STRESS-LUNG Trial Shows Psychological Distress is Prevalent, Impacts Treatment Efficacy in Patients With SCLC

More than half of patients with newly diagnosed small cell lung cancer (SCLC) experienced psychological distress, which affected treatment efficacy, according to findings from the STRESS-LUNG clinical trial.

The prospective, observational cohort study evaluated psychological distress hormone levels, including serum cortisol and adrenocorticotropic hormone, in 97 patients who had received chemotherapy or immunotherapy as first-line treatment. The objective response rate (ORR) and median progression-free survival (PFS) outcomes were also examined.

A team of researchers from China presented their findings during the 2024 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois.

“Despite advancements, treating SCLC remains challenging, necessitating improved strategies. Prior research indicates that psychological distress can impact cancer treatment efficacy, with severe psychological distress correlating with poorer prognosis,” the researchers said.

They measured psychological distress using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) scales. Through a series of questions, the PHQ-9 ranks a patient’s mental health status as minimal depression (score 1-4) to severe depression (score 20-27), while the GAD-7 uses 7 items to measure worry and anxiety symptoms in patients. Both are self-reported.

Patients included in the study were a median age of 61.5 years old and had extensive-stage (72.1%) or limited-stage SCLC (27.8%).

The study showed that 53 patients (54%) had psychological distress as well as elevated serum cortisol levels (P<.001). Moreover, a significantly lower ORR was observed by the researchers in patients who had experienced psychological distress (50.9%) compared with patients who didn’t show distress (72.7%).

Psychological distress was also associated with a shorter median PFS compared with no distress (8.4 vs 19.4 months; P = .004).

Similar to what previous clinical trials have shown, this study also found that higher serum cortisol concentration (P=.011) was associated with a poorer response to SCLC treatment with chemotherapy and immunotherapy.

“Psychological distress is prevalent among patients with SCLC. Our investigation has uncovered a potential mechanism involving neuroendocrine hormone resistance to treatment modalities,” the researchers said.

Reference

Wu F, Wang S, Zeng Y, et al. Association between psychological distress and treatment efficacy in patients with newly diagnosed SCLC. Abstract #12107. Presented at the 2024 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2024, Chicago, Illinois.