The Relationship Between Cigarette Smoking and Quality of Life After Lung Cancer Diagnosis

Spiritual well-being in lung cancer survivors

PURPOSE

Spiritual well-being (SWB) among lung cancer survivors has not been well-delineated. Additionally, little is known about how SWB is affected over the trajectory of the disease process. The aims of this study were to examine the SWB of individuals with a diagnosis of lung cancer, to assess the stability of SWB over time, and to identify the factors associated with SWB.

METHODS

A prospective cohort of patients with lung cancer first seen at the Mayo Clinic over a 10-year period of time was included in this study. Study entry was at the time of diagnosis or referral to the Mayo Clinic, and participation involved annual survey using the Functional Assessment in Chronic Illness Therapy-Spiritual Well-being, Medical Outcome Short Form 8, and Quality of Life (QOL) Linear Analog Scale Assessment. Associations were explored using Fisher's exact test, chi-squared test, Kruskal-Wallis test, and Spearman correlations. Linear regression was used to explore multivariate relationships.

RESULTS

There were 1,578 participants over a 10-year period of time. Group SWB scores were relatively high and stable over a 10-year period of time ([Formula: see text], standard deviation = 14.47-18.46, possible scale of 0-100). However, individual scores varied widely across almost the entire scale (2.1-100) and revealed a chaotic trajectory for SWB. Males, current smokers, and those with higher pack-years experienced lower SWB compared to females, nonsmokers, and those with lower pack-years (p < 0.0001, 0.0455, and 0.0004, respectively). SWB was strongly associated with overall QOL.

CONCLUSIONS

SWB is an individualistic experience that can change dramatically over time for cancer survivors. Ongoing assessments are important.

Smoking cessation interventions for lung cancer patients

SUMMARY Worldwide, lung cancer contributes to over 1.4 million deaths per year. Smoking cessation is strongly recommended in clinical practice guidelines for lung cancer management, yet evidence suggests a translational gap between evidence and practice. There are significant health benefits following smoking cessation even after a short period of time. Long-term implications for lung cancer patients include improvements in quality of life, reductions in postoperative complications and reductions in 12-month mortality. Evidence suggests that combining pharmacotherapy, in particular varenicline tartrate (varenicline), with cognitive and behavioral interventions offers the best opportunity for successful long-term abstinence. This review summarizes the latest evidence for smoking cessation interventions in lung cancer patients, identifies gaps in current clinical practice and highlights priority areas for future research.

Radical treatment of non-small cell lung cancer during the last 5 years

The management of non-small cell lung cancer (NSCLC) has continued to improve over the last 5 years due to advances in surgery, radiological staging, combined modality therapies and advances in radiation technology. We have an updated staging classification (7th Edition American Joint Committee on Cancer staging) and now in 2011, a new histology classification introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications as the role of limited resection is reconsidered for early stage lesions. Surgery is curative in early stage disease. The role of surgery in locally advanced NSCLC remains controversial. The principal aim is a complete resection as this will determine long-term prognosis. Intraoperative staging of lung cancer is extremely important to determine the extent of resection according to the tumour and nodal status. Systematic nodal dissection is generally advocated to obtain accurate intraoperative staging and to help decide on adjuvant therapy. Radiotherapy currently plays a major role in the management of lung cancer as most patients are not surgical candidates due to disease stage, fitness and co-morbidities. In the last 5 years we have seen continuing optimisation of chemo-radiotherapy combinations and technological advances including the development of image guided radiotherapy (IGRT), stereotactic ablative body radiotherapy (SABR) and intensity modulated radiotherapy (IMRT). Quality of life evaluation is becoming increasingly important and should be considered when deciding on a specific treatment, especially in a multimodality setting.

Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer

BACKGROUND

Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer.

METHODS

A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach.

RESULTS

Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N = 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N = 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse.

CONCLUSIONS

Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients.

Health-related quality of life of breast cancer patients in Iran: pooled analysis using generalized estimating equations

OBJECTIVE

The aim of current study was to evaluate the changes of health-related quality of life (HRQoL) and its clinical, demographic and socioeconomic determinants during chemotherapy and 4 months follow-up in women with breast cancer using a repeated measures framework.

METHODS AND MATERIALS

A double blind cohort study was performed in 100 breast cancer patients given fluorouracil, doxorubicin and cyclophosphamide (FAC) or docetaxel, doxorubicin, cyclophosphamide (TAC) in south of Iran. HRQoL was assessed at baseline, end of chemotherapy and four months thereafter using the QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer (EORTC). Generalized estimating equations (GEE) was applied for statistical analysis.

RESULTS

The mean of age at baseline was 48.5±10.6. 70% and 14% of patients were married and smokers, respectively, and 20% suffered from another disease besides breast cancer. The results of GEE showed that after control for baseline scores, the HRQoL significantly improved over time. Although, the patients in FAC group had higher scores than the TAC group, the differences also diminished over time. Smoking, marital status and having child affected some scales of HRQoL. None of other variables were significantly related to HRQoL.

CONCLUSION

Although patients in TAC groups had lower level of HRQoL over 8 months follow up, they experienced faster improvement than the FAC group. This implies that in long-term, improvements in TAC group are higher than FAC. Having children was positively correlated with HRQoL. Generally, there were no demographic and socio-economic differences in HRQoL in these patients between the chemotherapeutic regimens.

Persistent cigarette smoking and other tobacco use after a tobacco-related cancer diagnosis

INTRODUCTION

People who continue to smoke after a cancer diagnosis have an increased risk for recurrences or development of new malignancies. These risks may be even higher among tobacco-related cancer survivors (TRCS). We describe tobacco use behaviors among TRCS, other cancer survivors, and people without a history of cancer.

METHODS

We used 2009 Behavioral Risk Factor Surveillance System data to describe demographic characteristics, smoking history, current smoking prevalence, and smokeless tobacco use among TRCS, other cancer survivors, and people without a history of cancer (cigarette smoking and smokeless tobacco use were calculated after adjusting for age, sex, race, and insurance status). Tobacco-related cancers were defined as lung/bronchial, pharyngeal, laryngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical, and acute myeloid leukemia.

RESULTS

A total of 20 % of all cancer survivors were TRCS. TRCS were primarily female (68 %) and white (78 %). Smoking prevalence was higher among TRCS (27 %) compared with other cancer survivors (16 %) and respondents without a history of cancer (18 %). Smokeless tobacco use was higher among respondents without a history of cancer (4 %) compared with TRCS (3 %) and other cancer survivors (3 %).

CONCLUSIONS

The self-reported smoking prevalence among TRCS is higher than among other cancer survivors and people without a history of cancer. Targeted smoking prevention and cessation interventions are needed for cancer survivors, especially those diagnosed with a tobacco-related cancer.

IMPLICATIONS FOR CANCER SURVIVORS

We recommend all cancer survivors be made aware of the health risks associated with smoking after a cancer diagnosis, and smoking cessation services be offered to those who currently smoke. We provide the first population-based report on demographic characteristics and tobacco use behaviors among self-reported tobacco-related cancer survivors.

