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Top Unfulfilled Needs in Lung Cancer Survivors: Financial Struggle and Quality of Life

Among survivors of lung cancer, the most significant unmet needs identified included exacerbated financial toxicity and a decline in quality of life (QOL), as reported in recent findings published online.

The data for this analysis were sourced from the thoracic oncology clinics at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, with the study conducted between December 1, 2020, and September 30, 2021. Subsequent data analysis was performed from May 9 to December 8, 2022. The researchers considered physical, social, emotional, and medical needs in addition to financial toxicity and QOL. To assess the study population (N = 232), the investigators utilized a Mayo Survey Research Center needs survey, the Comprehensive Score for Financial Toxicity (COST) measure, and the European Organization for Research and Treatment of Cancer QLQ-C30 QOL scale.

The median (IQR) age of the patients was 69 (60.5-75.0) years, with 62.1% being women, 71.1% married, and 74.1% self-identifying as White. Furthermore, 14.2% identified as Black, and 11.6% as Other. Patients were eligible if they had survived beyond a year from their cancer diagnosis, regardless of the cancer stage.

The study revealed that decreased QOL and increased financial toxicity were correlated with a higher total of unmet needs (both P < .001). Specifically, a greater number of unmet physical, social, and medical needs were associated with worsened QOL (P = .01), while heightened financial toxicity was linked to increased social needs (P < .001).

In terms of demographics, 80% of participants had private insurance, with or without Medicare, while 57.3% were retired. Moreover, 11.6% experienced a change in employment status post-diagnosis, and 67.2% had an annual household income exceeding $75,000, with 87.1% reporting some college education. The majority of patients had lung adenocarcinoma, stage III/IV disease, and had been diagnosed between 1 to 5 years prior to study participation.

The study’s median EORTC Global Health Status/QOL score was 66.7 (50.0-83.3). Factors such as being unemployed, a current or former smoker, receiving specific treatments, and the timing of therapy administration were associated with lower QOL in univariate analysis. Multivariate analysis further demonstrated that higher total physical, medical, and social needs were independently linked to reduced QOL.

The median overall COST score was 28 (22-34), with various factors such as age, income, employment status, treatment history, and total unmet needs showing associations with increased financial toxicity in univariate analysis.

In the multivariate analysis, independent relationships were observed between financial toxicity and factors such as radiation therapy, total social needs, and income levels.

The authors emphasized the importance of addressing the unmet needs of lung cancer survivors to enhance their QOL and alleviate financial toxicity. They suggested potential interventions, including multidisciplinary financial navigation and cost evaluations for ongoing therapies, to mitigate these challenges.

The study underscored the critical role of addressing unmet needs in improving the well-being of lung cancer survivors, highlighting the significance of tailored interventions based on the identified factors.


  1. Hsu ML, Boulanger MC, Olson S, et al. Unmet needs, quality of life, and financial toxicity among survivors of lung cancer. JAMA Netw Open. Published online April 17, 2024. doi:10.1001/jamanetworkopen.2024.6872
  2. Nekhlyudov L, Mollica MA, Jacobsen PB, Mayer DK, Shulman LN, Geiger AM. Developing a quality of cancer survivorship care framework: implications for clinical care, research, and policy. J Natl Cancer Inst. 2019;111(11):1120-1130. doi:10.1093/jnci/djz089