Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer

The association of physical function and quality of life on physical activity for non-small cell lung cancer survivors

PURPOSE

Our study aimed to assess the association between physical function and quality of life (QOL) with physical activity among non-small cell lung cancer (NSCLC) survivors.

METHODS

Participants were 92 NSCLC survivors. Physical activity was assessed by a self-report with physiatrist's interview and the Korean version of the short form of the International Physical Activity Questionnaire (IPAQ-SF). All participants were required to perform three standardized fitness tests. The Korean version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was used to assess QOL. Factors associated with physical functioning and QOL were determined using multiple linear regression.

RESULTS

A significant correlation between metabolic equivalent task minutes per week (MET-min/wk) and aerobic fitness was found (r = 0.277, p = 0.008). Factors associated with aerobic fitness include gender, age, and MET-min/wk. The meeting physical activity guideline group was also a factor associated with aerobic fitness. In the QOL aspect, a significant correlation between MET-min/wk and some QOL score was found. The meeting physical activity guideline group was a factor associated with QOL (global health status, physical function, and role function), not total MET-min/wk.

CONCLUSIONS

Increased physical activity was associated with higher aerobic fitness and QOL. Engagement in physical activity that met physical activity guidelines was a factor related to aerobic fitness and better QOL in some domains. To improve aspects of aerobic fitness and QOL, we may consider the pattern of physical activity, including regular participation and intensity, rather than total physical activity including basal activity.

B-type natriuretic peptide predicts deterioration in functional capacity following lung resection

OBJECTIVES

Following lung resection, there is a decrease in the functional capacity and quality of life, which is not fully explained by changes in pulmonary function. Previous work demonstrates that B-type natriuretic peptide (BNP) is associated with short- and long-term complications following lung resection, leading to the suggestion that cardiac dysfunction may contribute to functional deterioration. Our aim was to investigate any relationship between BNP and subjective and objective indices of functional deterioration following lung resection surgery.

METHODS

Twenty-seven patients undergoing lung resection had serum BNP measured preoperatively, on postoperative day (POD)1 and POD2, and at 2 months postoperatively. The functional deterioration was assessed using 6-min walk tests and the Medical Research Council dyspnoea scale. 'Deterioration in functional capacity' was defined as either an increase in the Medical Research Council dyspnoea score or a significant decrease in the 6-min walk test distance.

RESULTS

BNP increased over time (P < 0.01) and was significantly elevated on POD1 and POD2 (P < 0.02 for both). Seventeen patients demonstrated functional deterioration 2 months postoperatively. At all perioperative time points, BNP was significantly higher in patients showing deterioration (P < 0.05 for all). Preoperative BNP was predictive of functional deterioration at 2 months with an area under the receiver-operating characteristic curve of 0.82 (P = 0.01, 95% confidence interval 0.65-0.99).

CONCLUSIONS

This study has demonstrated, using subjective and objective measures, that preoperative BNP is a predictor of functional deterioration following lung resection. BNP may have a role in preoperative risk stratification in this population, allowing therapy in future to be targeted towards high-risk patients with the aim of preventing postoperative cardiac dysfunction.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01892800.

Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer

BACKGROUND

Decreased exercise capacity and health-related quality of life (HRQoL) are common in people following lung resection for non-small cell lung cancer (NSCLC). Exercise training has been demonstrated to confer gains in exercise capacity and HRQoL for people with a range of chronic conditions, including chronic obstructive pulmonary disease and heart failure, as well as in people with prostate and breast cancer. A programme of exercise training may also confer gains in these outcomes for people following lung resection for NSCLC. This systematic review updates our 2013 systematic review.

OBJECTIVES

The primary aim of this review was to determine the effects of exercise training on exercise capacity and adverse events in people following lung resection (with or without chemotherapy) for NSCLC. The secondary aims were to determine the effects of exercise training on other outcomes such as HRQoL, force-generating capacity of peripheral muscles, pressure-generating capacity of the respiratory muscles, dyspnoea and fatigue, feelings of anxiety and depression, lung function, and mortality.

SEARCH METHODS

We searched for additional randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 2 of 12), MEDLINE (via PubMed) (2013 to February 2019), Embase (via Ovid) (2013 to February 2019), SciELO (The Scientific Electronic Library Online) (2013 to February 2019), and PEDro (Physiotherapy Evidence Database) (2013 to February 2019).

SELECTION CRITERIA

We included RCTs in which participants with NSCLC who underwent lung resection were allocated to receive either exercise training, which included aerobic exercise, resistance exercise, or a combination of both, or no exercise training.

DATA COLLECTION AND ANALYSIS

Two review authors screened the studies and identified those eligible for inclusion. We used either postintervention values (with their respective standard deviation (SD)) or mean changes (with their respective SD) in the meta-analyses that reported results as mean difference (MD). In meta-analyses that reported results as standardised mean difference (SMD), we placed studies that reported postintervention values and those that reported mean changes in separate subgroups. We assessed the certainty of evidence for each outcome by downgrading or upgrading the evidence according to GRADE criteria.

MAIN RESULTS

Along with the three RCTs included in the original version of this review (2013), we identified an additional five RCTs in this update, resulting in a total of eight RCTs involving 450 participants (180 (40%) females). The risk of selection bias in the included studies was low and the risk of performance bias high. Six studies explored the effects of combined aerobic and resistance training; one explored the effects of combined aerobic and inspiratory muscle training; and one explored the effects of combined aerobic, resistance, inspiratory muscle training and balance training. On completion of the intervention period, compared to the control group, exercise capacity expressed as the peak rate of oxygen uptake (VO₂peak) and six-minute walk distance (6MWD) was greater in the intervention group (VO₂peak: MD 2.97 mL/kg/min, 95% confidence interval (CI) 1.93 to 4.02 mL/kg/min, 4 studies, 135 participants, moderate-certainty evidence; 6MWD: MD 57 m, 95% CI 34 to 80 m, 5 studies, 182 participants, high-certainty evidence). One adverse event (hip fracture) related to the intervention was reported in one of the included studies. The intervention group also achieved greater improvements in the physical component of general HRQoL (MD 5.0 points, 95% CI 2.3 to 7.7 points, 4 studies, 208 participants, low-certainty evidence); improved force-generating capacity of the quadriceps muscle (SMD 0.75, 95% CI 0.4 to 1.1, 4 studies, 133 participants, moderate-certainty evidence); and less dyspnoea (SMD -0.43, 95% CI -0.81 to -0.05, 3 studies, 110 participants, very low-certainty evidence). We observed uncertain effects on the mental component of general HRQoL, disease-specific HRQoL, handgrip force, fatigue, and lung function. There were insufficient data to comment on the effect of exercise training on maximal inspiratory and expiratory pressures and feelings of anxiety and depression. Mortality was not reported in the included studies.

AUTHORS' CONCLUSIONS

Exercise training increased exercise capacity and quadriceps muscle force of people following lung resection for NSCLC. Our findings also suggest improvements on the physical component score of general HRQoL and decreased dyspnoea. This systematic review emphasises the importance of exercise training as part of the postoperative management of people with NSCLC.

Increased expression of TRPV1 in patients with acute or chronic cough after lung cancer surgery

BACKGROUND

We investigated preoperative and postoperative TRPV1, bradykinin (BK), and prostaglandin e-2 (PGE2) levels in patients who underwent lung cancer surgery and evaluated the correlations between these levels and the development of acute or chronic cough after surgery.

