Mindfulness-based stress reduction training and supplemented Jinshui Liujun decoction promote recovery in patients with non-small cell lung cancer

Abstract

BACKGROUND

Conventional chemotherapy (CC) administered to patients with non-small cell lung cancer (NSCLC) often causes adverse effects, such as cardiopulmonary dysfunction and immune system imbalance. Patients may experience anxiety and depression during the perioperative period due to various factors, such as treatment costs and cancer recurrence risks, thereby compromising the overall quality of life. Consequently, we hypothesized that integrating mindfulness-based stress reduction training (MSRT) with Jinshui Liujun decoction may mitigate negative emotions and promote recovery in patients with NSCLC.

AIM

To explore the effects of MSRT and Jinshui Liujun decoction on the immune function and emotional state of NSCLC patients.

METHODS

A retrospective clinical study was conducted involving 92 patients with stage IIIb-IV NSCLC; 35 patients in the control group (CG) received CC therapy (combination of pemetrexed and carboplatin), and 57 patients in the treatment group (TG) received MSRT-assisted flavored Jinshui Liujun decoction (FJLD) in addition to CC. We evaluated the survival time, Karnofsky performance status, treatment efficacy, traditional Chinese medicine syndrome score, immune function, negative emotional level, and adverse reactions of the CG and TG.

RESULTS

Median progression-free survival, Karnofsky performance status, and clinical efficacy of the TG were superior to those of the CG (P < 0.05). Symptoms of cough, weakness, bloody sputum, shortness of breath, and chest pain significantly decreased in the TG compared to that in the CG (P < 0.05). In the TG, MSRT + FJLD treatment increased the numbers of CD3⁺ and CD4⁺ immune cells, effectively reduced the number of CD8⁺ cells, and enhanced the CD4⁺/CD8⁺ ratio, thereby restoring the immune function of patients. In the TG, the self-rating anxiety scale and self-rating depression scale scores decreased significantly. There was no statistically significant difference in the incidence of adverse reactions between the CG and TG (P > 0.05).

CONCLUSION

MSRT + FJLD proved to be an effective treatment for patients with NSCLC.

Key Words: Non-small cell lung cancer; Mindfulness-based stress reduction training; Flavored Jinshui Liujun decoction; Curative effect; Immune function; Negative emotion

Core Tip: The combined effects of mindfulness-based stress reduction training with flavored Jinshui Liujun decoction and conventional chemotherapy on survival time, Karnofsky performance status, traditional Chinese medicine syndrome score, immune function, negative emotion levels, and incidence of adverse reactions in patients with non-small cell lung cancer were evaluated. We found that combining mindfulness-based stress reduction training + flavored Jinshui Liujun decoction with conventional chemotherapy for patients with non-small cell lung cancer extended survival time, improved Karnofsky performance status scores, increased CD3⁺ and CD4⁺ immune cells, reduced CD8⁺ cells, and improved the CD4⁺/CD8⁺ ratio, thereby restoring immune function.

INTRODUCTION

Lung cancer, also known as primary bronchopulmonary carcinoma, is one of the deadliest malignancies among patients with cancer worldwide[1]. Non-small cell lung cancer (NSCLC), a subtype of lung cancer, accounts for approximately 85% of cases. It includes several different types of cancers, such as lung adenocarcinoma and lung squamous cell carcinoma, with lesion foci mainly in the alveolar epithelium and bronchial mucosal epithelium[2]. Stages I-IIIa are considered the initial phases of lung cancer, during which clinical features do not manifest. At the time of diagnosis, most patients have already progressed to intermediate and late stages (stages IIIb-IV) and can only be treated with conservative methods, such as chemotherapy[3].

Chemotherapy is a widely used treatment for NSCLC that aims to kill or slow the growth of cancer cells using chemical agents[4]. However, chemotherapeutic agents act systemically, affecting not only cancer cells but also healthy cells. This can cause side effects, such as myelosuppression, alopecia, cardiotoxicity, and pulmonary toxicity, as well as perioperative stresses, such as prolonged hospitalization, high treatment costs, and cancer recurrence with metastasis, increasing the risk of passive mood (anxiety and depression) in patients[5]. In addition, the combination therapy of pemetrexed and carboplatin is mainly used for the treatment of late-onset NSCLC. Although it has low toxicity and is well tolerated, long-term use of pemetrexed is likely to induce drug resistance, leading to poor therapeutic efficacy. Therefore, it is necessary to identify effective treatments based on conventional chemotherapy (CC) to maintain patient health and improve survival[6].

