Discrepancy in the perception of symptoms among patients and healthcare providers after lung cancer surgery

Sex-related differences in postoperative patient-reported outcomes among lung cancer patients: a multicenter cohort study

BACKGROUND

Studies on sex-related differences in post-lung cancer surgery symptoms are limited. Understanding these differences may provide insights into patient recovery. Therefore, we investigated sex-related differences in these symptoms and their underlying associated factors.

METHODS

We included patients aged ≥ 18 years undergoing surgery for lung cancer from a multicenter cohort study (CN-PRO-Lung 1) that focused on postoperative lung cancer symptoms trajectories. On a daily assessment schedule, we evaluated patients' symptoms and their impact on functioning from the day before surgery until discharge using the MD Anderson Symptom Inventory-Lung Cancer module. We evaluated sex-related differences in symptom scores over time and identified influencing factors using linear mixed models.

RESULTS

Of 372 eligible patients (196 men and 176 women;) symptoms were milder in men than in women for pain (estimate = 0.427, P = 0.021), fatigue (estimate = 1.071, P < 0.001), shortness of breath (estimate = 0.431, P = 0.021), lack of appetite (estimate = 0.728, P < 0.001), dry mouth (estimate = 0.438, P = 0.015), and constipation (estimate = 0.887, P < 0.001) during postoperative hospitalization (median: 7 days). Pain scores decreased over time in both sexes (estimate = -0.440 in men, P < 0.001; -0.510 in women, P < 0.001), while different factors were associated with increased pain in each group. In men, higher American Society of Anesthesiologists (ASA) classification (estimate = 0.430, P = 0.035), advanced pTNM stage (estimate = 0.550, P = 0.007), and having more than one chest drain (estimate = 0.690, P = 0.001) were associated with greater pain. In women, systematic lymph node dissection was associated with increased pain (estimate = 0.700, P = 0.033).

CONCLUSIONS

Women reported a higher symptom burden than men in the early postoperative period after lung cancer surgery. Key factors associated with worse postoperative pain include higher ASA classification, advanced pTNM stage, and more than one chest tube in men and systematic lymph node dissection in women.

TRIAL REGISTRATION NUMBER

NCT03341377.

A Delphi Method Comfort Status Scale for Patients With Lung Cancer After Thoracoscopic Surgery

PURPOSE

To construct the comfort status scale for patients with lung cancer after thoracoscopic surgery.

DESIGN

Delphi method inquiry to 15 clinical and nursing experts.

METHODS

On the basis of the comfort status scale and the subjective experience and objective symptoms of patients with lung cancer after thoracoscopic surgery, the relevant literature was consulted, semistructured interviews and group discussions were conducted, the pool of items of the postoperative comfort status scale for patients with lung cancer was initially formed, and the postoperative comfort status scale for patients with lung cancer was finally established.

FINDINGS

The positive coefficient of experts was 100%, the coefficient of authority was 0.92 and 0.93, and the Kendal's W was 0.257 and 0.298, the degree of coordination of expert opinions was statistically significant (P < .05). Finally, a total of 28 items in four dimensions were formed to assess the postoperative comfort status of patients with lung cancer after thoracoscopic surgery.

CONCLUSIONS

The Delphi method-based comfort status scale for patients with lung cancer after thoracoscopic surgery is scientific and reliable, and can provide a quantitative basis for the evaluation of the comfort status of patients after lung cancer thoracoscopic surgery, to further provide individual comfort care measures.

Comparing the Efficacy of Empirical Anti-Infective Therapy and Follow-Up Observation for Newly Diagnosed Pulmonary Ground-Glass Nodules With Suspected Inflammatory Etiology: A Multicenter Prospective Observational Study Protocol

Background and Aims

The optimal management strategy for newly diagnosed pulmonary ground-glass nodules (GGNs) with suspected inflammatory etiology remains controversial in clinical practice. Empirical anti-inflammatory therapy is commonly used, but its efficacy compared with that of follow-up observation lacks high-quality evidence. Therefore, this study aims to compare the effectiveness of empirical anti-infective therapy and follow-up observation for pulmonary GGNs in real-world settings.

Methods

This study intends to include 254 participants with newly discovered pulmonary ground-glass opacities (GGOs) suspected to be related to inflammation but without current radiographic features suggestive of malignancy. Antibiotics will be recommended when the doctor considers the GGOs may be infection-related. Upon enrollment, all participants will be assessed with the Self-Rating Anxiety Scale (SAS) and divided into either the intervention or observation group. A repeat CT scan and SAS assessment will be conducted with all participants after 1 month ( ± 2 weeks) following the initial discovery of the GGOs. The primary outcome is the participants' response rate at the first follow-up CT. The secondary outcome is the GGO response rate and total scores of SAS at 1 month after enrollment. A non-inferiority test will be conducted to compare the outcomes between the two groups.

Discussion

To date, the efficacy and necessity of using antibiotics for GGOs suspected to be inflammatory upon primary CT screening remain controversial. This protocol describes the rationale and methodology to address this unmet clinical need using real-world data, aiming to bridge the gap between clinical guidelines and real-world practice. Trial Registration: ChiCTR2200056975.