METHODS

We evaluated 60 patients with non-small cell lung cancer who underwent lobectomy at our center between August and October 2018. TRPV1, BK, and PGE2 levels were determined by enzyme-linked immunosorbent assay and postoperative cough was assessed using the visual analog scale (VAS).

RESULTS

The postoperative serum TRPV1, BK, and PEG2 levels of the 60 patients were significantly higher than the preoperative levels (P < 0.001). Thirty-five patients (58.3%) were diagnosed with acute cough (VAS ≥ 60 mm), and 25 were diagnosed with non-acute cough (41.7%). Three days after surgery, the serum TRPV1, BK, and PGE2 levels were significantly higher in the acute cough group than in the non-acute cough group (P < 0.001). Twenty-two patients (36.7%) were diagnosed with chronic cough (VAS ≥ 60 mm), and 25 (62.3%) were diagnosed with non-chronic cough. Eight weeks after surgery, the serum TRPV1, BK, and PGE2 levels were significantly higher in the chronic cough group than in the non-chronic cough group (P < 0.05).

CONCLUSIONS

The postoperative TRPV1, BK and PGE2 levels were significantly higher than the preoperative levels. The TRPV1 level was also higher in patients with an acute or chronic cough than in patients without. Postoperative acute or chronic cough symptoms can be improved and alleviated by blocking the TRPV1 pathway.

Analysis of factors related to chronic cough after lung cancer surgery

Background

In this study, we investigated the relationship between chronic cough and clinicopathological features in postoperative patients with non‐small cell lung cancer (NSCLC) and evaluated the effectiveness of acupuncture therapy for the treatment of postoperative chronic cough in patients with NSCLC.

Methods

We retrospectively evaluated 171 patients with NSCLC who received lobectomy at our center between September 2017 and February 2018. The Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ‐MC) was used to evaluate the degree of cough in patients. Postoperative cough was assessed by a visual analog scale (VAS).

Results

The total LCQ‐MC score for the whole group was 19.79 ± 0.53 before surgery and 18.40 ± 0.70 after surgery (p < 0.001). Logistic regression analysis showed that right lung cancer, difficult airway, acute cough and history of COPD were independent predictors of chronic cough. Of the 68 patients diagnosed with chronic cough, 41 received acupuncture therapy (acupuncture therapy group), and 27 received no acupuncture therapy (no therapy group). No significant difference was found between the two groups in terms of their LCQ‐MC scores at eight weeks after surgery (p = 0.756). However, the acupuncture therapy group had a significantly higher LCQ‐MC score than the no therapy group at 10 weeks after surgery (p = 0.002).

Conclusions

Right lung cancer, difficult airway, acute cough, and history of COPD are independent predictors of chronic cough after surgery. For patients with chronic cough, acupuncture therapy can shorten the recovery time and improve quality of life after surgery.

The right ventricular response to lung resection

OBJECTIVES

Lung cancer is a leading cause of cancer death and in suitable cases the best chance of cure is offered by surgery. Lung resection is associated with significant postoperative cardiorespiratory morbidity, with dyspnea and reduced functional capacity as dominant features. These changes are poorly associated with deterioration in pulmonary function and a potential role of right ventricular (RV) dysfunction has been hypothesized. Cardiovascular magnetic resonance imaging is a reference method for noninvasive assessment of RV function and has not previously been applied to this population.

METHODS

We used cardiovascular magnetic resonance imaging to assess the RV response to lung resection. Cardiovascular magnetic resonance imaging with volume and flow analysis was performed on 27 patients preoperatively, on postoperative day 2 and at 2 months. Left ventricular ejection fraction and RV ejection fraction, the ratio of stroke volume to end systolic volume, pulmonary artery acceleration time, and distensibility of main and branch pulmonary arteries were studied.

RESULTS

Mean ± standard deviation RV ejection fraction deteriorated from 50.5% ± 6.9% preoperatively to 45.6% ± 4.5% on postoperative day 2 and remained depressed at 44.9% ± 7.7% by 2 months (P = .003). The ratio of stroke volume to end systolic volume deteriorated from median 1.0 (quartile 1, quartile 3: 0.9, 1.2) preoperatively to median 0.8 (quartile 1, quartile 3: 0.7, 1.0) on postoperative day 2 (P = .011). On postoperative day 2 there was a decrease in pulmonary artery acceleration time and operative pulmonary artery distensibility (P < .030 for both). There were no changes in left ventricular ejection fraction during the study period (P = .621).

CONCLUSIONS

These findings suggest RV dysfunction occurs following lung resection and persists 2 months after surgery. The deterioration in the ratio of stroke volume to end systolic volume suggests a mismatch between afterload and contractility. There is an increase in indices of pulsatile afterload resulting from the operative pulmonary artery.

The Utility of Eccentricity Index as a Measure of the Right Ventricular Function in a Lung Resection Cohort

Context

Right ventricular (RV) dysfunction occurs after lung resection and is associated with postoperative morbidity. Noninvasive evaluation of the RV is challenging, particularly in the postoperative period. A reliable measure of RV function would have value in this population.

Aims

This study compares eccentricity index (EI) obtained by transthoracic echocardiography (TTE) with cardiovascular magnetic resonance (CMR) determined measures of RV function in a lung resection cohort. CMR is the reference method for noninvasive assessment of RV function.

Design and Setting

Prospective observational cohort study at a single tertiary hospital.

Materials and Methods

Twenty-eight patients scheduled for elective lung resection underwent contemporaneous TTE and CMR imaging preoperatively, on postoperative day (POD) 2 and at 2-month. Systolic and diastolic EI was measured offline from anonymized and randomized TTE and CMR images.

Statistical Analysis

Bland-Altman analysis was performed to determine agreement between EI^TTE and EI^CMR. Changes over time and comparison with CMR determined RV ejection fraction (RVEF^CMR) was assessed.

Results

Bland-Altman analysis showed a negligible mean difference between EI^TTE and EI^CMR, but limits of agreement were wide (SD 0.24 and 0.28). There were no significant changes in EI^TTE and EI^CMR over time (P > 0.35). We found no association between EI^TTE with RVEF^CMR at all-time points (P > 0.22). Systolic and diastolic EI^CMR on POD 2 demonstrated moderate association with RVEF^CMR (r = -0.54 and r = -0.59, P ≤ 0.01). At 2-month, only diastolic EI^CMR correlated with RVEF^CMR (r = -0.43, P = 0.03). There were no meaningful associations between EI^TTE and EI^CMR with TTE-derived RV systolic pressure (P > 0.31).

Conclusions

TTE determined EI is not useful as a noninvasive method of assessing RV function following lung resection.

Quality of Life in NSCLC Survivors - A Multicenter Cross-Sectional Study

INTRODUCTION

The objective was to assess quality of life (QoL) in lung cancer survivors, compare it to the general population, and identify factors associated with global QoL, physical functioning, emotional functioning, fatigue, pain, and dyspnea.

METHODS

Data from NSCLC patients who had survived 1 year or longer after diagnosis were collected cross-sectionally in a multicenter study. QoL was assessed with the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the lung cancer module QLQ-LC13 across different clinical subgroups and compared to age- and sex-standardized general population reference values. Multivariable linear regression analyses were performed to test the associations of patient-, tumor-, and treatment-related factors with the six primary QoL scales.

