chemotherapy didn?t improve survival in non small cell lung cancer, cancer stage and cancer response of chemotherapy had a close relationship between survival.Key words: Lung cancer, quality of life, survival timeLung cancer is the most common cancer in the world and Turkey and has a high mortality rate. In spite of developments in the diagnosis and treatment of lung cancer, survival stay unchanged. The aim of this study was to evaluate the treatment response, side effects, quality of life and survival in lung cancer patients and establish the relationship between patient and cancer response.166 lung cancer patients who were given chemotherapy in Trakya University Chest Department between March 2004-September 2006 were enrolled into the study. This study designed as prospective observational study. Patients? treatment response, side effects after chemotherapy and survival time were observed. Quality of life were analyzed with Lung Cancer Symptom Scale before each course.Average survival time was 315.6 ± 25.1 days in non small cell lung cancer, 414.8 ± 58.8 days in small cell lung cancer (p>0.05). A highly significant better survival was observed in stage 3A patients (633.5 ± 102.8 days) compared with stage 3B (280.2 ± 34.6 days) and stage 4 (283.9 ± 28.7 days) in non-small cell lung cancer and in limited disease of small cell lung cancer (550.9 ± 117.1 days) compared with common disease (322.2 ± 46.1 days) (p<0.05).Complete or partial response was shown in 46.3% of small cell lung cancer patients and 26.4% of non small cell lung cancer patients (p<0.05). Progressive disease was shown in 22% of small cell lung cancer patients and 46.4% of non small cell lung cancer patients (p<0.05).We found the avarage survival time 421.5 ± 268.3 days in patients with complete response and 254.6 ± 195.7 days in patients with progressive disease (p<0.05).In non small cell lung cancer avarage basal quality of life score was 29.03 ± 19.72, and 30.73 ± 22.66 in small cell lung cancer (p>0.05).A worse quality of life scores determined in patients with low Karnofsky Performance status and advanced disease. We could not demonstrate the improvement in quality of life with chemotherapy in non-small cell lung cancer. But in small cell lung cancer significant improvement in quality of life was shown especially after second course chemotherapy.Common side effects of chemotherapy were alopecia, asthenia, nausea-vomiting and constipation. Low levels of hemoglobin and albumin, high levels of alkalen phosphatase, poor performance status and quality of life scores were determined as prognostic factors on survival.Avarage survival time was same in patients who were given ?4 (394.2 ± 55.0) and >4 (397.5 ± 41.4) course chemotherapy in non small cell lung cancer (p>0.05).Patients with complete response stayed in hospital 10% of their survival time while patients with progressive disease stayed in hospital 20% (p<0.001)As a conclusion, we showed that chemotherapy didn?t improve the quality of life in non-small cell lung cancer, but improved in small cell lung cancer and quality of life was found as one of the prognostic factors that effects survival. Also we showed that Karnofsky performance status had a close relationship between Lung Cancer Symtom Scale, >4 course chemotherapy didn?t improve survival in non small cell lung cancer, cancer stage and cancer response of chemotherapy had a close relationship between survival.Key words: Lung cancer, quality of life, survival time