Tobacco use treatment at the U.S. National Cancer Institute's designated Cancer Centers

INTRODUCTION

Tobacco use is a leading cause of cancer, and continued use after cancer diagnosis puts patients at greater risk for adverse health outcomes, including increased risk for cancer recurrence. This study surveyed National Cancer Institute (NCI)-designated Cancer Centers to assess the availability of tobacco use treatment (TUT) services.

METHODS

Directors and oncology providers of 58 NCI-designated Cancer Centers received invitations to participate in an online survey. The questionnaire asked about attitudes, awareness, policies, and practices related to TUT; barriers to treatment provision; and factors likely to increase services.

RESULTS

All 58 Cancer Centers participated. Twelve (20.7%) Centers reported no TUT services for their patients. Of the remainder, 34 (58.6%) reported a TUT program within their Center and 12 (20.7%) reported external TUT services in their health care system or affiliated university. Only 62% of Centers reported routinely providing tobacco education materials to patients, just over half reported effective identification of patient tobacco use, and less than half reported an employee dedicated to providing TUT services or a clear commitment to providing TUT services from Center leadership. The 34 centers with internal TUT programs reported significantly greater services and administration support for TUT Services.

CONCLUSIONS

These data demonstrate a national need for Cancer Centers to embrace and incorporate recommended standards for TUT. Tying TUT services to NCI recognition and providing stable funding for TUT services in Cancer Centers could lead to better health outcomes, treatment efficacy, and satisfaction for all U.S. Cancer Centers and their patients.

Relationship between deficits in overall quality of life and non-small-cell lung cancer survival

PURPOSE

Evidence has suggested a clinically meaningful relationship between self-reported quality of life (QOL) of a patient with cancer at the time of receiving a cancer diagnosis and overall survival (OS). This study evaluated the prognostic value of QOL assessments with regard to OS in a large cohort of patients with lung cancer.

PATIENTS AND METHODS

A total of 2,442 patients with non-small-cell lung cancer were observed between 1997 and 2007 and completed a single-item measure of overall QOL within the first 6 months of receiving a lung cancer diagnosis; these were dichotomized using an a priori definition of a clinically deficient score (CDS; ≤ 50 v > 50). Kaplan-Meier estimates and Cox models were used to evaluate the prognostic importance of QOL on OS alone and in the presence of covariates. Logistic regression modeling was used to identify which clinical and patient characteristics were related to a clinically meaningful deficit in QOL.

RESULTS

QOL deficits at time of lung cancer diagnosis were significantly associated with OS (hazard ratio [HR], 1.55; P < .001), as were performance status, older age, smoking history, male sex, treatment factors, and stage of disease. The median survival for patients with CDS QOL was 1.6 years versus 5.6 years for patients with non-CDS QOL. After controlling for all these covariates, the indication of a clinically deficient baseline QOL still contributed significantly to the prediction of patient survival (HR, 0.67; P < .001).

CONCLUSION

Overall QOL measured by a simple single item at the time of lung cancer diagnosis is a significant and independent prognostic factor for survival in patients with lung cancer.

Health behaviors of early-stage non-small cell lung cancer survivors

INTRODUCTION

Lung cancer survivors are at risk for cancer recurrence and other chronic illnesses related predominantly to prior tobacco use and older age. Optimal quality of post-treatment care requires greater knowledge of survivors' adherence to behavioral health recommendations. This study reports the rates of smoking, physical activity, alcohol use, cancer screenings, and routine primary care visits in non-small cell lung cancer (NSCLC) survivors.

METHODS

Stage IA and IB NSCLC survivors (N = 183, mean age = 69.0 years) with no evidence of disease 1-6 years post-treatment completed standard survey items regarding health and cancer screening behaviors.

RESULTS

Most survivors (83.5%) had a history of smoking, but 64.8% quit prior to diagnosis and only 5.5% continued to smoke. Alcohol intake recommendations were exceeded by 5.4% and 17.3% of men and women, respectively. In a typical week, 23.1% met physical activity guidelines. Regarding cancer screenings, 89.3% were adherent to colorectal cancer screening guidelines. Among women, 72.0% had a mammogram within the previous year and 81.5% had a pap test in the previous 3 years; among men, 86.7% had a prostate-specific antigen test in the previous year. Almost all (97.3%) had seen a primary care provider in the past year.

DISCUSSIONS/CONCLUSIONS

The majority of lung cancer survivors were adherent to health promotion recommendations, but few engaged in the recommended level of physical activity.

IMPLICATIONS FOR CANCER SURVIVORS

Physical and pulmonary rehabilitation interventions may help lung cancer survivors maintain sufficient levels of physical activity, which can have numerous benefits for older adults.

Smoking cessation counseling beliefs and behaviors of outpatient oncology providers

PURPOSE

Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the "teachable moment" of cancer diagnosis to provide smoking cessation assistance. PROVIDERS AND METHODS: Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices.

RESULTS

Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but <30% of providers reported frequently or always providing intervention to smoking patients (e.g., nicotine replacement therapy or other medications, self-help materials, and/or referrals). Only 30% of providers reported that they frequently or always followed up with patients to assess progress with quitting. Few providers (18.1%) reported high levels of confidence in their ability to counsel smoking patients. Patients' lack of motivation was identified as the most important barrier to smoking cessation.

CONCLUSIONS

Although beliefs about providing cessation services to smoking patients were generally positive, few providers reported commonly providing interventions beyond advice to quit. Additional training and clinic-based interventions may improve adherence to tobacco cessation practice guidelines in the outpatient oncology setting.

A snapshot of smokers after lung and colorectal cancer diagnosis

BACKGROUND

Continued smoking after a cancer diagnosis may adversely affect treatment effectiveness, subsequent cancer risk, and survival. The prevalence of continued smoking after cancer diagnosis is understudied.

METHODS

In the multi-regional Cancer Care Outcomes Research and Surveillance cohort (lung cancer [N = 2456], colorectal cancer [N = 3063]), the authors examined smoking rates at diagnosis and 5 months after diagnosis and also study factors associated with continued smoking.

RESULTS

Overall, 90.2% of patients with lung cancer and 54.8% of patients with colorectal cancer reported ever smoking. At diagnosis, 38.7% of patients with lung cancer and 13.7% of patients with colorectal cancer were smoking; whereas, 5 months after diagnosis, 14.2% of patients with lung cancer and 9.0% of patients with colorectal cancer were smoking. Factors that were associated independently with continued smoking among patients with nonmetastatic lung cancer were coverage by Medicare, other public/unspecified insurance, not receiving chemotherapy, not undergoing surgery, prior cardiovascular disease, lower body mass index, lower emotional support, and higher daily ever-smoking rates (all P < .05). Factors that were associated independently with continued smoking among patients with nonmetastatic colorectal cancer were male sex, high school education, being uninsured, not undergoing surgery, and higher daily ever-smoking rates (all P < .05).

