Monitoring changes in quality of life in patients with lung cancer by using specialised questionnaires: implications for clinical practice

Histological subtype of lung cancer affects acceptance of illness, severity of pain, and quality of life

Introduction

Histologic classification of lung cancer plays an important role in clinical practice. Two main histological subtype of lung cancer: small-cell lung cancer (SCLC) and nonsmall-cell lung cancer (NSCLC) differ in terms of invasiveness, response to treatment, and risk factors, among others.

Aims

To evaluate differences in acceptance of illness, level of perceived pain, and quality of life (QoL) between patients with SCLC and NSCLC.

Materials and methods

Two hundred and fifty-seven lung cancer patients, who were treated in 2015, completed Acceptance of Illness Scale, Visual Analog Scale for pain, and European Organization for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire and European Organization for Research and Treatment of Cancer 13-item Lung Cancer specific Quality of Life Questionnaire. Clinical and sociodemographic data were collected. For statistical analysis, the Student t-test and the Mann–Whitney U test were used. For comparisons among three or more groups, analysis of variance was employed.

Results

Patients with SCLC had significantly worse health as measured with the presence of metastases, parameters of lung function, comorbidities, and number of previous hospitalizations. The Acceptance of Illness Scale score and Visual Analog Scale score were significantly worse in patients with SCLC than in those with NSCLC (24.58±8.73 vs 27.05±9.06; p=0.046 and 4.81±2.01 vs 4.17±1.97; p=0.003). Patients with SCLC achieved worse scores of all aspects of QoL than patients with NSCLC. Comparison with the reference values showed that all dimensions of functioning are impaired in patients with lung cancer regardless of its type; only the role functioning in patients with NSCLC remains unaffected.

Conclusion

Monitoring of QoL, personalized approach to treatment, and interventions for symptom management should be conducted in a tailored manner. Socioeconomic status in lung cancer patients, especially those suffering from SCLC, needs to be addressed.

Thoracic surgeon and patient focus groups on decision-making in early-stage lung cancer surgery

AIM

To investigate medical decision-making from the thoracic surgeons' and patients' perspectives in early-stage lung cancer.

PATIENTS & METHODS

We conducted one focus group with thoracic surgeons (n = 15) and one with a group of early-stage lung cancer patients treated with surgery (n = 7). Focus groups were recorded, transcribed and coded for themes.

RESULTS

For surgeons, surgical procedure choice was a primary concern, followed by the surgical treatment plan decision-making process. Survivors focused primarily on the physical and mental health-related postsurgical burden for which they felt they were not well prepared and placed less emphasis on surgical decision-making.

CONCLUSION

As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.

Health-related quality of life in congenital heart disease surgery patients in Pakistan: protocol for a mixed-methods study

INTRODUCTION

Reduced health-related quality of life (HRQOL) has been reported in postoperative patients with congenital heart disease (CHD). However, there is a paucity of data from low-income and middle-income countries (LMIC). Differences in sociodemographics and sociocultural contexts may influence HRQOL. This protocol paper describes a study exploring HRQOL in surgical patients with CHD from a tertiary hospital in Pakistan. The study findings will assist development of strategies to improve HRQOL in a resource-constrained context.

METHODS AND ANALYSIS

This prospective, concurrent triangulation, mixed-methods study aims to compare HRQOL of postsurgery patients with CHD with age-matched healthy siblings and to identify HRQOL predictors. A qualitative component aims to further understand HRQOL data by exploring the experiences related to CHD surgery for patients and parents. Participants include patients with CHD (a minimum of n~95) with at least 1-year postsurgery follow-up and no chromosomal abnormality, their parents and age-matched, healthy siblings. PedsQL 4.0 Generic Core Scales, PedsQL Cognitive Functioning Scale and PedsQL 3.0 Cardiac Module will measure HRQOL. Clinical/surgical data will be retrieved from patients' medical files. Student's t-test will be used to compare the difference in the means of HRQOL between CHD and siblings. Multiple regression will identify HRQOL predictors. A subsample of enrolled patients (n~20) and parents (n~20) from the quantitative arm will be engaged in semistructured qualitative interviews, which will be analysed using directed content analysis. Anticipated challenges include patient recruitment due to irregular follow-up compliance. Translation of data collection tools to the Urdu language and back-translation of interviews increases the study complexity.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from The Aga Khan University, Pakistan (3737-Ped-ERC-15). Study findings will be published in peer-reviewed journals and presented at national and international conferences.

A randomized, double-blind, phase III study comparing two doses of erlotinib for second-line treatment of current smokers with advanced non-small-cell lung cancer (CurrentS)

OBJECTIVES

Active smokers with non-small-cell lung cancer (NSCLC) have increased erlotinib metabolism versus non-smoking patients, which reduces exposure. Therefore, an increased erlotinib dose may be beneficial. The CurrentS study (NCT01183858) assessed efficacy and safety of 300mg erlotinib (E300) as second-line therapy in current smokers with locally advanced or metastatic NSCLC versus the standard 150mg dose (E150).

