1
|
Albashayreh A, Bandyopadhyay A, Zeinali N, Zhang M, Fan W, Gilbertson White S. Natural Language Processing Accurately Differentiates Cancer Symptom Information in Electronic Health Record Narratives. JCO Clin Cancer Inform 2024; 8:e2300235. [PMID: 39116379 DOI: 10.1200/cci.23.00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE Identifying cancer symptoms in electronic health record (EHR) narratives is feasible with natural language processing (NLP). However, more efficient NLP systems are needed to detect various symptoms and distinguish observed symptoms from negated symptoms and medication-related side effects. We evaluated the accuracy of NLP in (1) detecting 14 symptom groups (ie, pain, fatigue, swelling, depressed mood, anxiety, nausea/vomiting, pruritus, headache, shortness of breath, constipation, numbness/tingling, decreased appetite, impaired memory, disturbed sleep) and (2) distinguishing observed symptoms in EHR narratives among patients with cancer. METHODS We extracted 902,508 notes for 11,784 unique patients diagnosed with cancer and developed a gold standard corpus of 1,112 notes labeled for presence or absence of 14 symptom groups. We trained an embeddings-augmented NLP system integrating human and machine intelligence and conventional machine learning algorithms. NLP metrics were calculated on a gold standard corpus subset for testing. RESULTS The interannotator agreement for labeling the gold standard corpus was excellent at 92%. The embeddings-augmented NLP model achieved the best performance (F1 score = 0.877). The highest NLP accuracy was observed in pruritus (F1 score = 0.937) while the lowest accuracy was in swelling (F1 score = 0.787). After classifying the entire data set with embeddings-augmented NLP, we found that 41% of the notes included symptom documentation. Pain was the most documented symptom (29% of all notes) while impaired memory was the least documented (0.7% of all notes). CONCLUSION We illustrated the feasibility of detecting 14 symptom groups in EHR narratives and showed that an embeddings-augmented NLP system outperforms conventional machine learning algorithms in detecting symptom information and differentiating observed symptoms from negated symptoms and medication-related side effects.
Collapse
Affiliation(s)
| | | | | | - Min Zhang
- School of Economics and Management, Communication University of China, Beijing, China
| | - Weiguo Fan
- Tippie College of Business, University of Iowa, Iowa City, IA
| | | |
Collapse
|
2
|
Pathan RK, Shorna IJ, Hossain MS, Khandaker MU, Almohammed HI, Hamd ZY. The efficacy of machine learning models in lung cancer risk prediction with explainability. PLoS One 2024; 19:e0305035. [PMID: 38870229 PMCID: PMC11175504 DOI: 10.1371/journal.pone.0305035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
Among many types of cancers, to date, lung cancer remains one of the deadliest cancers around the world. Many researchers, scientists, doctors, and people from other fields continuously contribute to this subject regarding early prediction and diagnosis. One of the significant problems in prediction is the black-box nature of machine learning models. Though the detection rate is comparatively satisfactory, people have yet to learn how a model came to that decision, causing trust issues among patients and healthcare workers. This work uses multiple machine learning models on a numerical dataset of lung cancer-relevant parameters and compares performance and accuracy. After comparison, each model has been explained using different methods. The main contribution of this research is to give logical explanations of why the model reached a particular decision to achieve trust. This research has also been compared with a previous study that worked with a similar dataset and took expert opinions regarding their proposed model. We also showed that our research achieved better results than their proposed model and specialist opinion using hyperparameter tuning, having an improved accuracy of almost 100% in all four models.