CONCLUSIONS

After diagnosis, a substantial minority of patients with lung and colorectal cancers continued smoking. Patients with lung cancer had higher rates of smoking at diagnosis and after diagnosis; whereas patients with colorectal cancer were less likely to quit smoking after diagnosis. Factors that were associated with continued smoking differed between lung and colorectal cancer patients. Future smoking-cessation efforts should examine differences by cancer type, particularly when comparing cancers for which smoking is a well established risk factor versus cancers for which it is not.

Effect of cigarette smoking on quality of life in small cell lung cancer patients

BACKGROUND

Continued cigarette smoking after small cell lung cancer (SCLC) diagnosis has been shown to shorten patients' survival, but little is known about the impact of smoking and cessation on quality of life (QOL) profile (e.g., overall QOL, pain, fatigue, cough, dyspnea, appetite change, and performance status) in SCLC survivors (who survived at least 6 months post initial diagnosis). In this study, we sought to evaluate the relationship between cigarette smoking and QOL profiles in SCLC patients.

METHODS

A total of 223 survivors were classified into five groups: never smokers, former smokers (quit more than 1 year prior to diagnosis), recent quitters (quit within 1 year surrounding diagnosis), late quitters (quit after 1 year post diagnosis) and never quitters. One hundred and sixty-eight of these survivors were matched with 334 lung-cancer-free controls on age, gender, and smoking status for comparative analysis. QOL scales were scored from 0 (worse) to 100 (best). Conditional logistic regression, linear mixed-effect models, and Wilcoxon signed rank tests were used.

RESULTS

SCLC survivors consistently showed a significant deficit in QOL profile; e.g., mean overall QOL in patients was 17.5 points worse than the controls (p<0.0001). Among all smokers, former smokers reported the best QOL profile, while late or never quitters reported the worst. The recent quitters showed an improving trend in QOL profile and lower percent of reduced appetite (an average of 43%) compared to the late or never quitters (58%).

CONCLUSIONS

Our study confirmed the negative impact of smoking on SCLC survivors' QOL and found that smoking cessation surrounding the time of diagnosis could improve overall QOL and symptoms. The findings of this study provide evidence for oncologists to recommend smoking cessation to their SCLC patients.

Adults surviving lung cancer two or more years: A systematic review

BACKGROUND

Lung cancer has had a low survival rate throughout the years. Some studies have shown that psychological variables such as hardiness and resiliency may play a role in the meaningfulness of survival among lung cancer patients.

OBJECTIVE

The objective of this systematic review was to synthesize the best available evidence on the experiences of surviving lung cancer (including psychological/affective well-being dimensions such as resiliency, optimism, quality of life, and coping strategies) in adults over the age of 18, two or more years after diagnosis.

INCLUSION CRITERIA

The review considered adults (18 years and older) who have survived lung cancer two or more years post diagnosis.The review included studies that examined the experiences (including psychological/affective well-being dimensions such as resiliency, optimism, quality of life, and coping strategies) of surviving lung cancer two or more years post diagnosis.The review considered patients' experiences of surviving lung cancer post two years diagnosis, including the examination of specific psychological/affective well-being aspects such as resiliency, optimism, quality of life and coping strategies.The review included quantitative descriptive studies and qualitative studies.

SEARCH STRATEGY

A search for published and unpublished studies in English language from January 1999 through December 2010 was undertaken in multiple databases including MEDLINE, CINAHL, ProQuest and Psyc INFO.

METHODOLOGICAL QUALITY

Assessment of methodological quality of studies was undertaken using critical appraisal tools from the Joanna Briggs Institute.

DATA COLLECTION

Data was extracted using the Joanna Briggs Institute Data Extraction forms.

DATA SYNTHESIS

Results were presented in a narrative format as the synthesis of qualitative or quantitative data was not appropriate.

RESULTS

13 studies were included in the review: one mixed methods study (including a qualitative research component) and 12 quantitative studies.The qualitative component of the included mixed methods study identified five findings related to the meaningfulness of surviving lung cancer post two years. The central themes that emerged were existential issues, health and self-care, physical ability, adjustment, and support.Quantitative studies identified that distressed groups had less meaningful experiences related to lung cancer survival than not distressed groups. The studies also found that emotional states and style of coping were related to the meaningfulness of lung cancer survival.

CONCLUSIONS

With less emotional distress, seeing the good in everything, adjusting life to fit the changes from lung cancer, and adding physical activity to the daily routine, the life of a lung cancer survivor can be more meaningful.

IMPLICATION FOR PRACTICE

Healthcare providers must assess lung cancer survivors for potential symptom clusters affecting key patient outcomes such as quality of life. Consider introducing interventions to promote light to moderate physical activity in older patients and moderate to vigorous physical activity in younger patients, and ceasing smoking. Teach active coping strategies.

IMPLICATIONS FOR RESEARCH

There is a need for qualitative research studies exploring the experiences of lung cancer survivors. Further research is recommended on symptom clusters that might impact outcomes such as quality of life.

Small-cell lung cancer

The incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. Patients often present with rapid-onset symptoms due to local intrathoracic tumour growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. Staging aims ultimately to define disease as metastatic or non-metastatic. Combination chemotherapy, generally platinum-based plus etoposide or irinotecan, is the mainstay first-line treatment for metastatic small-cell lung cancer. For non-metastatic disease, evidence supports early concurrent thoracic radiotherapy. Prophylactic cranial irradiation should be considered for patients with or without metastases whose disease does not progress after induction chemotherapy and radiotherapy. Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain. Signalling pathways have been identified that might yield new drug targets.

A smoking cessation intervention for thoracic surgery and oncology clinics: a pilot trial

INTRODUCTION

Although most smokers diagnosed with lung cancer report that they want to quit smoking, many do not succeed. Smokers who quit when lung cancer is diagnosed have improved treatment efficacy, quality of life, and survival. Effective smoking cessation interventions targeted to thoracic oncology patients are needed.

METHODS

This pilot study examined the feasibility and potential efficacy of a 12-week program that combined smoking cessation counseling with varenicline. Seven-day point prevalence tobacco abstinence rates at the end of treatment were compared with a usual care control group. From January 2008 to August 2009, patients with a diagnosed or suspected thoracic malignancy were recruited at their initial visit to a thoracic surgeon or thoracic oncologist at Massachusetts General Hospital.

RESULTS

Of 1130 patients screened, 187 (17%) were current smokers, and an additional 66 (6%) reported quitting within the past 6 months. One hundred sixteen (67%) of smokers were eligible, and 49 (42%) of eligible smokers enrolled (control group n = 17, intervention group n = 32). Intervention participants completed a median of nine counseling sessions; 50% of intervention participants completed the full varenicline course. At 12-week follow-up, biochemically validated 7-day point prevalence tobacco abstinence rates were 34.4% in the intervention group versus 14.3% in the control group (odds ratio = 3.14, 95% confidence interval = 0.59-16.62, p = 0.18).

CONCLUSION

Our findings support the feasibility and acceptability of this program. At the end of treatment, quit rates were higher in the intervention [corrected] group. Further testing is indicated to establish the efficacy of this treatment package in a randomized clinical trial.

