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Cheng C, Zhang W, Jin B, Yang S, Lu H, Ren Y. Knowledge, attitude, and practice (KAP) towards pulmonary nodules among Chinese adults: a mediation analysis. Sci Rep 2024; 14:28950. [PMID: 39578539 PMCID: PMC11584867 DOI: 10.1038/s41598-024-79657-9] [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: 05/19/2024] [Accepted: 11/11/2024] [Indexed: 11/24/2024] Open
Abstract
The management of pulmonary nodules involves self-management. This study, conducted in China between September and October 2022, explored the knowledge, attitude, and practice (KAP) towards pulmonary nodules among Chinese adults. The participants were enrolled through convenience sampling when they visited the hospital. The KAP questionnaire was developed by the investigators. Participants who received scores of ≥ 75% of the total score for each dimension were defined as good or positive, 50-75% as moderate, and ≤ 50% as poor or negative. A total of 1209 participants, with an average age of 38.7 years, completed a self-administered online questionnaire. The knowledge, attitude, and practice scores were 5.95 ± 3.54/12, 29.05 ± 4.04/40, and 23.72 ± 6.08/45, respectively, indicating poor knowledge, moderate attitude, and moderate practice regarding pulmonary nodules. The multivariable analyses showed significant associations among knowledge, attitudes, and practice. The mediation analysis indicated that knowledge, education, income, smoking habits, and awareness of pulmonary nodules influenced participants' practices. In conclusion, a significant population of adults in China had inadequate knowledge, attitude, and practice towards pulmonary nodules. Sufficient knowledge was associated with appropriate practices toward pulmonary nodules. Therefore, health education programs aimed at improving knowledge about pulmonary nodules may be helpful for encouraging appropriate attitudes and maintaining healthy practices.
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Affiliation(s)
- Chuangang Cheng
- Departement of Cardiothoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China
| | - Wei Zhang
- Departement of Ultrasound, The Third Affiliated Hospital of Jinzhou Medical University, Section 5, Heping Road, Linghe District, Jinzhou, 121000, China.
| | - Bingji Jin
- Departement of Cardiothoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China
| | - Su Yang
- Physical Examination Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China
| | - Heng Lu
- Departement of Cardiothoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China
| | - Yao Ren
- Departement of Cardiothoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China
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Świątkowski F, Lambrinow J, Górnicki T, Jurga M, Chabowski M. The Influence of Sociodemographic Factors and Clinical Aspects on the Quality of Life of Surgically Treated Patients with Colorectal Cancer. Cancer Manag Res 2024; 16:1293-1303. [PMID: 39355765 PMCID: PMC11444071 DOI: 10.2147/cmar.s478179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/13/2024] [Indexed: 10/03/2024] Open
Abstract
Introduction Due to the increasing number of cases and the levels of mortality, colorectal cancer is still a major health problem. Therefore, the growing interest in the quality of life of patients and the assessment of the quality of life of patients with colorectal cancer seems to be particularly important. The aim of the study was to investigate and determine factors that have a significant impact on the QoL of patients who were diagnosed with colorectal cancer that was surgically treated in the Surgical Department of the 4th Military Clinical Hospital in Wroclaw. Methods 102 respondents were enrolled into the study. The QLQ-C30, QLQ-CR29 as well as an original questionnaire regarding the socioeconomic factors were used for the assessment. The information was supplemented with patients' clinical data. Results According to the QLQ-C30 questionnaire the average QoL of the respondents was 55%. Factors such as male gender, younger age, higher BMI, no significant weight loss, living with family, lower level of education and being professionally active have significant positive impact on QoL. In contrary, patients with more advanced and malignant cancer with tumor located in the right half of the colon had worse QoL. The particular domains of QoL influenced by these factors were also identified. Determining these factors will allow for more effective treatment, for the shortening of the hospitalization and finally for the reduction of the costs. Conclusion The better QoL of the patients with colorectal cancer treated surgically showed younger men, living with family and with the support from close people, professionally active, with primary level of education, and without significant weight loss, ie less than 5% of body weight in the last 6 months. Moreover, patients with cancer located in the left colon, at a lower stage, with a lower grading demonstrated a better QoL.