Collapse
Affiliation(s)
- Refat Khan Pathan
- Department of Computing and Information Systems, School of Engineering and Technology, Sunway University, Selangor, Malaysia
| | | | - Md. Sayem Hossain
- School of Computing Science, Faculty of Innovation and Technology, Taylor’s University Lakeside Campus, Selangor, Malaysia
| | - Mayeen Uddin Khandaker
- Applied Physics and Radiation Technologies Group, CCDCU, School of Engineering and Technology, Sunway University, Selangor, Malaysia
- Faculty of Graduate Studies, Daffodil International University, Daffodil Smart City, Savar, Dhaka, Bangladesh
| | - Huda I. Almohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Zuhal Y. Hamd
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Presley CJ, Dalal N, Davenport AP, Gounden A, Ramchandran K, Tonorezos E. Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities. Am Soc Clin Oncol Educ Book 2024; 44:e433298. [PMID: 38768420 DOI: 10.1200/edbk_433298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
People with advanced lung cancer represent a distinct group whose needs remain understudied, especially compared with people diagnosed with limited-stage disease. Fortunately, novel treatments such as tyrosine kinase inhibitors and immune checkpoint inhibitors are leading to significant advances in prognosis and survival, even among those with advanced disease at the time of diagnosis. However, there are known gaps in symptom management, psychosocial and nutritional support, complex care coordination, health behavior coaching, and health care delivery efforts among patients living with advanced lung cancer. Many of these patients would benefit from survivorship and palliative care approaches. In particular, survivorship care may include health care maintenance, treatment of immune-related adverse events and late- or long-term effects, frailty assessment and rehabilitation, and care coordination. Palliative care may be best suited to discuss ongoing symptom management, advanced care planning, and end-of-life considerations, as well as psychosocial well-being. To this end, we share a review of the current status of the palliative and survivorship care infrastructure for patients with advanced lung cancer and provide suggestions across the care continuum for this diverse group of patients and families.
Collapse
Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ashley P Davenport
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | |
Collapse
|
4
|
Majem M, Basch E, Cella D, Garon EB, Herbst RS, Leighl NB. Understanding health-related quality of life measures used in early-stage non-small cell lung cancer clinical trials: A review. Lung Cancer 2024; 187:107419. [PMID: 38070301 DOI: 10.1016/j.lungcan.2023.107419] [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: 06/02/2023] [Revised: 08/30/2023] [Accepted: 10/31/2023] [Indexed: 01/08/2024]
Abstract
Health-related quality of life (HRQoL) is an important consideration in cancer clinical research, which can be substantially influenced by cancer treatment procedures and medications. The treatment landscape for early-stage (stage I-III) non-small cell lung cancer (NSCLC) is rapidly evolving. In this light, it is important to evaluate the most suitable instruments for HRQoL assessment and timing. Given there is often a requirement for patients with early-stage disease to receive long-term treatment to reduce the risk of disease recurrence after surgery, maintenance or improvement in HRQoL is an important goal of both neoadjuvant and adjuvant treatments. Key challenges with assessing HRQoL relate to the suitability of existing instruments to measure relevant treatment-related adverse effects, consistency in HRQoL assessment approach between similar studies, gaps in data collection and reporting, and interpretation of longitudinal data. Frequent assessments during and after treatment are warranted to capture the true impact of treatment and disease progression on HRQoL, and changes in the relative importance of these factors over time. There is scope for improving existing HRQoL approaches, including ease of use and integration of digital tools to facilitate analysis and interpretation, to enhance the experience of both patients and healthcare professionals. In this narrative review, we discuss key considerations for HRQoL assessment and evaluate the tools currently available to measure HRQoL in NSCLC, many of which were designed with advanced disease in mind. We focus on the key challenges of measuring HRQoL for the specific needs of patients with early-stage disease, and consider future perspectives, to determine the most appropriate HRQoL instruments and analysis methods to use in early-stage NSCLC clinical trials.1.
