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Wongkalasin K, Matchim Y, Kanhasing R, Pimvichai S. Uncertainty among patients with advanced-stage lung cancer. Int J Palliat Nurs 2024; 30:160-169. [PMID: 38630643 DOI: 10.12968/ijpn.2024.30.4.160] [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] [Indexed: 04/19/2024]
Abstract
BACKGROUND Uncertainty is the inability to define the meaning of illness-related events, which may result in anxiety, depression, poor coping, the self-perception of being a burden and low quality of life. Uncertainty among Thai patients with advanced-stage lung cancer (ASLC) has not been well documented. AIMS To assess uncertainty in patients with ASLC. METHODS A cross-sectional survey design was adopted. Data were collected from 60 patients with ASLC at a university hospital. A demographic data form and the Mishel Uncertainty in Illness Scale (MUIS) were used to collect data. The data were analysed using descriptive statistics. RESULTS The patients had moderate levels of uncertainty in illness (83.73±15.25). Ambiguity about the illness and unpredictability of the prognosis scored at a moderate level for patients, while complexity of treatment and the system of care and inconsistency or lack of information, about the diagnosis or severity of the illness were at a low level. CONCLUSION The results of this study may help healthcare professionals better understand and manage uncertainty in patients with ASLC.
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Affiliation(s)
| | - Yaowarat Matchim
- Associate Professor, Faculty of Nursing, Thammasat University, Thailand
| | - Ruankwan Kanhasing
- Assistant Professor, Faculty of Medicine, Thammasat University, Thailand
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Yu Q, Yu H, Xu W, Pu Y, Nie Y, Dai W, Wei X, Wang XS, Cleeland CS, Li Q, Shi Q. Shortness of Breath on Day 1 After Surgery Alerting the Presence of Early Respiratory Complications After Surgery in Lung Cancer Patients. Patient Prefer Adherence 2022; 16:709-722. [PMID: 35340757 PMCID: PMC8943684 DOI: 10.2147/ppa.s348633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/04/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Patient-reported outcome (PRO)-based symptom assessment with a threshold can facilitate the early alert of adverse events. The purpose of this study was to determine whether shortness of breath (SOB) on postoperative day 1 (POD1) can inform postoperative pulmonary complications (PPCs) for patients after lung cancer (LC) surgery. METHODS Data were extracted from a prospective cohort study of patients with LC surgery. Symptoms were assessed by the MD Anderson Symptom Inventory-lung cancer module (MDASI-LC) before and daily after surgery. Types and grades of complications during hospitalization were recorded. SOB and other symptoms were tested for a possible association with PPCs by logistic regression models. Optimal cutpoints of SOB were derived, using the presence of PPCs as an anchor. RESULTS Among 401 patients with complete POD1 MDASI-LC and records on postoperative complications, 46 (11.5%) patients reported Clavien-Dindo grade II-IV PPCs. Logistic regression revealed that higher SOB score on POD1 (odds ratio [OR]=1.13, 95% CI=1.01-1.27), male (OR=2.86, 95% CI=1.32-6.23), open surgery (OR=3.03, 95% CI=1.49-6.14), and lower forced expiratory volume in one second (OR=1.78, 95% CI=1.66-2.96) were significantly associated with PPCs. The optimal cutpoint was 6 (on a 0-10 scale) for SOB. Patients reporting SOB < 6 on POD1 had shorter postoperative length of stay than those reporting 6 or greater SOB (median, 6 vs 7, P =0.007). CONCLUSION SOB on POD1 can inform the onset of PPCs in patients after lung cancer surgery. PRO-based symptom assessment with a clinically meaningful threshold could alert clinicians for the early management of PPCs.
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Affiliation(s)
- Qingsong Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yang Pu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Qiuling Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
- Correspondence: Qiuling Shi, School of Public Health and Management, Chongqing Medical University, No. 1, Medical School Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86-18290585397, Fax +86-28-85420116, Email
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Moreno-Rubio J, Ponce S, Álvarez R, Olmedo ME, Falagan S, Mielgo X, Navarro F, Cruz P, Cabezón-Gutiérrez L, Aguado C, Colmenarejo G, Muñoz-Fernández de Leglaria M, Enguita AB, Cebollero M, Benito A, Alemany I, Del Castillo C, Ramos R, Ramírez de Molina A, Casado E, Sereno M. Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer. Cancer Biol Med 2021; 17:444-457. [PMID: 32587780 PMCID: PMC7309469 DOI: 10.20892/j.issn.2095-3941.2019.0363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/17/2020] [Indexed: 01/07/2023] Open
Abstract
Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization. Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples. Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0–1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047). Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.
