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Xu J, Ni H, Zhan H, Yu H, Lu Z, Zhang J, Meng H, Hang L, Mao L, Xu X, Ma X, Wu Q, Xu W, Xiang D, Zeng Y, Meng D, Teng X, Yu L, Zeng L, Ni P, Miao H, Fu S, Wang L, He Z, Zhang C, Lv X, Xu H, Wu Y, Lv W, Shi Q, Hu J. Efficacy of digital therapeutics for perioperative management in patients with lung cancer: a randomized controlled trial. BMC Med 2025; 23:186. [PMID: 40155969 PMCID: PMC11951826 DOI: 10.1186/s12916-025-04012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/14/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Perioperative management and lung function recovery are vital for lung cancer patients. We conducted an open-label, single-center, noninferiority, randomized controlled trial in China to evaluate the efficacy of digital therapeutic (DTx)-assisted management vs. multidisciplinary management (MM) in the perioperative management of patients with lung cancer. METHODS From July 2022 to June 2023, 186 minimally invasive lung surgery patients were randomized, and 147 completed the study. The participants were randomly assigned a 1:1 ratio to receive DTx-assisted management (n = 72) or traditional MM (n = 75). The primary endpoint was the pulmonary function recovery rate measured by forced expiratory volume in the first second (FEV1%) 3 weeks after surgery, and the noninferiority margin was set to 4.8%. The secondary endpoints included hospital stay duration, 90-day unplanned readmission rate, symptom scores, patient management time, and patient satisfaction rate. Exploratory endpoints include factors influencing postoperative lung function recovery. RESULTS The lung function FEV1% recovery rate of the DTx group was not inferior to that of the MM group (87.18% ± 11.01% vs. 84.21% ± 11.75%). There were no significant differences between the two groups in terms of postoperative hospitalization duration or 90-day unplanned readmission rates. The patient management time in the DTx group was significantly shorter than that in the MM group (1.48 ± 3.22 min vs. 16.67 ± 6.41 min, P < 0.001). Patient symptom scores tended to decrease over time after discharge, and the 5 target symptoms included pain, coughing, shortness of breath, disturbed sleep, and fatigue. On the 7th day after discharge, the DTx group had a lower occurrence rate of the 5 target symptoms triggering the alert threshold compared to the MM group (P = 0.002). Patients with higher education levels achieved a better FEV1% recovery rate with DTx-assisted management (P = 0.021). CONCLUSIONS Compared with the MM group, the DTx group achieved noninferior results in all evaluated clinically meaningful endpoints but was significantly more efficient in perioperative management, providing an alternative digitalized management mode for patients with lung cancer surgery. TRIAL REGISTRATION ChiCTR2200064723.
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Affiliation(s)
- Jinming Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Ni
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hanyu Zhan
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongfan Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zhongjie Lu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jieping Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongbo Meng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Hang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoying Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojian Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiongyin Wu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danyu Xiang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yufang Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Di Meng
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Teng
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Yu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liping Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pengzhi Ni
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huiwen Miao
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaozi Fu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhehao He
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiayi Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heyun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihua Wu
- Department of Toxicology of School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
- School of Public Health, Chongqing Medical University, Chongqing, China.
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Enhanced Recovery After Surgery (ERAS) Center of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, China.
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Lai Y, Zhou S, Tian L, Li H, Ye X, Che G. Preoperative heart rate variability as a predictor of postoperative pneumonia and lung function recovery in surgical lung cancer patients: a prospective observed study. BMC Cancer 2025; 25:404. [PMID: 40045322 PMCID: PMC11883988 DOI: 10.1186/s12885-025-13778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 02/20/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND The objective of this study was to evaluate the significance of preoperative heart rate variability (HRV) as a surrogate marker for vagus nerve activity in predicting the incidence of postoperative pneumonia (POP) and lung function recovery in patients undergoing lung cancer surgery. METHOD A prospective observational study was conducted at a single center. Patients were categorized into two groups: the POP group, which included those who developed pneumonia post-surgery, and the non-POP group, comprising patients who did not experience POP. RESULTS A total of 257 subjects met the inclusion criteria and were ultimately included in the study. 33 patients presented POP, accounting for 12.8% (33/257) of the patients. Logistic regression revealed that preRMSSD (OR: 0.812, 95%CI: 0.720-0.912, P = 0.001) and preHFP (OR: 0.990, 95%CI: 0.983-0.996, P = 0.002) were the independent factors for POP; receiver operating characteristic curve (ROC) analysis for predicting the occurrence of the POP revealed that the combination of BMI, preHFP and preRMSSD showed the positive diagnostic accuracy (AUC: 0.867, P < 0.001). A logistic regression analysis showed that HRV indicators including preRMSSD (OR: 0.937, 95%CI: 0.892-0.985, P = 0.010) and preHFP (OR: 0.995, 95%CI: 0.992-0.998, P = 0.001) were independent factors for well-recovery in FEV1% within postoperative 30 days. Similar results can be found in well-recovery in FVC% or DLCO%. CONCLUSION These findings provided compelling evidence supporting the utility of HRV indicators in predicting both POP and postoperative lung function recovery among surgical lung cancer patients. TRIAL REGISTRATION ChiCTR2400085997, registered in 24/06/2024.
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Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Sicheng Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Long Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Hongjun Li
- West China Hospital of Medicine, Sichuan University, Chengdu, 610041, P. R. China
| | - Xinyi Ye
- Department of Endoscopy Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China.
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China.
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Lin W, Chen S, Chen J, Wang C, Lu F. Global research and emerging trends in depression in lung cancer: a bibliometric and visualized study from 2014 to 2024. Front Oncol 2025; 15:1490108. [PMID: 40110200 PMCID: PMC11919658 DOI: 10.3389/fonc.2025.1490108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 02/18/2025] [Indexed: 03/22/2025] Open
Abstract
Background The impact of depression on the physical and psychological well-being of lung cancer patients has raised significant concerns. This study explored lung cancer-related depression research from a bibliometric perspective. Methods Articles and reviews on depression in lung cancer published from 2014 to 2024 in the Web of Science Core Collection were retrieved and identified. The information extracted included "Full Record and Cited References". Bibliometric analysis was conducted using CiteSpace and Excel to examine relevant publications in terms of country, institution, authorship, journal, citations, and keywords. Results A total of 761 publications on depression in lung cancer were identified for analysis, contributed by 4,667 authors from 305 institutions and 58 countries. The annual publication count has steadily increased, culminating in a peak in 2024. China (275 papers), Harvard University (58 publications), and Joseph A. Greer (25 publications) were the most productive and influential country, institution, and author, respectively. Jennifer S. Temel emerges as a highly influential author, securing the second position in terms of both publication count and citation impact. The journal with the highest number of publications is Supportive care in cancer, while the Journal of Clinical Oncology has garnered the most citations. Reference and keyword analysis indicated that the research hotspots mainly included 1) Epidemiology of lung cancer-related depression; 2) The deleterious impact of depression on lung cancer patients, particularly with regards to their quality of life; 3) Association between inflammation and depression in lung cancer; 4) Treatment. Conclusions Our study employed bibliometric analysis to identify prevalent focal areas and emerging trends in the field of research on lung cancer-related depression. Our study found that numerous unanswered questions persist, including the intricate relationship between lung cancer and depression, the profound impact of depression on lung cancer patients, and the interplay between inflammation and depression in this specific population. Furthermore, a current challenge in clinical practice involves the development of secure and more efficacious treatment strategies for individuals with lung cancer-related depression. These findings provide valuable guidance for scholars seeking to explore new avenues of investigation.