RESULTS

Six hundred fifty-seven NSCLC patients participated in the study with a median time since diagnosis of 3.7 years (range, 1.0-21.2 years). Compared to the age- and sex-standardized general population, clinically meaningful differences in the QoL detriment were found on almost all domains: lung cancer survivors had clinically relevant poorer global QoL (10 points, p < 0.001). Whereas in 12 months or longer treatment-free patients this detriment was small (8.3), it was higher in patients currently in treatment (16.0). Regarding functioning and symptom scales, respective detriments were largest for dyspnea (41 points), role function (33 points), fatigue (27 points), social function (27 points), physical function (24 points), and insomnia (21 points) observed across all subgroups. The main factor associated with poorer QoL in all primary QoL scales was mental distress (β |19-31|, all p < 0.001). Detriments in QoL across multiple primary QoL scales were also observed with current treatment (β |8-12|, p < 0.01), respiratory comorbidity (β |4-5|, p < 0.01), and living on a disability pension (β |10-11|, p < 0.01). The main factor associated with better QoL in almost all primary QoL scales was higher physical activity (β |10-20|, p < 0.001). Better QoL was also observed in patients with high income (β |10-14|, p < 0.01).

CONCLUSIONS

Lung cancer survivors experience both functional restrictions and symptoms that persist long term after active treatment ends. This substantiates the importance of providing long-term supportive care.

Risk factors of cough in non-small cell lung cancer patients after video-assisted thoracoscopic surgery

Background

Cough is a common respiratory complication in non-small cell lung cancer (NSCLC) patients after surgery. Previous studies have proposed a number of risk factors for postoperative cough; however, these studies are mainly based on traditional thoracotomies and tend to lack adequate objective assessment methods. The purpose of this study was to identify the risk factors of cough in NSCLC patients after video-assisted thoracoscopic surgery (VATS) using the Leicester Cough Questionnaire in Mandarin Chinese (LCQ-MC) to evaluate postoperative cough.

Methods

A total of 198 NSCLC patients were enrolled. Overall, 91 patients (46.0%) developed cough after VATS, and 73 patients remained cough after 1 month. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors of postoperative cough.

Results

The independent factors of postoperative cough included female sex [odds ratio (OR) 2.399, 95% confidence interval (CI): 1.260-4.565, P=0.008], duration of anesthesia (over 164 minutes; OR 2.810, 95% CI: 1.368-5.771, P=0.005), resection of the lower paratracheal nodes (OR 3.697, 95% CI: 1.439-9.499, P=0.007), and resection of the subcarinal nodes (OR 4.175, 95% CI: 1.203-14.495, P=0.024). The follow-up LCQ-MC total score after 1 month (18.00±1.80) was significantly higher than the postoperative total score (16.35±2.26; P=0.004).

Conclusions

Female sex, duration of anesthesia over 164 minutes, lower paratracheal node resection and subcarinal node resection were independent risk factors related to cough in NSCLC patients after VATS. In addition, the LCQ-MC performed satisfactorily in describing the longitudinal changes in cough symptoms.

A Longitudinal Investigation of Internalized Stigma, Constrained Disclosure, and Quality of Life Across 12 Weeks in Lung Cancer Patients on Active Oncologic Treatment

INTRODUCTION

Internalized lung cancer stigma (i.e., feelings of regret, shame, and self-blame about one's lung cancer) is related to poorer psychological outcomes. Less is known about how internalized stigma relates to physical and functional outcomes or how constrained disclosure (i.e., avoidance of or discomfort about disclosing one's lung cancer status to others) relates to well-being. Furthermore, no study has examined whether internalized stigma and constrained disclosure predict changes in well-being for lung cancer patients. This longitudinal study characterized relationships of internalized stigma and constrained disclosure with emotional and physical/functional outcomes.

METHODS

Participants (N = 101, 52.4% male, 63.4% currently/formerly smoked) were lung cancer patients on active medical treatment who completed questionnaires on stigma and well-being at study entry and at 6- and 12-week follow-up. Multivariable linear regressions characterized relationships of internalized stigma and constrained disclosure with emotional and physical/functional well-being at study entry and across time.

RESULTS

Participants who currently or formerly smoked reported higher levels of internalized stigma (but not constrained disclosure), compared to never smokers (p < 0.001). Higher internalized stigma and constrained disclosure were uniquely associated with poorer emotional and physical/functional well-being at study entry (all p < 0.05), beyond sociodemographic characteristics, time elapsed since diagnosis, and smoking status. Higher internalized stigma predicted significant declines in emotional well-being across 6 and 12 weeks (all p < 0.01) and declines in physical/functional well-being across 6 weeks (p < 0.05).

CONCLUSIONS

Internalized lung cancer stigma and constrained disclosure relate to emotional and physical/functional maladjustment. Findings carry implications for provider- and patient-focused interventions to reduce internalized stigma and promote well-being.

Long-Term Active Surveillance of Screening Detected Subsolid Nodules is a Safe Strategy to Reduce Overtreatment

INTRODUCTION

Lung cancer presenting as subsolid nodule (SSN) can show slow growth, hence treating SSN is controversial. Our aim was to determine the long-term outcome of subjects with unresected SSNs in lung cancer screening.

METHODS

Since 2005, the Multicenter Italian Lung Detection (MILD) screening trial implemented active surveillance for persistent SSN, as opposed to early resection. Presence of SSNs was related to diagnosis of cancer at the site of SSN, elsewhere in the lung, or in the body. The risk of overall mortality and lung cancer mortality was tested by Cox proportional hazards model.

RESULTS

SSNs were found in 16.9% (389 of 2303) of screenees. During 9.3 ± 1.2 years of follow-up, the hazard ratio of lung cancer diagnosis in subjects with SSN was 6.77 (95% confidence interval: 3.39-13.54), with 73% (22 of 30) of cancers not arising from SSN (median time to diagnosis 52 months from SSN). Lung cancer-specific mortality in subjects with SSN was significantly increased (hazard ratio = 3.80; 95% confidence interval: 1.24-11.65) compared to subjects without lung nodules. Lung cancer arising from SSN did not lead to death within the follow-up period.

CONCLUSIONS

Subjects with SSN in the MILD cohort showed a high risk of developing lung cancer elsewhere in the lung, with only a minority of cases arising from SSN, and never representing the cause of death. These results show the safety of active surveillance for conservative management of SSN until signs of solid component growth and the need for prolonged follow-up because of high risk of other cancers.

Maekmoondong-tang in treatment of postoperative cough in patients with lung cancer: Study protocol for a randomized, double-blind, placebo-controlled, multicenter trial

BACKGROUND

Cough is a common symptom that occurs in 25% of patients after lung cancer surgery. It might last a long time and degrade the quality of life of patients. Maekmoondong-tang (Bakumondo-to in Japanese or Mai-Men-Dong-Tang in Chinese) is a herbal medicine which has been widely used for respiratory diseases with cough in Korea, China, and Japan.

AIMS

The aim of the present study is to evaluate the efficacy and safety of Maekmoondong-tang for postoperative cough in patient with lung cancer.

METHODS/DESIGN

This study is a randomized, double-blind, placebo-controlled, multicenter trial of Maekmoondong-tang. A total of 96 participants will be enrolled and allocated to 2 parallel groups: the Maekmoondong-tang group and the placebo group from 5 university hospitals. The participants will be administered either Maekmoondong-tang or a placebo 3 times a day for 4 weeks. The primary outcome measurement is the change in the Leicester Cough Questionnaire (LCQ) score. The secondary outcome measurements are the changes in the cough visual analog scale and Yin Deficiency Scale. The participants will visit 4 times in total for 4 weeks of trial period.

