Cancer-related distress and unmet needs among those with metastatic and non-metastatic non-small cell lung cancer: Findings from the Cancer Experience Registry.

539 Background: Individuals with non-small cell lung cancer (NSCLC) are susceptible to distress across multiple life domains. This study aims to describe how those with metastatic and non-metastatic NSCLC characterize cancer-related distress and identify sociodemographic and clinical factors predicting distress. Methods: From Feb 2015-Nov 2023, 279 US adults with a history of NSCLC took the Cancer Experience Registry®, an online survey about the multidimensional impact of cancer. CancerSupportSource™ (CSS) is a validated 25-item tool asking patients about distress across 5 domains: (1) emotional well-being (EWB); (2) symptom burden & impact (SYM); (3) body image & healthy lifestyle (BHL); (4) healthcare team communication (HTC); (5) relationships & intimacy (REL). Multiple linear regression analysis was used to assess the relationships between CSS scores, demographic variables (age, gender, income, employment status), and clinical factors (time since diagnosis, metastatic status, treatment). Results: The sample was 68% women, 88% non-Hispanic White, with a mean age of 64 (SD=11). Time since diagnosis varied: 28% <1 year, 37% 2–5 years, and 32% ≥5 years; 40% on treatment at survey, and 56% metastatic. Distress was highest for BHL (1.26), then EWB (1.23), REL (1.20), SYM (1.07), and HCT (0.83), with no significant differences by metastatic status in bivariate analyses. For both groups, top concerns included future uncertainty, fatigue, and physical activity. Finances were a primary concern for metastatic patients, whereas eating/nutrition was a top concern for non-metastatic patients. While metastatic patients reported significantly greater worry about family, friends, and romantic partners, non-metastatic patients expressed significantly greater concern about daily mobility. In multivariable analysis, younger age predicted higher EWB, BHL, REL, and overall distress. Women expressed greater concerns about EWB, SYM, BHL, and overall distress. Those employed or retired, rather than unemployed due to disability, had lower distress in all domains. Clinical factors were not significant predictors of distress in multivariable models. Conclusions: NSCLC patients report substantial distress related to future uncertainty, fatigue, and physical activity regardless of metastatic status. While metastatic individuals expressed more concern about loved ones, non-metastatic patients reported more distress around daily mobility. In multivariable analysis, demographic factors were significant predictors of distress instead of metastatic status or other clinical factors. Findings highlight the importance of psychosocial interventions tailored to distress profiles, not just clinical indicators, and prioritizing resources related to coping with uncertainty, managing fatigue, and improving daily activity.