Electronic symptom monitoring after lung cancer surgery: establishing a core set of patient-reported outcomes for surgical oncology care in a longitudinal cohort study

BACKGROUND

Electronic symptom monitoring via patient-reported outcomes in surgical oncology is limited owing to lengthy instruments and non-specific items in common patient-reported outcome instruments. To establish electronic symptom monitoring through a clinically relevant and fit-for-purpose core set of patient-reported outcome in patients undergoing lung cancer surgery.

MATERIALS AND METHODS

One qualitative (Cohort 1) and two prospective studies (Cohorts 2 and 3) were conducted between 2018 and 2022. Patients undergoing lung cancer surgery were recruited. Items of symptoms and daily functioning were generated through extensive interviews in Cohort 1 and incorporated into a smartphone-based platform to establish the electronic Perioperative Symptom Assessment for Lung surgery (ePSA-Lung). This instrument was finalized and validated in Cohort 2. Patients in Cohort 3 were longitudinally monitored for the first-year post-surgery using the validated ePSA-Lung.

RESULTS

In total, 1037 patients scheduled for lung cancer surgery were recruited. The 11-item draft PSA-Lung was generated based on qualitative interview with 39 patients and input from a Delphi study involving 42 experts. A 9-item ePSA-Lung was finalized by assessing 223 patients in the validation cohort; the results supported the instrument's understandability, reliability, sensitivity, and surgical specificity. In Cohort 3 ( n =775), compliance ranged from 63.21 to 84.76% during the 1-year follow-up after discharge. Coughing, shortness of breath, and disturbed sleep were the most severe symptoms after discharge. Longitudinally, patients who underwent single-port video-assisted thoracic surgery had a lower symptom burden than those who underwent multi-port video-assisted thoracic surgery or thoracotomy (all symptoms, P <0.001).

CONCLUSIONS

The ePSA-Lung is valid, concise, and clinically applicable as it supports electronic symptom monitoring in surgical oncology care. The need for long-term extensive care was identified for patients after discharge, even in early-stage cancer with potential curative treatment.

Comparison of early postoperative patient-reported outcomes after multiportal robotic-assisted thoracoscopic surgery and uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer

INTRODUCTION

We aimed to compare early postoperative patient-reported outcomes between multiportal robotic-assisted thoracoscopic surgery (M-RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) for non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

Symptom severity and functional status were measured using the Perioperative Symptom Assessment for Lung Surgery at pre-surgery, during postoperative hospitalisation, and within 4 weeks of discharge. A propensity score-matched (PSM) analysis of patients with NSCLC who were treated with M-RATS and U-VATS was performed. The symptom severity and daily functional status presented as proportion of moderate-to-severe scores on a 0-10-point scale, were compared using a generalised estimation equation model.

RESULTS

We enrolled 762 patients with NSCLC from a prospective cohort (CN-PRO-Lung 3), including 151 and 611 who underwent M-RATS and U-VATS, respectively, before PSM analysis. After 1:1 PSM, two groups of 148 patients each were created. Pain severity (P = 0.019) and activity limitation (P = 0.001) during hospitalisation were higher in the M-RATS group. However, no significant differences existed post-discharge in pain (P = 0.383), cough (P = 0.677), shortness of breath (P = 0.526), disturbed sleep (P = 0.525), drowsiness (P = 0.304), fatigue (P = 0.153), distress (P = 0.893), walking difficulty (P = 0.242), or activity limitation (P = 0.513). M-RATS caused less intraoperative blood loss (P = 0.013), more stations of dissected lymph nodes (P = 0.001), more numbers of dissected lymph nodes (P = 0.001), and less tube drainage on the first postoperative day (P = 0.003) than U-VATS.

CONCLUSION

M-RATS and U-VATS achieved comparable symptom burden and functional impairment after discharge. However, compared to U-VATS, M-RATS was associated with more severe pain and activity limitation in the short postoperative period.

TRIAL REGISTRATION NUMBER

ChiCTR2000033016.

Shortness of breath on the day of discharge: an early alert for post-discharge complications in patients undergoing lung cancer surgery

PURPOSE

Symptom assessment based on patient-reported outcome (PRO) can correlate with disease severity, making it a potential tool for threshold alerts of postoperative complications. This study aimed to determine whether shortness of breath (SOB) scores on the day of discharge could predict the development of post-discharge complications in patients who underwent lung cancer surgery.

METHODS

Patients were from a study of a dynamic perioperative rehabilitation cohort of lung cancer patients focusing on patient-reported outcomes. Patients were assessed using the Perioperative Symptom Assessment Scale for Lung surgery (PSA-Lung). Logistic regression model was used to examine the potential association between SOB on the day of discharge and complications within 3 months after discharge. The post-discharge complications were taken as the anchor variable to determine the optimal cutpoint for SOB on the day of discharge.