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Affiliation(s)
- Filip Świątkowski
- Department of Surgery, 4th Military Clinical Hospital, Wroclaw, 50-981, Poland
- Division of Anaesthesiologic and Surgical Nursing, Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, Wroclaw, 51-618, Poland
| | - Jakub Lambrinow
- Department of Angiology and Internal Medicine, Wroclaw Medical University, Wroclaw, 50-556, Poland
| | - Tomasz Górnicki
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Marta Jurga
- Student Research Club No 180, Faculty of Medicine, Wroclaw Medical University, Wroclaw, 50-367, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Clinical Hospital, Wroclaw, 50-981, Poland
- Department of Clinical Surgical Sciences, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, 50-556, Poland
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Peters EJ, Buduhan G, Tan L, Srinathan SK, Kidane B. Preoperative quality of life predicts complications in thoracic surgery: a retrospective cohort study. Eur J Cardiothorac Surg 2024; 66:ezae301. [PMID: 39133147 DOI: 10.1093/ejcts/ezae301] [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: 03/22/2024] [Revised: 07/23/2024] [Accepted: 08/09/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVES Patients undergoing thoracic surgery experience high complication rates. It is uncertain whether preoperative health-related quality of life (HRQOL) measurements can predict patients at higher risk for postoperative complications. The objective of this study was to determine the association between preoperative HRQOL and postoperative complications among patients undergoing thoracic surgery. METHODS This was a retrospective cohort study of prospectively collected data. Consecutive patients undergoing elective thoracic surgery at a Canadian tertiary care centre between January 2018 and January 2019 were included. Patient HRQOL was measured using the Euroqol-5 Dimension (EQ-5D) survey. Complications were recorded using the Ottawa Thoracic Morbidity and Mortality system. Uni- and multivariable analysis were performed. RESULTS Of 515 surgeries performed, 133 (25.8%) patients experienced at least 1 postoperative complication; 345 (67.0%) patients underwent surgery for malignancy. A range of 271 (52.7%) to 310 (60.2%) patients experienced pain/discomfort at each timepoint. On multivariable analysis, lower preoperative EQ-5D visual analogue scale scores were significantly associated with postoperative complications (adjusted odds ratio 0.97, 95% confidence interval 0.95-0.99; P = 0.01). Presence of malignancy was not independently associated with complications (P = 0.68). CONCLUSIONS Self-reported preoperative HRQOL can predict incidence of postoperative complications among patients undergoing thoracic surgery. Assessments of preoperative HRQOL may help identify patients at higher risk for developing complications. These findings could be used to direct preoperative risk-mitigation strategies in areas of HRQOL where patients suffer most, such as pain. The full perioperative trajectory of patient HRQOL should be discerned to identify subsets of patients who share common risk factors.
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Affiliation(s)
- Eagan J Peters
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sadeesh K Srinathan
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada
- Department of Physiology & Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
- Department of Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada
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Halms T, Strasser M, Hasan A, Rüther T, Trepel M, Raab S, Gertzen M. Smoking and quality of life in lung cancer patients: systematic review. BMJ Support Palliat Care 2024; 13:e686-e694. [PMID: 37607808 DOI: 10.1136/spcare-2023-004256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Lung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor in the treatment of patients with LC, the impact of smoking status on QoL remains unclear. This systematic review aims to provide a comprehensive overview of available evidence on the relationship between smoking status and QoL among patients with LC. METHODS A systematic search of Embase, Medline and Web of Science was conducted. Studies reporting the impact of smoking status on QoL among patients with LC were eligible for inclusion. Two reviewers independently assessed the eligibility of studies, extracted data and evaluated the risk of bias using the Critical Appraisal Skills Programme appraisal tool for cohort studies. A descriptive synthesis was performed due to the heterogeneity of the studies. RESULTS A total of 23 studies met the inclusion criteria (17 studies providing cross-sectional and 6 longitudinal data). The studies included a total of 10 251 participants. The results suggested a tendency towards lower QoL among smokers compared with non-smokers. The effect of smoking cessation on QoL was insufficiently investigated in the included studies and therefore remains inconclusive. CONCLUSIONS The findings of this review suggest that current smokers may experience worse QoL than former and never smokers. The results of this systematic review should, however, be viewed in the context of the difficulty of data collection in this patient group given the low survival rates and low performance status, among other factors and in light of the large variety of different QoL measures used. Future research requires uniform QoL measures, a holistic representation of all patients with LC as well as a comprehensive consideration of all potential determinants of QoL. The potential benefits of smoking cessation on QoL among patients with LC require investigation.