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Affiliation(s)
- Weilan Lin
- Respiratory Department, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- First Clinical College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Clinical Research Center for Integrative Medicine on Early Lung Cancer Diagnosis and Treatment of Fujian Province, Fuzhou, China
| | - Shun Chen
- Respiratory Department, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- First Clinical College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Clinical Research Center for Integrative Medicine on Early Lung Cancer Diagnosis and Treatment of Fujian Province, Fuzhou, China
| | - Jiawei Chen
- Respiratory Department, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Clinical Research Center for Integrative Medicine on Early Lung Cancer Diagnosis and Treatment of Fujian Province, Fuzhou, China
| | - Chune Wang
- Respiratory Department, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Clinical Research Center for Integrative Medicine on Early Lung Cancer Diagnosis and Treatment of Fujian Province, Fuzhou, China
| | - Feng Lu
- Respiratory Department, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Clinical Research Center for Integrative Medicine on Early Lung Cancer Diagnosis and Treatment of Fujian Province, Fuzhou, China
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Su J, Ye C, Zhang Q, Liang Y, Wu J, Liang G, Cheng Y, Yang X. Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial. JMIR Res Protoc 2025; 14:e60420. [PMID: 39610048 PMCID: PMC11736221 DOI: 10.2196/60420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 10/12/2024] [Accepted: 11/27/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management through electronic patient-reported outcomes (ePROs) offers a potential solution to improve adherence by enabling more effective monitoring and intervention. OBJECTIVE This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery for lung cancer. METHODS In this single-center, prospective, randomized controlled trial, 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomly assigned 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and postdischarge days 3, 7, 14, 21, and 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, and fatigue) scored ≥4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is the rehabilitation exercise adherence rate. Secondary outcomes include postdischarge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction. RESULTS The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data have been collected and thoroughly reviewed. CONCLUSIONS This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence after video-assisted thoracic surgery for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/60420.
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Affiliation(s)
- Jianwei Su
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Cuiling Ye
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Qian Zhang
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Yi Liang
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Jianwei Wu
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Guixi Liang
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Yalan Cheng
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Xiaojuan Yang
- Department of cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
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Huang Y, Chen M, Wu Z, Liu P, Zhang S, Chen C, Zheng B. Postoperative chronic operation-related symptoms after minimally invasive lung surgery: a prospective observational protocol. BMJ Open 2024; 14:e082412. [PMID: 39097304 PMCID: PMC11298735 DOI: 10.1136/bmjopen-2023-082412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Significant numbers of patients undergoing minimally invasive lung surgery develop chronic symptoms such as chronic pain and chronic cough after surgery, which may lead to a reduced quality of life (QoL). Despite this, there remains a dearth of high-quality prospective studies on this topic. Therefore, our study aims to systematically investigate the incidence and progression of long-term chronic symptoms following minimally invasive lung surgery, as well as changes in patient's psychological status and long-term QoL. METHODS This is a single-centre, observational, prospective study that included patients with stage I non-small cell lung cancer or benign lesions. Prior to surgery, patients' baseline levels of chronic pain, chronic cough and sleep will be documented. Anxiety, depression and QoL assessments will be conducted using the Hospital Anxiety and Depression Scale (HADS) and the European Organisation for Research and Treatment of Cancer (EORTC) 30-item QoL Questionnaire (QLQ-C30). Following surgery, pain and cough will be evaluated during the initial 3 days using the Numeric Pain Rating Scale and Visual Analogue Scale score, with assessments performed thrice daily. Additionally, sleep status will be recorded daily during this period. Subsequently, postoperative chronic symptoms and QoL will be assessed at weeks 1, 2, 4, 12, 26 and 52. Chronic cough will be evaluated using the Leicester Cough Questionnaire, chronic pain will be assessed via the Brief Pain Inventory and McGill Pain Questionnaire while the EORTC QLQ-C30 questionnaire and HADS will provide continuous monitoring of QoL, anxiety and depression statuses. Data will also include the timing of chronic symptom onset, predisposing factors, as well as aggravating and relieving factors. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committees of Fujian Medical University Union Hospital. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT06016881.
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Affiliation(s)
- Yizhou Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Maohui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Zhihui Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Peichang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Shuliang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
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Xiao J, Peng Y, Li Y, Ye F, Zeng Z, Lin X, Xie Y, Cheng S, Wen Y, Luo W. Exploring the symptoms and psychological experiences among lung cancer convalescence patients after radical lobectomy: A qualitative study. Cancer Med 2024; 13:e70048. [PMID: 39082931 PMCID: PMC11289897 DOI: 10.1002/cam4.70048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/07/2024] [Accepted: 07/13/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE This study aims to explore the symptom experiences and psychological feelings of lung cancer patients after radical lobectomy in China. METHODS A qualitative study was conducted using face-to-face semistructured interviews with lung cancer patients who had a radical lobectomy for treatment of their cancer during the convalescence period. Participants (n = 18) were recruited from a general hospital in China, and patients were selected using purposive sampling from September 2021 to February 2022. Interviews were recorded and transcribed verbatim, and Colaizzi's seven-step method of phenomenology was used. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was conducted to report the study. RESULTS Four themes were extracted from the interview data: physiological dimensions (fatigue, cough or sputum, chest tightness and shortness of breath, daily activities affected, sleep disturbance, lack of appetite); psychological dimensions (negative emotion, fear of cancer recurrence, learning to accept reality, strengthened faith and hope); family dimensions (heavy economic burden, perceived family care, improved health management behavior); and social dimensions (perceived support of medical staff, decreased sense of social value and self-identity, changes in social and working style). CONCLUSION Lung cancer patients are still troubled by many problems during the postoperative recovery period. Medical staff should design and implement effective evaluations and targeted interventions for patients' physical and mental health as soon as possible to improve patients' physical and mental health, as well as their quality of life.
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Affiliation(s)
- Julan Xiao
- Department of Thoracic SurgeryShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
| | - Yueming Peng
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
- Department of NursingShenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital; Southern University of Science and Technology)ShenzhenGuangdongChina
| | - Yun Li
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
- Department of the Operating RoomShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
| | - FengQing Ye
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
- Department of the Operating RoomShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
| | - Zhixong Zeng
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
- Department of the Operating RoomShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
| | - XiaoXu Lin
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
- Department of the Operating RoomShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
| | - Yanheng Xie
- Department of Thoracic SurgeryShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
| | - Sijiao Cheng
- Department of Thoracic SurgeryShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
| | - Yi Wen
- Department of Thoracic SurgeryShenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
| | - Weixiang Luo
- Shenzhen Clinical Research Centre for GeriatricsShenzhen People's HospitalShenzhenGuangdongChina
- Department of NursingShenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital; Southern University of Science and Technology)ShenzhenGuangdongChina
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7
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Su X, Huang Y, Gong R, Xu W, Dai W, Pu Y, Yu J, Yu Q, Zhang L, Zhang J, Shi Q. Undergoing Lung Surgery (PSA-Lung) was appropriate for symptom assessment after discharge. Qual Life Res 2024; 33:1807-1818. [PMID: 38735915 DOI: 10.1007/s11136-024-03636-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To examine whether a 7-day or 24-h recall period of Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) was appropriate for symptom assessment after discharge. METHODS A total of 377 patients were recruited in a cohort study of patients who underwent lung surgery. We measured patient symptoms daily and weekly using the two recall period versions of the PSA-Lung scale, respectively. The psychometric properties of both versions were calculated. Spearman rank correlation coefficients and kappa (k) coefficients were used to measure the association between items score measured by the two version scales each week. Cohen's d effect size and mixed linear model were used to measure responsiveness to change over time. RESULTS Spearman rank correlation coefficients between the symptom scores generated by the 7-day and 24-h versions (range 0.48-0.77; all P < 0.05). The correlations increased in patients in stable condition (weekly symptom change < 2). Cronbach's α coefficients for both ratings were > 0.87 and both had good test-retest reliability. The longitudinal analysis and Cohen's d effect sizes showed that both ratings had good ability to detect changes in all items. CONCLUSION The 7-day retrospective scale was as effective as the 24-h retrospective scale in terms of psychometric performance. In the stage where the patient's symptoms change rapidly, it is recommended to use the 24-h retrospective scale for symptom monitoring. On the contrary, in a stable state, it can be considered to use the 7-day retrospective scale for monitoring to reduce the patient's burden.
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Affiliation(s)
- Xueyao Su
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China
| | - Yanyan Huang
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China
| | - Ruoyan Gong
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Xu
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine,, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yang Pu
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China
| | - Jingwen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qingsong Yu
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Lijun Zhang
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China
| | - Jiayuan Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, No.1, Medical School Road, Yuzhong District, Chongqing, 400016, China.
