•  
  •  
 

Abstract

Background: Lung cancer presents a significant global health challenge, with its incidence and mortality rates remaining high. This study aimed to investigate survival rates and factors contributing to mortality among lung cancer patients in rural northeastern Thailand.

Methods: A prospective cohort study was conducted at Roi Et Hospital in rural northeastern Thailand. The study included 130 newly diagnosed lung cancer patients between March 1, 2015, and October 31, 2017. All participants were interviewed and followed up for vital status until death or the end of the study on December 31, 2019. Data analysis was performed using descriptive statistics, Kaplan–Meier survival analysis, and Cox proportional hazards regression models.

Results: Over 1,462 person-months of follow-up, 113 participants died (86%, 95% CI: 79.86-91.77), yielding an incidence rate of 7.73 deaths per person-month (95% CI: 6.37–9.29). The overall median survival time was 5.07 months (95% CI: 1.60-19.30), with survival rates at 3, 6 months, and 1, 2, and 3 years of 72.31%, 46.15%, 36.02%, 19.13%, and 11.33%, respectively. Multivariate analysis using a Cox proportional hazards regression model identified local invasion (Adjusted Hazard Ratio [AHR] = 1.70; 95% CI: 1.13–2.55) and chemotherapy (AHR = 1.56; 95% CI: 1.01–2.40) as factors associated with higher mortality rates after adjustment for covariates.

Conclusion: The findings emphasize the critical need for intensive palliative care interventions and quality-of-life enhancements from the early stages of diagnosis and treatment for lung cancer patients, ensuring comprehensive and optimal end-of-life care.


References

[1] Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74(3): 229-63. https://doi.org/10.3322/caac.21834.

[2] Li Y, Yan B, He S. Advances and challenges in the treatment of lung cancer. Biomed Pharmacother 2023;169:115891. https://doi.org/10.1016/j.biopha.2023.115891.

[3] de Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl Lung Cancer Res 2018;7(3): 220-33. https://doi.org/10.21037/tlcr.2018.05.06.

[4] Phunmanee A, Wirasorn K, Thavornpitak Y, Sookprasert A, Chindaprasirt J. Lung cancer in hospitalized patients of Thailand. J Med Assoc Thai 2012;95(Suppl 7):S201-5. PMID: 23130455.

[5] Thandra KC, Barsouk A, Saginala K, Aluru JS, Barsouk A. Epidemiology of lung cancer. Contemp Oncol (Pozn) 2021; 25(1):45-52. https://doi.org/10.5114/wo.2021.103829.

[6] Barta JA, Powell CA, Wisnivesky JP. Global epidemiology of Lung Cancer. Ann Glob Health 2019;85(1):8. https://doi.org/ 10.5334/aogh.2419.

[7] Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Respir J 2016; 48(3):889-902. https://doi.org/10.1183/13993003.00359-2016.

[8] Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-86. https://doi.org/10.1002/ijc. 29210.

[9] Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016;66(2): 115-32. https://doi.org/10.3322/caac.21338.

[10] Virani S, Bilheem S, Chansaard W, Chitapanarux I, Daoprasert K, Khuanchana S, et al. National and subnational population-based incidence of cancer in Thailand: assessing cancers with the highest burdens. Cancers (Basel) 2017;9(8): 108. https://doi.org/10.3390/cancers9080108.

[11] Insamran W, Sangrajrang S. National cancer control program of Thailand. Asian Pac J Cancer Prev 2020;21(3):577-82. https://doi.org/10.31557/APJCP.2020.21.3.577.

[12] Sriplung H, Wiangnon S, Sontipong S, Sumitsawan Y, Martin N. Cancer incidence trends in Thailand, 1989-2000. Asian Pac J Cancer Prev 2006;7(2):239-44. PMID: 16839216.

[13] Musika W, Kamsa-Ard S, Jirapornkul C, Santong C, Phunmanee A. Lung cancer survival with current therapies and new targeted treatments: a comprehensive update from the Srinagarind hospital-based cancer registry from (2013 to 2017). Asian Pac J Cancer Prev 2021;22(8):2501-7. https://doi. org/10.31557/APJCP.2021.22.8.2501.