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Affiliation(s)
- Theresa Halms
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Martina Strasser
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig‑Maximilians University Munich, Munich, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- Comprehensive Cancer Center Augsburg (CCCA), Augsburg, Germany
| | - Stephan Raab
- Department of Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Marcus Gertzen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
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Teba PP, Esther MG, Raquel SG. Association between physical activity and patient-reported outcome measures in patients with lung cancer: a systematic review and meta-analysis. Qual Life Res 2022; 31:1963-1976. [DOI: 10.1007/s11136-021-03053-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/14/2023]
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Bodtger U, Marsaa K, Siersma V, Bang CW, Høegholm A, Brodersen J. Breaking potentially bad news of cancer workup to well-informed patients by telephone versus in-person: A randomised controlled trial on psychosocial consequences. Eur J Cancer Care (Engl) 2021; 30:e13435. [PMID: 33989444 DOI: 10.1111/ecc.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/08/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of telephone in delivering cancer care increases, but not in cancer workup. Current protocols for breaking bad news assume a single in-person meeting. Cancer workup involves multiple opportunities for patient information. We investigated the psychosocial consequences in gradually informed patients of receiving lung cancer workup results by telephone versus in-person. METHODS A randomised, controlled, open-label, assessor-blinded, single-centre trial including patients referred for invasive workup for suspected malignancy (clinical trials no. NCT04315207). Patients were informed on probable cancer at referral, after imaging, and on the day of invasive workup (Baseline visit). Primary endpoint: change (Δ) from baseline to follow-up (4 weeks after receiving workup results) in scores of a validated, sensitive, condition-specific questionnaire (COS-LC) assessing consequences on anxiety, behaviour, dejection and sleep. RESULTS Of 492 eligible patients, we randomised 255 patients (mean age: 68 years; female: 38%; malignancy diagnosed: 68%) to the telephone (n = 129) or in-person (n = 126) group. Groups were comparable at baseline and follow-up, and no between-groups difference in ΔCOS-LC was observed in the intention-to-treat population, or in subgroups diagnosed with or without malignancy. CONCLUSION Breaking final result of cancer workup by telephone is not associated with adverse psychosocial consequences compared to in-person conversation in well-informed patients.
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Affiliation(s)
- Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark.,Department of Respiratory Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Kristoffer Marsaa
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Palliative Unit, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Christine Winther Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Fernandes S, Williams G, Williams E, Ehrlich K, Stone J, Finlayson N, Bradley M, Thomson RR, Akram AR, Dhaliwal K. Solitary pulmonary nodule imaging approaches and the role of optical fibre-based technologies. Eur Respir J 2021; 57:2002537. [PMID: 33060152 PMCID: PMC8174723 DOI: 10.1183/13993003.02537-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
Abstract
Solitary pulmonary nodules (SPNs) are a clinical challenge, given there is no single clinical sign or radiological feature that definitively identifies a benign from a malignant SPN. The early detection of lung cancer has a huge impact on survival outcome. Consequently, there is great interest in the prompt diagnosis, and treatment of malignant SPNs. Current diagnostic pathways involve endobronchial/transthoracic tissue biopsies or radiological surveillance, which can be associated with suboptimal diagnostic yield, healthcare costs and patient anxiety. Cutting-edge technologies are needed to disrupt and improve, existing care pathways. Optical fibre-based techniques, which can be delivered via the working channel of a bronchoscope or via transthoracic needle, may deliver advanced diagnostic capabilities in patients with SPNs. Optical endomicroscopy, an autofluorescence-based imaging technique, demonstrates abnormal alveolar structure in SPNs in vivo Alternative optical fingerprinting approaches, such as time-resolved fluorescence spectroscopy and fluorescence-lifetime imaging microscopy, have shown promise in discriminating lung cancer from surrounding healthy tissue. Whilst fibre-based Raman spectroscopy has enabled real-time characterisation of SPNs in vivo Fibre-based technologies have the potential to enable in situ characterisation and real-time microscopic imaging of SPNs, which could aid immediate treatment decisions in patients with SPNs. This review discusses advances in current imaging modalities for evaluating SPNs, including computed tomography (CT) and positron emission tomography-CT. It explores the emergence of optical fibre-based technologies, and discusses their potential role in patients with SPNs and suspected lung cancer.