Collapse
Affiliation(s)
- Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Ethan Basch
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Edward B Garon
- Department of Medicine, Division of Hematology / Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Roy S Herbst
- Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Natasha B Leighl
- Division of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Cardellino A, Shah M, Hanlon J, Kelly K, Martin A, Roborel de Climens A, Taiyari S, Stojadinovic A. Perspectives of patients with advanced or metastatic non-small cell lung cancer on symptoms, impacts on daily activities, and thresholds for meaningful change: a qualitative research study. Front Psychol 2023; 14:1217793. [PMID: 37744571 PMCID: PMC10516440 DOI: 10.3389/fpsyg.2023.1217793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Advanced or metastatic non-small cell lung cancer (NSCLC) is associated with significant symptom burden. It is important to understand the impact of these disease-and treatment-related symptoms on patients' daily lives and explore from a patient perspective what constitutes a meaningful change in NSCLC symptoms. Methods Patient experience of advanced or metastatic NSCLC was explored in this prospective, non-interventional qualitative research study recruiting patients from the United States (US). Interviews were conducted to explore the most important symptoms, daily life impacts, and patients' perspectives of what constitutes meaningful change when considering their current symptoms versus 6-12 months prior, based on the Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Change (PGI-C) items. Results Between February and April 2022, 19 US-based patients with Stage IV NSCLC were recruited; 95% were female, 63% were White, 79% had been diagnosed >1 year prior, and 63% were receiving targeted therapy. Over half the patients indicated their most important symptoms were fatigue, shortness of breath, and cough. Patient differentiation between whether symptoms were disease- or treatment-related lacked concordance, and often patients were unable to distinguish the two. The most frequently mentioned impacts of these symptoms on patients' daily lives were difficulty walking, sleep disturbance, anxiety/depression, impact on relationships, and difficulty doing daily tasks. Most patients considered a one-point change on the PGI-S or PGI-C to be meaningful based on rating their symptom severity at the time of the interview compared with 6-12 months before the interview. Conclusion Based on their own symptom experience, patients with advanced or metastatic NSCLC indicated a one-point threshold for meaningful change, whether improvement or worsening. This suggests a one-point change on the PGI-S or PGI-C may be a potential anchor for patient-reported outcome (PRO) endpoints used in clinical trials. It is important to use PRO instruments that capture the symptoms and impacts identified as most important to patients. These findings highlight the importance of using qualitative methods to assess disease-related symptoms, treatment-related side effects, and the impacts on daily life for patients with advanced or metastatic NSCLC, underscoring how qualitative assessments can complement quantitative PRO instruments for evaluating clinical trials.
Collapse
Affiliation(s)
- Anna Cardellino
- Patient Centered Outcomes Group, GSK, Collegeville, PA, United States
| | - Manasee Shah
- Patient Centered Outcomes Group, GSK, Collegeville, PA, United States
| | - Jennifer Hanlon
- GSK, Waltham, MA, United States
- Patient-Centered Solutions, IQVIA, New York, NY, United States
| | - Kimberly Kelly
- Patient-Centered Solutions, IQVIA, New York, NY, United States
| | | | | | | | - Alexander Stojadinovic
- Patient Centered Outcomes Group, GSK, Collegeville, PA, United States
- LumaBridge, San Antonio, TX, United States
| |
Collapse
|
6
|
Fradelos EC, Prapa PM, Tsaras K, Papagiannis D, Chatzi M, Papathanasiou IV, Guillen B, Saridi M, Souliotis K. The Validation of the COmprehensive Score for Financial Toxicity (COST) Scale in Greek Language. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:191-197. [PMID: 37581793 DOI: 10.1007/978-3-031-31986-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The aim of this study was to investigate the psychometric properties of the Greek version of FACIT-COST, as well as to assess the levels of financial distress of patients suffering from lung cancer in relation to their quality of life and lung cancer symptom burden. This was a cross-sectional quantitative study. A self-assessment instrument was used to gather the data. The study involved 120 lung cancer patients who were treated using chemotherapy in a day clinic of a General Hospital in Athens. Data were collected with the COST-FACIT-v2 (used to assess the patients' financial toxicity), The 12-item Health Survey (SF-12), and functional Assessment of Cancer Therapy-Lung Symptom Index Questionnaire-7 items-version 4 (FACIT-FACT-LCS). Descriptive statistics as well as exploratory factor analysis performed all the statistical analyses, which were conducted using IBM SPSS Statistics 25 and had p-values with a significance level of 0.05. The majority of the participants were male (68.3%), married or cohabitated (81.3%), and had been diagnosed with microcell cancer (90%). The factor analysis resulted in one factor that interpreted 35% of the total variance. FACT-L (r = 0.365, p < 0.001), physical component SF-12 (r = 0.184, p = 0.045), and mental health component SF-12 (r = 0.268, p = 0.003) were positively correlated to FACIT-OST, as expected. The Greek validated COST-FACIT-v2 is a reliable tool in providing rapid assessment of cancer patients' level of financial distress.