DISCUSSION

The present study will be the first multicener study to evaluate the efficacy and safety of Maekmoondong-tang for postoperative cough in patient with lung cancer surgery. The results of this study will provide a new treatment for cough using herbal medicine and will be a reference for planning clinical trial of herbal medicine in patient with cough.

Exercise capacity and cancer-specific quality of life following curative intent treatment of stage I-IIIA lung cancer

PURPOSE

Lung cancer survivors are at risk for health impairments resulting from the effects and/or treatment of lung cancer and comorbidities. Practical exercise capacity (EC) assessments can help identify impairments that would otherwise remain undetected. In this study, we characterized and analyzed the association between functional EC and cancer-specific quality of life (QoL) in lung cancer survivors who previously completed curative intent treatment.

METHODS

In a cross-sectional study of 62 lung cancer survivors who completed treatment ≥ 1 month previously, we assessed functional EC with the 6-min walk distance (6MWD) and cancer-specific QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC-QLQ-C30). Cancer-specific QoL was defined using a validated composite EORTC-QLQ-C30 summary score. Univariable (UVA) and multivariable linear regression analyses (MVA) were performed to assess the relationship between functional EC and cancer-specific QoL.

RESULTS

Lung cancer survivors had reduced functional EC (mean 6MWD = 335 m, 65% predicted) and QoL (mean EORTC-QLQ-C30 summary score = 77, scale range 0-100). In UVA, 6MWD was significantly associated with cancer-specific QoL (R2 = 0.16, p = 0.001). In MVA, in a final model that also included heart failure, obstructive sleep apnea, and psychiatric illness, 6MWD was independently associated with cancer-specific QoL (partial R2 = 0.20, p = 0.001).

CONCLUSIONS

Functional EC was independently associated with cancer-specific QoL in lung cancer patients postcurative intent treatment. Exercise-based interventions aimed at improving EC may improve cancer-specific QoL in these patients.

Changes in Health-Related Quality of Life During Rehabilitation in Patients With Operable Lung Cancer: A Feasibility Study (PROLUCA)

INTRODUCTION

Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life.

OBJECTIVES

The objective is to present health-related quality of life (HRQoL) changes over time before and 1 year after surgery in patients with NSCLC participating in a rehabilitation program.

METHODS

Forty patients with NSCLC in disease stage I to IIIa, referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, were included in the study. The rehabilitation program comprised supervised group exercise program, 2 hours weekly for 12 weeks, combined with individual counseling. The study endpoints were self-reported HRQoL (Functional Assessment of Cancer Therapy-Lung, European Organization for Research and Treatment in Cancer-Quality of Life Questionnaire-QLQ-C30, Short-Form-36) and self-reported distress, anxiety, depression, and social support (National Comprehensive Cancer Network Distress Thermometer, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support), measured presurgery, postintervention, 6 months, and 1 year after surgery.

RESULTS

Forty patients were included, 73% of whom completed rehabilitation. Results on emotional well-being ( P < .0001), global quality of life ( P = .0032), and mental health component score ( P = .0004) showed an overall statistically significant improvement during the study.

CONCLUSION

This feasibility study demonstrated that global quality of life, mental health, and emotional well-being improved significantly during the study, from time of diagnosis until 1 year after resection, in patients with NSCLC participating in rehabilitation.

Effect of different thoracic anesthesia on postoperative cough

Background

The objective of the study is to retrospectively analyze the cough status after double lumen tube (DLT) and spontaneous respiration thoracic anesthesia, to compare the degree of influence of anesthesia and surgical factors, and to investigate whether spontaneous respiration anesthesia can reduce the incidence of cough.

Methods

Postoperative follow-ups were performed on 1,162 patients from July 2011 to December 2015 who meet the selected conditions, whose surgical approach is limited to VAST bullectomy, wedge resection, segmentectomy, or lobectomy. Patients' probability of cough in 1st day (T1), 2nd days (T2), 3rd days (T3), 1st month (T4), 3rd months (T5), 6th months (T6) and 12th months (T7) after thoracoscopic surgery were recorded, as well as the Leicester cough questionnaire (LCQ) survey results, visual cough score (VAS), and cough symptom scores. All cases were divided into double-lumen endotracheal tubes anesthesia group (group T, n=925 cases) and spontaneous respiratory anesthesia group (group S, n=456 cases), and group S was further divided into intravenous composite intercostal nerve block anesthesia group (group SB, n=157 cases) and intravenous combined epidural anesthesia group (group SE, n=299 cases).

Results

The probability of cough decreases with the increasing of postoperative time (P<0.05). The probability of cough is similar between group SE and group SB (P>0.05). The probability of cough in group T is significantly higher than other groups at any time point (P<0.05). In group T, the symptom of cough is the most severe, the scores of physiological, psychological, and social parts of LCQ are the lowest, and the VAS score is the highest (P<0.05), but all these are similar in group SE and group SB (P>0.05). The duration of antibiotic application, the days of chest drainage tube indwelling, and the days of hospital stay are all lower in group S than in group T (P<0.05).

Conclusions

There is a correlation between pulmonary surgery and postoperative cough. The probability of postoperative cough is higher in the more invasive patients. The probability of coughing is approximately 27% to 36% at 3 months after surgery, and approximately 2.6% to 7.9% in one year after surgery. The combination of surgery and anesthesia methods increases the probability of cough from 48.9% to 65.1% at 3 months after surgery, and about 20.5% to 22.8% in 1 year after surgery. Spontaneous respiration anesthesia can significantly reduce the probability of cough, improve postoperative recovery, and improve postoperative quality of life.

Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in non-small cell lung cancer patients after surgery

Background

There are no validated and reliable cough‐specific instruments to assess health‐related quality of life with respect to postoperative cough in non‐small cell lung cancer (NSCLC) patients. We used the Leicester Cough Questionnaire in Mandarin‐Chinese (LCQ‐MC) and investigated the validity, reliability, and repeatability of this instrument.

Methods

A total of 130 NSCLC patients (average age 58.75 ± 9.43 years, 65 men, 65 women) completed the LCQ‐MC, cough Visual Analogue Scale (VAS), Cough Symptom Score (CSS), Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study 36‐item Short‐Form Health Survey (SF‐36). Forty patients completed the LCQ‐MC again one week later. Concurrent validity, internal consistency, and repeatability were assessed.

Results

Analyses of concurrent validity showed significant correlations between the LCQ‐MC and the cough VAS (r = −0.488 to −0.660) and CSS (r = −0.495 to −0.601). The corresponding domains of the LCQ‐MC and the SF‐36 exhibited moderate correlations (r = 0.421–0.432). However, there was no significant correlation between the LCQ‐MC and the HADS (P > 0.05). Internal consistency was acceptable (Cronbach's α of 0.74–0.90). Test‐retest reliability was high (intraclass correlation coefficients of 0.89–0.95).

Conclusion

The LCQ‐MC is a reliable, valid instrument for assessing postoperative cough in NSCLC patients.

Symptom practice guide for telephone assessment of patients with cancer treatment-related cardiotoxic dyspnea: Adaptation and evaluation of acceptability

BACKGROUND

Patients with cancer treatment-related cardiotoxicity, which may manifest as heart failure (HF), can present with dyspnea. Nurses frequently assess, triage and offer self-care strategies to patients experiencing dyspnea in both the cardiology and oncology settings. However, there are no known tools available for nurses to manage patients in the setting of cancer treatment-related cardiotoxicity. The objective of this study was to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses over the telephone for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity.

