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Although treatment options for lung cancer have improved, treatment outcome remains poor. The disease burden may interfere with patients’ well-being. Our objective was to prospectively evaluate lung cancer-specific quality of life (QoL) in patients with lung cancer treated with radiotherapy (RT).

At our department, all patients treated for lung cancer are included in a prospective data registration program. This program prospectively evaluates patient, tumor, treatment, and outcome characteristics at baseline, during RT, and at 3 months, 6 months, 1 year, and yearly thereafter. For the current study, we selected patients treated with (non-stereotactic) (chemo)radiotherapy (≥40 Gy) for (N)SCLC. QoL was evaluated using the radiotherapy-related questions of the lung cancer module of the EORTC Core lung cancer specific QoL Questionnaire (EORTC QLQ-LC13). The 4-point scale ranging from 1 (“not at all”) to 4 (“very much”) was dichotomized for the analyses. QoL scores upon baseline were compared with QoL scores upon the aforementioned follow-up time points. 

From 2013 to 2018, 692 patients were included in this program. Compliance for QoL assessments at baseline was 99%. At 12, 24, 48, and 60 months after RT, the compliance rates of eligible, surviving patients were 94%, 90%, 85, and 69%, respectively. Mean age at diagnosis was 67±10 SD years, 58% was male, and 16% had SCLC. WHO performance score was ≥2 in 16%. Most patients (69%) had stage III disease. The majority of patients received 60 Gy (75%) in 25 fractions (84%). Fifteen percent of patients received concurrent chemoradiotherapy, 61% received induction chemotherapy and concurrent chemoradiotherapy.

At the end of RT, 24% of the patients reported moderate-to-severe swallowing problems, compared with 2% at baseline (P<0.001). Additionally, 12% reported to have moderate-to-severe chest pains at the end of RT, compared with 4% at baseline (P<0.001) (Figure 1). At 3 months of follow-up, these problems had recovered.

At baseline, 16%, 9%, and 25% of patients reported problems with coughing, shortness of breath (SOB) when walking or SOB when climbing stairs, respectively. These percentages significantly increased to a maximum of 27%, 17%, and 38% and persisted significantly up to 2 years after treatment (P<0.001, P<0.001, and P<0.001, respectively)

At baseline, 1% reported hemoptysis, 1% had SOB in rest, and 5% had arm or shoulder pain. These complaints did not increase significantly during follow-up, except for arm or shoulder pain that was reported more often (increase from 5% to 8%; P<0.05) at 1 year of follow-up.

After modern photon-based radiotherapy for lung cancer, patients experienced a short-term increase of problems with swallowing and chest pain. Long-term complaints of coughing, shortness of breath during walking or climbing stairs persisted up to 2 years after treatment.