Disparities between blacks and whites in tobacco and lung cancer treatment

Racial disparities exist in lung cancer incidence, morbidity, and mortality. Smoking is responsible for the majority of lung cancers, and racial disparities also exist in smoking outcomes. Black smokers are less likely than white smokers to engage in evidence-based tobacco treatment, and black smokers are less likely than white smokers to stop smoking. Continued smoking following a lung cancer diagnosis is a potential indicator of poor lung cancer treatment outcomes, yet lung cancer patients who smoke are unlikely to receive evidence-based tobacco treatment. The risks from continued smoking after diagnosis deserve attention as a modifiable factor toward lessening racial disparities in lung cancer outcomes.

Professional practice and accessibility to equipment in thoracic oncology. Results of a survey in Rhônes-Alpes region (France)

This survey, conducted in region Rhône-Alpes (France), aims to assess some data in thoracic oncology practice including availability of specialized equipments. This study is based on a questionnaire mailed to oncologists and pulmonologists in the region. Of 401 questionnaires, the response rate was 56%. Responses of 71 (20%) physicians practicing thoracic oncology are presented in this article. Eighty percent of physicians routinely screen occupational exposure in case of lung cancer. The oncologists are less likely than pulmonologists to screen it (50% vs. 12%, p = 0.0015). Sixty-one percent of practitioners do not routinely propose smoking cessation in stage IV. Sixty-nine percent of practitioners' reports obtain an appointment for PET-scanner within 15 days and 72% indicate that this equipment is located within 50 km of their place of practice. Sixty-two percent reports using a surgical team specialized in chest disease, which is located in their city in 77% of cases. Sixty-one percent say that the period between the decision of an emergency radiotherapy and the start of it is less than one week. In 73% radiotherapy department is located in their city of practice. Forty-one percent of practitioners say they have a centralized and specialized preparation unit for cancer drugs. It seems that specialized equipment in Rhône-Alpes is adapted to practice with the exception of units dedicated to the preparation of cytotoxic drugs.

Behavior matters

Behavior has a broad and central role in health. Behavioral interventions can be effectively used to prevent disease, improve management of existing disease, increase quality of life, and reduce healthcare costs. A summary is presented of evidence for these conclusions in cardiovascular disease/diabetes, cancer, and HIV/AIDS as well as with key risk factors: tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. For each, documentation is made of (1) moderation of genetic and other fundamental biological influences by behaviors and social-environmental factors; (2) impacts of behaviors on health; (3) success of behavioral interventions in prevention; (4) disease management; (5) quality of life, and (6) improvements in the health of populations through behavioral health promotion programs. Evidence indicates the cost effectiveness and value of behavioral interventions, especially relative to other common health services as well as the value they add in terms of quality of life. Pertinent to clinicians and their patients as well as to health policy and population health, the benefits of behavioral interventions extend beyond impacts on a particular disease or risk factor. Rather, they include broad effects and benefits on prevention, disease management, and well-being across the life span. Among priorities for dissemination research, the application of behavioral approaches is challenged by diverse barriers, including socioeconomic barriers linked to health disparities. However, behavioral approaches including those emphasizing community and social influences appear to be useful in addressing such challenges. In sum, behavioral approaches should have a central place in prevention and health care of the 21st century.

Association of Smoking Status With Quality of Life in a Cross-sectional Population-Based Sample of Iranian Adults

This study aimed to examine the association between smoking status and quality of life (QOL) in a population-based sample of Iranian adults. The study used data from the Isfahan Healthy Heart Program (IHHP). A total of 5830 participants were included. They were categorized as current, former, or never smokers. QOL was evaluated using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Persian version. Data entry was performed using SPSS (SPSS Inc, Chicago, IL) software version 13.0. QOL was associated with marital status ( P = .014), education ( P = .001), occupation ( P = .007), and income ( P < .000) among current smokers. After adjusting for sociodemographic characteristics, smoking decreased QOL among current (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.97-0.99) and past (OR = 0.97; 95%CI = 0.95-0.98) smokers relative to never smokers. QOL is lower among Iranian current and past smokers, and the relation is independent of underlying sociodemographic factors.

Nicotinic acetylcholine receptor signaling in tumor growth and metastasis

Cigarette smoking is highly correlated with the onset of a variety of human cancers, and continued smoking is known to abrogate the beneficial effects of cancer therapy. While tobacco smoke contains hundreds of molecules that are known carcinogens, nicotine, the main addictive component of tobacco smoke, is not carcinogenic. At the same time, nicotine has been shown to promote cell proliferation, angiogenesis, and epithelial-mesenchymal transition, leading to enhanced tumor growth and metastasis. These effects of nicotine are mediated through the nicotinic acetylcholine receptors that are expressed on a variety of neuronal and nonneuronal cells. Specific signal transduction cascades that emanate from different nAChR subunits or subunit combinations facilitate the proliferative and prosurvival functions of nicotine. Nicotinic acetylcholine receptors appear to stimulate many downstream signaling cascades induced by growth factors and mitogens. It has been suggested that antagonists of nAChR signaling might have antitumor effects and might open new avenues for combating tobacco-related cancer. This paper examines the historical data connecting nicotine tumor progression and the recent efforts to target the nicotinic acetylcholine receptors to combat cancer.

Patient-reported receipt of and interest in smoking-cessation interventions after a diagnosis of cancer

BACKGROUND

Smoking cessation is essential after the diagnosis of cancer to enhance clinical outcomes. Although effective smoking-cessation treatments are available, <50% of smokers with cancer report receiving treatment. Reasons for the low dissemination of such treatment are unclear.

METHODS

Data were collected from questionnaires and medical record reviews from 160 smokers or recent quitters with lung or head and neck cancer. Descriptive statistics, Cronbach alpha coefficients, and logistic regression were used in the analyses. The median age of participants was 57 years, 63% (n = 101) were men, 93% (n = 149) were white, and 57% (n = 91) had lung cancer.

RESULTS

Eight-six percent (n = 44) of smokers and 75% (n = 82) of recent quitters reported that healthcare providers gave advice to quit smoking. Sixty-five percent (n = 33) of smokers and 47% (n = 51) of recent quitters reported that they were offered assistance from their healthcare providers to quit smoking. Fifty-one percent (n = 26) of smokers and 20% (n = 22) of recent quitters expressed an interest in a smoking-cessation program. An individualized smoking-cessation program was the preferred type of program. Among smokers, younger patients with early stage disease and those with partners who were smokers were more interested in programs.

CONCLUSIONS

Although the majority of patients received advice and were offered assistance to quit smoking, approximately 50% of smokers were interested in cessation programs. Innovative approaches to increase interest in cessation programs need to be developed and tested in this population.