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Affiliation(s)
- Susan Fernandes
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Gareth Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Elvira Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Katjana Ehrlich
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - James Stone
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Centre for Photonics and Photonic Materials, Dept of Physics, The University of Bath, Bath, UK
| | - Neil Finlayson
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute for Integrated Micro and Nano Systems, School of Engineering, The University of Edinburgh, Edinburgh, UK
| | - Mark Bradley
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- EaStCHEM, School of Chemistry, The University of Edinburgh, Edinburgh, UK
| | - Robert R. Thomson
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute of Photonics and Quantum Sciences, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Ahsan R. Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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Health-Related Quality of Life in Patients with Lung Cancer Applying Integrative Oncology Concepts in a Certified Cancer Centre. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5917382. [PMID: 32454866 PMCID: PMC7238336 DOI: 10.1155/2020/5917382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/02/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
Background Pretreatment health-related quality of life (HRQOL) is associated with survival outcome in lung cancer patients. There is a lack of systematic research on pretreatment HRQOL in lung cancer patients who receive integrative oncology (IO). We evaluated patient-reported outcomes in these patients at time of diagnosis at a certified oncology and lung cancer centre. Methods The present analysis is a prospective real-world data study. Clinical and demographic data were obtained from the accredited Network Oncology cancer registry. Pretreatment HRQOL was evaluated (international standardized questionnaires) for people with all-stage lung cancer at first diagnosis that received IO consisting of standard therapy and multimodal add-on complementary concepts. Univariate and adjusted multivariate regression analyses were performed with R. Results. Eighty seven patients with all-stage lung cancer were eligible for the questionnaire analysis (median age 68.0 years, IQR 59.0–74.4). Thirty percent of the total cohort reported financial difficulties. Self-reported pretreatment financial difficulty was associated with younger age (p=0.007), pretreatment pain (p=0.006), anxiety (p=0.04), and low mood (p=0.03). Pain (p=0.03) and young age (p=0.02) in the early- and late-stage lung cancer were associated with financial difficulties. Conclusion We suggest physicians screen lung cancer patients at working age (broadly aged ≤65 years) and/or who report increased pain at the time of diagnosis as they might be at particular risk for emotional, physical, and financial problems. Our results emphasize to address emotional and physical needs before and during early treatment in lung cancer patients as suggested in integrative and supportive cancer concepts.
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Hirpara DH, Gupta V, Davis LE, Zhao H, Hallet J, Mahar AL, Sutradhar R, Doherty M, Louie AV, Kidane B, Darling G, Coburn NG. Severe symptoms persist for Up to one year after diagnosis of stage I-III lung cancer: An analysis of province-wide patient reported outcomes. Lung Cancer 2020; 142:80-89. [PMID: 32120228 DOI: 10.1016/j.lungcan.2020.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Lung cancer is associated with significant disease- and treatment-related morbidity. The Edmonton Symptom Assessment System (ESAS) is a tool developed to elicit patients' own assessment of the severity of common cancer-associated symptoms. The objective of this study was to examine symptom severity in the 12 months following diagnosis of lung cancer, and to identify predictors of high symptom burden. MATERIALS AND METHODS This was a retrospective population-based cohort study, including patients with stage I-III lung cancer diagnosed between 2007-2016, and who had symptom screening in the 12 months following diagnosis. The proportion of patients reporting severe symptoms (ESAS ≥ 7) in the year following diagnosis was plotted over time. Multivariable regression models were constructed to identify factors associated with severe symptoms. RESULTS 69,440 unique symptom assessments were reported by 11,075 lung cancer patients. Tiredness was the most prevalent severe symptom (47.3 %), followed by shortness of breath (39.4 %) and poor wellbeing (36.5 %) among all disease stages. Patients diagnosed with higher stage disease reported more severe symptoms, but symptom trajectories were similar for all stages in the year following diagnosis. Disease stage (RR 1.10-2.01), comorbidity burden (RR 1.17-1.51), degree of socioeconomic marginalization (RR1.15-1.45), and female sex (RR 1.15-1.50) were associated with reporting severe symptoms in the year following diagnosis. CONCLUSION Severe physical and psychological symptoms persist throughout the first year following lung cancer diagnosis, regardless of disease stage. Those at risk of experiencing high symptom burden may benefit from targeted supportive care interventions, including psychosocial support aimed at improving health-related quality of life.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Haoyu Zhao
- ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada; Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy, University of Manitoba, 727 McDermot Ave., Winnipeg, MB R3B 3P5, Canada
| | - Rinku Sutradhar
- Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Mark Doherty
- Division of Medical Oncology, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Alexander V Louie
- Division of Radiation Oncology, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, 820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada
| | - Gail Darling
- Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, 149 College St., Toronto, ON M5T 1P5, Canada; Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; ICES, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada.