Collapse
Affiliation(s)
| | | | | | | | - Maria Chatzi
- Department of Infections, University Hospital of Larissa, Larissa, Greece
| | | | | | - Maria Saridi
- Department of Nursing, University of Thessaly, Larissa, Greece
| | - Kyriakos Souliotis
- Department of Social and Education Policy, University of Peloponnese, Corinth, Greece
- Health Policy Institute, Athens, Greece
| |
Collapse
|
7
|
Carlson ML, Lohse CM, Link MJ, Tombers NM, McCaslin DL, Saoji AA, Hutchins M, Yost KJ. Development and validation of a new disease-specific quality of life instrument for sporadic vestibular schwannoma: the Mayo Clinic Vestibular Schwannoma Quality of Life Index. J Neurosurg 2022; 138:981-991. [PMID: 36057121 DOI: 10.3171/2022.7.jns221104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Facial nerve function, hearing preservation, and tumor control have been the primary benchmarks used to assess vestibular schwannoma (VS) outcomes. Acknowledging the frequent discrepancy between what physicians prioritize and what patients value, there has been increasing prioritization of patient-reported outcome measures when evaluating the impact of VS diagnosis and its treatment. Motivated by reported limitations of prior instruments used to assess quality of life (QOL) in patients with VS, the authors describe the development and validation of a new disease-specific QOL measure: the Vestibular Schwannoma Quality of Life (VSQOL) Index. METHODS The content development phase comprised identification of clinically important domains and prioritization of feelings or concerns individuals with VS may have. The validation phase encompassed determining how items were grouped into domains and eliminating redundant items. Both phases leveraged data from cross-sectional and longitudinal surveys, expertise from a multidisciplinary working group, and patients with a broad range of experiences with VS (n = 42 during content development and n = 263 during validation). Domain scores from the new instrument were assessed for reliability and correlation with other measures of similar constructs. RESULTS The VSQOL Index consists of 40 items that evaluate the impact of VS diagnosis and its management on QOL, treatment satisfaction, and employment and is estimated to take 8-10 minutes to complete. Domain scores range from 0 (worst) to 100 (best) and demonstrate excellent psychometric properties, including content, construct, and convergent validity and both internal consistency (Cronbach's alphas 0.83 to 0.91) and test-retest reliability (reliability coefficients 0.86 to 0.96). CONCLUSIONS The VSQOL Index is a valid and reliable measure that overcomes several limitations of prior instruments, including omission or underrepresentation of domains that frequently impact well-being, such as pain, cognition, satisfaction or regret surrounding treatment decisions, and occupational limitations, to comprehensively evaluate the impact of VS diagnosis or its treatment on QOL.
Collapse
Affiliation(s)
- Matthew L Carlson
- Departments of1Otolaryngology-Head and Neck Surgery.,2Neurosurgery, and
| | | | | | | | - Devin L McCaslin
- 4Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Kathleen J Yost
- 3Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
8
|
Griffiths P, Peipert JD, Leith A, Rider A, Morgan L, Cella D, Cocks K. Validity of a single-item indicator of treatment side effect bother in a diverse sample of cancer patients. Support Care Cancer 2022; 30:3613-3623. [PMID: 35031830 PMCID: PMC8857159 DOI: 10.1007/s00520-022-06802-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022]
Abstract
Purpose With higher efficacy of cancer therapies, the numbers and types of side effects experienced by patients have also increased, evidencing a need for brief assessments of side effect bother. The Functional Assessment of Cancer Therapy-General (FACT-G) includes the item “I am bothered by side effects of treatment” (GP5). This study aimed to confirm GP5’s validity in a large, diverse, real-world patient sample. Methods Real-world data were drawn from 10 Adelphi Disease Specific Programmes (DSP™) conducted between 2015 and 2019 in France, Germany, Italy, Spain, the UK and the USA, covering 10 cancer sites. We examined correlations between GP5 responses and varied measures of patient-reported global health and the number of side effects experienced. We explored whether more advanced patients and those with worse Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) reported greater side effect bother. Finally, we conducted differential item functioning (DIF) assessment using the Mantel–Haenszel approach. Results The sample included 6755 advanced cancer patients. GP5 responses were distributed similarly across most cancer sites. A moderate, negative correlation (rpolyserial = − 0.43) between GP5 responses and global health evidenced convergent validity. Known groups validity was evidenced by dichotomised distributions of GP5, showing expected results between cancer stage 2 vs. 3 and 4 and with ECOG PSR (p < 0.001). Little evidence of DIF was found. Conclusion GP5 exhibited evidence of validity across cancer sites and countries and appeared to measure the same construct across these countries. GP5 has significant promise as a summary indicator of side effect bother.