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine,, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
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8
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Yang Y, Chen X, Pan X, Tang X, Fan J, Li Y. The unmet needs of patients in the early rehabilitation stage after lung cancer surgery: a qualitative study based on Maslow's hierarchy of needs theory. Support Care Cancer 2023; 31:677. [PMID: 37934256 DOI: 10.1007/s00520-023-08129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study aimed to explore the unmet needs of lung cancer patients in early rehabilitation, based on Maslow's hierarchy of needs theory. METHODS Information on the experiences of 20 patients was collected through semi-structured interviews. The interviews were conducted in the surgical nursing clinic within 1 week of discharge from hospital. The data were analysed using a combination of deductive (theory-driven) and inductive (data-driven) methods, using Maslow's Hierarchy of Needs as a framework for identifying and organising themes. RESULTS Patients had a mean age of 50.92 years (SD 11.88); n = 11 (55%) were female. Major themes aligned with the dimensions of Maslow's hierarchy of needs model. Five major themes with 12 corresponding sub-themes emerged: (1) physiological needs, including "self-care and independence in life", "return to pre-operative status as soon as possible", "increase exercise under specialist guidance" and "reduce cough and pain and improve sleep quality"; (2) safety and security needs, such as "symptom management", "regulation of the emotions of worry and fear" and "access accurate treatment information"; (3) love and belonging needs, including "accompany family members" and "chat with friends";(4)Esteem needs: "live with dignity";(5) Self-actualization, such as "accept and submit to the reality of cancer" and "live meaningfully". CONCLUSIONS The findings of this study indicated that there were many unmet needs for patients during the early recovery period after lung cancer surgery. An overview of the different areas of need identified in this study may guide future research and development of interventions to improve patients' quality of life during the home rehabilitation phase.
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Affiliation(s)
- Yingzi Yang
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
- Department of Nursing, Huadong Sanatorium, No. 67, Dajishan, Wuxi City, Jiangsu Province, 214100, People's Republic of China
| | - Xinxin Chen
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, No.507, Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Xiaoting Pan
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
| | - Xuefeng Tang
- Department of Nursing, Huadong Sanatorium, No. 67, Dajishan, Wuxi City, Jiangsu Province, 214100, People's Republic of China
| | - Jiaxin Fan
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
| | - Yumei Li
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, No.507, Zhengmin Road, Shanghai, 200433, People's Republic of China.
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9
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Su X, Huang Y, Dai W, Zhang Y, Zhang L, Zhang J, Gong R, Yu J, Kang D, Xiang R, Chen J, Shi Q. Recall Bias in the Assessment of Cough for Patients Discharged from Lung Surgery. Patient Prefer Adherence 2023; 17:1561-1572. [PMID: 37426047 PMCID: PMC10327912 DOI: 10.2147/ppa.s399635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose This study aimed to evaluate the presence of recall bias when patients retrospectively report cough scores. Patients and Methods Patients who underwent lung surgery between July 2021 and November 2021 were recruited for this study. We retrospectively assessed the severity of cough within the past 24 hours and the past 7 days using a 0-10 numerical rating scale. Recall bias was defined as the difference between the scores reported on the two assessments. Patients were grouped based on the longitudinal change in cough scores from pre-operation to 4 weeks after discharge using group-based trajectory models. Using generalized estimating equation to explore the factors influencing recall bias. Results Overall, 199 patients were analyzed and demonstrated the three distinct trajectories of post-discharge cough: high (21.1%), medium (58.3%), and low (20.6%). Significant recall bias was found in week 2 for the high-trajectory patients (6.26 vs 5.10, P<0.01) and in week 3 for the medium-trajectory patients (2.88 vs 2.60, P=0.01). Among all recall bias, 41.8% were of underestimation, and 21.7% of overestimation. The high trajectory group (β=1.14, P<0.01) and measurement interval (β=0.36, P<0.01) were risk factors for underestimation, while post-discharge time (β=-0.57, P<0.01) and measurement interval (β=-0.13, P=0.02) were protective factors for overestimation. Conclusion Retrospective assessment of post-discharge cough in patients who underwent lung surgery will introduce recall bias, with a tendency of underestimation. The high-trajectory group, interval time and post-discharge time are influencing factors of recall bias. For patients with severe cough at discharge, a shorter recall periods should be employed for monitoring, due to the large bias that results from a longer recall period.
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Affiliation(s)
- Xueyao Su
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yanyan Huang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Yubo Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Lijun Zhang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jiayuan Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Ruoyan Gong
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jingwen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Dan Kang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Rumei Xiang
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jiaojiao Chen
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
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10
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Wang F, Zhang S, Song B, Han Y. Anxiety, depression, and quality of life in postoperative non-small cell lung cancer patients under the intervention of cognitive-behavioral stress management. Front Psychol 2023; 14:1138070. [PMID: 37325749 PMCID: PMC10264623 DOI: 10.3389/fpsyg.2023.1138070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Objective Cognitive-behavioral stress management (CBSM) is a psychotherapy that helps patients cognize and manage stress to improve mental health and quality of life. This study aimed to explore the influence of CBSM on anxiety, depression, and quality of life in non-small cell lung cancer (NSCLC) patients. Methods In total, 172 NSCLC patients who received tumor resection were randomized 1:1 into the usual care (UC) group (N = 86) and CBSM group (N = 86) to receive 10-week UC and CBSM interventions. Moreover, all participants attended a 6-month follow-up. Results Hospital Anxiety and Depression Scales (HADS)-anxiety score at 3rd month (M3) (P = 0.015) and 6th month (M6) (P = 0.018), HADS-depression score at M3 (P = 0.040) and M6 (P = 0.028), and depression rate at M6 (P = 0.035) were descended in CBSM group compared to UC group. Besides, depression severity was reduced at M6 (P = 0.041) in CBSM group compared to UC group, but anxiety severity only showed a decreased trend (P = 0.051). Additionally, Quality of Life Questionnaire-Core 30 (QLQ-C30) global health status score and QLQ-C30 function score at 1st month (M1), M3, and M6 were elevated (all P < 0.05), while QLQ-C30 symptoms score was declined at M1 (P = 0.031) and M3 (P = 0.014) in CBSM group compared to UC group. Notably, the efficacy of CBSM was impressive in patients with baseline depression or undergoing adjuvant therapy. Conclusion CBSM is a feasible intervention that effectively improves mental health and quality of life in postoperative NSCLC patients.
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Affiliation(s)
- Fengju Wang
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shuyan Zhang
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Bingbing Song
- Department of Urology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yuxiang Han
- Department of Pain Medicine, Harbin Medical University Cancer Hospital, Harbin, China
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11
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Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, Escalante CP, Gozal D, Granger CL, Presley CJ, Smith SM, Chamberlaine DM, Long JM, Malone DJ, Pirl WF, Robinson HL, Yasufuku K, Rivera MP. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e6-e28. [PMID: 36856560 PMCID: PMC10870898 DOI: 10.1164/rccm.202210-1963st] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.
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12
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McDonnell KK, Andrews JO, Yang CH, Newsome BR, Weinkle E, Davis JE, Dunsiger S. Study Protocol for the Breathe Easier Trial: A Pilot RCT of a Dyad-Based, Multiple-Behavior Intervention for Improving Physical and Emotional Health in Survivors Facing Lung Cancer. Integr Cancer Ther 2023; 22:15347354231212876. [PMID: 38009546 PMCID: PMC10683396 DOI: 10.1177/15347354231212876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Research targeting survivors of lung cancer has yet to adequately address the management of physical deconditioning and unresolved symptoms (dyspnea, fatigue). The objective of the Breathe Easier trial is to test the feasibility and preliminary effects of a theory-based, multiple-behavior intervention (physical activity, smoking reduction for current smokers, stress management) targeting survivors of localized non-small-cell lung cancer (NSCLC, stages I-III) and their supportive partners. METHODS This pilot RCT will enroll 30 dyads (60 participants). Each dyad will consist of one survivor and one partner (defined as a family member or friend) Dyads will be randomized to the Intervention Group (IG) or the Attention Control Group (AC). IG members will receive the 12-week, home-based intervention based on the individual and family self-management theory, which targets improvements in self-efficacy, social support, and self-regulation. Improvement in lifestyle behaviors is a proximal outcome. Improvements in physical and emotional health are distal outcomes. Breathe Easier (IG) includes educational content written in plain language as well as breathing exercises and meditations; SMART goal setting; daily text messaging; and weekly telephone calls with trained staff. The AC program includes relevant National Institutes of Health publications plus weekly telephone chats. Members who currently smoke will also receive an evidence-based smoking cessation resource. DISCUSSION Breathe Easier focuses on changes in multiple behaviors in dyads coping with a diagnosis of NSCLC (stages I-III) with the overall purpose of improving physical and emotional health. Findings will provide additional evidence of the feasibility and preliminary effects of this intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05956782; This trial was registered retrospectively.