Lung cancer in chronic obstructive pulmonary disease: enhancing surgical options and outcomes

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for both the development of primary lung cancer, as well as poor outcome after lung cancer diagnosis and treatment. Because of existing impairments in lung function, patients with COPD often do not meet traditional criteria for tolerance of definitive surgical lung cancer therapy. Emerging information regarding the physiology of lung resection in COPD indicates that postoperative decrements in lung function may be less than anticipated by traditional prediction tools. In patients with COPD, more inclusive consideration for surgical resection with curative intent may be appropriate as limited surgical resections or nonsurgical therapeutic options provide inferior survival. Furthermore, optimizing perioperative COPD medical care according to clinical practice guidelines including smoking cessation can potentially minimize morbidity and improve functional status in this often severely impaired patient population.

Smoking concordance in lung and colorectal cancer patient-caregiver dyads and quality of life

BACKGROUND

Distress may be heightened among members of cancer patient-caregiver dyads that are mismatched on smoking status (either the patient or caregiver smokes, but the other does not), negatively affecting quality of life (QoL). The purpose of this study was to examine associations between patient-caregiver smoking concordance, caregiver psychological adjustment, and caregiver and patient mental and physical QoL.

METHODS

Lung and colorectal patient-caregiver dyads (N = 742) were identified from the Cancer Care Outcomes Research and Surveillance (CanCORS) and CanCORS Caregiver studies. The majority of the cancer patients were male (67.0%) with local (45.6%) or regional (12.9%) disease. The majority of the informal caregivers were females (78.6%), under 65 years of age (69.6%), and often spouses (57.8%) of the patients.

RESULTS

Lung and colorectal cancer caregivers, who were members of dyads where one or both members continued to smoke, reported worse mental health QoL than nonsmoking dyads. For colorectal cancer patients, continuing to smoke when the caregiver did not was associated with worse mental health QoL compared with nonsmoking dyads. Dyad smoking was less strongly associated with physical QoL for both caregivers and patients.

CONCLUSION

Results highlight the importance of assessing smoking in both cancer patients and their caregivers and referring families to appropriate psychosocial and smoking cessation services.

IMPACT

This is the first study to show associations between cancer patient-caregiver smoking status and QoL for both dyad members. Future studies will need to confirm these associations longitudinally and investigate potential mechanisms linking dyad smoking and QoL.

Smoking patterns in cancer survivors

INTRODUCTION

More than 11 million cancer survivors are at risk for new cancers, yet many are receiving inadequate guidance to reduce their risk. This study describes smoking trends among a group of cancer survivors (CaSurvivors) compared with a no cancer (NoCancer) control group.

METHODS

The Health Information National Trends Survey 2003, 2005, and 2007 cross-sectional surveys were used in this secondary data analysis. Descriptive statistics were produced, and logistic regressions of current smokers were performed on weighted samples using SUDAAN. The sample included 2,060 CaSurvivors; the average age was 63 years; and the majority of respondents were female (67%), White (80.6%), married, or partnered (52.5%), with at least some college education (57%). The mean time since diagnosis was 12 years; 28.7% reported fair or poor health status.

RESULTS

The overall smoking rate was 18.7% for CaSurvivors and 21.7% for the NoCancer group. Education (less than college), age (younger), marital status (widowed or divorced), and health care access (none or partial) were significant personal variables associated with a greater likelihood of being a current smoker. Controlling for these variables, there were no differences between the CaSurvivors and NoCancer groups over time. Women with cervical cancer were still more likely to be smokers (48.9%) than other CaSurvivors (p < .001).

CONCLUSIONS

CaSurvivors' current smoking trends were similar to the control group. While most variation was explained by demographic variables, women with cervical cancer, a smoking-related cancer, had the highest prevalence of smoking. Smoking cessation interventions should be targeted to this high-risk group.

Effects of continued tobacco use during treatment of lung cancer

Lung carcinoma is one of the most common cancers diagnosed in the USA. A significant portion of these patients have a history of tobacco use and many are smoking at the time of diagnosis. Despite smoking cessation interventions, many patients continue to smoke even after their diagnosis. Those who are able to quit smoking after their diagnosis still have a high rate of relapse of smoking within the first year. Continued smoking has been found to have multiple negative consequences for these patients including increased toxicity from treatment and decreased effectiveness of therapy. Overall, patients who continue to smoke after their diagnosis have poorer outcomes than those patients who are successfully able to quit and abstain from smoking. Knowing this, physicians should encourage smoking cessation in this patient population. Future studies are needed to help define the best approach for encouraging smoking cessation, taking into account patient characteristics and the stress associated with the lung cancer diagnosis.

Smoking and quality of life among female survivors of breast, colorectal and endometrial cancers in a prospective cohort study

PURPOSE

To examine the association of smoking and quality of life (QOL) among survivors of breast, colorectal, or endometrial cancers.

METHODS

The study included women who joined the Iowa Women's Health Study in 1986 and were subsequently diagnosed with breast, colorectal, or endometrial cancers through 2004 (n = 1920). Smoking status was reported at baseline and in 2004; QOL was assessed in 2004 using the Medical Outcomes Study Short Form-36. Multivariate-adjusted odds ratios were calculated to examine the associations of smoking status and poor QOL (score lower than one-half a standard deviation below the mean of the non-smokers).

RESULTS

Compared with non-smokers, persistent smokers had higher likelihood of reporting poor Physical Functioning (odds ratio [OR] = 2.40, 95% confidence interval [CI] = 1.32-4.37), Mental Health (OR = 1.92, CI = 1.09-3.40), and Role Emotional (OR = 2.01, CI = 1.10-3.66), whereas former smokers had higher likelihood of reporting poor Physical Functioning (OR = 1.65, CI = 1.10-2.45), Mental Health (OR = 1.62, CI = 1.11-2.37), and General Health (OR = 1.51, CI = 1.03-2.21). A statistically significant trend toward higher likelihood of poor QOL was observed across smoking groups in Vitality, Physical Functioning, Mental Health, and Role Emotional. Further adjustment for physical activity resulted in attenuation of the odds ratios and p-values for trend.

CONCLUSION

Among women with breast, colorectal, or endometrial cancers, smokers were more likely than former or non-smokers to have poor QOL. Physical activity explained, in part, the association between smoking status and QOL in our study.

Smoking cessation: an integral part of lung cancer treatment

Lung cancer is the leading cause of cancer death in the US. About 50% of lung cancer patients are current smokers at the time of diagnosis and up to 83% continue to smoke after diagnosis. A recent study suggests that people who continue to smoke after a diagnosis of early-stage lung cancer almost double their risk of dying. Despite a growing body of evidence that continued smoking by patients after a lung cancer diagnosis is linked with less effective treatment and a poorer prognosis, the belief prevails that treating tobacco dependence is useless. With improved cancer treatments and survival rates, smoking cessation among lung cancer patients has become increasingly important. There is a pressing need to clarify the role of smoking cessation in the care of lung cancer patients.

OBJECTIVE

This paper will report on the benefits of smoking cessation for lung cancer patients and the elements of smoking cessation treatment, with consideration of tailoring to the needs of lung cancer patients.