Collapse
Affiliation(s)
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | |
Collapse
|
9
|
Bushnell DM, Atkinson TM, McCarrier KP, Liepa AM, DeBusk KP, Coons SJ. Non-Small Cell Lung Cancer Symptom Assessment Questionnaire: Psychometric Performance and Regulatory Qualification of a Novel Patient-Reported Symptom Measure. Curr Ther Res Clin Exp 2021; 95:100642. [PMID: 34567289 PMCID: PMC8449168 DOI: 10.1016/j.curtheres.2021.100642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background The Non–Small Cell Lung Cancer Symptom Assessment Questionnaire (NSCLC-SAQ) was developed to incorporate the patient's perspective into evaluation of clinical benefit in advanced non–small cell lung cancer trials and meet regulatory expectations for doing so. Qualitative evidence supported 7 items covering 5 symptom concepts. Objective This study evaluated measurement properties of the NSCLC-SAQ's items, overall scale, and total score. Methods In this observational cross-sectional study, a purposive sample of patients with clinician-diagnosed advanced non–small cell lung cancer, initiating or undergoing treatment, provided sociodemographic information and completed the NSCLC-SAQ, National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Lung Symptom Index (FLSI-17), and a Patient Global Impression of Severity item. Rasch analyses, factor analyses, and assessments of construct validity and reliability were completed. Results The 152 participants had a mean age of 64 years, 57% were women, and 87% where White. The majority were Stage IV (83%), 51% had an Eastern Cooperative Oncology Group performance status of 1 (32% performance status 0 and 17% performance status 2), and 33% were treatment naïve. Rasch analyses showed ordered thresholds for response options. Factor analyses demonstrated that items could be combined for a total score. Internal consistency (Cronbach α = 0.78) and test–retest reliability (intraclass correlation coefficient = 0.87) were quite satisfactory. NSCLC-SAQ total score correlation was 0.83 with the National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Lung Symptom Index-17. The NSCLC-SAQ was able to differentiate between symptom severity levels and performance status (both P values < .001). Conclusions The NSCLC-SAQ generated highly reliable scores with substantial evidence of construct validity. The Food and Drug Administration's qualification supports the NSCLC-SAQ as a measure of symptoms in drug development. Further evaluation is needed on its longitudinal measurement properties and interepretation of meaningful within-patient score change. (Curr Ther Res Clin Exp. 2021; 82:XXX–XXX)
Collapse
Affiliation(s)
| | - Thomas M Atkinson
- Memorial Sloan Kettering Cancer Center, Patient-Reported Outcomes, Community-Engagement, and Language Core Facility, New York, New York
| | - Kelly P McCarrier
- Pharmerit International, Patient-Centered Outcomes, Bethesda, Maryland
| | - Astra M Liepa
- Eli Lilly and Company, Global Patient Outcomes and Real World Evidence, Indianapolis, Indiana
| | | | - Stephen Joel Coons
- Critical Path Institute, Patient-Reported Outcome Consortium, Tucson, Arizona
| | | |
Collapse
|
10
|
Osborne J, Kerr H. Role of the clinical nurse specialist as a non-medical prescriber in managing the palliative care needs of individuals with advanced lung cancer. Int J Palliat Nurs 2021; 27:205-212. [PMID: 34169745 DOI: 10.12968/ijpn.2021.27.4.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Rapid identification of the palliative care needs of individuals with a diagnosis of advanced lung cancer is crucial to maximise the patient's quality of life by upholding exemplary standards of patient-centred holistic care. The clinical nurse specialist is in an ideal position to contribute to the identification and management of the palliative care needs of individuals with advanced lung cancer through the assessment and timely prescribing of medications to manage distressing symptoms. AIM This paper reviews and critiques the role of the clinical nurse specialist as an independent non-medical prescriber in the management of palliative symptoms in end-of-life care for patients with advanced lung cancer. RESULTS Published literature highlights the positive impact the clinical nurse specialist has as a non-medical prescriber in addressing the palliative needs of individuals with lung cancer. However, there are barriers and challenges, and to overcome these, maximising resources and the availability of support is required to ensure the delivery of timely, person-centred care. CONCLUSION The clinical nurse specialist as a non-medical prescriber is an evolving role. There are a range of factors that may influence the clinical nurse specialist to confidently and competently undertake this role. These include the perception that there will be an escalation in the workload, concerns about increased accountability and inadequate mentoring for this new role. To incentivise this role, multidisciplinary support is essential in promoting the clinical nurse specialist's confidence for developing this service to individuals with advanced lung cancer.