Mindfulness-based stress reduction training (MSRT) is a variation of progressive muscle relaxation training based on the concept of self-movement and alternating cycles of muscle “contraction-relaxation-reduction”. The repetitive muscle relaxation regimen trains people to tense and relax different muscle groups, relieves negative emotions such as anxiety, and has been widely used in recent years to treat lung cancer and other cancers[7]. Additionally, traditional Chinese herbal therapy can reduce the toxic effects of chemotherapy in patients with NSCLC. This approach not only reduces toxicity, improves efficacy, and promotes recovery but also promotes the recovery of the patient’s immune system by improving the levels of the body’s immune function indicators[8].

Flavored Jinshui Liujun decoction (FJLD) is commonly used in clinical practice to treat lung diseases, such as chronic obstructive pulmonary disease, asthma, and chronic bronchitis. It comprises prepared Rehmannia root, Pinellia ternata rhizome, chenpi, licorice, Poria cocos, and milkvetch root. Its pharmacological actions include blood-supplementing and yin-supplementing effects, and has blood-nourishing, diuretic, expectorant, anti-inflammatory, and immunomodulating properties[9]. In a combined treatment regimen of traditional Chinese medicine (TCM) and Western medicine, FJLD has been shown to have a positive impact on the T lymphocyte subsets of patients with NSCLC after chemotherapy and to improve the immune function of patients[10]. However, most existing treatment protocols for patients with NSCLC focus on the effects of Chinese and Western medical treatments on physical health. Moreover, only a few studies have examined the combination of MSRT and CC to mitigate negative emotions and promote recovery in patients with NSCLC. This study selected 92 patients with NSCLC for a retrospective clinical trial to investigate the effect of MSRT + FJLD in addition to CC for the treatment of NSCLC.

MATERIALS AND METHODS

Physical data

Ninety-two patients with NSCLC admitted to the First Affiliated Hospital of Hebei North University between December 2022 and December 2023 were retrospectively selected and divided into the control group (CG) and the treatment group (TG) according to treatment modalities. Telephone follow-up was conducted to improve case data. The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Hebei North University (Approval No. K2020227).

The inclusion criteria were as follows: (1) Patients who met diagnostic criteria for NSCLC with clinical stage IIIb-IV, as confirmed by imaging, histological specimens, and other pathological tests[6]; (2) Patients who provided informed consent and had complete clinical data; (3) Patients newly diagnosed with NSCLC; (4) Patients with Karnofsky performance status (KPS) ≤ 60 points; (5) Patients with a follow-up period for case data of 2 years; and (6) Patients with no serious immunological or other diseases[3]. The exclusion criteria were as follows: (1) Individuals with drug allergies; (2) Individuals with complications from other cancers; (3) Patients with bronchial asthma and lung diseases such as chronic obstructive pulmonary disease; (4) Individuals with mental or consciousness disorders; and (5) Patients who received treatment for less than one cycle or dropped out midway.

The disease control rate (DCR) of the subjects was the outcome index. According to the literature review, the DCR of the intervention group is expected to be 80%, that of the CG is expected to be 45%, the bilateral α = 0.05, and the test efficacy β is 90%. According to the sample size calculation formula N = [2P × (1−P)× (Z_α + Z_β)²]/(p1 - p2)², a total of 78 subjects in the intervention group and the CG were estimated to be required. The 92 patients included in this study met the statistical requirements.

Procedures

CG: Thirty-five patients were treated with CC, including pemetrexed and carboplatin. Pemetrexed disodium, administered by injection (Jiangsu Osaikang Pharmaceutical Co., Ltd., State Pharmaceutical License No. H20080624, specification: 0.2 g), was administered intravenously on the first day at a dose of 500 mg/m², while carboplatin (Yunnan Phyto-Pharmaceutical Co. H10950273, specification: 50 mg) was also administered by injection on the first day. The area under the curve was controlled at 5. Another course of treatment was administered after 3 weeks, totaling two courses of treatment.

TG: Fifty-seven cases were treated using MSRT[11] supplemented with FJLD. The FJLD consisted of prepared Rehmannia root (1 g), Pinellia ternata rhizome (12 g), chenpi (12 g), licorice (9 g), Poria cocos (9 g), milkvetch root (15 g), Radix Pseudostellariae (12 g), coastal glehnia root (15 g), and dwarf lilyturf tuber (9 g). It was administered as a 300-mL juice, taken with warm water twice daily in the morning and evening, along with two cycles of chemotherapy treatment.