RESULTS

Given the significant benefits of smoking cessation and that tobacco dependence remains a challenge for many lung cancer patients, cancer care providers need to offer full support and intensive treatment with a smoking cessation program that is tailored to lung cancer patients' specific needs.

CONCLUSION

A tobacco dependence treatment plan for lung cancer patients is provided.

Control of cardiovascular risk factors among adult cancer survivors: a population-based survey

INTRODUCTION

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in cancer survivors, with the risk increasing significantly with the presence of multiple cardiac risk factors (RF). The proportion of cancer survivors at elevated risk of CVD on the basis of multiple RF is unknown.

METHODS

The National Health and Nutrition Examination Survey (NHANES 1999-2006) was used to examine the proportion of cancer survivors with multiple RF (≥2RF) and those at high cardiac risk (≥4 RF) compared with matched controls. RF (hypertension, hypercholesterolemia, weight, exercise, smoking) were defined according to AHA/ACC.

RESULTS

A total of 1,227 cancer survivors and 4,782 controls were identified. The majority of both cancer survivors and controls had multiple RF (91.5 vs. 89.9%) with a substantial proportion at high cardiac risk (35.2 vs. 32.6%). Compared to controls, survivors were more likely to be smokers (34.5 vs. 25.7%, p = 0.001), but less likely be overweight (67.2 vs. 72.0%, p = 0.02). There was no significant difference in the proportion with hypertension (30.6 vs. 30.8%), hypercholesterolemia (52.4 vs. 54.7%) or low exercise (75.6 vs. 73.0%). Among survivors, only age was associated with RF; with older survivors significantly more likely to have poor control than younger survivors (p = 0.005).

CONCLUSION

The prevalence of multiple RF was similar but suboptimal among cancer survivors and controls. Cardiac RF control, particularly among older survivors, is an important area of focus for improvement in survivorship care.

Nicotine promotes tumor growth and metastasis in mouse models of lung cancer

BACKGROUND

Nicotine is the major addictive component of tobacco smoke. Although nicotine is generally thought to have limited ability to initiate cancer, it can induce cell proliferation and angiogenesis in a variety of systems. These properties might enable nicotine to facilitate the growth of tumors already initiated. Here we show that nicotine significantly promotes the progression and metastasis of tumors in mouse models of lung cancer. This effect was observed when nicotine was administered through intraperitoneal injections, or through over-the-counter transdermal patches.

METHODS AND FINDINGS

In the present study, Line1 mouse adenocarcinoma cells were implanted subcutaneously into syngenic BALB/c mice. Nicotine administration either by intraperitoneal (i.p.) injection or transdermal patches caused a remarkable increase in the size of implanted Line1 tumors. Once the tumors were surgically removed, nicotine treated mice had a markedly higher tumor recurrence (59.7%) as compared to the vehicle treated mice (19.5%). Nicotine also increased metastasis of dorsally implanted Line1 tumors to the lungs by 9 folds. These studies on transplanted tumors were extended to a mouse model where the tumors were induced by the tobacco carcinogen, NNK. Lung tumors were initiated in A/J mice by i.p. injection of NNK; administration of 1 mg/kg nicotine three times a week led to an increase in the size and the number of tumors formed in the lungs. In addition, nicotine significantly reduced the expression of epithelial markers, E-Cadherin and beta-Catenin as well as the tight junction protein ZO-1; these tumors also showed an increased expression of the alpha(7) nAChR subunit. We believe that exposure to nicotine either by tobacco smoke or nicotine supplements might facilitate increased tumor growth and metastasis.

CONCLUSIONS

Our earlier results indicated that nicotine could induce invasion and epithelial-mesenchymal transition (EMT) in cultured lung, breast and pancreatic cancer cells. This study demonstrates for the first time that administration of nicotine either by i.p. injection or through over-the-counter dermal patches can promote tumor growth and metastasis in immunocompetent mice. These results suggest that while nicotine has only limited capacity to initiate tumor formation, it can facilitate the progression and metastasis of tumors pre-initiated by tobacco carcinogens.

The Self-regulation Model of Illness applied to smoking behavior in lung cancer

Thirteen to 20% of lung cancer patients continue to smoke after diagnosis. Guided by Self-regulation Theory, the purpose of this study was to examine illness perceptions over time in a sample of lung cancer patients. This prospective 1-group descriptive longitudinal design study included participants 18 years or older, with a lung cancer diagnosis within the past 60 days who self-reported smoking within the past 7 days. At baseline, patients completed a sociodemographics and tobacco use history questionnaire. The Illness Perception Questionnaire-Revised (IPQ-R) was repeated at 3 time points (baseline, 2-4 weeks, and 6 months). Fifty-two participants provided data for the IPQ-R at baseline, 47 at 2 to 4 weeks, and 29 at 6 months. Differences between mean scores for each illness representation attribute of the IPQ-R at repeated time points were calculated by within-subjects repeated-measures analysis of variance and Wilcoxon Signed-Rank Tests. Identity (baseline vs 2-4 weeks: P = .026; baseline vs 6 months: P = .005) and acute/chronic timeline (P = .018) mean scores significantly increased over time; personal and treatment control mean scores significantly decreased over time (P = .007 and P = .047, respectively). Understanding the context in which a patient perceives disease and smoking behavior may contribute to developing interventions that influence behavior change.

Cost-effectiveness of a smoking cessation program implemented at the time of surgery for lung cancer

BACKGROUND

Many patients are active smokers at the time of a diagnosis of surgically resectable lung cancer. Perioperative smoking cessation is associated with improved survival, but the cost-effectiveness of a smoking cessation program initiated immediately before surgery is unknown.

METHODS

We developed a decision analytic Markov model to evaluate the incremental cost-effectiveness of a formal smoking cessation program. The parameter estimates were taken from the available literature. The model included the cost and effectiveness of the smoking cessation program, cost and incidence of perioperative complications, postoperative mortality, and utility measured in quality adjusted life years (QALY). Dollars per QALY and life year were calculated and one-way sensitivity analyses were performed.

RESULTS

The cost/QALY and cost/life year were $16,415 and $45,629 at 1 year after surgery and $2609 and $2703 at 5 years, respectively. Most sensitivity analyses showed the 1 year postsurgery cost/QALY estimates were less than $50,000, and all were less than $12,000 at 5 years. Cost-effectiveness estimates were most sensitive to the frequency of perioperative complications and the estimated short-term utility estimates.

CONCLUSION

A smoking cessation program initiated before surgical lung resection is cost-effective at both 1 and 5 years postsurgery. Providers should encourage patients who are still smoking to engage in formal smoking cessation programs.