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Affiliation(s)
| | | | | | - Brandi R. Newsome
- University of South Carolina, Columbia, SC, USA
- Prisma Health, Columbia, SC, USA
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13
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Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Support Care Cancer 2022; 31:85. [PMID: 36574040 DOI: 10.1007/s00520-022-07491-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The latest systematic review on the prevalence of pain in cancer survivors was published 5 years ago. The current review aims to provide an extended overview on the prevalence of pain, pain mechanisms, pain characteristics, and assessment methods in cancer survivors. METHODS A systematic research was conducted on 17th of April 2020 using MEDLINE, Embase, Scopus, Web of Science, and Cochrane looking at studies from 2014 to 2020. Studies had to report pain prevalence rates in cancer survivors with a solid tumor who finished curative treatment at least 3 months ago. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute quality appraisal tool. Characteristics of the included studies, participants and reported pain prevalence rates were extracted. The reported prevalence rates of the individual studies were pooled within a meta-analysis. Meta-regressions were performed to identify possible determinants of the pooled pain prevalence. RESULTS After deduplication, 7300 articles were screened, after which 38 were included in the meta-analysis. Risk of bias was rated low in 26 articles and moderate in 12 articles. The pooled pain prevalence was 47% (95%CI 39-55), with a heterogeneity of 98.99%. CONCLUSION This meta-analysis suggests that nearly half of cancer survivors report pain after completing curative treatment at least 3 months ago. However, substantial unexplained heterogeneity warrants cautious interpretation of these results. Meta-regression using cancer type, treatment location, pain measurement, and follow-up time as a covariate could not explain influencing factors explaining the high heterogeneity.
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14
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Merlo A, Carlson R, Espey J, Williams BM, Balakrishnan P, Chen S, Dawson L, Johnson D, Brickey J, Pompili C, Mody GN. Postoperative Symptom Burden in Patients Undergoing Lung Cancer Surgery. J Pain Symptom Manage 2022; 64:254-267. [PMID: 35659636 PMCID: PMC10744975 DOI: 10.1016/j.jpainsymman.2022.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
Abstract
CONTEXT Previous studies on quality of life (QOL) after lung cancer surgery have identified a long duration of symptoms postoperatively. We first performed a systematic review of QOL in patients undergoing surgery for lung cancer. A subgroup analysis was conducted focusing on symptom burden and its relationship with QOL. OBJECTIVE To perform a qualitative review of articles addressing symptom burden in patients undergoing surgical resection for lung cancer. METHODS The parent systematic review utilized search terms for symptoms, functional status, and well-being as well as instruments commonly used to evaluate global QOL and symptom experiences after lung cancer surgery. The articles examining symptom burden (n = 54) were analyzed through thematic analysis of their findings and graded according to the Oxford Centre for Evidence-based Medicine rating scale. RESULTS The publication rate of studies assessing symptom burden in patients undergoing surgery for lung cancer have increased over time. The level of evidence quality was 2 or 3 for 14 articles (cohort study or case control) and level of 4 in the remaining 40 articles (case series). The most common QOL instruments used were the Short Form 36 and 12, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, and the Hospital Anxiety and Depression Score. Thematic analysis revealed several key findings: 1) lung cancer surgery patients have a high symptom burden both before and after surgery; 2) pain, dyspnea, cough, fatigue, depression, and anxiety are the most commonly studied symptoms; 3) the presence of symptoms prior to surgery is an important risk factor for higher acuity of symptoms and persistence after surgery; and 4) symptom burden is a predictor of postoperative QOL. CONCLUSION Lung cancer patients undergoing surgery carry a high symptom burden which impacts their QOL. Measurement approaches use myriad and heterogenous instruments. More research is needed to standardize symptom burden measurement and management, with the goal to improve patient experience and overall outcomes.
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Affiliation(s)
- Aurelie Merlo
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca Carlson
- University Libraries (R.C.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Espey
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brittney M Williams
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Sarah Chen
- Department of Surgery (S.C.), Medical University of South Carolina, South Carolina, USA
| | - Lauren Dawson
- University of North Carolina at Chapel Hill School of Medicine (L.D., D.J., J.B.), Chapel Hill, North Carolina, USA
| | - Daniel Johnson
- University of North Carolina at Chapel Hill School of Medicine (L.D., D.J., J.B.), Chapel Hill, North Carolina, USA
| | - Julia Brickey
- University of North Carolina at Chapel Hill School of Medicine (L.D., D.J., J.B.), Chapel Hill, North Carolina, USA
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research (C.P.), Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Gita N Mody
- Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Lineberger Comprehensive Cancer Center (G.N.M.), University of North Carolina, Chapel Hill, North Carolina, USA.
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15
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Shin S, Kong S, Kang D, Lee G, Cho JH, Shim YM, Cho J, Kim HK, Park HY. Longitudinal changes in pulmonary function and patient-reported outcomes after lung cancer surgery. Respir Res 2022; 23:224. [PMID: 36042472 PMCID: PMC9429784 DOI: 10.1186/s12931-022-02149-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Surgery is the mainstay of treatment for non-small cell lung cancer, but the decline in pulmonary function after surgery is noticeable and requires attention. This study aimed to evaluate longitudinal changes in pulmonary function and integrated patient-reported outcomes (PROs) after lung cancer surgery. Methods Data were obtained from a prospective cohort study, the Coordinate Approach to Cancer Patients’ Health for Lung Cancer. Changes in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) at 2 weeks, 6 months, and 1 year after surgery, and the corresponding modified Medical Research Council (mMRC) dyspnea scale and chronic obstructive lung disease assessment test (CAT) scores were evaluated. Mixed effects model was used to investigate changes in pulmonary function and PROs. Results Among 620 patients, 477 (76.9%) underwent lobectomy, whereas 120 (19.4%) and 23 (3.7%) were treated with wedge resection/segmentectomy and bilobectomy/pneumonectomy, respectively. Both FVC and FEV1 markedly decreased 2 weeks after surgery and improved thereafter; however, they did not recover to baseline values. The corresponding mMRC dyspnea scale and CAT scores worsened immediately after surgery. The dyspnea scale of the mMRC was still higher, while CAT scores returned to baseline one year after surgery, although breathlessness and lack of energy persisted. Compared to the changes from baseline of FVC and FEV1 in patients who underwent lobectomy, patients who underwent bilobectomy/pneumonectomy showed a greater decrease in FVC and FEV1, while wedge resection/segmentectomy patients had smaller decreases in FVC and FEV1 at 2 weeks, 6 months, and 1 year after surgery. Bilobectomy/pneumonectomy patients had the highest mMRC dyspnea grade among the three groups, but the difference was not statistically significant one year after surgery. Conclusions After lung cancer surgery, pulmonary function and PROs noticeably decreased in the immediate post-operative period and improved thereafter, except for dyspnea and lack of energy. Proper information on the timeline of changes in lung function and symptoms following lung cancer surgery could guide patient care approaches after surgery. Trial registration: ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02149-9.