Observational index

Evaluation indicators: Primary evaluation index: Progression-free survival (PFS) to investigate the patient’s disease progression or death. Secondary evaluation index: Overall survival (OS) to investigate the patient’s death or the last follow-up visit.

KPS score: 100 points: Indicates normalcy, with no discomfort. 90 points: Indicates the ability to perform normal activities with mild illness. 80 points: Indicates having few symptoms. 70 points: Indicates an inability to maintain normal activities or heavy work. 60 points: Indicates living independently most of the time and needing some assistance. 50 points: Indicates needing more assistance. 40 points: Indicates poor self-care ability and needing special care or assistance. 30 points: Indicates an inability to live independently. 20 points: Indicates the patient is critically ill and needs hospitalization. 10 points: Indicates closeness to death. 0 points: Indicates death.

Clinical efficacy: The treatment efficacy in the CG and TG was evaluated after the two treatment courses. Complete remission: Complete disappearance of symptoms, maintained for ≥ 4 weeks. Partial remission: ≥ 30% decrease in the sum of the largest diameters of the lesions, maintained for ≥ 4 weeks. Stable disease: < 30% decrease or < 20% increase in the sum of the largest diameters of the lesions. Progressive disease: ≥ 20% increase in the sum of the largest diameters of the lesions or appearance of new lesions. DCR = complete remission + partial remission + stable disease.

TCM syndrome score: The TCM syndrome scores of the CG and TG were compared before and after treatment, with a maximum score of 3. Lower scores indicate a better treatment effect.

Measurement of the immune function index: 5 mL of venous blood was collected before and after treatment from the CG and TG. The percentages of CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ cells in the CG and TG were measured using a flow cytometer (BriCyte E6, Myriad BioMedical Electronics Co. Ltd., Shenzhen, China).

Negative mood assessment: The self-rating anxiety scale (SAS) was used to assess anxiety in patients in the CG and TG. The judging criteria were as follows: Severe anxiety ≥ 70 points, general anxiety 60-69 points, less anxiety 50-59 points, and no anxiety < 50 points. The self-rating depression scale (SDS) was used to assess depression status before and after treatment in the CG and TG. The judging criteria were as follows: Severe depression ≥ 70 points, general depression 60-69 points, less depression 50-59 points, and no depression < 50 points.

Adverse reactions: The incidences of dyspnea, diarrhea, vomiting, and proteinuria after treatment in the CG and TG were statistically analyzed.

Statistical analysis

SPSS 26.0 (IBM, NY, United States) statistical analysis software was used for data analysis. The measurement data were analyzed using the t-test, and the results were expressed as mean ± SD. Count data were tested using the χ² test and expressed as n (%). Kaplan-Meier analysis was used to enumerate the PFS and OS of each group, and survival curves were compared between the groups. P < 0.05 indicated statistical significance.

RESULTS

Baseline data

The TG (n = 57) included 38 men and 19 women, with a mean age of 59.77 ± 5.22 years. The mean body mass index was 21.44 ± 1.84 kg/m². Eight patients had a history of hypertension, and 49 patients had no history of hypertension. Four patients had diabetes, and 53 patients had no history of diabetes. The NSCLC disease course was 6-12 months (8.82 ± 6.04 months). Pathological staging comprised 23 cases of IIIb, 15 cases of IIIc, and 8 cases of IV. Pathological classification included 16 cases of adenocarcinoma, 32 cases of squamous cell carcinoma, and 9 cases of others. The mean lesion diameter was 3.14 ± 1.16 cm.

The CG (n = 35) included 23 men and 12 women, with an average age of 60.74 ± 6.18 years and an average body mass index of 21.20 ± 2.00 kg/m². There were 5 cases with a history of hypertension and 30 cases without hypertension. There were three cases with a history of diabetes and 32 cases without a history of diabetes. The NSCLC disease course was 6-12 months (9.00 ± 2.20 months). Pathological staging comprised 10 cases of IIIb, 20 cases of IIIc, and 5 cases of IV. Pathological classification included 16 cases of adenocarcinoma and 14 cases of squamous cell carcinoma (Table 1).

Table 1 Baseline data of patients with non-small cell lung cancer.

