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World J Psychiatry. Oct 19, 2026; 16(10): 122462
Published online Oct 19, 2026. doi: 10.5498/wjp.122462
Psychological distress in advanced non-small cell lung cancer: Impact on targeted therapy and quality of life
Wen-Jun Chen, Xue-Yang Hu, Sen-Bang Yao, Mao-Xi Chen, Zi-Ran Bi, Huai-Dong Cheng
Wen-Jun Chen, Sen-Bang Yao, Zi-Ran Bi, Huai-Dong Cheng, Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
Wen-Jun Chen, Sen-Bang Yao, Zi-Ran Bi, Huai-Dong Cheng, Department of Oncology, Anhui Medical University, Hefei 230000, Anhui Province, China
Wen-Jun Chen, Mao-Xi Chen, Department of Oncology, Anhui Chest Hospital, Hefei 230000, Anhui Province, China
Xue-Yang Hu, Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
Huai-Dong Cheng, Department of Oncology, Shenzhen Clinical Medical School of Southern Medical University, Shenzhen 518000, Guangdong Province, China
Author contributions: Chen WJ, Cheng HD contributed to conceptualization and design; Hu XY, Yao SB, Chen MX, and Bi ZR contributed to material preparation, data acquisition, and analysis; Chen WJ and Yao SB contributed to writing-draft manuscript and writing-revision and approved to submit the final version.
AI contribution statement: Portions of this manuscript were edited using DeepSeek AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by the Shenzhen Science and Technology Program, No. JCYJ20240813145301002 and No. JCYJ20250604183455074; and the National Natural Science Foundation of China, No. 82573690.
Institutional review board statement: The study was reviewed and approved by the by the Ethics Committee of Anhui Chest Hospital (approval No. K2023-019).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Corresponding author: Huai-Dong Cheng, MD, PhD, Professor, Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Avenue, Hefei 230000, Anhui Province, China.
chd1975ay@126.com
Received: April 30, 2026
Revised: June 17, 2026
Accepted: July 1, 2026
Published online: October 19, 2026
Processing time: 163 Days and 1.1 Hours
BACKGROUND
Psychological distress is highly prevalent in patients with advanced non-small cell lung cancer (NSCLC). Although previous studies have explored the impact of psychological distress on chemotherapy tolerance and quality of life, the correlation between the level of psychological distress and the efficacy of targeted therapy and quality of life in patients with NSCLC remains unclear. It is also unclear whether psychological distress is associated with the incidence of adverse reactions to targeted therapy.
AIM
To explore the effects of psychological distress on targeted therapy outcomes and quality of life in patients with advanced NSCLC.
METHODS
A total of 143 patients with NSCLC who received guideline-recommended standard targeted therapy based on genetic testing results were enrolled. Psychological distress and quality of life were assessed using the Distress Thermometer (DT) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before and after targeted therapy. Changes in psychological distress and quality of life, as well as the correlation between them, were analyzed.
RESULTS
The progression-free survival in non-DT patients with advanced NSCLC who received comprehensive targeted therapy was significantly better than that in the DT patients (hazard ratio: 0.425; 95% confidence interval: 0.298-0.608; P < 0.01). Similarly, when targeted therapy was combined with chemotherapy, the non-distress (non-DT) group also demonstrated significantly prolonged progression-free survival compared with the psychological distress (DT) group (hazard ratio: 0.395; 95% confidence interval: 0.238-0.656; P < 0.01). After targeted therapy combined with chemotherapy, clinical efficacy in the non-distress group was significantly superior to that in the distress group (P < 0.001). Quality of life scores before and after targeted therapy showed significant differences between the two groups, with the non-distress group achieving significantly higher scores than the distress group (P < 0.001). The adverse events were similar between the two groups, mainly including elevated transaminases, vomiting, rash, and diarrhea.
CONCLUSION
The psychological distress could affect the quality of life of NSCLC patients during targeted therapy, providing a theoretical basis for improving the quality of life of patients with advanced NSCLC. And psychological distress is one of the factors affecting the effect of targeted therapy in patients with advanced NSCLC.
Core Tip: This study is the first to demonstrate that psychological distress significantly impairs the efficacy of targeted therapy and quality of life in patients with advanced non-small cell lung cancer. Patients without distress showed superior objective response rates, disease control rates, and progression-free survival. Psychological distress is a critical factor affecting treatment outcomes, highlighting the need for routine distress screening and psychological support during non-small cell lung cancer targeted therapy.