RESULTS

Complications within 3 months post-discharge occurred in 71 (10.84%) of 655 patients. Logistic regression analysis revealed that being female (OR 1.764, 95% CI 1.006-3.092, P < 0.05) and having two chest tubes (OR 2.026, 95% CI 1.107-3.710, P < 0.05) were significantly associated with post-discharge complications. Additionally, the SOB score on the day of discharge (OR 1.125, 95% CI 1.012-1.250, P < 0.05) was a significant predictor. The optimal SOB cutpoint was 5 (on a scale of 0-10). Patients with an SOB score ≥ 5 at discharge experienced a lower quality of life 1 month later compared to those with SOB score<5 at discharge (73 [50-86] vs. 81 [65-91], P < 0.05).

CONCLUSION

SOB on the day of discharge may serve as an early warning sign for the timely detection of 3 month post-discharge complications.

Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications

BACKGROUND

Electronic patient-reported outcome measures (ePROMs) for real-time remote symptom monitoring facilitate early recognition of postoperative complications. We sought to determine whether remote, electronic, patient-reported symptom-monitoring with Recovery Tracker predicts 30-day readmission or reoperation in outpatient mastectomy patients.

METHODS

We conducted a retrospective review of breast cancer patients who underwent outpatient (< 24-h stay) mastectomy with or without reconstruction from April 2017 to January 2022 and who received the Recovery Tracker on Days 1-10 postoperatively. Of 5,130 patients, 3,888 met the inclusion criteria (2,880 mastectomy with immediate reconstruction and 1,008 mastectomy only). We focused on symptoms concerning for surgical complications and assessed if symptoms reaching prespecified alert levels-prompting a nursing call-predicted risk of 30-day readmission or reoperation.

RESULTS

Daily Recovery Tracker response rates ranged from 45% to 70%. Overall, 1,461 of 3,888 patients (38%) triggered at least one alert. Most red (urgent) alerts were triggered by pain and fever; most yellow (less urgent) alerts were triggered by wound redness and pain severity. The 30-day readmission and reoperation rates were low at 3.8% and 2.4%, respectively. There was no statistically significant association between symptom alerts and 30-day reoperation or readmission, and a clinically relevant increase in risk can be excluded (odds ratio 1.08; 95% confidence interval 0.8-1.46; p = 0.6).

CONCLUSIONS

Breast cancer patients undergoing mastectomy with or without reconstruction in the ambulatory setting have a low burden of concerning symptoms, even in the first few days after surgery. Patients can be reassured that symptoms that do present resolve quickly thereafter.

Comparison of early patient-reported outcomes between uniportal thoracoscopic segmentectomy and wedge resection for peripheral small-sized non-small-cell lung cancer

BACKGROUND

Analysis of patient-reported outcomes (PROs) offers valuable insights into distinguishing the effects of closely related medical procedures from the patient's perspective. In this study we compared symptom burden in patients undergoing uniportal thoracoscopic segmentectomy and wedge resection for peripheral small-sized non-small cell lung cancer (NSCLC).

METHODS

This study included patients with peripheral NSCLC from an ongoing longitudinal prospective cohort study (CN-PRO-Lung 3) who underwent segmentectomy or wedge resection with tumor diameter ≤ 2 cm and consolidation tumor ratio (CTR) ≤ 0.5. PROs data were collected using the Perioperative Symptom Assessment for Lung Surgery questionnaire pre-operatively, daily post-surgery up to the fourth hospitalization day, and weekly post-discharge up to the fourth week. Propensity score matching and a generalized estimation equation model were employed to compare symptom severity. In addition, short-term clinical outcomes were compared.

RESULTS

In total, data of 286 patients (82.4%) undergoing segmentectomy and 61 patients (17.6%) undergoing wedge resection were extracted from the cohort. No statistically significant differences were found in the proportion of moderate-to-severe symptoms and mean scores for pain, cough, shortness of breath, disturbed sleep, fatigue, drowsiness, and distress during the 4-day postoperative hospitalization or the 4-week post-discharge period before or after matching (all p > 0.05). Compared with segmentectomy, wedge resection showed better short-term clinical outcomes, including shorter operative time (p = 0.001), less intraoperative bleeding (p = 0.046), and lower total hospital costs (p = 0.002).

CONCLUSIONS

The study findings indicate that uniportal thoracoscopic segmentectomy and wedge resection exert similar early postoperative symptom burden in patients with peripheral NSCLC (tumor diameter ≤ 2 cm and CTR ≤ 0.5).

CLINICAL TRIAL REGISTRATION

Not applicable.

A study demonstrating users' preference for the adapted-REQUITE patient-reported outcome questionnaire over PRO-CTCAE® in patients with lung cancer

Introduction

The use of patient-reported outcomes (PROs) has been shown to enhance the accuracy of symptom collection and improve overall survival and quality of life. This is the first study comparing concordance and patient preference for two PRO tools: Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE®) and the adapted-REQUITE Lung Questionnaire.

Materials and Methods

Patients with lung cancer were recruited to the study while attending outpatient clinics at a tertiary cancer centre. Clinician-reported outcomes were generated through initial patient assessment with CTCAE v4.03. Participants then completed the PRO-CTCAE® and adapted-REQUITE questionnaires. Concordance between the 2 questionnaires was assessed by calculating Pearson correlation coefficient. PRO-CTCAE® and CTCAE concordance was demonstrated by calculating Pearson correlation coefficient from the linear predictors of an ordinal logistic regression. P-values were also calculated.