Projects	n	TG (n = 57)	CG (n = 35)	χ2/t	P value
Sex, n (%)				0.009	0.925
Male	61	38 (66.67)	23 (65.71)
Female	31	19 (33.33)	12 (34.29)
Age, mean ± SD		59.77 ± 5.22	60.74 ± 6.18	-0.807	0.422
BMI (kg/m2), mean ± SD		21.44 ± 1.84	21.20 ± 2.00	0.584	0.561
Hypertension history, n (%)				0.001	0.973
Find	13	8 (14.04)	5 (14.29)
Nil	79	49 (85.96)	30 (85.71)
History of diabetes, n (%)				0.074	0.785
Find	7	4 (7.02)	3 (8.57)
Nil	85	53 (92.98)	32 (91.43)
Duration of disease (month), mean ± SD		8.82 ± 6.04	9.00 ± 2.20	-0.389	0.698
Pathological stage, n (%)				0.038	0.981
IIIb	26	16 (28.07)	10 (28.57)
IIIc	52	32 (56.14)	20 (57.14)
IV	14	9 (15.79)	5 (14.29)
Pathological classification, n (%)				0.025	0.988
Adenocarcinoma	43	27 (47.37)	16 (45.71)
Squamous carcinoma	36	22 (38.60)	14 (40.00)
Others	13	8 (14.04)	5 (14.29)
Tumor diameter (cm), mean ± SD		3.14 ± 1.16	3.17 ± 1.13	-0.122	0.903

CG: Control group; TG: Treatment group; BMI: Body mass index.

Survival time

The median PFS in the TG and CG significantly differed at 20.50 and 13.10 months, respectively (χ² = 4.138, P < 0.05). The median OS was 22.00 months in the TG and 19.10 months in the CG, with no statistically significant difference between the two groups (χ² = 0.291, P > 0.05) (Figure 1).

Figure 1 Survivorship curve. A: Progression-free survival; B: Overall survival. PFS: Progression-free survival; OS: Overall survival; TG: Treatment group; CG: Control group; HR: Hazard ratio.

KPS score

Before treatment, there was no difference in the KPS scores between the TG and CG (P > 0.05). After treatment, the KPS score of the TG was significantly higher than that of the CG (P < 0.05) (Table 2).

Table 2 Karnofsky performance status scores.

Group	n	KPS scores
		Before treatment	After treatment
TG	57	50 (40, 60)	60 (40, 70)
CG	35	50 (40, 60)	50 (40, 60)
χ2		0.015	12.394
P value		0.992	0.006

CG: Control group; TG: Treatment group; KPS: Karnofsky performance status.

Clinical efficacy

Compared to the CG, the TG had a higher DCR value (71.94% vs 51.43%) (P < 0.05), indicating that MSRT + FJLD improved treatment efficacy in NSCLC (Table 3).

Table 3 Therapeutic efficacy in the treatment group and control group, n (%).

Group	n	CR	PR	SD	PD	DCR	χ2	P value
TG	57	13 (22.81)	15 (26.32)	13 (22.81)	16 (28.06)	41 (71.94)	3.962	0.047
CG	35	3 (8.57)	5 (14.29)	10 (28.57)	17 (48.57)	18 (51.43)

CR: Complete remission; PR: Partial remission; SD: Stable disease; PD: Progressive disease; DCR: Disease control rate; CG: Control group; TG: Treatment group.

TCM syndrome score

There were no significant differences in TCM syndrome scores for cough (CG: 2.02 ± 0.66, TG: 2.03 ± 0.63), weakness (CG: 1.97 ± 0.59, TG: 1.97 ± 0.61), bloody sputum (CG: 2.01 ± 0.69, TG: 1.93 ± 0.59), shortness of breath (CG: 2.06 ± 0.53, TG: 2.08 ± 0.50), and chest pain (CG: 1.91 ± 0.56, TG: 1.96 ± 0.62) between the CG and the TG, respectively. After two courses of treatment, the TCM syndrome scores in the TG and the CG decreased to some extent. In the TG, the scores for cough (0.91 ± 0.50), weakness (0.94 ± 0.58), bloody sputum (0.89 ± 0.55), shortness of breath (0.83 ± 0.48), and chest pain (0.90 ± 0.62) were significantly lower than those in the CG (1.14 ± 0.57, 1.20 ± 0.57, 1.17 ± 0.57, 1.10 ± 0.53, 1.25 ± 0.57, respectively) (P < 0.05). These results suggest that MSRT + FJLD significantly improves cough, weakness, bloody sputum, shortness of breath, and chest pain in patients with NSCLC (Figure 2).

Figure 2 Traditional Chinese medicine syndrome scores of patients with non-small cell lung cancer before and after treatment. A: Cough; B: Weakness; C: Bloody sputum; D: Shortness of breath; E: Chest pain. ^aP < 0.05; ^bP < 0.01. CG: Control group; TG: Treatment group.