METHODS

The CAN-IMPLEMENT© methodology guided this descriptive study. A systematic search was conducted in four databases to identify cardio-oncology and HF guidelines and systematic reviews. Screening was conducted by two reviewers, with data extracted into a recommendation matrix from eligible guidelines and systematic reviews on: assessment criteria, medications, and/or self-care strategies to manage dyspnea. Healthcare professionals with an expertise in oncology and/or cardiology were recruited using purposeful and snowball sampling. Evaluation of acceptability of the adapted SPG was gathered through semi-structured interviews and a survey with open- and closed-ended questions. Quantitative findings and participant feedback from the interviews and the open-ended survey questions were analyzed descriptively.

RESULTS

Of 490 citations, seven HF guidelines were identified. Evidence from these guidelines was added to the original SPG. Eleven healthcare professionals completed the interview and acceptability survey. The adapted SPG was iteratively revised three times during the interviews. The original SPG was adaptable, and participants indicated the adapted SPG was comprehensive, easy to follow, and would be useful in clinical practice.

CONCLUSIONS

This study highlights the lack of knowledge tools and available clinical practice guidelines to guide healthcare professionals to assess, triage and/or offer self-care strategies to patients with cancer treatment-related cardiotoxic dyspnea. Moreover, most nurses require assistance to differentiate among the various causes of dyspnea from oncology treatment in order to triage severity appropriately. Further research should focus on evaluating the validity of the adapted SPG in clinical practice.

Exchanging narratives-A qualitative study of peer support among surgical lung cancer patients

AIM AND OBJECTIVE

The aim of this study was to examine how hospitalised, surgical lung cancer patients experience talking to a former patient, and how the former patient experiences the role as supportive.

BACKGROUND

During hospitalisation, patients often create a community in which they can engage with fellow patients. The exchange of experiences with others in a similar situation might increase opportunities for support and complement nursing care, but there is a need for more evidence and understanding on the topic.

DESIGN

The methodological framework is based on the French philosopher Paul Ricoeur's text interpretation theory. Qualitative interviews were conducted with nine patients, including a peer informant, using a narrative structure. The analysis was conducted on three levels: (i) naïve reading, (ii) structural analysis and (iii) critical interpretation .

RESULTS

Four themes were developed from the analysis of the interviews: Exchanging emotional thoughts is easier with a peer; Talking to a peer reduces loneliness; Being ambiguous about a relationship with fellow patients; and Being the main person in the conversation with a peer. Sharing stories about having similar symptoms and undergoing similar journeys predominated, and the key feature of the contact between patients was the commonality of their stories.

CRITICAL INTERPRETATION AND CONCLUSION

Telling one's story to a former patient, and thereby creating a joint, common story, is the essence of this study. The support received in this process can be empowering because knowledge of the illness experience is shared and increased. This can help create new coping strategies. The contact with a former patient offered a way to confirm one's thoughts and to find a way out of the illness perspective, by seeing how the former patient had recovered.

RELEVANCE TO CLINICAL PRACTICE

The nursing field faces challenges in the relational aspect of caring because of ever greater efficient and shortened hospital stays; therefore, the peer support concept is becoming increasingly relevant. Patient peers offer each other their own perspectives, and it is important to raise awareness of the value of this and incorporate it into patient stays in hospital.

Timeliness of Treatment Initiation and Associated Survival Following Diagnosis of Non-Small-Cell Lung Cancer in South Carolina

OBJECTIVES

Non-small-cell lung cancer (NSCLC) patient survival depends on a number of factors, including early diagnosis and initiation of treatment. Standard treatment options for patients with NSCLC include surgery, radiation therapy, and chemotherapy. The objective of this study was to evaluate the impact that the initiation of timely treatment has on patient survival among a cohort of privately insured patients with NSCLC in South Carolina.

METHODS

Data for the study were retrospectively obtained from the South Carolina Central Cancer Registry and the state health plan Blue Cross and Blue Shield claims. Patients were diagnosed as having NSCLC between January 1, 2005 and December 31, 2010, were aged 18 years or older, and were covered under the state health plan for at least 1 year before diagnosis. The final study sample included 746 patients. Kaplan-Meier curves and Cox proportional hazard modeling were conducted to examine factors associated with survival, stratified by stage at diagnosis.

RESULTS

The majority in the study cohort (80%) received timely (≤6 weeks) rather than untimely (>6 weeks) care (20%). The mean survival time for patients receiving timely treatment by stage was 36.9, 27.1, and 12.4 months for localized, regional, and distant metastasis, respectively. The mean survival time for patients receiving untimely care by stage was 39.4, 33.8, and 25.2 months for localized, regional, and distant metastasis, respectively. Among patients with NSCLC in the distant metastasis stage, those receiving timely treatment experienced significantly decreased survival (hazard ratio 2.2) in comparison to those receiving untimely care.

CONCLUSIONS

Initiation of treatment within 6 weeks is not associated with greater survival time across all stages of cancer (localized, regional, and distant metastasis). Additional research is needed to examine the impact of other treatment quality metrics on the survival of patients with NSCLC, different time thresholds for treatment initiation that may be more meaningful to survival among patients with NSCLC, and timely care among patients with NSCLC in other geographic areas and populations.

Global Cancer in Women: Burden and Trends

This review is an abbreviated version of a report prepared for the American Cancer Society Global Health department and EMD Serono, Inc., a subsidiary of Merck KGaA, Darmstadt, Germany, which was released at the Union for International Cancer Control World Cancer Congress in Paris in November 2016. The original report can be found at https://www.cancer.org/health-care-professionals/our-global-health-work/global-cancer-burden/global-burden-of-cancer-in-women.html. Staff in the Intramural Research Department of the American Cancer Society designed and conducted the study, including analysis, interpretation, and presentation of the review. The funding sources had no involvement in the study design, data analysis and interpretation, or preparation of the reviewThere are striking disparities in the global cancer burden in women, yet few publications highlight cancer occurrence in this population, particularly for cancers that are not sex specific. This article, the first in a series of two, summarizes the current burden, trends, risk factors, prevention, early detection, and survivorship of all cancers combined and seven sites (breast, cervix, uterine corpus, ovary, colorectum, lung, and liver) that account for about 60% of the cancer burden among women worldwide, using data from the International Agency for Research on Cancer. Estimated 2012 overall cancer death rates in general are higher among women in low- and middle-income countries (LMICs) than high-income countries (HICs), despite their lower overall incidence rates, largely due to inadequate access to early detection and treatment. For example, the top mortality rates are in Zimbabwe (147 deaths per 100,000) and Malawi (138). Furthermore, incidence rates of cancers associated with economic development (e.g., lung, breast, colorectum) are rising in several LMICs. The burden of cancer among women could be substantially reduced in both HICs and LMICs through broad and equitable implementation of effective interventions, including tobacco control, HPV and HBV vaccination, and screening (breast, cervix, and colorectum). Cancer Epidemiol Biomarkers Prev; 26(4); 444-57. ©2017 AACRSee related article by Islami et al. in this CEBP Focus section, "Global Cancer in Women."

Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire

CONTEXT

The Dyspnea-12 (D-12) Questionnaire is a well-validated instrument in respiratory illnesses for breathlessness assessment, but its psychometric properties have not been tested in lung cancer.

OBJECTIVE

To demonstrate the psychometric properties of the D-12 in lung cancer patients.