Results

Out of 74 patients approached, 65 provided written informed consent to participate in the study. 63 (96.9%) patients completed both PRO-CTCAE® and adapted-REQUITE questionnaires. Pearson correlation coefficient between PRO tools was 0.8-0.83 (p <.001). Correlation between CTCAE and PRO-CTCAE® ranged between 0.66-0.82 (p <.001). Adapted-REQUITE and CTCAE correlation was higher for all symptoms ranging between 0.79-0.91 (p <.001). Acceptable discrepancies within one grade were present in 96.8%-100% of symptom domains for REQUITE and in 92.1%-96.8% for all domains in the PRO-CTCAE®. 54% of the total participant cohort favored the adapted-REQUITE questionnaire due to reduced subjectivity in the questions and ease of use.

Conclusion

The adapted-REQUITE questionnaire has shown a superior correlation to clinician-reported outcomes and higher patient preference than the PRO-CTCAE®. The results of this study suggest the use of the REQUITE questionnaire for patients with lung cancer in routine clinical practice.

Application of the patient-reported outcome-based postoperative symptom management model in lung cancer: a multicenter randomized controlled trial protocol

INTRODUCTION

Lung cancer is the most common cancer in China, with the highest mortality rate. Surgery is the primary treatment for early lung cancer. However, patients with lung cancer have a heavy burden of symptoms within 3 months after surgery, which seriously affects their quality of life (QOL). The symptom management model based on the patient-reported outcome (PRO) is considered the best caregiving model. The clinical evidence about the symptom management of lung cancer within 3 months after the operation is very limited. Herein, we propose a randomized controlled trial to evaluate the PRO score-based monitoring and alert system for follow-up on psychological and physiological symptoms of lung cancer patients within 3 months after surgery and further investigate the effect of intervention measures based on this PRO score-based system.

METHODS AND ANALYSIS

This multicenter, open-label, randomized, parallel superiority trial will be conducted at four hospitals in China. A total of 440 lung cancer patients will be recruited in this study, who will be randomly assigned to the intervention group or the control group in a ratio of 1:1. Any of the target symptoms reaches the preset threshold (score ≥ 4), the patients will accept the symptom management advices based on the PRO. The patients in the control group will follow the current standard procedure of symptom management. The symptom management system is an electronic management system based on WeChat mini programs. All patients will be evaluated for symptoms through the lung cancer module of the MDASI lung cancer-specific scale on the day before surgery, days 1, 3, 5, and 7 after surgery, and once a week during the 12-week post-discharge period. Simultaneously, the EORTC QLQ-C30 scale will be used to evaluate patients' quality of life at baseline and the fourth and twelfth week after the surgery. The mean number of symptom threshold events of the intervention and the control groups were compared by t-test, and the changes of PRO were compared by a mixed effect model. The primary endpoint has been set as the 12-week post-discharge period.

DISCUSSION

This study will test the feasibility of the symptom management system based on the mobile social media applet in postoperative caregiving and the efficacy of psychiatrist-assisted treatment and provide evidence in managing the symptoms of patients in the medium and long term.

TRIALS REGISTRATION

Trials registration number: ChiCTR 2200058876, Registered 18 April 2022.

Robotic-assisted right upper lobectomy with systemic pulmonary vein anomaly: a case report

BACKGROUND

While the role of low-dose computed tomography (CT) in lung cancer screening is established, its limitations in detailing pulmonary vascular variations are less emphasized. Three-dimensional reconstruction technology allows surgeons to reconstruct a patient's bronchial and pulmonary vascular structures using CT scan results. However, low-dose CT may not provide the same level of clarity as enhanced CT in displaying pulmonary vascular details. This limitation can be unfavorable for preoperative detection of potential pulmonary vascular variations, especially in cases involving planned segmentectomy.

CASE PRESENTATION

We report a case of a 58-year-old female with lung cancer, initially planned for Da Vinci robot-assisted thoracoscopic segmentectomy. Unexpectedly, during surgery, a pulmonary vein variation in the right upper lobe was discovered, leading to a change in the surgical method to a lobectomy. The patient had four variant right upper lobe veins draining into the superior vena cava and one into the left atrium. The surgery was complicated by significant bleeding and postoperative pulmonary congestion. Postoperative pathology confirmed adenocarcinoma.

CONCLUSIONS

This case highlights the importance of meticulous intraoperative exploration, particularly in cases involving planned segmentectomy, as unexpected pulmonary vein variations can significantly affect surgical decision-making. While three-dimensional reconstruction based on preoperative CT data is a valuable tool, it may not capture the full complexity of the anatomical variations. We discuss potential preoperative imaging techniques, including contrast-enhanced CT and CT angiography, as methods to better identify these variations. The enhanced visualization provided by robot-assisted surgery plays a crucial role in identifying and adapting to these variations, underscoring the advantages of this surgical approach. Our report contributes to the existing literature by providing a detailed account of how these principles were applied in a real-world scenario, reinforcing the need for surgical adaptability and awareness of the limitations of low-dose CT in complex cases.