Collapse
Affiliation(s)
- Jenny Osborne
- Macmillan Lung Cancer Clinical Nurse Specialist, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Helen Kerr
- Senior Lecturer, School of Nursing and Midwifery, Queen's University, Belfast
| |
Collapse
|
11
|
Krueger E, Secinti E, Wu W, Hanna N, Durm G, Einhorn L, Jalal S, Mosher CE. Measurement of patients' acceptable symptom levels and priorities for symptom improvement in advanced lung cancer. Support Care Cancer 2021; 29:5895-5904. [PMID: 33763726 DOI: 10.1007/s00520-021-06159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Little research has assessed cancer patients' success criteria and priorities for symptom improvement to inform patient-centered care. Thus, we modified and tested a measure of these constructs for advanced lung cancer patients. We compared acceptable severity levels following symptom treatment across eight symptoms and identified patient subgroups based on symptom importance. METHODS Advanced lung cancer patients (N=102) completed a one-time survey, including the modified Patient-Centered Outcomes Questionnaire (PCOQ), standard symptom measures, and other clinical characteristics. RESULTS The modified PCOQ showed evidence of construct validity through associations with theoretically related constructs. Symptom severity and importance were moderately correlated. Levels of acceptable symptom severity were low and did not differ across the eight symptoms. Four patient subgroups were identified: (1) those who rated all symptoms as low in importance (n=12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n=29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n=23); and (4) those who rated all symptoms as highly important (n=33). Subgroups were unrelated to clinical characteristics, except for functional status. CONCLUSION The modified PCOQ showed evidence of construct validity. Patients considered low symptom severity to be acceptable, irrespective of the symptom. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Patients have heterogeneous priorities for symptom improvement, which has implications for tailoring treatment.
Collapse
Affiliation(s)
- Ellen Krueger
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA.
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lawrence Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shadia Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| |
Collapse
|
12
|
Kim GD. Impact of Symptom Clusters on the Quality of Life in Lung Cancer Patients Undergoing Chemotherapy. ASIAN ONCOLOGY NURSING 2021. [DOI: 10.5388/aon.2021.21.4.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gyung Duck Kim
- Department of Nursing, Dongyang University, Yeongju, Korea
| |
Collapse
|
13
|
Lehto RH. Symptom burden in lung cancer: management updates. Lung Cancer Manag 2016; 5:61-78. [PMID: 30643551 PMCID: PMC6310300 DOI: 10.2217/lmt-2016-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.
Collapse
Affiliation(s)
- Rebecca H Lehto
- C-344 Bogue, College of Nursing, Michigan State University, East Lansing, MI 48824-1317, USA
| |
Collapse
|
14
|
What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer. Support Care Cancer 2015; 23:3455-63. [PMID: 25791391 DOI: 10.1007/s00520-015-2699-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/09/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool. METHODS Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS). RESULTS Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007). CONCLUSIONS Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.