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Vogel J, Wang X, Troxel AB, Simone CB, Rengan R, Lin LL. Prospective assessment of demographic characteristics associated with worse health related quality of life measures following definitive chemoradiation in patients with locally advanced non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:332-339. [PMID: 31555509 DOI: 10.21037/tlcr.2019.08.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to evaluate baseline demographic characteristics which may be associated with worse health related quality of life (HRQOL) for patients with locally advanced non-small cell lung cancer (NSCLC) receiving definitive chemoradiation (CRT). Materials Patients with NSCLC were prospectively enrolled on an Institutional Review Board-approved clinical trial between 2009 and 2012. HRQOL assessments were collected pre-radiation therapy (RT), during RT, and within 3 months post-RT using Euroqol (EQ-5D), MD Anderson Symptom Inventory (MDASI), and Functional Assessment of Cancer Therapy General (FACT-G). HRQOL correlation was assessed with categorical variables by Wilcoxon rank sum tests and with continuous variables by Pearson correlation. P<0.05 was defined as statistically significant. Results Forty-three consecutive patients received definitive concurrent CRT and completed assessments at one or more time-points. Patients most commonly had stage IIIB disease (72%), were married or with a partner (70%) and Caucasian (91%). Median patient age was 65 (range: 39-79) years and Charlson comorbidity index (CCI) was 0 (range: 0-5). Female gender, African-American ethnicity, age, chemotherapy type, baseline hemoglobin, and CCI were associated with worse post-treatment HRQOL measures. Conclusions We have identified novel characteristics associated with worse quality of life following definitive CRT for lung cancer. Patients at risk for worse post-treatment quality of life may benefit from earlier follow-up and greater supportive measures following treatment.
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Affiliation(s)
- Jennifer Vogel
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Xingmei Wang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lilie L Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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Hoang JM, Upadhyay N, Dike DN, Lee J, Johnson ML, Cleeland CS, Mendoza T, Chen H, Trivedi MV. Patient-reported outcomes in light of supportive medications in treatment-naïve lung cancer patients. Support Care Cancer 2019; 28:1809-1816. [PMID: 31338641 DOI: 10.1007/s00520-019-05004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of supportive medications on patient-reported outcomes (PROs) has not been systematically evaluated. We describe the supportive medications used by treatment-naïve lung cancer patients and assess their association with PROs from MD Anderson Symptom Inventory (MDASI). METHODS Treatment-naïve lung cancer patients who completed PROs from MDASI at the initial visit to MD Anderson Cancer Center were included. Medications from the initial visit were abstracted from the electronic medical records system and categorized into therapeutic classes based on U.S. Pharmacopeia v7.0. A chi-square or Mann-Whitney U test was conducted as appropriate. RESULTS Among 459 patients, ~ 50% took any analgesics and 25% were on opioids. One-third of patients with moderate-severe pain were not on any analgesics. Patients taking opioids had significantly worse median pain scores (6 vs. 0) compared with those not taking any analgesics (p < 0.0001). Higher proportion of patients with moderate-severe pain took opioids compared with those with mild pain (52% vs. 16%, p < 0.0001). Patients on opioids also reported significantly worse scores for five other cancer-specific core symptoms and all six symptoms rating interference with daily life. Only 15% of patients with higher composite score for depression-related symptoms were on antidepressants. However, patients taking antidepressants did not significantly differ in any individual MDASI symptom scores compared with those not on antidepressants (p = 0.4858). CONCLUSIONS Our results suggest a need for better screening for pain and depression and optimization of pain management in treatment-naïve lung cancer patients since their poor functional status may result in suboptimal cancer therapy.
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Affiliation(s)
- Johnny M Hoang
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Navneet Upadhyay
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Dozie N Dike
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Jaekyu Lee
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Michael L Johnson
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA.