Persistent smoking after a diagnosis of lung cancer is associated with higher reported pain levels

The purpose of this study was to evaluate the impact of smoking status after a diagnosis of lung cancer on reported pain levels. We conducted a telephone survey of patients with lung cancer identified from 4 participating sites between September 2004 and July 2006. Patients were asked to rate their usual pain level over the past week on a 0 to 10 rating scale on which 0 was "no pain" and 10 "pain as bad as you can imagine." We operationally defined persistent smokers as patients who reported continuing to smoke after their lung cancer diagnosis. A logistic regression analysis was used to test the hypothesis that persistent smokers report higher usual pain levels than nonsmokers. Overall, 893 patients completed the survey. The majority (76%) was found to have advanced cancer (stages IIIb and IV). The mean age was 63 years (SD = 10). Seventeen percent of the patients studied were categorized as persistent smokers. The mean pain score for the study sample was 3.1 (SD = 2.7) and 41% reported moderate (4 to 6) or severe pain (7 to 10). A greater proportion of persistent smokers reported moderate or severe pain than nonsmokers or former smokers (P < .001). Logistic regression analysis revealed that smoking status was associated with the usual pain even after adjusting for age, perceived health status, and other lung cancer symptoms such as dyspnea, fatigue, and trouble eating. In conclusion, patients who continue to smoke after a diagnosis of lung cancer report higher levels of usual pain than nonsmokers or former smokers. More research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression in late-stage lung cancer.

PERSPECTIVE

This article examines the relationship between pain and persistent smoking in patients with lung cancer. Although more research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression, physicians can promote smoking cessation in patients with lung cancer to improve health and quality of life.

Health behaviours in older cancer survivors in the English Longitudinal Study of Ageing

OBJECTIVES

To assess health behaviours in cancer survivors in a population-based sample of older adults in the United Kingdom (UK).

METHODS

Data were from wave 1 of the English Longitudinal Study of Ageing. Prevalence of smoking, alcohol consumption and physical activity was compared in cancer survivors and those with no cancer diagnosis. Associations between health behaviours and quality of life (QoL) and depressive symptoms were compared in both groups.

RESULTS

There were 716 (6.2%) cancer survivors in the sample. Cancer survivors were more likely to be former smokers (p<0.001) and less likely to do moderate or vigorous physical activity (p<0.05) than those with no cancer diagnosis. Physical activity was associated with better QoL and lower depressive symptoms, and smoking with poorer QoL and higher depressive symptoms, in both groups.

DISCUSSION

Levels of health behaviours among cancer survivors in the UK are suboptimal. Effective strategies to promote healthy lifestyles are needed in this vulnerable population.

A psychometric analysis of quality of life tools in lung cancer patients who smoke

Lung cancer is the leading cause of cancer death for both men and women in the United States. Patient quality of life (QOL) prior to cancer treatment is known to be a strong predictor of survival and toleration of treatment toxicities. A lung cancer patient's self-assessment of QOL is highly valued among clinicians as it guides treatment-related decisions and impacts clinical outcomes. Smokers are known to report a lower QOL. Limited research has been conducted on QOL outcomes in lung cancer patients who continue to smoke. To assess QOL, a reliable and valid QOL measure specific to lung cancer is required. The functional assessment of cancer therapy-lung cancer (FACT-L) and lung cancer symptom scale (LCSS) are instruments that specifically examine QOL among lung cancer patients. The LCSS is a focused QOL instrument that includes physical and functional domains of QOL and disease symptomatology. The FACT-L is a broader QOL instrument that includes physical, functional, social and emotional domains and disease symptomatology. Both are psychometrically valid and are widely used in the literature, but have not been exclusively evaluated in smokers. Furthermore, there is no 'gold standard' instrument since there has never been a correlation study to compare estimates of reliability and validity between these instruments. The purpose of this study is to report the internal consistency and convergence validity of the FACT-L and the LCSS among newly diagnosed lung cancer patients who smoke. This data were collected and analyzed from a larger study examining smoking behavior among newly diagnosed lung cancer patients (n=51). Descriptive statistics were calculated on the FACT-L and LCSS scores, internal consistency was assessed by estimating Cronbach's alpha coefficients, and Pearson correlation coefficients were estimated between the two scales. Internal consistency coefficients demonstrated good reliability for both scales, and the two instruments demonstrated a strong correlation, suggesting good convergence validity. Either of these instruments are appropriate measures for QOL in lung cancer patients who smoke. Given the conceptual difference between the two instruments, it is important to carefully consider the research aims when selecting the appropriate QOL measurement instrument.

Smoking cessation interventions in cancer care: opportunities for oncology nurses and nurse scientists

Smoking cessation is essential after the diagnosis of cancer to improve clinical outcomes. The purpose of this chapter is to provide a systematic review of research on smoking cessation in the context of cancer care with an emphasis on nursing contributions to the field. Data sources included research reports of smoking cessation interventions conducted in people with cancer. Nineteen primary studies were reviewed. High intensity interventions, targeting multiple behaviors, and/or using a multicomponent intervention that included pharmacotherapy, behavioral counseling, and social support were characteristics of the most successful treatments for tobacco dependence. The majority of interventions were conducted in adults with smoking-related malignancies during acute phases of illness. The most striking finding was that more than one half of the studies tested the efficacy of nurse-delivered interventions. Conceptual and methodological issues that can be improved in future studies include: using theoretical frameworks to specify how the intervention will affect outcomes, ensuring adequate sample sizes, using biochemical verification to monitor smoking outcomes, and using standardized outcome measures of abstinence. Although effective interventions are available for healthy populations, further research is needed to determine if tailored cessation interventions are needed for patients with cancer. To provide optimal quality care it is imperative that delivery of evidence-based smoking cessation interventions be integrated into the cancer treatment trajectory. Multiple barriers, including patient and nurse attitudes toward smoking and lack of knowledge related to tobacco treatment, prevent translating evidence-based tobacco dependence treatment into clinical practice. Further nursing research is needed to address these barriers.

Symptom Severity 1 to 4 Months After Thoracotomy for Lung Cancer

Background Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery.

Objectives To describe symptom severity during the first 4 months after thoracotomy for non–small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months.

Methods Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies–Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms.

Results Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months.

Conclusions Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

Smoking cessation and lung cancer: oncology nurses can make a difference

OBJECTIVES

To provide an overview of the impact of smoking after a diagnosis of lung cancer, discuss the relationship between smoking cessation and improved outcomes, present information about tobacco-dependence treatments, reimbursement for these treatments, and resources available for patients and health care professionals.

DATA SOURCES

Published articles, reports, websites, and research studies.

CONCLUSION

Prevention of tobacco use and cessation are primary ways to prevent lung cancer. However, even after a diagnosis of lung cancer, smoking cessation is important in improving survival and quality of life. Although effective treatments are available to help smokers quit, persistent efforts over repeated contacts may be necessary to achieve long-term cessation.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nursing action is essential in the identification of and intervention with patients who struggle with tobacco dependence after diagnosis.

Pneumonectomy: Post-operative quality of life and lung function

BACKGROUND

Pneumonectomy is associated with high morbidity and mortality. After pneumonectomy, data on health-related quality of life (HRQoL) or its correlation with dyspnea and lung function are scarce. Our main aim was to evaluate long-term HRQoL after pneumonectomy.

