Introduction Lung cancer (LC) and mesothelioma (M) are usually terminal, with poor 5-year survival. Therefore, symptom control is crucial. Cough is a significant problem with physical, psychological and social consequences. It has a broad aetiology and its physiological mechanisms remain unclear. Methods for its assessment are unreliable and available treatments are limited; the absence of valid quantification of cough prevalence and impact hinders the development of novel therapies. CLAIM evaluates the impact and prevalence of cough in LC and M using validated assessment tools.
Methods Consecutive outpatients attending two cancer centres over a 5 week period completed the Manchester Cough in Lung Cancer Scale (MCLCS) and a cough severity visual analogue scale (VAS). Demographic and clinical data were collected.
Results Patients were of advanced age (LC mean 66years, M mean 71years), predominately male (LC 54.9%, M 75.0%), with advanced disease (advanced non-small-cell LC 80.5%, extensive small-cell LC 71.4%). Those on treatment largely received palliative treatment (LC 89.7%, M 100%). The majority of patients were performance status ≥2 (LC 51.7%, M 60%). Cough was reported by 58% of LC patients (n = 224) and 43% of M patients (n = 60); painful cough was reported by 23% and 18%, respectively. LC and M patients felt their cough warranted treatment in 53% and 40% of cases. Cough was associated with breathlessness (LC 61.9%, M 63.6%), disrupted sleep (LC 47.8%, M 52.4%) and interrupted conversations (LC 64.6%, M 59.1%). There were moderate-strong correlations between MCLCS and VAS scores in all patient groups [non-small-cell (r = 0.68), small-cell LC (r = 0.66) and mesothelioma (r = 0.71), all p < 0.01].
Conclusions This is the first study comparing the prevalence and impact of cough in LC and M using validated cough-specific assessment tools, in a clinically representative population. Cough is common in these cancers and has marked effects on quality of life. In the absence of evidence-based treatments, it represents an unmet clinical need. The high prevalence of cough in M is counterintuitive, in view of the tumour location. The MCLCS and VAS correlations suggest these are complementary tools which perform reliably in these disease groups.