Collapse
|
15
|
Hinchcliff ME, Beaumont JL, Carns MA, Podlusky S, Thavarajah K, Varga J, Cella D, Chang RW. Longitudinal evaluation of PROMIS-29 and FACIT-dyspnea short forms in systemic sclerosis. J Rheumatol 2014; 42:64-72. [PMID: 25362656 DOI: 10.3899/jrheum.140143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the sensitivity of the Patient-Reported Outcomes Measurement Information System 29-item Health Profile (PROMIS-29) and the Functional Assessment of Chronic Illness Therapy-Dyspnea 10-item short form (FACIT-Dyspnea) for measuring change in health status and dyspnea in systemic sclerosis (SSc). METHODS One hundred patients with SSc completed the PROMIS-29, FACIT-Dyspnea, and traditional instruments [Medical Research Council Dyspnea Score, St. George's Respiratory Questionnaire (SGRQ), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Medical Outcomes Study Short Form-36 (SF-36)] at baseline and 1-year visits. PROMIS-29, FACIT-Dyspnea, and traditional instrument change scores were compared across composite modified Medsger Disease Severity and modified Rodnan Skin score (mRSS) change groups. RESULTS Moderately high Spearman correlation coefficients were observed between FACIT-Dyspnea and SGRQ (r = 0.57), FACIT-Dyspnea functional limitations and SF-36 physical component summary (PCS; r = 0.51), PROMIS-29 physical functioning and HAQ-DI (r = 0.50), and SF-36 PCS (r = 0.52) change scores. In most validity comparisons, PROMIS-29, FACIT-Dyspnea, HAQ-DI, and SF-36 scores performed similarly. While PROMIS-29 covers more content areas than SF-36 (e.g., sleep), it may do so at the expense of responsiveness of its 4-item physical function scale as compared to the multiitem-derived SF-36 PCS. Statistically significant increases in SF-36 role physical (p = 0.01) and physical component scale (p = 0.016), but not PROMIS-29, were observed in patients with mRSS improvement. CONCLUSION PROMIS-29 and FACIT-Dyspnea are valid instruments to measure health status and dyspnea in patients with SSc. In physical function assessment, longer PROMIS short forms or computer adaptive testing should be considered to improve responsiveness to the effect of skin disease changes on physical function in patients with SSc.
Collapse
Affiliation(s)
- Monique E Hinchcliff
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine.
| | - Jennifer L Beaumont
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| | - Mary A Carns
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| | - Sofia Podlusky
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| | - Krishna Thavarajah
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| | - John Varga
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| | - David Cella
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| | - Rowland W Chang
- From the Department of Medicine, Division of Rheumatology, Department of Medical Social Sciences, and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine, Chicago, Illinois; Center for Lung Health, Henry Ford Hospital, Detroit, Michigan, USA.M.E. Hinchcliff, MD, MS, Assistant Professor of Medicine; M.A. Carns, MS; S. Podlusky, BA, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; J.L. Beaumont, MS, Statistical Analyst/Programmer, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; K. Thavarajah, MD, MS, Clinical Assistant Professor of Medicine, Center for Lung Health, Henry Ford Hospital; J. Varga, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; D. Cella, PhD, Professor of Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine; R.W. Chang, MD, MPH, Professor of Medicine, Department of Medicine, Division of Rheumatology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, and the Institute for Public Health and Medicine
| |
Collapse
|
16
|
Otis-Green S, Sidhu RK, Del Ferraro C, Ferrell B. Integrating social work into palliative care for lung cancer patients and families: a multidimensional approach. J Psychosoc Oncol 2014; 32:431-46. [PMID: 24797998 DOI: 10.1080/07347332.2014.917140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lung cancer patients and their family caregivers face a wide range of potentially distressing symptoms across the four domains of quality of life. A multidimensional approach to addressing these complex concerns with early integration of palliative care has proven beneficial. This article highlights opportunities to integrate social work using a comprehensive quality of life model and a composite patient scenario from a large lung cancer educational intervention National Cancer Institute-funded program project grant.