METHODS

In a retrospective one-center cross-sectional study, we investigated 31 of 98 patients who underwent pneumonectomy between January 1997 and October 2003 due to primary lung cancer. Pre- or postoperative chemotherapy or radiotherapy was applied according to hospital protocol. In June 2004, all patients alive received the generic HRQoL instrument (15D), as well as the Baseline Dyspnea Index (BDI). Results of the 15D were compared with those for an age- and gender-standardized general population. In April 2005, 20 patients participated in follow-up spirometric pulmonary function tests.

RESULTS

The 15D total score and its various dimensions were significantly lower after pneumonectomy than in the general population. Females both in 15D score and in the BDI had more dyspnea (p<0.05). No difference appeared between right and left pneumonectomy patients, except for more prominent dyspnea in women with right-sided pneumonectomy.

CONCLUSIONS

Pneumonectomy had a negative impact on patients' HRQoL. The use of a broad HRQoL instrument like the 15D, which covers multiple dimensions of HRQoL, yields a more accurate evaluation than did a single-dimension HRQoL instrument. Possibilities for sleeve-resection should be considered thoroughly before any pneumonectomy.

SUMMARY

Quality of life (QoL) after pneumonectomy, as measured with a generic QoL instrument, the 15D, was compared in an age- and gender-standardized population. QoL after pneumonectomy was significantly lower, especially in women after right-sided pneumonectomy.

Follow-up and surveillance of the lung cancer patient following curative intent therapy: ACCP evidence-based clinical practice guideline (2nd edition)

BACKGROUND

To develop an evidence-based approach to follow-up of patients after curative intent therapy for lung cancer.

METHODS

Guidelines on lung cancer diagnosis and management published between 2002 and December 2005 were identified by a systematic review of the literature, and supplemental material appropriate to this topic was obtained by literature search of a computerized database (Medline) and review of the reference lists of relevant articles.

RESULTS

Adequate follow-up by the specialist responsible for the curative intent therapy should be ensured to manage complications related to the curative intent therapy and should last at least 3 to 6 months. In addition, a surveillance program should be considered to detect recurrences of the primary lung cancer and/or development of a new primary lung cancer early enough to allow potentially curative retreatment. A standard surveillance program for these patients, coordinated by a multidisciplinary tumor board and overseen by the physician who diagnosed and initiated therapy for the original lung cancer, is recommended based on periodic visits with chest imaging studies and counseling patients on symptom recognition. Smoking cessation and, if indicated, facilitation in participation in special programs is recommended for all patients following curative intent therapy for lung cancer.

CONCLUSIONS

The current evidence favors follow-up of complications related to curative intent therapy, and a surveillance program at regular intervals with imaging and review of symptoms. Smoking cessation after curative intent therapy to prevent recurrence of lung cancer is strongly supported by the available evidence.

Quality of life, drinking to cope, alcohol consumption and smoking in successfully treated HNSCC patients

CONCLUSION

The level of coping by alcohol consumption is broadly associated with level of general quality of life (QoL) in patients with successfully treated head and neck squamous cell carcinoma (HNSCC).

OBJECTIVE

The aim of this study was to investigate the association between self-reported level of general coping, drinking to cope (DTC), reported alcohol and tobacco use as well as QoL in successfully treated HNSCC patients.

PATIENTS AND METHODS

We employed a cross-sectional design. Sample I included all patients <80 years old who had been diagnosed with HNSCC in Western Norway in the period from 1992 to 1997, and who were disease-free in the year 2000. The patients were interviewed at a routine follow-up visit. Sample II included all Norwegian laryngectomized patients. General coping and DTC were assessed by the COPE questionnaire and the QoL was assessed by the EORTC-QLQ (C30/H&N35) questionnaire. Reported level of alcohol consumption was associated with global QoL (r = -0.22) and with DTC (r = 0.31). Reported smoking level was associated with DTC (r = 0.26) and inversely with C30 functional/symptom sum QoL scores (r = -0.31/0.27). Level of DTC was associated with C30 global (r = -0.30) and C30 functional/symptom sum QoL scores (r = -0.31/0.27) and this association was still present after adjustment for gender, age, levels of neuroticism and avoidance coping.

Health behaviors in cancer survivors

PURPOSE/OBJECTIVES

To describe health behaviors of cancer survivors by cancer diagnosis and to compare them to people without a personal or family cancer history.

DESIGN

Cross-sectional secondary data analysis.

SETTING

A national, list-assisted telephone survey using random-digit dialing of U.S. adults about use of cancer-related information and cancer beliefs.

SAMPLE

619 cancer survivors and 2,141 participants without a history of cancer from the original 6,369 Health Information National Trends Survey (HINTS) respondents.

METHODS

Using the National Cancer Institute's 2003 HINTS, further analyses were conducted.

MAIN RESEARCH VARIABLES

Cancer history, current smoking, fruit and vegetable consumption, physical activity, and body mass index (BMI).

FINDINGS

When controlling for demographic variables, no differences were found in self-reported health behaviors between survivors and those without cancer: 22.5% of survivors and 18.4% of those without cancer were current smokers, 18% of survivors and 14.9% of those without cancer consumed at least five fruits or vegetables per day, 45.3% of survivors and 53% of those without cancer were physically active at least weekly, and 58% of survivors and 54.9% of those without cancer were overweight or obese (i.e., BMI > 25). Only 7.4% of survivors and 6.4% of participants without cancer reported positively on all three health behaviors and had a healthy or normal weight.

CONCLUSIONS

Survivors did not have different health behaviors when compared to participants without a history of cancer. Neither group met the American Cancer Society or Healthy People 2010 objectives for these behaviors. Adoption of healthy lifestyle behaviors should be addressed in cancer survivors.

IMPLICATIONS FOR NURSING

Cancer survivors need to be assessed for current smoking, dietary habits, physical activity, and weight. Information and resources should be made available, if needed, to promote the adoption of healthy lifestyle behaviors.

Tobacco use in women with lung cancer

BACKGROUND

Smoking cessation after a cancer diagnosis is associated with improved clinical outcomes.

PURPOSE

The aims of this study are to determine smoking prevalence, describe patterns of smoking, identify readiness to quit and cessation strategies, identify factors associated with continued smoking among women with lung cancer, and determine smoking prevalence among household members.

METHODS

Data were collected through questionnaires and medical record review from 230 women. Smoking was determined through self-report and biochemical verification with urinary cotinine.

RESULTS

Eighty-seven percent of women reported ever-smoking, and 37% reported smoking at the time of diagnosis. Ten percent of women were smoking at entry to the study, 13% were smoking at 3 months, and 11% at 6 months. Fifty-five percent of smokers planned a quit attempt within the next month. One third of smokers received cessation assistance at diagnosis, and pharmacotherapy was the most common strategy. Significant factors associated with continued smoking included younger age, depression, and household member smoking. Continued smoking among household members was 21%. Twelve percent of household members changed their smoking behavior; 77% quit smoking, but 12% started smoking.

CONCLUSIONS

The diagnosis of cancer is a strong motivator for behavioral change, and some patients need additional support to quit smoking. Family members should also be targeted for cessation interventions.