Prognostic value of emotional distress in advanced non–small cell lung cancer: a systematic review and meta-analysis

Objective To evaluate the association between emotional distress (ED) and the efficacy of anti-tumor therapies in advanced non-small cell lung cancer (NSCLC). Methods Eligible studies were cohort studies investigating the association between ED and treatment outcomes in patients with advanced NSCLC receiving anti-tumor therapies. All statistical analyses were performed using RevMan 5.4, R 4.2.3, and Stata 13.0. Results Eight studies involving 911 patients were included, and the overall risk of bias was judged to be acceptable. Two studies involved treatment regimens based on immune checkpoint inhibitors (ICIs), another two focused solely on chemotherapy, while the remaining four included patients receiving various therapies involving chemotherapy, radiotherapy, or targeted therapy. Meta-analysis showed that ED was significantly associated with reduced overall survival (OS) (HR = 1.85, 95% CI: 1.50–2.28), an increased risk of progression (HR = 1.80, 95% CI: 1.22–2.66), and a lower objective response rate (ORR) (OR = 0.55, 95% CI: 0.37–0.80). These associations were generally consistent across treatment subgroups, without significant interaction effects. Sensitivity analysis supported the stability of the OS results. Additionally, subgroup analyses did not demonstrate statistically significant differences by age or timing of ED assessment, although the direction of effects was consistent. The certainty of evidence was low for OS and ORR, and very low for PFS. Conclusions ED is significantly associated with poorer prognosis in patients with advanced NSCLC undergoing active anti-tumor therapies, contributing to both reduced short-term efficacy and diminished long-term survival. Further research should focus on elucidating the underlying mechanisms and exploring effective strategies to improve clinical outcomes in patients with advanced NSCLC and ED.