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Affiliation(s)
- Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sunga Kong
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Genehee Lee
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.,Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea. .,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea. .,Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea.
| | - Hye Yun Park
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
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DUPLICATE: Acupuncture-moxibustion for lung cancer patient-reported outcomes: a systematic review and meta-analysis protocol. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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XI ZQ, WEI XQ, YE Z, WANG K, ZHOU J. Acupuncture-moxibustion for lung cancer patient-reported outcomes: A systematic review and meta-analysis protocol. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Linares-Moya M, Rodríguez-Torres J, Heredia-Ciuró A, Granados-Santiago M, López-López L, Quero-Valenzuela F, Valenza MC. Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors. Support Care Cancer 2022; 30:1579-1586. [PMID: 34541609 PMCID: PMC8727403 DOI: 10.1007/s00520-021-06537-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients with lung cancer experience a variety of distressing symptoms which could adversely affect quality of life. The aim of this study was to determine whether psychological distress prior to surgery is associated to health status and symptom burden in lung cancer survivors. METHODS A longitudinal observational study with 1-year follow-up was carried out. Health status was measured by the WHO Disability Assessment Scale (WHO-DAS 2.0), the Euroqol-5 dimensions (EQ-5D) and the Pittsburgh Sleep Quality Index (PSQI). Symptoms severity included dyspnoea (Multidimensional Profile of Dyspnoea); pain (Brief Pain Inventory); fatigue (Fatigue Severity Scale); and cough (Leicester Cough Questionnaire). RESULTS One hundred seventy-four lung cancer patients were included. Patients in the group with psychological distress presented a worse self-perceived health status, functionality and sleep quality. The group with psychological distress also presented higher dyspnoea, fatigue and pain. CONCLUSION Patients with psychological distress prior surgery present with a greater symptom burden and a poorer self-perceived health status, lower functionality and sleep quality, than patients without distress 1 year after the lung resection.
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Affiliation(s)
- Marta Linares-Moya
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - María Granados-Santiago
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain
| | | | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016, Granada, Spain.
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Ha DM, Prochazka AV, Bekelman DB, Stevens-Lapsley JE, Studts JL, Keith RL. Modifiable factors associated with health-related quality of life among lung cancer survivors following curative intent therapy. Lung Cancer 2022; 163:42-50. [PMID: 34896804 DOI: 10.1016/j.lungcan.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The number of lung cancer survivors is increasing along with advances in screening, diagnosis, and treatment. Following curative intent therapy, many lung cancer survivors experience significant health-related quality of life (HRQL) impairments. We sought to identify potentially modifiable factors that contribute to the HRQL of these patients. MATERIALS AND METHODS In this cross-sectional observational study of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy, we used a conceptual model to examine factors that included behavioral, objective functional and physiologic, self-rated function and symptom burden, specific comorbidities, and non-modifiable demographic and clinical lung cancer-related characteristics. We assessed HRQL using the valid and prognostic European Organization for Research and Treatment of Cancer Quality of Life (QoL) Core 30 global health/QoL subscale. We used univariable and multivariable linear regression modeling with backward elimination of potentially modifiable and non-modifiable factors, and interpreted clinically and statistically significant, consistent, and independent modifiable factors as meaningful. RESULTS Among 75 participants at a median of 12 months since treatment completion, the mean (standard deviation) C30 global health/QoL score was 62.7 (23.3) points (0-100 scale range). In multivariable analysis, with and without non-modifiable factors, we identified three clinically and statistically significant, consistent, and independent factors (unstandardized β range) associated with global health/QoL: 1) abnormal exercise-induced dyspnea (-9.23 to -10.0 points); 2) impaired self-rated role function (or inability to perform work or daily activities and pursuing leisure-time activities) (-12.6 to -16.4 points); and 3) abnormal insomnia (or trouble sleeping) (-12.6 to -16.4 points). CONCLUSION We identified meaningful modifiable factors associated with the HRQL of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy. Interventions to improve the HRQL of these patients should aim to reduce exercise-induced dyspnea, improve role function - the ability to perform work and other daily including leisure-time activities, and control insomnia.
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Affiliation(s)
- Duc M Ha
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Allan V Prochazka
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David B Bekelman
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Jamie L Studts
- Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, United States; Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert L Keith
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Cochrane A, Woods S, Dunne S, Gallagher P. Unmet supportive care needs associated with quality of life for people with lung cancer: A systematic review of the evidence 2007-2020. Eur J Cancer Care (Engl) 2021; 31:e13525. [PMID: 34729855 DOI: 10.1111/ecc.13525] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/01/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this review was to systematically examine the evidence on the relationship between quality of life (QoL) and unmet supportive care needs in patients with lung cancer. METHODS Six databases were searched for studies published since 2007. Studies were included if they measured QoL using a standardised tool and examined its association with unmet supportive care needs in lung cancer patients. RESULTS Six studies involving 562 patients were included. Nearly two thirds of the patients had been diagnosed with advanced cancer (Stage III or IV), and the majority had been diagnosed for less than 2 years. There was a negative association between QoL and unmet needs using two different measures (Supportive Care Needs Survey[SCNS] and Cancer Survivors Unmet Needs Survey [CaSUN]). In two studies, the relationship was limited to physical and/or psychological domains. CONCLUSIONS Unmet supportive care needs are associated with poorer QoL for people with lung cancer: The findings suggest that unmet physical and psychological needs may have the most impact on QoL and reflect the high symptom burden and psychological distress associated with lung cancer. Further work is needed to examine these relationships to identify the services and interventions that address the range of care needs across the disease trajectory.
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Affiliation(s)
- Andy Cochrane
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Siobhan Woods
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Simon Dunne
- School of Psychology, Dublin City University, Dublin, Ireland
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21
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Ha D, Ries AL, Lippman SM, Fuster MM. Effects of curative-intent lung cancer therapy on functional exercise capacity and patient-reported outcomes. Support Care Cancer 2020; 28:4707-4720. [PMID: 31965306 PMCID: PMC7371511 DOI: 10.1007/s00520-020-05294-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Lung cancer treatment can lead to negative health consequences. We analyzed the effects of curative-intent lung cancer treatment on functional exercise capacity (EC) and patient-reported outcomes (PROs). METHODS We performed a prospective, observational cohort study of consecutive patients with stage I-IIIA lung cancer undergoing curative-intent therapy and assessed functional EC (primary outcome, six-minute walk distance (6MWD)), cancer-specific quality of life (QoL) (secondary outcome, European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC-QLQ-C30) summary score), and exploratory outcomes including dyspnea (University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ)) and fatigue Brief Fatigue Inventory (BFI)) symptoms before and at 1 to 3 months post-treatment. We analyzed the time effect of treatment on outcomes using multivariable generalized estimating equations. RESULTS In 35 enrolled participants, treatment was associated with a clinically meaningful and borderline-significant decline in functional EC ((mean change, 95% CI) 6MWD = - 25.4 m (- 55.3, + 4.47), p = 0.10), clinically meaningful and statistically significant higher dyspnea (UCSD SOBQ = + 13.1 (+ 5.7, + 20.6), p = 0.001) and fatigue (BFI = + 10.0 (+ 2.9, + 17.0), p = 0.006), but no clinically meaningful or statistically significant change in cancer-specific QoL (EORTC-QLQ-C30 summary score = - 3.4 (- 9.8, + 3.0), p = 0.30). CONCLUSIONS Among the first prospective analysis of the effect of curative-intent lung cancer treatment on functional EC and PROs, we observed worsening dyspnea and fatigue, and possibly a decline in functional EC but not cancer-specific QoL at 1 to 3 months post-treatment. Interventions to reduce treatment-related morbidities and improve lung cancer survivorship may need to focus on reducing dyspnea, fatigue, and/or improving functional EC.
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Affiliation(s)
- Duc Ha
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd Suite 200, Aurora, CO, 80014, USA.
- Pulmonary, Critical Care, and Sleep Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
- Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Andrew L Ries
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Scott M Lippman
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego Health, La Jolla, CA, USA
| | - Mark M Fuster
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Pulmonary and Critical Care Medicine, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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22
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Gjeilo KH, Oksholm T, Follestad T, Wahba A, Rustøen T. Trajectories of Pain in Patients Undergoing Lung Cancer Surgery: A Longitudinal Prospective Study. J Pain Symptom Manage 2020; 59:818-828.e1. [PMID: 31733353 DOI: 10.1016/j.jpainsymman.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Lung cancer surgery is among the surgical procedures associated with the highest prevalence of pain, but prospective longitudinal studies after the pain trajectory are scarce. OBJECTIVES We aimed to describe the pain trajectory in patients undergoing surgery for primary lung cancer and investigate whether distinct groups of patients could be identified based on different pain trajectories. METHODS Patients (n = 264; 95% thoracotomies) provided data on the average and worst pain intensity, pain location, and comorbidities before, and at one month and five, nine, and 12 months after surgery. Pain profiles were analyzed by latent class mixed models. RESULTS The occurrence of any pain increased from 40% before surgery to 69% after one month and decreased to 56%, 57%, and 55% at five, nine, and 12 months, respectively. Latent class mixed models identified two classes both for average and worst pain; one class started low with high ratings after one month, then returning to a level slightly higher than baseline. The other class started higher with similar scores through the trajectory. Patients reporting no pain (8%) were placed in a separate class. Higher comorbidity score, preoperative use of both pain and psychotropic medicine characterized the class with overall highest pain for average and/or worst pain. CONCLUSION Pain was highly prevalent after surgery, and subgroups could be identified based on different pain trajectories. Patients reported both postoperative pain and pain from chronic conditions. Knowledge about vulnerable patients and risk factors for pain is important to tailor interventions and information about pain.