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Clark ME, Bedford LE, Young B, Robertson JFR, das Nair R, Vedhara K, Littleford R, Sullivan FM, Mair FS, Schembri S, Rauchhaus P, Kendrick D. Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules. Lung Cancer 2018; 124:160-167. [PMID: 30268456 DOI: 10.1016/j.lungcan.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine the psychological response (thoughts, perceptions and affect) to a diagnosis of pulmonary nodules following a novel antibody blood test and computed tomography (CT) scans within a UK population. MATERIALS AND METHODS This study was nested within a randomised controlled trial of a blood test (Early CDT®-Lung test), followed by a chest x-ray and serial CT-scanning of those with a positive blood test for early detection of lung cancer (ECLS Study). Trial participants with a positive Early CDT®-Lung test were invited to participate (n = 338) and those agreeing completed questionnaires assessing psychological outcomes at 1, 3 and 6 months following trial recruitment. Responses of individuals with pulmonary nodules on their first CT scan were compared to those without (classified as normal CT) at 3 and 6 months follow-up using random effects regression models to account for multiple observations per participant, with loge transformation of data where modelling assumptions were not met. RESULTS There were no statistically significant differences between the nodule and normal CT groups in affect, lung cancer worry, health anxiety, illness perceptions, lung cancer risk perception or intrusive thoughts at 3 or 6 months post-recruitment. The nodule group had statistically significantly fewer avoidance symptoms compared to the normal CT group at 3 months (impact of events scale avoidance (IES-A) difference between means -1.99, 95%CI -4.18, 0.21) than at 6 months (IES-A difference between means 0.88, 95%CI -1.32, 3.08; p-value for change over time = 0.003) with similar findings using loge transformed data. CONCLUSION A diagnosis of pulmonary nodules following an Early CDT®-Lung test and CT scan did not appear to result in adverse psychological responses compared to those with a normal CT scan.
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Affiliation(s)
- Marcia E Clark
- University of Nottingham, Division of Primary Care, United Kingdom
| | - Laura E Bedford
- University of Nottingham, Division of Primary Care, United Kingdom
| | - Ben Young
- University of Nottingham, Division of Primary Care, United Kingdom
| | - John F R Robertson
- University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, United Kingdom
| | - Roshan das Nair
- University of Nottingham, Institute of Mental Health, United Kingdom
| | - Kavita Vedhara
- University of Nottingham, Division of Primary Care, United Kingdom
| | | | | | - Frances S Mair
- University of Glasgow, General Practice and Primary Care, United Kingdom
| | - Stuart Schembri
- University of Dundee, Scottish Centre for Respiratory Research, United Kingdom
| | - Petra Rauchhaus
- University of Dundee, Tayside Clinical Trials Unit, United Kingdom
| | - Denise Kendrick
- University of Nottingham, Division of Primary Care, United Kingdom.
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13
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Ran J, Wang J, Bi N, Jiang W, Zhou Z, Hui Z, Liang J, Feng Q, Wang L. Health-related quality of life in long-term survivors of unresectable locally advanced non-small cell lung cancer. Radiat Oncol 2017; 12:195. [PMID: 29197373 PMCID: PMC5712080 DOI: 10.1186/s13014-017-0909-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heath-related quality of life (HRQoL) among survivors with unresectable locally-advanced non-small cell lung cancer (LA-NSCLC) treated with radiotherapy and chemotherapy still is not clear. The current study were performed to determine HRQoL for long-term survivors with unresectable LA-NSCLC and to identify risk factors for poor HRQoL. METHODS Among patients with LA-NSCLC receiving radiotherapy and chemotherapy between January 2006 and December 2010, 82 long-term survivors beyond 5 years were identified in this cross-sectional study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and the lung cancer-specific questionnaire QLQ-LC13 were employed to gather information on HRQoL. HRQoL scores were compared between different subgroups to analyze factors related to HRQoL. RESULTS Fifty-five out of 82 (67%) long-term survivors completed the HRQoL survey. They reported a mild reduction in global health status and physical and emotional functioning. Fatigue, dyspnea, coughing, and financial difficulties ranked the highest scores in the symptom scales. Analysis of risk factors for HRQoL showed age, exercise, smoking status, and treatment regimen were associated with global health status and functional scores, while age, gender, radiation pneumonitis, weight loss, and exercise were associated with symptom scores. CONCLUSIONS This study provides the first description of the HRQoL of long-term LA-NSCLC survivors receiving radiotherapy and chemotherapy who may experience a relatively high HRQoL. Factors related to poorer HRQoL are potential targets for intervention.
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Affiliation(s)
- Juntao Ran
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Wei Jiang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China.