MATERIALS AND METHODS

Patients with stage IIIB/IV NSCLC (current smokers who failed first-line platinum-based chemotherapy) were randomized to receive E150 or E300 until progression/death/unacceptable toxicity.

PRIMARY ENDPOINT

progression-free survival (PFS). Secondary endpoints: overall survival (OS), disease control rate and safety.

RESULTS

A total of 342 patients were screened; the intent-to-treat population comprised 159 E300 patients and 154 E150 patients. Median PFS was 7.0 versus 6.9 weeks with E300 versus E150, respectively (unstratified hazard ratio [HR]=1.05, 95% confidence interval [CI]: 0.83-1.33; unstratified log-rank P=0.671). Median OS was 6.8 months in both arms (unstratified HR=1.03, 95% CI: 0.80-1.32; unstratified log-rank P=0.846). Overall, 89.2% (E300 arm) and 84.4% (E150 arm) experienced ≥1 adverse event (AE) of any grade (44.3% and 37%, respectively, experienced grade ≥3 AEs); AEs of special interest were reported in 67.7% and 47.4% of patients, respectively. E300 resulted in higher mean plasma concentrations versus E150, however, this did not improve efficacy.

CONCLUSIONS

Despite the difference in erlotinib exposure, there was no evidence of an incremental efficacy benefit of a higher erlotinib dose versus the standard dose in this population of highly active smokers.

Drug Eluting Stents for Malignant Airway Obstruction: A Critical Review of the Literature

Lung cancer being the most prevalent malignancy in men and the 3(rd) most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement.

Chemotherapeutic Response and Prognosis among Lung Cancer Patients with and without Depression

Purpose: The current study examined quality of life, progression of disease, and survival rate during chemotherapy in newly diagnosed non-small cell lung cancer (NSCLC) patients with depression (n=48) and without depression (n=78). Further, the study explored the hypothesis that the survival benefit resulted from the chemotherapy of docetaxel and cisplatin (the DC regimen).

Patients and Methods: In total, 126 patients with newly diagnosed NSCLC participated in a cross-sectional study of DC chemotherapy integrated with standard oncology care in depression and non-depression groups. The health-related quality of life (HR-QOL) was assessed using the quality of life questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC). Depression was self-rated using the Zung Self-Rating Depression Scale (Z-SDS). Both HR-QOL and Z-SDS were completed before the first and after the last cycle of chemotherapy. Association between depression and quality of life, treatment responses, adverse effects and survival rate was considered positive at the significance level of p<0.05. Pearson and Spearman correlation coefficient, t-test and other statistical analysis were performed using the SPSS software version 13.0 for Windows.

Results: In total, 126 lung cancer patients were evaluated, 38% had a diagnosis of depression. The presence of depression was associated with reduced quality of life, increased progression of disease, nausea and fatigue and reduced survival rate by nearly 90 days on follow-up. Therefore, depression significantly predicted worse survival (P=0.009).In addition, the chemotherapy DC regimen did not appear to improve the quality of life in depressed patients (SDS 94.96±18.14 before chemotherapy vs. SDS 100.04±16.61 after therapy, P=0.155). In a secondary analysis, there was a positive relationship between depression and nausea and fatigue but there was no significant difference in hematologic toxicities between the depression and non-depression groups.

Conclusion: Depression was associated with worse survival in patients with newly diagnosed NSCLC. Also, the chemotherapy DC regimen did not improve quality of life in depressed patients and the data do not support the hypothesis that treatment responses of NSCLC patients with depression mediated the observed survival benefit from the DC regimen. There were more cases of progressed disease in the depressed group. Findings suggest that NSCLC patients with depression are at increased risk for decline in HR-QOL and survival rate during chemotherapy than patients without depression.

DDMC-p53 gene therapy with or without cisplatin and microwave ablation

Lung cancer remains the leading cause of death in cancer patients. Severe treatment side effects and late stage of disease at diagnosis continue to be an issue. We investigated whether local treatment using 2-diethylaminoethyl-dextran methyl methacrylate copolymer with p53 (DDMC-p53) with or without cisplatin and/or microwave ablation enhances disease control in BALBC mice. We used a Lewis lung carcinoma cell line to inoculate 140 BALBC mice, which were divided into the following seven groups; control, cisplatin, microwave ablation, DDMC-p53, DDMC-p53 plus cisplatin, DDMC-p53 plus microwave, and DDMC-p53 plus cisplatin plus microwave. Microwave ablation energy was administered at 20 W for 10 minutes. Cisplatin was administered as 1 mL/mg and the DDMC-p53 complex delivered was 0.5 mL. Increased toxicity was observed in the group receiving DDMC-p53 plus cisplatin plus microwave followed by the group receiving DDMC-p53 plus cisplatin. Infection after repeated treatment administration was a major issue. We conclude that a combination of gene therapy using DDMC-p53 with or without cisplatin and microwave is an alternative method for local disease control. However, more experiments are required in a larger model to identify the appropriate dosage profile.