Immunological function

Before treatment, there were no significant differences in the percentages of CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ between the CG (62.21% ± 4.58%, 37.52% ± 4.57%, 35.20% ± 3.27%, 1.08% ± 0.19%) and the TG (62.91% ± 4.87%, 37.51% ± 4.44%, 35.92% ± 2.93%, 1.05% ± 0.15%) after statistical analysis. After two courses of treatment, the percentages of immune function indices in the CG and TG changed. The percentages of CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ in the TG (70.86% ± 3.36%, 43.67% ± 4.86%, 24.95% ± 3.46%, 1.78% ± 0.30%, respectively) were significantly higher than those in the CG (64.90% ± 3.32%, 39.62% ± 3.83%, 30.75% ± 3.35%, 1.30% ± 0.17%, respectively) (P < 0.05) (Figure 3). This indicates that MSRT + FJLD can improve immune system function in patients with NSCLC.

Figure 3 Changes in immune function indices in patients with non-small cell lung cancer before and after treatment. A: CD3⁺; B: CD4⁺; C: CD8⁺; D: CD4⁺/CD8⁺. ^aP < 0.05. TG: Treatment group; CG: Control group.

Negative emotion

Before treatment, the SAS and SDS scores of the CG (58.86 ± 4.82 and 59.09 ± 5.43, respectively) and the TG (58.44 ± 5.47 and 58.72 ± 5.05, respectively) were not significantly different. After two courses of treatment, the SAS and SDS scores in both the CG and the TG decreased; however, the scores in the TG (47.37 ± 4.69 and 47.63 ± 4.79, respectively) were significantly lower than those in the CG (53.31 ± 5.07 and 54.54 ± 4.59, respectively) (P < 0.05) (Figure 4). This indicates that MSRT + FJLD can effectively improve the emotional state of patients with NSCLC and maintain their mental health.

Figure 4 Negative emotion scores of patients with non-small cell lung cancer before and after treatment. A: Self-rating anxiety scale; B: Self-rating depression scale. ^bP< 0.01. IQR: Interquartile range; CG: Control group; TG: Treatment group; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Adverse reactions

Compared to the CG, the TG had a lower occurrence rate of adverse reactions (breathing difficulties, diarrhea, vomiting, and proteinuria) after two courses of treatment. No statistically significant differences were observed in the overall response rate between the TG (10.52%) and the CG (11.44%) (Table 4).

Table 4 Occurrence rate of adverse reactions in the treatment group and control group, n (%).

Group	n	Breathing difficulties	Diarrhea	Vomiting	Proteinuria	Overall response rate	χ2	P value
TG	57	1 (1.75)	2 (3.51)	2 (3.51)	1 (1.75)	6 (10.52)	0.018	0.893
CG	35	1 (2.86)	1 (2.86)	1 (2.86)	1 (2.86)	4 (11.44)

CG: Control group; TG: Treatment group.

DISCUSSION

This study retrospectively examined the clinical efficacy of MSRT + FJLD in the treatment of patients with NSCLC. Our results showed that MSRT + FJLD significantly prolonged median PFS (P < 0.05) and improved the KPS score of patients with NSCLC, indicating the potential long-term efficacy of MSRT + FJLD for these patients. Patients with NSCLC typically experience faster tumor progression and shorter survival times. However, the survival curve showed that the median OS of the TG was higher than that of the CG. Further studies with larger sample sizes should be conducted to validate these statistical results. Additionally, this study found that administering MSRT + FJLD in addition to CC in patients with NSCLC exhibited significant therapeutic efficacy, a significant decrease in TCM syndrome scores, and an improvement in immune function-related indicators (CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺).

MSRT is generally administered by specific professionals who guide mindfulness exercises for the target participants, including body scanning, mindfulness breathing, mindfulness meditation, mindfulness eating, mindfulness walking, and compassion meditation exercises. It focuses on the connection between cognitive categories, such as thinking, attention, emotions, and the body[12]. MSRT is a product of Eastern Zen thought and Western quantitative science. It is often used to address the recurrence of psychological diseases, such as depression, autism, and schizophrenia. MSRT is a psychological intervention that can influence an individual’s psychological cognition, physical health, and social relationships.