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14
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Malnutrition and Quality of Life in Patients with Non-Small-Cell Lung Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1021:15-26. [DOI: 10.1007/5584_2017_23] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Freiman MR, Clark JA, Slatore CG, Gould MK, Woloshin S, Schwartz LM, Wiener RS. Patients' Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey. J Thorac Oncol 2016; 11:700-708. [PMID: 26961390 DOI: 10.1016/j.jtho.2016.01.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Pulmonary nodules are detected in more than 1 million Americans each year. Prior qualitative work suggests that the detection of incidental pulmonary nodules can be burdensome for patients, but whether these findings generalize to a broader sample of patients is unknown. We categorized patients' knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, as well as their impressions of clinician communication. METHODS We administered a cross-sectional survey to adults with an incidental pulmonary nodule who were recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital. RESULTS Of the 490 individuals mailed surveys, 244 (50%) responded. Median nodule size was 7 mm, mean patient age was 67 years, 29% of respondents were female, and 86% were white. A quarter of the respondents (26%) reported clinically significant distress related to their nodule, our primary outcome, as measured by the Impact of Event Scale. Patients reported multiple concerns, including uncertainty about the nodule's cause (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall, there was no correlation between perceived and actual risk (r = -0.007, p = 0.93). The 23% of patients who did receive information on cancer risk from their provider were more likely to find this information reassuring (16%) than scary (7%). CONCLUSION A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.
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Affiliation(s)
- Marc R Freiman
- Pulmonary Center, Boston University Medical Center, Boston, Massachusetts
| | - Jack A Clark
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford, Massachusetts; Boston University School of Public Health, Boston, Massachusetts
| | - Christopher G Slatore
- Center to Improve Veteran Involvement and Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven Woloshin
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Lisa M Schwartz
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Renda Soylemez Wiener
- Pulmonary Center, Boston University Medical Center, Boston, Massachusetts; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford, Massachusetts.
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16
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Polanski J, Jankowska-Polanska B, Rosinczuk J, Chabowski M, Szymanska-Chabowska A. Quality of life of patients with lung cancer. Onco Targets Ther 2016; 9:1023-8. [PMID: 27013895 PMCID: PMC4778772 DOI: 10.2147/ott.s100685] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lung cancer is the major cause of oncologic-related death worldwide. Due to delayed diagnosis, 5-year survival rate accounts for only 15%. Treatment includes surgery, adjuvant chemotherapy, and radiation therapy; however, it is burdened by many side effects. Progress of the disease, severity of its symptoms, and side effects decrease significantly the quality of life (QoL) in those patients. The level of self-assessed QoL helps in predicting survival, which is especially important among patients receiving palliative care. Patients assess their functioning in five dimensions (physical, psychological, cognitive, social, and life roles), severity of symptoms, financial problems, and overall QoL. The QoL in lung cancer patients is lower than in healthy population and patients suffering from other malignancies. It is affected by the severity and the number of symptoms such as fatigue, loss of appetite, dyspnea, cough, pain, and blood in sputum, which are specific for lung tumors. Fatigue and respiratory problems reduce psychological dimension of QoL, while sleep problems reduce cognitive functioning. Physical dimension (related to growing disability) decreases in most of the patients. Also, most of them are unable to play their family and social roles. The disease is a frequent reason of irritation, distress, and depression. Management of the disease symptoms may improve QoL. Controlling the level of fatigue, pulmonary rehabilitation, and social and spiritual support are recommended. Early introduction of tailored palliative treatment is a strategy of choice for improvement of QoL in lung cancer patients.
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Affiliation(s)
- Jacek Polanski
- Lower Silesian Oncology Center, Home Hospice, Wroclaw Medical University, Wroclaw, Poland
| | | | - Joanna Rosinczuk
- Department of Nervous System Diseases, Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Mariusz Chabowski
- Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Szymanska-Chabowska
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
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17
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How should pulmonary nodules be optimally investigated and managed? Lung Cancer 2016; 91:48-55. [DOI: 10.1016/j.lungcan.2015.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/12/2015] [Indexed: 12/21/2022]
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18
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 646] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Lemonnier I, Guillemin F, Arveux P, Clément-Duchêne C, Velten M, Woronoff-Lemsi MC, Jolly D, Baumann C. Quality of life after the initial treatments of non-small cell lung cancer: a persistent predictor for patients' survival. Health Qual Life Outcomes 2014; 12:73. [PMID: 24884836 PMCID: PMC4026822 DOI: 10.1186/1477-7525-12-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/06/2014] [Indexed: 12/13/2022] Open