Collapse
Affiliation(s)
- Shirley Otis-Green
- a Division of Nursing Research & Education, City of Hope National Medical Center , Duarte , CA , USA
| | | | | | | |
Collapse
|
17
|
Magasi S, Mallick R, Kaiser K, Patel JD, Lad T, Johnson ML, Kaplan EH, Cella D. Importance and relevance of pulmonary symptoms among patients receiving second- and third-line treatment for advanced non-small-cell lung cancer: support for the content validity of the 4-item Pulmonary Symptom Index. Clin Lung Cancer 2012; 14:245-53. [PMID: 23036663 DOI: 10.1016/j.cllc.2012.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/21/2012] [Accepted: 07/30/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND In advanced non-small-cell lung cancer (NSCLC), reducing symptoms can be a meaningful treatment outcome. This study characterizes the pulmonary symptoms of patients receiving second- and third-line systemic therapies for NSCLC and assesses the content validity of the 4-item Pulmonary Symptom Index (PSI) of the Functional Assessment of Cancer Therapy-Lung (FACT-L). METHODS Twenty patients with advanced NSCLC undergoing second- and third-line treatment ("qualitative sample") completed semistructured interviews regarding their NSCLC symptoms and the importance of pulmonary symptoms. Results were mapped to the PSI. In addition, existing PSI data from 912 patients with cancer ("validation sample") was analyzed to evaluate the scalability of the 4 PSI items. RESULTS In the qualitative sample, mean age was 62 years (range 30-79 years); 80% had nonsquamous histologic type, and 25% had comorbid chronic obstructive pulmonary disease (COPD). A core set of pulmonary symptoms emerged in the data-shortness of breath, cough, and chest tightness. These mapped to 3 PSI items. A quarter of the patients reported an absence of pulmonary symptoms, which supports the inclusion of the final PSI item, "breathing is easy." In the validation sample, for the shortness of breath/breathing ease item pair, weighted kappa representing chance-adjusted agreement ranged from 0.39 to 0.54 and percent agreement from 44% to 49% (both considered moderate), supporting a distinct contribution of each item. CONCLUSION The PSI captures the most important and relevant symptoms reported by patients with NSCLC receiving second- and third-line treatment. Our results suggest that the PSI may provide a clinically useful method to measure patient benefit from lung cancer therapies.
Collapse
Affiliation(s)
- Susan Magasi
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Kurita K, Garon EB, Stanton AL, Meyerowitz BE. Uncertainty and psychological adjustment in patients with lung cancer. Psychooncology 2012; 22:1396-401. [PMID: 22887017 DOI: 10.1002/pon.3155] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/13/2012] [Accepted: 07/20/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND For many patients with lung cancer, disease progression occurs without notice or with vague symptoms, and unfortunately, most treatments are not curative. Given this unpredictability, we hypothesized the following: (1) poorer psychological adjustment (specifically, more depressive symptoms, higher perceptions of stress, and poorer emotional well-being) would be associated with higher intolerance for uncertainty, higher perceived illness-related ambiguity, and their interaction; and (2) greater avoidance would mediate associations between higher intolerance of uncertainty and poorer psychological adjustment. METHODS Participants (N = 49) diagnosed with lung cancer at least 6 months prior to enrollment completed the Center for Epidemiologic Studies - Depression Scale, the Functional Assessment of Cancer Therapy - Lung Emotional Well-being subscale, the Perceived Stress scale, the Intolerance of Uncertainty scale, the Mishel Uncertainty in Illness Scale Ambiguity subscale, the Impact of Event - Revised Avoidance subscale, and the Short-scale Eysenck Personality Questionnaire - Revised Neuroticism subscale. Mean age was 64.2 years (standard deviation [SD] = 11.0), mean years of education was 15.6 (SD = 3.1), and 71.4% were female. Hypotheses were tested with regression analyses, adjusted for neuroticism. RESULTS Higher perceptions of stress and poorer emotional well-being were associated with higher levels of intolerance of uncertainty and higher perceived illness-related ambiguity. Non-somatic depressive symptoms were associated with higher levels of intolerance of uncertainty. Avoidance was found to mediate relations of intolerance of uncertainty with non-somatic depressive symptoms and emotional well-being only. CONCLUSIONS Findings suggest that interventions to address avoidance and intolerance of uncertainty in individuals with lung cancer may help improve psychological adjustment.
Collapse
Affiliation(s)
- Keiko Kurita
- Department of Psychology, University of Southern California, Los Angeles, CA 90089-1061, USA
| | | | | | | |
Collapse
|