FJLD is a type of TCM with advantages, such as reduced toxicity, increased efficiency, safe medication, and a low recurrence rate. It also delays tumor recurrence and metastasis, balances the proportion of immune cells, and regulates the immune system. The components of FJLD can enhance the body’s immune function in the treatment of NSCLC, inhibit tumor cell growth, prolong patient survival time, and reduce the clinical treatment risk index[13]. For example, Pinellia has anti-inflammatory and anti-tumor effects; it may negatively impact the survival and proliferation of tumor cells by regulating related proteins in the phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) signaling pathway. The active ingredients in orange peel may inhibit the PI3K-Akt signaling pathway, reduce the invasion and metastasis of tumor cells, and improve the immune response of the body. Glycyrrhizic acid and other components in licorice may reduce the proliferation of tumor cells by inhibiting the PI3K-Akt signaling pathway and have anti-inflammatory and immunomodulatory effects. Poria polysaccharide from Poria poria may enhance the immune function of the body, increase the proportion of CD3⁺ and CD4⁺ cells, and reduce the number of CD8⁺ cells by activating the Akt protein in the PI3K-Akt signaling pathway. Astragaloside and other components in milkvetch root may promote the activation of immune cells and augment the anti-tumor function of the body by activating the PI3K-Akt signaling pathway. CD3⁺, CD4⁺, and CD8⁺ cells are surface markers of T cells. CD3 is part of the T-cell receptor complex, which participates in cell-mediated immune responses, helps B cells produce antibodies, directly kills cells infected by pathogens, and regulates immune responses to avoid autoimmune reactions[14]. CD4⁺ T cells recognize antigens presented by major histocompatibility complex class II molecules and play a coordinating role in the immune response by activating other immune cells, such as B cells and macrophages, through the secretion of cytokines. CD4⁺ T cells can further differentiate into different subsets, such as T helper type 1 (Th1), Th2, and Th17, each playing different roles in the immune response[15]. CD8⁺ T cells, usually known as cytotoxic T cells or killer T cells, help regulate the immune response and prevent excessive attacks on the body[16]. Negative emotions, such as anxiety, depression, and stress, are believed to reduce survival and weaken immune system function. These emotional states may lead to excessive activation or inhibition of the immune system, thereby affecting the distribution and function of immune cells (e.g., a decrease in CD3⁺ and CD4⁺ cells and an increase in CD8⁺ cells).

Long-term psychological stress is associated with a decrease in the number and activity of immune cells[17]. A study by Chen et al[18] revealed that using TCM syndrome and long-term treatment with intravenous administration of TCM and oral Chinese patent medicine can prolong the survival time of patients with advanced NSCLC. Cheng et al[19] also reported that an increase in CD3⁺ and CD4⁺ levels and a decrease in CD8⁺ levels help restore immune function, which is in accordance with the results of our study.

Chemotherapy drugs affect rapidly dividing healthy cells and cancer cells simultaneously, leading to pulmonary fibrosis, heart damage, tumor lysis syndrome, immune system disorders, and other symptoms. This can also increase psychological pressure on patients, causing anxiety, depression, and other emotional changes during chemotherapy, which require psychological support and appropriate intervention[20]. Our findings showed that the SAS and SDS scores of patients with NSCLC treated only with CC were higher than those in the TG, indicating a possibility of mild anxiety and mild depression. Compared with the CG, the SAS and SDS scores of the TG decreased after MSRT + FJLD treatment, indicating that MSRT + FJLD had a positive effect on improving the negative emotions of patients with NSCLC. McDonnell et al[21] used MSRT intervention therapy for patients with lung cancer and found that the SAS and SDS scores of the patients were better than those in the CG[21,22], which aligned with our study’s results. MSRT + FJLD augments immune function and treatment efficacy in NSCLC patients through both psychological and physiological effects.

In summary, this study confirms that MSRT + FJLD has certain therapeutic effects on NSCLC; however, limitations such as the inability of the study design to control the experimental conditions, as in prospective studies, as well as the small sample size may limit the generalization and reliability of the results. Therefore, further studies with increased sample size and improved study design are warranted to obtain more reliable study results.

CONCLUSION

This retrospective clinical study found that MSRT + FJLD, in addition to CC, prolonged the survival time of patients with NSCLC, improved the KPS score, increased the number of CD3⁺ and CD4⁺ immune cells, effectively reduced the number of CD8⁺ cells, and increased the CD4⁺ and CD8⁺ ratio, thereby restoring the immune function of patients. Additionally, it alleviated symptoms such as cough, weakness, bloody sputum, shortness of breath, and chest pain, and improved the patients’ SAS and SDS scores. Therefore, this study suggests that MSRT + FJLD combined with CC is an effective treatment for patients with NSCLC.