METHODS

Baseline data from a lung cancer feasibility trial were adopted for this analysis. D-12 and a series of patient-reported tools, including five Numeric Rating Scales (NRS), the Hospital Anxiety and Depression Scale (HADS), and the Lung Cancer Symptom Scale (LCSS), were used for the psychometric assessment. Spearman's correlation coefficients (rs) were used to estimate the convergent validity of the D-12 with the NRS, HADS, and LCSS. Exploratory factor analysis was performed to examine construct validity. Reliability was tested by Cronbach's alpha and item-to-total correlations. D-12 score difference between patients with or without anxiety, depression, and chronic obstructive pulmonary disease (COPD) was explored to identify its discriminate performance.

RESULTS

One hundred and one lung cancer patients were included. There were significantly positive correlations between the D-12 and the HADS, LCSS, and NRS measuring breathlessness severity and its associated affective distress. Factor analysis clearly identified two components (physical and emotional) of the D-12. Cronbach's alpha for D-12 total, physical, and emotional subscales was 0.95, 0.92, and 0.94, respectively. Patients with anxiety or depression demonstrated significantly higher D-12 scores than those without it, and patients with COPD reported significantly more severe breathlessness than those without COPD.

CONCLUSION

The D-12 is a valid and reliable self-reported questionnaire for use in breathlessness assessment in lung cancer patients.

Dyspnea as a Prognostic Factor in Patients with Non-Small Cell Lung Cancer

PURPOSE

To investigate associations between dyspnea and clinical outcomes in patients with non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

From 2001 to 2014, we retrospectively reviewed the prospective lung cancer database of St. Paul's Hospital at the Catholic University of Korea. We enrolled patients with NSCLC and evaluated symptoms of dyspnea using modified Medical Research Council (mMRC) scores. Also, we estimated pulmonary functions and analyzed survival data.

RESULTS

In total, 457 NSCLC patients were enrolled, and 259 (56.7%) had dyspnea. Among those with dyspnea and whose mMRC scores were available (109 patients had no mMRC score), 85 (56.6%) patients had an mMRC score <2, while 65 (43.3%) had an mMRC score ≥2. Significant decreased pulmonary functions were observed in patients with dyspnea. In multivariate analysis, aging, poor performance status, advanced stage, low forced expiratory volume in 1 second (%), and an mMRC score ≥2 were found to be significant prognostic factors for patient survival.

CONCLUSION

Dyspnea could be a significant prognostic factor in patients with NSCLC.

Unmet supportive care needs and desire for assistance in patients receiving radiation treatment: Implications for oncology nursing

Unmet supportive care needs can contribute to emotional distress and reduced quality of life for cancer patients. We undertook a supportive care needs assessment for patients undergoing radiation therapy to provide a basis for program planning. A self-report supportive care needs survey was completed by a convenience sample of 115 patients on days five, seven and 16 during their course of radiation. The most frequently identified physical unmet needs at all three times were fatigue (33%-49%), dry and itchy skin (24%-37%), and sleep difficulties (23%-30%). The number of patients citing these unmet needs increased significantly over the study time period. Within the emotional domain, worry (34.5%) was cited most frequently on day five. The number of individuals expressing worry did not decrease significantly by day 16. Across all domains and individual items, there was wide variation in the percentage of individuals who had an unmet need and also indicated they wanted help with that unmet need. This pattern remained consistent over time. This study emphasizes the need for a defined or intentional process to assess supportive care needs and patient desire for assistance or help with unmet needs.

Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration

Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast-track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients' daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital-to-home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau-Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post-operative trajectory the patients' resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub-themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast-track surgery. Clinicians should be aware of patients' experiences of illness to facilitate patient reconstitution of own identity.

Buspirone for management of dyspnea in cancer patients receiving chemotherapy: a randomized placebo-controlled URCC CCOP study

PURPOSE

Cancer-related dyspnea is a common, distressing, and difficult-to-manage symptom in cancer patients, resulting in diminished quality of life and poor prognosis. Buspirone, a non-benzodiazepine anxiolytic which does not suppress respiration and has proven efficacy in the treatment of generalized anxiety disorder, has been suggested to relieve the sensation of dyspnea in patients with COPD. The main objective of our study was to evaluate whether buspirone alleviates dyspnea in cancer patients.

METHODS

We report on a randomized, placebo-controlled trial of 432 patients (mean age 64, female 51%, lung cancer 62%) from 16 participating Community Clinical Oncology Program (CCOP) sites with grade 2 or higher dyspnea, as assessed by the Modified Medical Research Council Dyspnea Scale. Dyspnea was assessed by the Oxygen Cost Diagram (OCD; higher scores are better) and anxiety by the state subscale of the State-Trait Anxiety Inventory (STAI-S; lower scores are better) at baseline and after the 4-week intervention (post-intervention).

RESULTS

Mean scores from baseline to post-intervention for buspirone were OCD 8.7 to 9.0 and STAI-S 40.5 to 40.1 and for placebo were OCD 8.4 to 9.3 and STAI-S 40.9 to 38.6 with raw improvements over time on both measures being greater in the placebo group. Analysis of covariance (ANCOVA) controlling for baseline scores showed no statistically significant difference between groups for OCD (P = 0.052) or STAI-S (P = 0.062).

CONCLUSION

Buspirone did not result in significant improvement in dyspnea or anxiety in cancer patients. Thus, buspirone should not be recommended as a pharmacological option for dyspnea in cancer patients.

Effect of caregiver education on pulmonary rehabilitation, respiratory muscle strength and dyspnea in lung cancer patients

[Purpose] This study evaluated the effects of caregiver education on pulmonary rehabilitation of patients who have undergone lung resection for cancer. [Subjects] Patients were divided into experimental (n = 22) and control (n = 19) groups. [Methods] The caregivers of the experimental group patients received education on pulmonary rehabilitation, while the control group patients received general management advice for 4 weeks. [Results] Pulmonary muscle strength (maximum inspiratory pressure and maximum expiratory pressure) was increased significantly in the experimental group compared to the control group. Modified Borg scale scores were decreased significantly in the experimental vs.

CONTROL GROUP

[Conclusion] Providing caregivers with education pertaining to pulmonary rehabilitation was associated with improved pulmonary function in lung cancer patients following lung resection.

Occurrence of respiratory symptoms in persons with restrictive ventilatory impairment compared with persons with chronic obstructive pulmonary disease: The PLATINO study

Patients with chronic obstructive pulmonary disease (COPD) usually complain of symptoms such as cough, sputum, wheezing, and dyspnea. Little is known about clinical symptoms in individuals with restrictive ventilatory impairment. The aim of this study was to compare the prevalence and type of respiratory symptoms in patients with COPD to those reported by individuals with restrictive ventilatory impairment in the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study. Between 2002 and 2004, individuals ≥40 years of age from five cities in Latin America performed pre and post-bronchodilator spirometry and had their respiratory symptoms recorded in a standardized questionnaire. Among the 5315 individuals evaluated, 260 (5.1%) had a restrictive spirometric diagnosis (forced vital capacity (FVC) < lower limit of normal (LLN) with forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≥ LLN; American Thoracic Society (ATS)/European Respiratory Society (ERS) 2005) and 610 (11.9%) were diagnosed with an obstructive pattern (FEV1/FVC < LLN; ATS/ERS 2005). Patients with mild restriction wheezed more ((30.8%) vs. (17.8%); p < 0.028). No difference was seen in dyspnea, cough, and sputum between the two groups after adjusting for severity stage. The health status scores for the short form 12 questionnaire were similar in restricted and obstructed patients for both physical (48.4 ± 9.4 vs. 48.3 ± 9.8) and mental (50.8 ± 10.6 vs. 50.0 ± 11.5) domains. Overall, respiratory symptoms are not frequently reported by patients with restricted and obstructed patterns as defined by spirometry. Wheezing was more frequent in patients with restricted pattern compared with those with obstructive ventilatory defect. However, the prevalence of cough, sputum production, and dyspnea are not different between the two groups when adjusted by the same severity stage.