[14] Rajer M, Zwitter M, Rajer B. Pollution in the working place and social status: co-factors in lung cancer carcinogenesis. Lung Cancer 2014;85:346-50. https://doi.org/10.1016/j.lungcan.2014.06.012.

[15] Hidayat K, Du X, Chen G, Shi M, Shi B. Abdominal obesity and lung cancer risk: systematic review and meta-analysis of prospective studies. Nutrients 2016;15:810. https://doi.org/10. 3390/nu8120810.

[16] Droste JH, Weyler JJ, Van Meerbeeck JP, Vermeire PA, van Sprundel MP. Occupational risk factors of lung cancer: a hospital based case-control study. Occup Environ Med 1999; 56:322-7. https://doi.org/10.1136/oem.56.5.322.

[17] Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two casecontrol studies. BMJ 2000;321:323-9. https://doi.org/10.1136/ bmj.321.7257.323.

[18] Stellman SD, Takezaki T, Wang L, Chen Y, Citron ML, Djordjevic MV, et al. Smoking and lung cancer risk in American and Japanese men: an international case-control study. Cancer Epidemiol Biomarkers Prev 2001;10:1193-9. PMID: 11700268.

[19] Tang N, Wu Y,MaJ, WangB,YuR.Coffee consumption and risk of lung cancer: a meta-analysis. Lung Cancer 2010;67: 17-22. https://doi.org/10.1016/j.lungcan.2009.03.012.

[20] Xie Y, Qin J, Nan G, Huang S, Wang Z, Su Y. Coffee consumption and the risk of lung cancer: an updated meta analysis of epidemiological studies. Eur J Clin Nutr 2016;70: 199-206. https://doi.org/10.1038/ejcn.2015.96.

[21] Wu X, Delclos GL, Annegers JF, Bondy ML, Honn SE, Henry B, et al. A case-control study of wood dust exposure, mutagen sensitivity, and lung cancer risk. Cancer Epidemiol Biomarkers Prev 1995;4:583-8. PMID: 8547823.

[22] Pillow PC, Hursting SD, Duphorne CM, Jiang H, Honn SE, Chang S, et al. Case-control assessment of diet and lung cancer risk in African Americans and Mexican Americans. Nutr Cancer 1997;29:169-73. https://doi.org/10.1080/ 01635589709514620.

[23] Liu C, Cui H, Gu D, Zhang M, Fang Y, Chen S, et al. Genetic polymorphisms and lung cancer risk: evidence from meta analyses and genome-wide association studies. Lung Cancer 2017;113:18-29. https://doi.org/10.1016/j.lungcan.2017.08.026.

[24] Chealong N, Saelim R, Lim A, Sangkhathat S, Bundhamcharoen K, Makka N. Lung cancer mortality pattern in Thailand, 2019. In: 2024 ASU international conference in emerging technologies for sustainability and intelligent systems (ICETSIS). Manama, Bahrain: Curran Associates, Inc. IEEE; 2024. p. 1065-9.

[25] Sriplung H, Sontipong S, Martin N,Wiangnon S, Vootiprux V, Cheirsilpa A, et al. Cancer incidence in Thailand, 1995-1997. Asian Pac J Cancer Prev 2005;6(3):276-81. PMID: 16235986.

[26] Reungwetwattana T, Oranratnachai S, Puataweepong P, Tangsujaritvijit V, Cherntanomwong P. Lung cancer in Thailand. J Thorac Oncol 2020;15(11):1714-21. https://doi. org/10.1016/j.jtho.2020.04.024.

[27] Srisam-Ang K, Podhipak A, Narksawat K, Supaattagorn P, Tipayamongkholgul M. Survival of patients with advanced non-small-cell lung cancer at Ubon Ratchathani Cancer Center, Thailand. Southeast Asian J Trop Med Publ Health 2005;36(4):994-1006. PMID: 16295558.

[28] Freeman LS. Tables of the number of patients required in clinical trials using the logrank test. Stat Med 1982;1:121-9.

[29] Hsieh FY. Comparing sample size formulae for trials with unbalance allocation using the logrank test. Stat Med 1992; 11:179-91.

[30] Schoenfeld DA. Sample-size formula for the proportional hazards model. Biometrics 1983;39:499-503.