Patient's experiences of coughing after lung cancer surgery: A multicenter qualitative study

PURPOSE

Cough is one of the most common symptoms after lung cancer surgery, which seriously affects the quality of life. Little research has been conducted on patient's experiences of cough following lung surgery. This study aimed to elucidate the experience of coughing after lung cancer surgery from the patient's perspective regarding symptoms and their impacts on daily life, as well as triggers and dealing strategies.

METHODS

Between June 2023 and July 2023, we conducted semi-structured interviews with patients from outpatient clinics of two hospitals who were pathologically diagnosed with lung cancer and experienced cough after surgery through convenience sampling. The interview recordings were transcribed and analyzed by two researchers. The traditional content analysis and thematic analysis were used to identify the common codes, subthemes, and themes.

RESULTS

A total of 28 participants were interviewed. The mean age of the participants was 55.21 years (range: 36-75 years), and 21 participants were female. Most patients (75%) were interviewed within 6 months of surgery. We identified five themes (accompanying symptoms, incentives, effects, solution, and information sources) and 12 subthemes (local symptoms, systemic symptoms, personal factors, external factors, emotion, relationship with others, reduced quality of life, medical measures, nonmedical measures, no measures, relatives and friends, and the Internet). Patients with lung cancer may experience various cough symptoms after surgery, which a variety of internal and external factors can trigger. The coughing imposes a double burden on the physical and psychological due to the negative emotions it provokes.

CONCLUSION

We generated a concept framework of cough after lung cancer surgery, providing a basis for further development of measurement tools from the patients' perspective. The lack of knowledge related to coughing highlights the need for adequate and timely health education and professional medical care.

Patient's experiences of coughing after lung cancer surgery: A multicenter qualitative study

Purpose

Cough is one of the most common symptoms after lung cancer surgery, which seriously affects the quality of life. Little research has been conducted on patient's experiences of cough following lung surgery. This study aimed to elucidate the experience of coughing after lung cancer surgery from the patient's perspective regarding symptoms and their impacts on daily life, as well as triggers and dealing strategies.

Methods

Between June 2023 and July 2023, we conducted semi‐structured interviews with patients from outpatient clinics of two hospitals who were pathologically diagnosed with lung cancer and experienced cough after surgery through convenience sampling. The interview recordings were transcribed and analyzed by two researchers. The traditional content analysis and thematic analysis were used to identify the common codes, subthemes, and themes.

Results

A total of 28 participants were interviewed. The mean age of the participants was 55.21 years (range: 36–75 years), and 21 participants were female. Most patients (75%) were interviewed within 6 months of surgery. We identified five themes (accompanying symptoms, incentives, effects, solution, and information sources) and 12 subthemes (local symptoms, systemic symptoms, personal factors, external factors, emotion, relationship with others, reduced quality of life, medical measures, nonmedical measures, no measures, relatives and friends, and the Internet). Patients with lung cancer may experience various cough symptoms after surgery, which a variety of internal and external factors can trigger. The coughing imposes a double burden on the physical and psychological due to the negative emotions it provokes.

Conclusion

We generated a concept framework of cough after lung cancer surgery, providing a basis for further development of measurement tools from the patients' perspective. The lack of knowledge related to coughing highlights the need for adequate and timely health education and professional medical care.

Patient-Reported Outcome-Based Prediction for Postdischarge Complications after Lung Surgery

BACKGROUND

Patients undergoing lung tumor surgery may experience various complications after discharge from the hospital. Using patient-reported outcomes (PROs), this study attempted to identify relevant indicators of postdischarge complications after lung tumor surgery and develop a predictive nomogram model to evaluate the risk for individual patients.

METHODS

Patients who underwent lung tumor surgery between December 2021 and June 2022 were included in this study. PROs were assessed using the Perioperative Symptom Assessment for Lung Surgery scale and were assessed preoperatively at baseline, on postoperative day 1 (POD1) 1 to POD4, and then weekly until the fourth week. A random forest machine learning prediction model was built to rank the importance of each PRO score of patients on POD1 to POD4. We then selected the top 10 variables in terms of importance for the multivariable logistic regression analysis. Finally, a nomogram was developed.

RESULTS

PROs, including coughing (POD3 and POD4), daily activity (POD1), and pain (POD1 and POD2), were associated with postdischarge complications in patients undergoing lung tumor surgery. The predictive model showed good performance in estimating the risk of postdischarge complications, with an area under the curve of 0.833 (95% confidence interval: 0.753-0.912), while maintaining good calibration and clinical value.

CONCLUSION

We found that PRO scores on POD1 to POD4 were associated with postdischarge complications after lung tumor surgery, and we developed a helpful nomogram model to predict the risk of postdischarge complications.

Post-Operative Poor Sleep Quality and Its Associated Factors Among Non-Small Cell Lung Cancer Patients: A Cross-Sectional Study

Objective

The study aimed to determine the post-operative prevalence and factors associated to poor sleep quality in non-small cell lung cancer (NSCLC) patients in China.