Abstract
Background Health-related quality of life (HRQoL) before treatment may predict survival of patients with non-small-cell lung cancer (NSCLC). We investigated the predictive role of HRQoL after the initial treatments, on the survival of these patients. Methods A prospective multi-center study conducted in northeastern France. The SF-36 and European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (QLQ C-30) were mailed to patients 3 months after the end of the diagnostic process. High scores for functioning dimensions on both questionnaires indicated better QoL, and low scores for symptom dimensions on the QLQ C-30 indicated few symptoms. Cox regression modeling was used to identify predictive factors of survival. Results In total, 230 (63.5%) patients responded to the SF-36 and QLQ C-30. Before completing the questionnaires, almost 60% of patients had undergone some chemotherapy, about 10% underwent radio/chemotherapy or both and more than 30% underwent surgery or surgery plus chemo/radiotherapy. On SF-36, the highest mean score was for social functioning dimension (55.5 ± 28), and the lowest was for the physical role dimension (17.9 ± 32.2). On QLQ C-30, for the functioning dimensions, the highest mean score was for cognitive functioning (74.6 ± 25.9) and the lowest was for role functioning (47.2 ± 34.1). For symptom dimensions, the lowest score was for diarrhoea (11.5 ± 24.2) and the highest was for fatigue (59.7 ± 27.7). On multivariate analysis, high bodily pain, social functioning and general health scores (SF-36) were associated with a lower risk of death (hazard ratio 0.580; 95% confidence interval [0.400–0.840], p = 0.004; HR 0.652 [0.455–0.935], p < 0.02; HR 0.625 [0.437–0.895] respectively). Better general QoL on QLQ C-30 was related to lower risk of death (HR 0.689 [0.501–0.946], p = 0.02). Conclusion Adding to previous knowledge about factors that may influence patients QoL, this study shows a persisting relationship between better perceived health in HRQoL after the initial treatment of NSCLC and better survival.
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McDonnell KK, Bullock LFC, Hollen PJ, Heath J, Kozower BD. Emerging Issues on the Impact of Smoking on Health-Related Quality of Life in Patients With Lung Cancer and Their Families. Clin J Oncol Nurs 2014; 18:171-81. [DOI: 10.1188/14.cjon.18-02ap] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Backhus L, Puneet B, Bastawrous S, Mariam M, Michael M, Varghese T. Radiographic evaluation of the patient with lung cancer: surgical implications of imaging. Curr Probl Diagn Radiol 2014; 42:84-98. [PMID: 23683850 DOI: 10.1067/j.cpradiol.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lung cancer is the leading cause of cancer deaths in the United States. Despite many advances in treatment, surgery remains the preferred treatment modality for patients presenting with early stage disease. Imaging is critical in the preoperative evaluation of these patients being considered for a curative resection. Advanced imaging techniques provide valuable information, including primary diagnostics, staging, and intraoperative localization for suspected lung cancer. Knowledge of surgical implications of imaging findings can aid both radiologists and surgeons in delivering safe and effective care.
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Affiliation(s)
- Leah Backhus
- Surgery Service, VA Puget Sound Health Care System, Seattle, WA, USA.
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22
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Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA. 'The thing is not knowing': patients' perspectives on surveillance of an indeterminate pulmonary nodule. Health Expect 2012; 18:355-65. [PMID: 23252477 DOI: 10.1111/hex.12036] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The hundreds of thousands of patients found to have a potentially malignant pulmonary nodule each year are faced with tremendous uncertainty regarding what the nodule is and how it should be evaluated. OBJECTIVE To explore patients' responses to the detection and evaluation of a pulmonary nodule. DESIGN Qualitative study based on four focus-group discussions. We performed inductive analysis using principles of grounded theory to identify themes relating to responses to the nodule and strategies to manage uncertainty. SETTING AND PARTICIPANTS Twenty-two patients from two medical centres who were undergoing surveillance for an indeterminate pulmonary nodule. RESULTS Patient responses to an indeterminate pulmonary nodule were varied and evolved over time. Although almost all patients reported an initial fear about cancer, subsequent depictions of the nodule diverged into four types defined on two dimensions: cognitive ('it's cancer' vs. 'I don't know what it is' vs. 'it's nothing serious') and emotional (anxiety vs. equanimity). Most eventually accepted that the nodule was unlikely to be malignant; however, some remained anxious, convinced the nodule could turn into cancer at any time and should be aggressively monitored for life. Patients used results of surveillance tests as well as their own strategies (e.g. vigilance for symptoms, information-seeking, contemplating and controlling modifiable risk factors, avoidance, faith) to manage uncertainty. CONCLUSIONS Surveillance for a pulmonary nodule can weigh heavily on some patients for months or years. Our findings may help clinicians prepare patients with a newly detected pulmonary nodule for the burden of the prolonged uncertainty of surveillance.
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Affiliation(s)
- Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; Center for Health Quality, Outcomes and Economic Research, ENRM VA Hospital, Bedford, MA, USA
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