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Affiliation(s)
- Kari Hanne Gjeilo
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Trine Oksholm
- VID Specialized University, Haraldsplass, Bergen, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Wahba
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Ullevål, Oslo, Norway
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Abstract
PURPOSE Dyspnea is highly prevalent in lung cancer survivors following curative-intent therapy. We aimed to identify clinical predictors or determinants of dyspnea and characterize its relationship with functional exercise capacity (EC). METHODS In an analysis of data from a cross-sectional study of lung cancer survivors at the VA San Diego Healthcare System who completed curative-intent therapy for stage I-IIIA disease ≥1 mo previously, we tested a thorough list of comorbidities, lung function, and lung cancer characteristics. We assessed dyspnea using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Lung Cancer Module 13 (LC13) and functional EC using the 6-minute walk. We replicated results with the University of California San Diego Shortness of Breath Questionnaire. RESULTS In 75 participants at a median of 12 mo since treatment completion, the mean ± SD LC13-Dyspnea score was 35.3 ± 26.2; 60% had abnormally high dyspnea. In multivariable linear regression analyses, significant clinical predictors or determinants of dyspnea were (β [95% CI]) psychiatric illness (-20.8 [-32.4 to -9.09]), heart failure with reduced ejection fraction (-15.5 [-28.0 to -2.97]), and forced expiratory volume in the first second of expiration (-0.28 [-0.49 to -0.06]). Dyspnea was an independent predictor of functional EC (-1.54 [-2.43 to -0.64]). These results were similar with the University of California San Diego Shortness of Breath Questionnaire. CONCLUSION We identified clinical predictors or determinants of dyspnea that have pathophysiological bases. Dyspnea was independently associated with functional EC. These results have implications in efforts to reduce dyspnea and improve exercise behavior and functional EC in lung cancer survivors following curative-intent therapy.
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Affiliation(s)
- Duc Ha
- Institute for Health Research, Kaiser Permanente Colorado, Aurora (Dr Ha); and Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla (Dr Ries)
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Dai W, Xie S, Zhang R, Wei X, Wu C, Zhang Y, Feng W, Liao X, Mu Y, Zhou H, Cheng X, Jiang Y, He J, Li Q, Yang X, Shi Q. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: a multicentre, prospective, observational cohort study protocol. BMJ Open 2019; 9:e030726. [PMID: 31662377 PMCID: PMC6830688 DOI: 10.1136/bmjopen-2019-030726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Patient-reported outcome-based symptom monitoring and alerting have been attractive for patient care after a tumour-removal surgery. However, the implementation parameters of this patient-centred symptom management system in perioperative patients with lung cancer are still lacking. We aim to develop a perioperative symptom scale (PSS) for monitoring, to determine the optimal time points for symptom assessment and to define the alert thresholds for medical intervention. METHODS AND ANALYSIS This study will prospectively recruit 300 patients undergoing lung cancer surgery in six hospitals. The MD Anderson Symptom Inventory-Lung Cancer Module (MDASI-LC) is used to collect longitudinal symptom data preoperatively, daily postoperatively during in-hospital stay and weekly after discharge until 4 weeks or the start of postoperative oncological therapy. Symptoms that change significantly over time will be generated as the PSS. We will determine the optimal time points for follow-up using the generalised linear mixed-effects models. The MDASI-LC interference-measured functional status will be used as the anchor for the alert thresholds. ETHICS AND DISSEMINATION Ethics Committee of Sichuan Cancer Hospital approved this study on 16 October 2017 (No. SCCHEC-02-2017-042). The manuscript is based on the latest protocol of Version 3.0, 15 September 2019. The results of this study will be presented at medical conferences and published in peer-reviewed journals. TRIALS REGISTRATION NUMBER NCT03341377.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chuanmei Wu
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanqiang Zhang
- Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, China
| | - Wenhong Feng
- Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, Jiangyou, China
| | - Xiaoqing Liao
- Department of Cardiothoracic Surgical Oncology, Dazhu County People's Hospital, Dazhu County, China
| | - Yunfei Mu
- Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Heling Zhou
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuemei Cheng
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanhua Jiang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaojun Yang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Dai W, Zhang Y, Feng W, Liao X, Mu Y, Zhang R, Wei X, Wu C, Xie S, Li Q, Shi Q. Using patient-reported outcomes to manage postoperative symptoms in patients with lung cancer: protocol for a multicentre, randomised controlled trial. BMJ Open 2019; 9:e030041. [PMID: 31455710 PMCID: PMC6720560 DOI: 10.1136/bmjopen-2019-030041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/18/2019] [Accepted: 08/01/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Surgery is one of the primary treatments for lung cancer. The postoperative symptom burden experienced by patients with lung cancer is substantial, seriously delaying their recovery from surgery and impairing their quality of life. Patient-reported outcome (PRO)-based symptom management is increasingly regarded as an optimal model for patient-centred care. Currently, clinical trial-based evidence involving early-phase (immediately after surgery for up to 1 month) symptom management of lung cancer is lacking. We propose a randomised trial to evaluate the effect of a PRO-based symptom-monitoring programme with overthreshold alerts and responses for postoperative recovery in patients with lung cancer. METHODS AND ANALYSIS The study will recruit 160 patients with lung cancer from six hospitals. The patients will be randomly allocated to the intervention group or control group in a ratio of 1:1. Patients in the intervention group will receive PRO-based symptom management from the specialists when their reported target symptom (pain, coughing, fatigue, disturbed sleep and shortness of breath) scores reach the preset threshold (score ≥4). Patients in the control group will not generate alerts and will follow the standard procedures for symptom management. All patients will receive symptom assessments via the MD Anderson Symptom Inventory-lung cancer module on the day before surgery, daily after surgery and twice a week after discharge until 4 weeks or the start of postoperative oncological treatment. The primary outcome-mean symptom threshold events-will be compared between the intervention and control group via independent sample Student's t-test. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of Sichuan Cancer Hospital on 22 November 2018 (No. SCCHEC-02-2018-045). This manuscript is based on V.2.0, 9 May 2019 of the protocol. The study results will be disseminated in publications in peer-reviewed journals and presentations at academic conferences. TRIALS REGISTRATION NUMBER ChiCTR1900020846.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanqiang Zhang
- Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, China
| | - Wenhong Feng
- Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, Jiangyou, China
| | - Xiaoqing Liao
- Department of Cardiothoracic Surgical Oncology, Dazhu County People's Hospital, Dazhu County, China
| | - Yunfei Mu
- Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chuanmei Wu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Pace TWW, Dodds SE, Sikorskii A, Badger TA, Segrin C, Negi LT, Harrison T, Crane TE. Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial. Trials 2019; 20:247. [PMID: 31036091 PMCID: PMC6489281 DOI: 10.1186/s13063-019-3320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/25/2019] [Indexed: 01/04/2023] Open
Abstract
Background Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers. Methods Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured. Discussion If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members. Trial registration Clinicaltrials.gov, NCT03459781. Prospectively registered on 9 March 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3320-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thaddeus W W Pace
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA. .,Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA. .,University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Sally E Dodds
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA
| | - Alla Sikorskii
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA.,Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Terry A Badger
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA
| | - Chris Segrin
- Department of Communication, College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - Lobsang Tenzin Negi
- Emory-Tibet Partnership, Department of Religion, Emory College, Emory University, Atlanta, GA, USA.,Emory-Tibet Partnership, CBCT Teacher Training, Emory University, Atlanta, GA, USA
| | - Timothy Harrison
- Emory-Tibet Partnership, CBCT Teacher Training, Emory University, Atlanta, GA, USA
| | - Tracy E Crane
- University of Arizona Cancer Center, Tucson, AZ, USA.,Division of Biobehavioral Healthscience, College of Nursing, University of Arizona, Tucson, AZ, USA
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Yli-Uotila T, Kaunonen M, Pylkkänen L, Suominen T. Adult cancer patients' perception of social support in non-profit electronic counselling services: a descriptive qualitative study. Contemp Nurse 2018; 54:304-318. [PMID: 30040050 DOI: 10.1080/10376178.2018.1502616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cancer patients may need to seek support from electronic sources because their needs are not fulfilled in the hospital settings.Objectives: The explore cancer patients' perception of social support in non-profit electronic counselling services.Design: A qualitative descriptive cross-sectional design.Methods: The data were collected from adult cancer patients who had utilized non-profit electronic counselling services. The interviews were conducted face-to-face or over the phone and analysed with inductive content analysis.Findings: Two patterns were identified: (1) a contact person that will ensure a personalized matching type of support to enhance patients' ability to cope with cancer if necessary and (2) deficient resources of the electronic counselling services to provide the matching type of support to enhance patients' coping with cancer.Conclusions: For patients to be able to successfully cope with their disease, it is essential that the electronic social support type matches each patient's specific needs.