Trajectories of Symptom Occurrence and Severity From Before Through Five Months After Lung Cancer Surgery

CONTEXT

Limited information is available about lung cancer patients' symptoms in the pre- and postoperative periods.

OBJECTIVES

Study purposes were to evaluate for changes in symptom occurrence and severity from the preoperative period to five months after surgery and to evaluate for predictors of the occurrence and trajectories of these symptoms.

METHODS

Patients completed the Memorial Symptom Assessment Scale before and at one and five months after surgery. Changes in the six most common physical symptoms and the most common psychological symptom were evaluated using multilevel growth mixture modeling. Age, gender, comorbidity, and receipt of adjuvant chemotherapy were included as covariates in the conditional models for symptom occurrence and severity.

RESULTS

The total number of symptoms increased significantly from the preoperative to the one month assessment. At five months, the number of symptoms was lower than at one month but significantly higher than at the preoperative assessment. The occurrence of five of the symptoms (i.e., pain, lack of energy, shortness of breath, feeling drowsy, and worrying) increased significantly from before through the first month after surgery and then decreased over time. Cough and difficulty sleeping persisted over the five months of the study. In general, the effect of the four covariates was to increase patients' overall symptom burden.

CONCLUSION

Changes in the occurrence and severity of these seven symptoms were variable. All seven symptoms occurred at relatively high rates and were of moderate severity. Findings can be used to identify patients who are at higher risk for more severe symptoms.

Chest wall tumors and prosthetic reconstruction: A comparative analysis on functional outcome

Background

To address the question of how much chest-wall (CW) resections and prosthetic reconstructions influence functional outcome.

Methods

We retrospectively reviewed 175 patients who underwent surgery for CW tumors. The clinical, histological, surgical, oncological, and functional factors were analyzed.

Results

We performed: 75 rib resections; 20 sternal resections; 15 combined resections; and 27 lung resections. In 39 cases (22.2%) CW was stabilized with non-rigid prosthesis (Vicryl-mesh: 8 patients; Goretex-mesh: 31 patients). Postoperative complications occurred in 22 cases (12.6%): a correlation with lung resection was evidenced by multivariate analysis (P = 0.025). Five-year survival for primary and secondary tumors was 50% and 36%, respectively: multivariate analysis (P = 0.048) showed a worse survival in men only. In the prosthesis subset, pulmonary function tested as percentage of forced expiratory volume in one second (%FEV1) (pre: 87.1 ± 18.9%; post: 82.3 ± 23.0%, P = ns), percentage of forced vital capacity (pre: 94.1 ± 19.3%; post: 82.0 ± 21.6%, P = ns), diffusing capacity of the lungs for carbon monoxide (pre: 15.7 ± 7.4; post: 12.1 ± 4.1, P = ns) and paO2 (pre: 82.6 ± 10.9 mmHg; post: 83.9 ± 7.3 mmHg, P = ns) was slightly modified from pre to postoperative. Interestingly, the decline of FEV1% was lower in the prosthesis-subset (4.1 ± 15.9%) compared with the subgroup who did not undergo prosthetic stabilization (17.5 ± 16.2%), but this difference was not statistically significant (P = ns).

Conclusion

Because of the low decrease of lung parameters, CW prosthetic reconstruction could be helpful for avoiding postoperative worsening of functional outcome, mostly in patients with pre-existing pulmonary diseases.

The effect of gender on health-related quality of life and related factors in post-lobectomy lung-cancer patients

PURPOSE

While studies have documented gender differences by histologic type among lung cancer patients, the effect of these differences on the health-related quality of life (HRQoL) of post-lobectomy lungcancer patients and related factors remain uncertain. This study examines gender-specific HRQoL and related factors in post-lobectomy lung-cancer patients.

METHODS

A cross-sectional study design was applied. A convenience sample of 231 post-lobectomy lungcancer patients was recruited from the thoracic surgery outpatient departments of two teaching hospitals in Taipei, Taiwan from March to December 2012. Patients performed a spirometry test and completed instruments that included a Beck Depression Inventory-II, an Interpersonal Support Evaluation List, and the symptom and function scales of the Quality of Life Questionnaire. Data analysis used descriptive statistics, including mean and standard deviations, frequency, and percentage values. Independent-sample Student's t-tests and multivariate analyses were used for comparative purposes.

RESULTS

This study confirmed a significant gender effect on HRQoL and HRQoL-related factors such as marital status, religious affiliation, smoking status, histologic type, symptoms, pulmonary function, depression, and family support. Moreover, multivariate analysis found gender to be a significant determinant of the HRQoL aspects of physical functioning, emotional functioning, and cognitive functioning. Finally, results indicated that factors other than gender were also significant determinants of HRQoL.

CONCLUSION

Gender impacts the HRQoL and related factors of postoperative lung-cancer patients. Therefore, gender should be considered in assessing and addressing the individual care needs of these patients in order to attain optimal treatment outcomes.

Sleep, mood, and quality of life in patients receiving treatment for lung cancer

PURPOSE/OBJECTIVES

To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer.

DESIGN

Descriptive, correlational study.

SETTING

Two ambulatory oncology clinics.

SAMPLE

35 patients with lung cancer.

METHODS

The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), a sleep diary, and a motionlogger actigraph.

MAIN RESEARCH VARIABLES

Sleep, mood, and QOL.

FINDINGS

Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures.

CONCLUSIONS

Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance.

IMPLICATIONS FOR NURSING

Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL.

KNOWLEDGE TRANSLATION

A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had lower QOL. Sleep disturbances may be more related to lung cancer symptoms than anxiety or depression. Improving lung cancer symptoms such as dyspnea may improve sleep.

Perceptions about using mindfulness therapy: a lung cancer focus group study

BACKGROUND

Patients with lung cancer are in need of effective strategies to modify symptom burden and improve health-related quality of life (HRQOL). One promising approach to symptom management is an 8-week mindfulness-based intervention, which incorporates meditation, breathing, and gentle yoga exercises. It requires few resources to implement, but has not been adequately tested with lung cancer patients.

OBJECTIVE

The purpose of this study was to obtain lung cancer patient perceptions of a mindfulness-based intervention.

METHODS

Eleven lung cancer patients participated in audio-taped focus group sessions led by the investigator. Discussion questions probed patient perceptions of mindfulness in terms of symptom management, including benefits and barriers to this therapy and ways the intervention may need to be adapted to accommodate them.

RESULTS

Three primary themes from the qualitative analysis include (1) awareness and interest, (2) perceived barriers and benefits, and (3) recommended adaptations. Specific perceptions included the importance of targeting key symptoms such as dyspnea, worry, and insomnia, whereas recommendations pointed out the need for a shorter duration than the standard 8-week protocol and a home-based approach for greater accessibility.

CONCLUSIONS

The design of mindfulness-based intervention protocols must consider unique characteristics of this vulnerable group, such as targeting specific symptoms, reducing the 8-week protocol, and a home-based offering.

IMPLICATIONS FOR PRACTICE

Nurses are integral to optimizing HRQOL and independent functioning for lung cancer patients. As lung cancer survivorship is extended, it becomes increasingly imperative that a range of supportive resources is available for patients to manage symptoms and improve HRQOL.