Methods

NSCLC patients (n=307) who underwent thoracoscopic surgery at the Department of Thoracic Surgery of Shanghai Pulmonary Hospital were enrolled in this study. The Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Prince Henry Hospital Pain Score and the Six-Minute Walk Test (6MWT), and Forced Expiratory Volume in one second (FEV-1) were used to assess the factors that could lead to poor sleep quality. All assessments were carried out between April 1 and May 30, 2023. Descriptive analyses and stepwise factor regression were employed to determine the impact of various factors on sleep quality. The factors predictive of poor sleep quality were used to develop a predictive nomogram. The Hosmer-Lemeshow test was used to assess the predictive value of the nomogram.

Results

The median PQSI score was 8 (interquartile range (IQR) 5-12), and 74.6% of patients had poor sleep quality. The median anxiety and depression scores were 6 (IQR 3-9) and 4 (IQR 2-7), respectively. The PSQI latency dimension had the highest score, while the use of sleep medications dimension had the lowest score. The multivariate analysis revealed that patients who were female (OR, 2.38; 95% CI, 1.40-4.05; P <0.01), had post-secondary education (OR, 0.42; 95% CI, 0.19-0.92; P =0.03), tertiary education (OR, 0.38; 95% CI, 0.17-0.84; P =0.02), comorbidities (OR, 2.57; 95% CI, 1.51-4.39; P <0.01), a pain score 1 (OR, 4.22; 95% CI, 2.37-7.50; P <0.01), and cough (OR, 2.97; 95% CI, 1.63-5.40; P <.001) were more like to experience poor sleep quality. The positive predictive value of the nomogram was 79.80% (p=0.390).

Conclusion

Sociodemographic variables, comorbidities, and pain could be used to predict the post-operative sleep quality in NSCLC patients.

Pain experience of lung cancer patients during home recovery after surgery: A qualitative descriptive study

BACKGROUND

Patients with lung cancer surgery often suffer pain after discharge. However, there is limited evidence to describe the pain experience from the qualitative investigation. This study was designed to describe the pain experience of lung cancer patients during home recovery after surgery and to provide evidence for developing pain management strategies.

METHODS

This qualitative descriptive study recruited 35 patients who had received lung resection and were discharged by purposive sampling from May to July 2022. Mobile phone interviews were conducted to collect views on patients' pain experience after discharge. The interviews were audio-recorded and converted verbatim into standard text, and the data were iteratively thematic analyzed.

RESULTS

A thematic framework was identified for three themes: perception and impact of pain, coping styles for pain, and unmet needs for pain. Whether short or long-term after discharge, patients complain that they suffer from different degrees and types of pain, causing them a "double burden" physically and mentally. The lack of knowledge about pain may lead them to adopt very different coping styles and desire professional continuous pain management.

CONCLUSIONS

This study may help clarify the status of pain problems that patients face after lung cancer surgery and provides multiple dimensions of pain assessment and management objectives for quantitative research. We call on medical staff to pay attention to patients' perspectives and related needs after discharge and formulate targeted management strategies to reduce pain and improve their quality of life.

The Relationship between Supportive Care Needs and Health-Related Quality of Life in Cancer Patients

The aim of this study was to analyze the relationship between quality of life (QoL) and supportive care needs (SCNs) in cancer patients. It is difficult to relate SCNs to detriments in QoL since SCNs and QoL assessment tools generally comprise different dimensions that cannot be directly related to each other. Therefore, we developed a short questionnaire with eight dimensions for uniformly measuring SCNs, QoL, and the subjective importance of these dimensions. A total of 1108 cancer patients with mixed diagnoses assessed eight dimensions of health-related QoL concerning SCNs, satisfaction, and importance. Among the eight dimensions of QoL, physical functioning received the highest SCN assessments (M = 3.4), while autonomy (M = 20.7) and social relationships (M = 1.88) were the dimensions with the lowest SCN mean scores on the 1-5 scale. For each of the eight dimensions, high levels of SCNs were reported by those patients who had low levels of satisfaction with that dimension (r between -0.32 and -0.66). The subjective importance of the dimensions was not consistently correlated with SCNs (r between -0.19 and 0.20). Females reported higher SCNs than males in six of the eight specific dimensions. Patients with prostate and male genital cancers reported the lowest SCNs. These results suggest gender-specific SCN patterns that warrant further exploration. This study highlights the value of a unified assessment instrument for SCNs and QoL, providing a robust basis for future cancer care strategies.

Unpleasant symptoms of immunotherapy for people with lung cancer: A mixed-method study

BACKGROUND

Immunotherapy has changed the outlook for lung cancer treatment. A closer look at the accompanying symptoms from the patient's perspective is necessary to improve their tolerance to the treatment, which is also the basis for standardized symptom management.

OBJECTIVE

To describe the symptomatic experiences of patients receiving immunotherapy for lung cancer and explore whether symptoms reported during immunotherapy were associated with survival outcomes.

DESIGN

Exploratory sequential mixed-method study.