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Affiliation(s)
- Tiina Yli-Uotila
- Faculty of Social Sciences, Health Sciences, Nursing Science, University of Tampere, Tampere FI-33014, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Nursing Science, University of Tampere, Tampere FI-33014, Finland.,General administration, Pirkanmaa Hospital District, Tampere, Finland
| | - Liisa Pylkkänen
- Cancer Society of Finland, Unioninkatu 22, Helsinki 00130, Finland
| | - Tarja Suominen
- Faculty of Social Sciences, Health Sciences, Nursing Science, University of Tampere, Tampere FI-33014, Finland
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28
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Yip R, Taioli E, Schwartz R, Li K, Becker BJ, Tam K, Htwe YM, Yankelevitz DF, Henschke CI. A Review of Quality of Life Measures used in Surgical Outcomes for Stage I Lung Cancers. Cancer Invest 2018; 36:296-308. [PMID: 30040490 DOI: 10.1080/07357907.2018.1474892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This review summarizes the literature on QoL in early stage lung cancer patients who underwent surgery. PubMed and PsycINFO were searched. Twelve articles from 10 distinct studies were identified for a total of 992 patients. Five QoL measures were used. One study reported only on pre-surgical QoL, six only on post-surgical QoL and three studies reported on both pre- and post-surgical QoL. Timing for the administration of post-surgical QoL surveys varied. The literature on QoL in Stage I non-small-cell lung cancer patients is very sparse. Additional research is needed to explore the impact of different surgical approaches on QoL.
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Affiliation(s)
- Rowena Yip
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Emanuela Taioli
- b Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Rebecca Schwartz
- b Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York , New York, USA.,c Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra-Northwell , Great Neck , New York, USA
| | - Kunwei Li
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA.,d Department of Radiology , Fifth Affiliated Hospital of Sun Yat-sen University , Zhuhai , China
| | - Betsy J Becker
- e Department of Educational Psychology and Learning Systems, College of Education , Florida State University , Tallahassee , Florida, USA
| | - Kathleen Tam
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Yu Maw Htwe
- f Department of Internal Medicine , Kingsbrook Jewish Medical Center , Brooklyn , New York , USA
| | - David F Yankelevitz
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Claudia I Henschke
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
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29
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Coolbrandt A, Wildiers H, Aertgeerts B, Dierckx de Casterlé B, van Achterberg T, Milisen K. Systematic development of CHEMO-SUPPORT, a nursing intervention to support adult patients with cancer in dealing with chemotherapy-related symptoms at home. BMC Nurs 2018; 17:28. [PMID: 29983638 PMCID: PMC6020323 DOI: 10.1186/s12912-018-0297-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 06/18/2018] [Indexed: 11/22/2022] Open
Abstract
Background Given the great symptom burden associated with chemotherapy on the one hand and generally poor self-management of symptoms by cancer patients on the other hand, our aim was to develop a nursing intervention to reduce symptom burden in adult cancer patients treated with chemotherapy and to support them in dealing with their various symptoms at home. Methods Development of the intervention was guided by the Intervention Mapping Approach and included following steps: needs assessment, formulation of proximal programme objectives, selection of methods and strategies, production of programme components, and planning for implementation and evaluation of the intervention. A panel of multidisciplinary healthcare professionals (n = 12) and a panel of patients and family caregivers (n = 7) were actively involved developing the intervention at each stage. Results For the intervention, four patient performance objectives relating to self-management were advanced. Self-efficacy and outcome expectations were selected as key determinants of dealing with chemotherapy-related symptoms. As methods for supporting patients, motivational interviewing and tailoring were found to fit best with the change objectives and determinants. Existing patient information materials were re-designed after panel input to reinforce the new intervention approach. Conclusion The intervention mapping approach, including active involvement of the intervention providers and receivers, informed the design of this nursing intervention with two or more contacts. Further evaluation is needed to gain insight into the potential effects, feasibility and mechanisms of this complex intervention. Electronic supplementary material The online version of this article (10.1186/s12912-018-0297-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annemarie Coolbrandt
- 1Department of Oncology Nursing, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,2Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Hans Wildiers
- 3Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Bert Aertgeerts
- 4Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Theo van Achterberg
- 2Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- 2Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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30
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Sommer MS, Trier K, Vibe-Petersen J, Christensen KB, Missel M, Christensen M, Larsen KR, Langer SW, Hendriksen C, Clementsen PF, Pedersen JH, Langberg H. Changes in Health-Related Quality of Life During Rehabilitation in Patients With Operable Lung Cancer: A Feasibility Study (PROLUCA). Integr Cancer Ther 2018; 17:388-400. [PMID: 27698263 PMCID: PMC6041926 DOI: 10.1177/1534735416668258] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/03/2016] [Accepted: 08/06/2016] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Maja S. Sommer
- Copenhagen Centre for Cancer and Health, Copenhagen, Denmark
| | - Karen Trier
- Copenhagen Centre for Cancer and Health, Copenhagen, Denmark
| | | | | | - Malene Missel
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Seppo W. Langer
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Paul F. Clementsen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Gentofte University Hospital, Hellerup, Denmark
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31
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Coolbrandt A, Wildiers H, Laenen A, Aertgeerts B, Dierckx de Casterlé B, van Achterberg T, Milisen K. A Nursing Intervention for Reducing Symptom Burden During Chemotherapy. Oncol Nurs Forum 2018; 45:115-128. [DOI: 10.1188/18.onf.115-128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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An Evolving Role for Cancer Rehabilitation in the Era of Low-Dose Lung Computed Tomography Screening. PM R 2017; 9:S407-S414. [DOI: 10.1016/j.pmrj.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/22/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
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33
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Peddle-McIntyre CJ, Baker MK, Lee YCG, Galvão DA, Cormie P, Graham V, Newton RU. The feasibility of a pragmatic distance-based intervention to increase physical activity in lung cancer survivors. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28597947 DOI: 10.1111/ecc.12722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to investigate the feasibility and preliminary efficacy of a pragmatic distance-based intervention designed to increase physical activity (PA) participation in lung cancer survivors. Fourteen lung cancer survivors were recruited via invitation from the State Cancer Registry to join a 12-week PA intervention of print materials paired with brief telephone follow-up. Outcome measures of feasibility, PA participation and quality of life (QoL) were assessed at baseline, post-intervention and follow-up via telephone interview. Eligibility, recruitment and attrition rates were 16%, 58% and 29% respectively. No adverse events were reported; however, pain scores worsened following the intervention (median change -3.6, IQR -8.0, 0.0). Average intervention adherence was 91% with low median ratings of participation burden (i.e., all items 1/7) and high trial evaluation (i.e., all items 7/7). Post-intervention, median change in self-reported moderate and vigorous PA was 84 min (IQR -22, 188), and several domains of QoL improved. However, for both of these outcomes, improvements were not maintained at follow-up. Our findings suggest that this pragmatic distance-based intervention was safe, had good adherence rates, and indicate potential for improving short-term PA and QoL in lung cancer survivors. Additional strategies are needed to improve other indicators of feasibility, particularly recruitment, retention and long-term maintenance of improvements. Australian New Zealand Clinical Trials Registration: ACTRN12612000085875.