Patient views on smoking, lung cancer, and stigma: a focus group perspective

PURPOSE

Patients with lung cancer, the leading cause of cancer death, are shown to have high levels of psychological distress and poorer quality of life as compared to patients with other cancer types. The purpose of this paper is to describe patient focus group discussions about the lung cancer experience in relation to perceived stigmatization, smoking behaviors, and illness causes; and to discuss implications of these findings relative to the role of the nurse as a patient advocate.

METHODS AND SAMPLE

Eleven adult lung cancer patients participated in audio taped focus group sessions. Discussion questions probed patient perceptions of lung cancer challenges and adaptation issues.

RESULTS

Six primary themes from the qualitative analysis included: 1) societal attitudes; 2) institutional practices and experiences; 3) negative thoughts and emotions such as guilt, self-blame and self-deprecation, regret, and anger; 4) actual stigmatization experiences; 5) smoking cessation: personal choices versus addiction; and 6) causal attributions.

CONCLUSIONS

Patients with lung cancer uniquely experience an added burden from developing an illness that the public recognizes is directly associated with smoking behaviors. Stigmatization and smoking related concerns are of high importance. Oncology nurses must be at the forefront in ensuring that patients with lung cancer do not experience additional burden from perceptions that they somehow deserve and need to defend why they have the illness that they are facing.

The Evaluation of a New Supportive Care Screening Tool for Radiation Therapy Patients

OBJECTIVES

Individuals undergoing radiation therapy for cancer may experience a wide range of supportive care needs that are frequently not addressed. A screening tool was designed and tested for psychometric properties (technical characteristics) to assist radiation therapists to quickly identify those patients who require additional intervention during the course of their radiation treatment, allowing early and timely referral and facilitating the provision of quality, in-depth, and patient-centred supportive care.

METHODOLOGY

A comprehensive and itemized screening tool was designed to identify the patient concerns and distress level, capture the patient desire to be helped with specific concerns, and inform the centre of alternative help provided. The tool was administered simultaneously with the standardized instrument quality-of-life questionnaire. One hundred and fifteen radiation therapy patients completed both instruments on three occasions; the first two were 2 days apart, and the third, 2 weeks later. To test the new tool for reliability and sensitivity, the agreement between the responses on the first two occasions and those between the first and third occasions were analysed for both instruments. Correlations between the responses on the two instruments were also examined for concurrent validity.

RESULTS

McNemar's test and the simple kappa coefficient both showed high agreement between item scores on the new screening tool when the first and the second occasions were compared. When the first and the third occasions were compared, the former test showed a shift from high agreement to lesser agreement across the item scores. The latter showed a shift in more than 97.7% of the items from a higher agreement to a lesser agreement. The new tool's sensitivity to change was further reinforced by the data from the validated quality-of-life questionnaire, which showed a similar change over time; the Pearson product moment correlation coefficient fell on average from 0.75 to 0.58 for the first and the second comparisons respectively, with all P values less than .0001. Concurrent validity was found to be acceptable.

CONCLUSIONS

The new screening tool was found to be reliable and sensitive, with acceptable validity. It is anticipated that the screening intervention will allow radiation therapists to standardize and formalize their approach to supportive care in radiation therapy outpatient clinics and enhance their capacity to identify and address patient concerns in a timely manner.

Safety and feasibility of an exercise intervention for patients following lung resection: a pilot randomized controlled trial

PURPOSE

Following surgical lung resection, patients frequently suffer functional decline and reduced activity levels. Despite this exercise interventions are not routinely provided. This study aimed to establish the safety and feasibility of exercise administered following lung resection in an Australian setting.

METHOD

Pilot randomized controlled trial. Fifteen individuals (53% male), mean ± standard deviation age 65.5 ± 16.1 years, undergoing surgery for suspected lung cancer. Randomization occurred postoperatively. Control arm received protocolized inpatient respiratory physiotherapy. Intervention arm additionally received twice daily exercise until discharge home and twice weekly as outpatient for 8 weeks. Outcome measures (safety, feasibility, functional capacity, functional mobility, and health-related quality of life [HRQoL]) were assessed preoperatively and 2 and 12 weeks postoperatively.

RESULTS

Fifteen participants (lung cancer n = 10) were assigned to control (n = 8) and intervention (n = 7) groups. Inpatient exercise was delivered on 71% of occasions (35 out of 49 planned sessions). Four participants attended outpatient exercise sessions and these participants attended sessions on 81% of occasions (52 out of 64 planned sessions). No adverse events occurred. There was a significant between group difference in 6-Minute Walk Test (6MWT; P = .024). In both groups the 6MWT declined from baseline to 2 weeks postoperative and then improved up to 12 weeks; improvements were greater in the intervention group. Intervention was associated with positive trends of improvement in some HRQoL domains.

CONCLUSIONS

Exercise intervention performed in the inpatient and outpatient settings for individuals following lung resection was safe and feasible. The uptake rate for outpatient exercise was 57%, similar to previous trials; however, adherence was excellent within the subgroup of participants who attended. Further research is required to investigate the best setting of exercise delivery and explore ways to improve the uptake rate.

Pneumonectomy with en bloc chest wall resection: is it worthwhile? Report on 34 patients from two institutions

OBJECTIVES

Pneumonectomy with en bloc chest wall resection is often denied because of the procedure-related high risk. We evaluated the short- and long-term outcome of this procedure.

METHODS

From January 1995 to October 2011, 34 patients (30 males and 4 females; mean age: 61.8 years) underwent pneumonectomy with en bloc chest wall resection for 33 non-small-cell lung cancer and 1 metastatic osteosarcoma in two institutions. Data were retrospectively reviewed.

RESULTS

Operative (30-day) mortality was 2.9% (1 of 34), and morbidity was 38.2% (13 of 34). There were 14 (41.1%) right-side procedures and 20 (58.8%) left-side procedures. Three (8.8%) patients developed bronchopleural fistulas. The mean number of resected ribs per patient was 2.7 ± 1.1. In 13 (38.2%) patients, a prosthetic reconstruction of the chest wall was needed. In 3 (8.8%) cases, the bronchial step was buttressed. Preoperative pain was statistically significantly related to the depth of chest wall invasion (P = 0.026). The N status was N0 in 18 (52.9%) cases, N1 in 9 (26.4%), N2 in 6 (17.6%) and Nx in 1 (metastatic osteosarcoma). Patients were followed-up for a total of 979 months. The median survival was 40 months. The overall 5-year survival was 46.8% (± 95% confidence interval [CI]: 0.2-0.6): 45.2 (± 95% CI: 0.03-0.8) for right-side and 48.4% (± 95% CI: 0.2-0.7) for left-side procedures, respectively. According to the N status, the 5-year survival was 59.7 (± 95% CI: 0.3-0.8) in N0, 55.5 (± 95% CI: 0.06-1) in N1 and 16.6% (± 95% CI: 0-0.4) in N2. The subgroup N0 plus N1 (27 patients) showed a 58.08% (± 95% CI: 0.3-0.8) 5-year survival compared with 16.6% (± 95% CI: 0-0.4) in N2 (χ(2): 3.7; P = 0.053).

CONCLUSIONS

Pneumonectomy with en bloc chest wall reconstruction can be safely offered to selected patients. The addition of en bloc chest wall resection to pneumonectomy does not affect operative mortality and morbidity compared with standard pneumonectomy. The pivotal additional effect of the chest wall resection should not be considered a contraindication for such procedures. Survival showed a clinically relevant difference by comparing N0 plus N1 with N2 (58.1 vs 16.6%), not confirmed by the statistical analysis (P = 0.053).