[31] Collins LG, Haines C, Perkel R, Enck RE. Lung cancer: diagnosis and management. Am Fam Physician 2007;75(1): 56-63. PMID: 17225705.

[32] Cerri MF, Madeira KP, Coitinho LB, Amorim FG, Victor I, Silva LB. Lung cancer and smoking: molecular aspects. Appl Cancer Res 2012;32(3):80-6.

[33] Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, et al. Ruraleurban disparities in cancer outcomes: opportunities for future research. J Natl Cancer Inst 2022;114(7):940-52. https://doi.org/10.1093/jnci/ djac030.

[34] Bolin JN, Bellamy GR, Ferdinand AO, Vuong AM, Kash BA, Schulze A, et al. Rural healthy people 2020: new decade, same challenges. J Rural Health 2015;31(3):326-33. https:// doi.org/10.1111/jrh.12116.

[35] Hanagiri T, Takenaka M, Oka S, Shigematsu Y, Nagata Y, Shimokawa H, et al. Results of a surgical resection for patients with stage IV non-small-cell lung cancer. Clin Lung Cancer 2012;13:220-4. https://doi.org/10.1016/j.cllc.2011.05. 006.

[36] Kawano D, Takeo S, Katsura M, Tsukamoto S, Masuyama E, Nakaji Y. Surgical treatment of stage IV non-small cell lung cancer. Interact Cardiovasc Thorac Surg 2012;14(2):167-70. https://doi.org/10.1093/icvts/ivr036.

[37] Schneider JL, Rowe JH, Garcia-de-Alba C, Kim CF, Sharpe AH, Haigis MC. The aging lung: physiology, disease, and immunity. Cell 2021;184(8):1990-2019. https://doi.org/ 10.1016/j.cell.2021.03.005.

[38] Pechet TT, Carr SR, Collins JE, Cohn HE, Farber JL. Arterial invasion predicts early mortality in stage I non-small cell lung cancer. Ann Thorac Surg 2004;78(5):1748-53. https:// doi.org/10.1016/j.athoracsur.2004.04.061.

[39] Huang H, Wang T, Hu B, Pan C. Visceral pleural invasion remains a size-independent prognostic factor in stage I non small cell lung cancer. Ann Thorac Surg 2015;99(4):1130-9. https://doi.org/10.1016/j.athoracsur.2014.11.052.

[40] Jiang L, Liang W, Shen J, Chen X, Shi X, He J, et al. The impact of visceral pleural invasion in node-negative non small cell lung cancer: a systematic review and meta-analysis. Chest 2015;148(4):903-11. https://doi.org/10.1378/chest. 14-2765.

[41] Driessen EJM, Schulkes KJG, Dingemans AC, van Loon JGM, Hamaker ME, Aarts MJ, et al. Patterns of treatment and survival among older patients with stage III nonsmall cell lung cancer. Lung Cancer 2018;116:55-61. https:// doi.org/10.1016/j.lungcan.2017.12.013.

[42] Arrieta O, Villarreal-Garza C, Zamora J, Blake-Cerda M, de la Mata MD, Zavala DG, et al. Long-term survival in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation. Radiat Oncol 2011;6:166. https:// doi.org/10.1186/1748-717x-6-166.

[43] Johung KL, Yeh N, Desai NB, Williams TM, Lautenschlaeger T, Arvold ND, et al. Extended survival and prognostic factors for patients with ALK-rearranged non-small-cell lung cancer and brain metastasis. J Clin Oncol 2016;34:123-9. https://doi.org/10.1200/jco.2015.62.0138.

[44] Brown LM, Cooke DT, David EA. Adjuvant chemotherapy does not improve survival for lung cancer with chest wall invasion. Ann Thorac Surg 2017;104(6):1798-804. https://doi. org/10.1016/j.athoracsur.2017.06.070.

[45] Xu Y, Wan B, Zhu S, Zhang T, Xie J, Liu H, et al. Effect of adjuvant chemotherapy on survival of patients with 8th edition stage IB non-small cell lung cancer. Front Oncol 2022;11:784289. https://doi.org/10.3389/fonc.2021. 784289.

Share

COinS