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Affiliation(s)
- C J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - M K Baker
- School of Exercise Science, Australian Catholic University, Strathfield, NSW, Australia
| | - Y C G Lee
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - D A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - P Cormie
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Institute for Health and Aging, Australian Catholic University, Melbourne, Vic., Australia
| | - V Graham
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia
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34
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Oliveira M, Oliveira G, Souza-Talarico J, Mota D. Surgical Oncology: Evolution of Postoperative Fatigue and Factors Related to Its Severity. Clin J Oncol Nurs 2017; 20:E3-8. [PMID: 26800419 DOI: 10.1188/16.cjon.e3-e8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fatigue has been reported by many patients undergoing surgery and is associated with a negative prognosis. The factors associated with postoperative fatigue and its evolution during the postoperative period are unclear. Adequate fatigue measurement instruments are necessary to obtain reliable evaluations and to direct effective care to control fatigue in this patient population. OBJECTIVES This article describes the evolution of postoperative fatigue in patients with cancer as well as related factors. METHODS A review of the literature using the CINAHL® and PubMed databases was undertaken. FINDINGS The prevalence of moderate and severe fatigue varies during the postoperative period, with a reduction in the 12 months after surgery. Various factors (e.g., stress, anxiety, depression, pain, changes in sleep patterns) seem to influence the severity of fatigue. More evidence is needed to explore the relationship between immediate postoperative fatigue and the evolution of fatigue during the period following surgical treatment for cancer.
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35
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Lehto RH. Symptom burden in lung cancer: management updates. Lung Cancer Manag 2016; 5:61-78. [PMID: 30643551 PMCID: PMC6310300 DOI: 10.2217/lmt-2016-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.
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Affiliation(s)
- Rebecca H Lehto
- C-344 Bogue, College of Nursing, Michigan State University, East Lansing, MI 48824-1317, USA
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36
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Kaptein AA, Kobayashi K, Matsuda A, Kubota K, Nagai S, Momiyama M, Sugisaki M, Bos BC, Warning TD, Dik H, Klink RV, Inoue K, Ramai R, Taube C, Kroep JR, Fischer MJ. We’re in this together: Patients’, caregivers’ and health care providers’ illness perceptions about non-small-cell lung cancer (NSCLC). Lung Cancer 2015; 90:575-81. [DOI: 10.1016/j.lungcan.2015.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 12/17/2022]
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37
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What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer. Support Care Cancer 2015; 23:3455-63. [PMID: 25791391 DOI: 10.1007/s00520-015-2699-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/09/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool. METHODS Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS). RESULTS Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007). CONCLUSIONS Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.
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38
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Coolbrandt A, Dierckx de Casterlé B, Wildiers H, Aertgeerts B, Van der Elst E, van Achterberg T, Milisen K. Dealing with chemotherapy-related symptoms at home: a qualitative study in adult patients with cancer. Eur J Cancer Care (Engl) 2015; 25:79-92. [DOI: 10.1111/ecc.12303] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 01/05/2023]
Affiliation(s)
- A. Coolbrandt
- Department of Public Health and Primary Care; Center for Health Services and Nursing Research; KU Leuven; Leuven Belgium
- Department of Oncology Nursing; University Hospitals Leuven; Leuven Belgium
| | - B. Dierckx de Casterlé
- Department of Public Health and Primary Care; Center for Health Services and Nursing Research; KU Leuven; Leuven Belgium
| | - H. Wildiers
- Department of Oncology; University Hospitals Leuven; Leuven Belgium
| | - B. Aertgeerts
- Department of Public Health and Primary Care; Academic Center for General Practice; KU Leuven; Leuven Belgium
| | - E. Van der Elst
- Department of Public Health and Primary Care; Center for Health Services and Nursing Research; KU Leuven; Leuven Belgium
| | - T. van Achterberg
- Department of Public Health and Primary Care; Center for Health Services and Nursing Research; KU Leuven; Leuven Belgium
| | - K. Milisen
- Department of Public Health and Primary Care; Center for Health Services and Nursing Research; KU Leuven; Leuven Belgium
- Department of Geriatric Medicine; University Hospitals Leuven; Leuven Belgium
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39
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Shen MJ, Coups EJ, Li Y, Holland JC, Hamann HA, Ostroff JS. The role of posttraumatic growth and timing of quitting smoking as moderators of the relationship between stigma and psychological distress among lung cancer survivors who are former smokers. Psychooncology 2014; 24:683-90. [PMID: 25345591 DOI: 10.1002/pon.3711] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients diagnosed with lung cancer report high levels of stigma and psychological distress. This study examined posttraumatic growth among lung cancer survivors as a potential buffer against this relationship between stigma and psychological distress and examined how these relationships differed by the timing of quitting smoking (pre versus post-diagnosis). METHODS Stages IA and IB non-small-cell lung cancer survivors (N = 141) who were former smokers, 1-6 years post-treatment, and had no evidence of disease completed standardized questionnaires assessing stigma, posttraumatic growth, timing of quitting smoking history, and psychological distress. RESULTS Hierarchical linear regression and simple slope analyses indicated that among those who quit smoking prior to diagnosis (pre-diagnosis quitters), stigma had a positive association with psychological distress at high levels of posttraumatic growth (p = 0.003) and had a positive (but non-significant) association with psychological distress among those with low levels of posttraumatic growth (p = 0.167). Among those who quit smoking after diagnosis (post-diagnosis quitters), stigma had a positive association with psychological distress among those with low levels of posttraumatic growth (p = 0.004) but had no relationship among those with high levels of posttraumatic growth (p = 0.880). CONCLUSIONS Findings indicate that posttraumatic growth buffers against the negative effects of stigma on psychological distress but only among post-diagnosis quitters. Future interventions could focus on fostering posttraumatic growth as a way to decrease the negative effects of stigma.
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Affiliation(s)
- Megan Johnson Shen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elliot J Coups
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jimmie C Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heidi A Hamann
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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40
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Hoffman AJ, Brintnall RA, von Eye A, Cooper J, Brown JK. The voice of postsurgical lung cancer patients regarding supportive care needs. LUNG CANCER-TARGETS AND THERAPY 2014; 5:21-31. [PMID: 28210139 PMCID: PMC5217509 DOI: 10.2147/lctt.s59703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Individuals with lung cancer present with multiple comorbid conditions and complex treatment plans. They are frequently vulnerable during critical transitions in the cancer survivorship trajectory. Limited research exists on the postsurgical non-small-cell lung cancer (NSCLC) population, relative to unmet supportive care needs. However, what is known is that the lung cancer population reports significantly more unmet supportive care needs than other cancer populations. The purpose of this study was to identify the postsurgical NSCLC patients' unmet supportive care needs during transition from hospital to home and through recovery after participating in a 16-week exercise intervention. MATERIALS AND METHODS Participants were 53-73 years of age with NSCLC (stage Ib-IIIa) and participated in a 16-week light-intensity exercise program after hospital discharge. For this study, participants were interviewed 12-18 months post-thoracotomy. A qualitative design was used, incorporating a semistructured guide with open-ended questions to support discussion regarding recovery experiences through 16 weeks after transitioning from hospital to home. The interview was transcribed verbatim, and data were analyzed using content analysis. Content themes were independently coded by investigators and later combined into a single report verified through participant verification of the report. RESULTS Participants reviewed and agreed with the focus group report. Dominant themes included: 1) unpreparedness for post-thoracotomy recovery; 2) significant unmet needs upon hospital discharge and throughout the cancer survivorship trajectory; 3) unexpected symptom burden after initial month of recovery; 4) the quality of information given when pain and fatigue were troublesome during recovery; and 5) the effectiveness of exercise during the recovery process. CONCLUSION Understanding the changing needs of this population during these transitions will assist in the development of targeted supportive care interventions, to preempt negative outcomes associated with breakdowns in care during critical transition periods of the cancer survivorship trajectory.
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Affiliation(s)
- Amy J Hoffman
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Ruth Ann Brintnall
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - Alexander von Eye
- Psychology Department, Michigan State University, East Lansing, MI, USA
| | - Julie Cooper
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - Jean K Brown
- School of Nursing, State University of New York at Buffalo, Buffalo, NY, USA
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