SETTINGS

Patients were continuously recruited from the oncology day ward of Guangdong Provincial People's Hospital between October 2019 and January 2020.

PARTICIPANTS

59 patients with advanced lung cancer and receiving immunotherapy (median [IQR] age was 64 [58-69]; 72.9 % pathological stage was IV) were included in the study.

METHODS

A sequential qualitative interview on symptom experiences was conducted from the perspective of lung cancer patients in immunotherapy. Summative content analysis was used to develop a standardized symptom reporting checklist. Survival outcome follow-ups of each patient were conducted 2 years after the interview.

RESULTS

47 symptoms were extracted from the 124 interviews of 59 patients, the common symptoms including musculoskeletal pain (52.5 %), itchy skin (45.8 %), fatigue (45.8 %), cough (44.1 %), shortness of breath (32.2 %), lack of appetite (32.2 %), and rashes (32.2 %). The timing, severity, and interference of symptoms were different among patients. The symptoms of shortness of breath, fatigue and chest pain were more common in chemo-immunotherapy, while dry mouth and blurred vision were more frequent with immunotherapy. The symptoms of musculoskeletal pain, shortness of breath, lack of appetite, drowsiness and taste change were more common for those who died two years after the interviews; for those who survived, the symptoms of rash and chill were more common.

CONCLUSIONS

We generated a symptom list related to lung cancer immunotherapy from the patients, provided a closer look at symptoms from the patient's perspective, and suggested differences in the presence of symptoms between the group of treatment and survival outcome. This enables clinicians and nurses to better understand and empathize with the patient's experience, so as to truly practice the essence of patient-centered care, and provide a basis for the development of standardized symptom measurement tools in the future.

TWEETABLE ABSTRACT

At least 47 unpleasant symptoms were present in immunotherapy from the perspective of lung cancer patients.

The Subjective Will and Psychological Experience of Home-Based Exercise in Lung Cancer Patients During Interval of Chemotherapy: A Qualitative Study

Purpose

This qualitative study explores the subjective will and psychological experience of home exercise in patients with lung cancer during the interval of chemotherapy.

Methods

Semi-structured interviews were conducted with 15 lung cancer patients undergoing chemotherapy. Following the Colaizzi 7-step analysis method, the interview data were read carefully, meaningful statements related to the research questions were extracted, coded, collected and described in detail, and the authenticity of the theme was verified.

Results

The analysis revealed the home-based exercise experience of patients' in the interval period of chemotherapy, and identified three themes: 1) the perception experience of home-based exercise (beneficial home-based exercise experience, negative home-based exercise experience); 2) the influencing factors of home-based exercise (exercise rehabilitation knowledge, disease symptoms and adverse effects of chemotherapy, exercise history, exercise self-efficacy, social support, restrictions on objective conditions); 3) Patients with lung cancer expected to get professional guidance about home-based exercise rehabilitation knowledge from medical care providers.

Conclusion

Patients' perception and attitude towards home-based exercise behavior is affected by many factors during the interval of chemotherapy, and they expect professional guidance from medical care providers. Medical care providers should know the problems and the influencing factors in the process of home-based exercise of patients, and formulate personalized exercise measures for patients based on their own characteristics and needs, so as to relieve the symptoms of discomfort and improve the quality of life of patients with lung cancer.

Postoperative Patient-Reported Outcomes after Uniportal Video-Assisted Thoracoscopic Surgery Using the Perioperative Symptom Assessment for Lung Surgery Scale

This study aimed to use a new special inventory for lung surgery patients to evaluate postoperative symptoms and functional status and to identify factors that may affect these after uniportal video-assisted thoracoscopic surgery (VATS). In this single-center longitudinal cohort observational study, we used a new scale, the perioperative symptom assessment for lung surgery (PSA-Lung), to evaluate the recovery from symptoms and the functional status of patients undergoing uniportal VATS. We divided patients into two groups, according to patients' symptom scores, and compared the clinical characteristics between the two groups under each item. Then, we conducted a qualitative interview regarding coughing in postoperative week 4. Exactly 104 patients were enrolled in this study. The two highest-scoring patient-reported outcome (PRO) items were "shortness of breath" and "coughing" in the fourth week after surgery. Thirty-one patients reported that "coughing" severely influenced their lives in postoperative week 4. Using the PSA-Lung inventory, we found that "shortness of breath" was the worst symptom in postoperative week 4. Although "coughing" was not the most important symptom in the early postoperative period, it affected some patients' lives in postoperative week 4. Therefore, further research is required to determine the optimal cut-off point for coughing.

Analysis of the Effect of Quality Nursing on Recovery after Thoracic Surgery

Objective

To observe the feasibility and safety of rapid rehabilitation nursing in the perioperative period of thoracoscopic treatment of lung cancer patients. Rapid rehabilitation nursing was compared with conventional perioperative nursing to explore its clinical efficacy, i.e., its advantages in improving postoperative comfort, postoperative rehabilitation efficiency, and hospitalization cost of patients undergoing thoracoscopic lung cancer resection.

Methods

We carried out a retrospective analysis of 337 lung cancer patients who underwent lobectomy in our thoracic surgery department from July 2019 to June 2021, of which 168 lung cancer patients whose perioperative care method was traditional rehabilitation care were classified as A and 169 lung cancer patients who started to implement the intelligent medical intervention method in the department in September were classified as intelligent medical B. By reviewing patient cases and departmental statistics, general information, length of stay, hospitalization cost, complication rate, pain score, bowel movement recovery time, and pulmonary function index of the two groups A and B were compared. Nursing satisfaction was investigated by using a questionnaire. All the data in the study were processed and analyzed using SPSS 17.0 software.

Results

There were no differences in preoperative general data, pathological findings, preoperative underlying diseases, lesion involvement sites, and postoperative TNM stages (P > 0.05), which were comparable; the incidence of postoperative pulmonary infection and atelectasis complications, postoperative hospitalization time, and hospitalization cost were lower in group B than in group A; the postoperative chest tube drain placement time was shorter in group B than in group A, and the difference between the two groups was statistically significant (P < 0.05). The incidence of postoperative pain and discomfort in group B was lower than that in group A, and the difference between the two groups was statistically significant (P < 0.05); the incidence of postoperative chest pain, bleeding, pneumothorax, pulmonary infection, and atelectasis in group B was lower than that in group A, and the difference between the two groups was statistically significant (P < 0.05).

Conclusion

Intelligent medical rehabilitation nursing has good application value in thoracoscopic lung cancer surgery. Applying the concept of intelligent medical rehabilitation nursing provides an important experimental basis and theoretical basis for improving the postoperative survival quality and clinical symptoms of patients undergoing thoracoscopic lung cancer resection, which helps to promote the postoperative recovery of patients with thoracoscopic lung cancer, improves the recovery efficiency of patients and their overall quality of life, and is superior to the conventional nursing group.

Protocol of an iterative qualitative study to develop a molecular testing decision aid for shared decision-making in patients with lung cancer after surgery

INTRODUCTION

Although molecular testing is crucial for many patients with lung cancer, the decision to carry out molecular testing is not easy to make in actual clinical scenarios. Using a specific decision aid (DA) to conduct shared decision-making (SDM) may help ameliorate this problem. However, no DA currently exists for lung cancer molecular testing (DA_LCMT). We aim to develop an evidence-based, iteratively refined DA, which may facilitate SDM and improve the quality of SDM.

METHODS AND ANALYSIS

After considering the Ottawa Decision Support Framework, International Patient Decision Aid Standards and Food and Drug Administration guidance about methods to identify what is important to patients, semistructured interviews with qualitative research methods will be used to generate the decision-making needs of patients with lung cancer diagnosed with lung adenocarcinoma by intraoperative frozen pathological sections. Input will be provided by patients and other stakeholders, including thoracic surgeons, nurses, hospital administrators, molecular testing company staff and insurance company staff. Then, a modified Delphi method will be used to develop the DA_LCMT V.1.0 (DA_LCMT 1.0). Structured interviews with qualitative research methods will be used in the cognitive debriefing (alpha tests) and field testing (beta tests) to revise and improve the DA_LCMT from version 1.0 to the final version, version 3.0. Descriptive statistics will be used to summarise the baseline characteristics of the patients and other stakeholders. Qualitative data will be analysed using the three steps of grounded theory: generate a codebook, update the codebook and create a comprehensive list of related items.

ETHICS AND DISSEMINATION

Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital approved this study. This protocol is based on the latest version 1.0, dated 31 October 2021. The study was also approved by the Ethics Committees of The Third People's Hospital of Chengdu, Zigong First People's Hospital and Jiangyou People's Hospital. The results of this study will be presented at medical conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05191485.

Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: a cross-sectional analysis

Background

Following lung cancer surgery, patients often experience severe symptoms which are not properly assessed at discharge. The aim of this study was to identify the clinical presentation at discharge and the influencing factors of postoperative symptoms in patients who have undergone lung cancer surgery.

Methods

This cross-sectional study analysed data from patients who participated in a prospective cohort study that enrolled patients who underwent lung cancer surgery at six tertiary hospitals in the People’s Republic of China, from November 2017 to January 2020. Patient symptoms at discharge were measured using the MD Anderson Symptom Inventory Lung Cancer module. The five core symptoms were defined according to ratings of moderate to severe symptoms (≥ 4 on a 0–10 scale). A multivariate linear regression model was used to identify the influencing factors of each symptom at discharge.

Results

Among the 366 participants, 51.9% were male and the mean (SD) age was 55.81 (10.43) years. At discharge, the core symptoms were cough (36.4%), pain (28.2%), disturbed sleep (26.3%), shortness of breath (25.8%), and fatigue (24.3%), and more than half of the participants (54.6%) had one to five of the core symptoms, with moderate to severe severity. A low annual income and the use of two chest tubes were significantly associated (P = 0.030 and 0.014, respectively) with higher mean scores of the core symptoms.

Conclusion

Though clinically eligible for discharge, more than half of the participants had severe symptoms at discharge after lung cancer surgery. Special attention should be given to patients who have two chest tubes after surgery and those who have a low annual income.