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Affiliation(s)
| | | | - Rosa Álvarez
- Gregorio Marañón University Hospital, Madrid 28009, Spain
| | | | - Sandra Falagan
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
| | - Xabier Mielgo
- Fundación Alcorcon University Hospital, Alcorcon, Madrid 28922, Spain
| | - Fátima Navarro
- Príncipe de Asturias University Hospital, Alcalá De Henares, Madrid 28805, Spain
| | | | | | - Carlos Aguado
- Clinico San Carlos University Hospital, Madrid 28040, Spain
| | | | | | | | | | - Amparo Benito
- Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Isabel Alemany
- Fundación Alcorcon University Hospital, Alcorcon, Madrid 28922, Spain
| | | | - Ricardo Ramos
- Parque Científico de Madrid Foundation, Madrid 28049, Spain
| | | | - Enrique Casado
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
| | - Maria Sereno
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
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Saetan P, Chaiviboontham S, Pokpalagon P, Chansriwong P. The Effects of the Respiratory Rehabilitation Program on Perceived Self-Efficacy and Dyspnea in Patients with Lung Cancer. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:277-285. [PMID: 32916339 DOI: 10.1016/j.anr.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/13/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to examine the effects of the respiratory rehabilitation program on perceived self-efficacy and dyspnea in patients with lung cancer. METHODS This is a quasi-experimental research study with a two-group repeated measures design with the pretest and post-test at Week 4 and Week 8. The theory of self-efficacy by Bandura was used as the conceptual framework. The sample consisted of patients with non-small-cell lung cancer Stage 4 who visited the oncology clinic in a university hospital. Twenty-eight patients were enrolled and equally allocated to the control group and experimental group. The control group received routine nursing care only, whereas the experimental group received the respiratory rehabilitation program. The program comprised dyspnea educating, breathing exercise, using handheld fans, effective coughing, respiratory strengthening training, and follow-up by phone in the third and sixth week. Data for perceived self-efficacy and dyspnea were collected before the program start and reassessment in the fourth and eighth week. Instrumentation was composed of the respiratory rehabilitation program, demographic data, perceived self-efficacy assessment for respiratory rehabilitation, and the Cancer Dyspnea Scale. Data were analyzed using descriptive statistics and one-factor repeated measures analysis of variance and by comparing means between groups. RESULTS The result revealed that almost all of the patients in the sample were men, and the mean age of the experimental group and control group was 65.80 years (standard deviation = 8.80) and 73.00 years (standard deviation = 7.60), respectively. There was significant different in the mean score of perceived self-efficacy and dyspnea between the experimental group and the control group (p < .050). CONCLUSION Based on the findings of the study, the respiratory rehabilitation program should be used to promote self-efficacy and relieve dyspnea in patients with lung cancer.
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Affiliation(s)
- Pramote Saetan
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchira Chaiviboontham
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Piyawan Pokpalagon
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Chansriwong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Haywood A, Duc J, Good P, Khan S, Rickett K, Vayne-Bossert P, Hardy JR. Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults. Cochrane Database Syst Rev 2019; 2:CD012704. [PMID: 30784058 PMCID: PMC6381295 DOI: 10.1002/14651858.cd012704.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dyspnoea is a common symptom in advanced cancer, with a prevalence of up to 70% among patients at end of life. The cause of dyspnoea is often multifactorial, and may cause considerable psychological distress and suffering. Dyspnoea is often undertreated and good symptom control is less frequently achieved in people with dyspnoea than in people with other symptoms of advanced cancer, such as pain and nausea. The exact mechanism of action of corticosteroids in managing dyspnoea is unclear, yet corticosteroids are commonly used in palliative care for a variety of non-specific indications, including pain, nausea, anorexia, fatigue and low mood, despite being associated with a wide range of adverse effects. In view of their widespread use, it is important to seek evidence of the effects of corticosteroids for the management of cancer-related dyspnoea. OBJECTIVES To assess the effects of systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Science Citation Index Web of Science, Latin America and Caribbean Health Sciences (LILACS) and clinical trial registries, from inception to 25 January 2018. SELECTION CRITERIA We included randomised controlled trials that included adults aged 18 years and above. We included participants with cancer-related dyspnoea when randomised to systemic corticosteroids (at any dose) administered for the relief of cancer-related dyspnoea or any other indication, compared to placebo, standard or alternative treatment. DATA COLLECTION AND ANALYSIS Five review authors independently assessed trial quality and three extracted data. We used means and standard deviations for each outcome to report the mean difference (MD) with 95% confidence interval (CI). We assessed the risk of bias and quality of evidence using GRADE. We extracted primary outcomes of sensory-perceptual experience of dyspnoea (intensity of dyspnoea), affective distress (quality of dyspnoea) and symptom impact (burden of dyspnoea or impact on function) and secondary outcomes of serious adverse events, participant satisfaction with treatment and participant withdrawal from trial. MAIN RESULTS Two studies met the inclusion criteria, enrolling 157 participants (37 participants in one study and 120 in the other study), of whom 114 were included in the analyses. The studies compared oral dexamethasone to placebo, followed by an open-label phase in one study. One study lasted seven days, and the duration of the other study was 15 days.We were unable to conduct many of our predetermined analyses due to different agents, dosages, comparators and outcome measures, routes of drug delivery, measurement scales and time points. Subgroup analysis according to type of cancer was not possible.Primary outcomesWe included two studies (114 participants) with data at one week in the meta-analysis for change in dyspnoea intensity/dyspnoea relief from baseline. Corticosteroid therapy with dexamethasone resulted in an MD of lower dyspnoea intensity compared to placebo at one week (MD -0.85 lower dyspnoea (scale 0-10; lower score = less breathlessness), 95% CI -1.73 to 0.03; very low-quality evidence), although we were uncertain as to whether corticosteroids had an important effect on dyspnoea as results were imprecise. We downgraded the quality of evidence by three levels from high to very low due to very serious study limitations and imprecision.One study measured affective distress (quality of dyspnoea) and results were similar between groups (29 participants; very low-quality evidence). We downgraded the quality of the evidence three times for imprecision, inconsistency, and serious study limitations.Both studies assessed symptom impact (burden of dyspnoea or impact on function) (113 participants; very low-quality evidence). In one study, it was unclear whether dexamethasone had an effect on dyspnoea as results were imprecise. The second study showed more improvement for physical well-being scores at days eight and 15 in the dexamethasone group compared with the control group, but there was no evidence of a difference for FACIT social/family, emotional or functional scales. We downgraded the quality of the evidence three times for imprecision, inconsistency, and serious study limitations.Secondary outcomesDue to the lack of homogenous outcome measures and inconsistency in reporting, we could not perform quantitative analysis for any secondary outcomes. In both studies, the frequency of adverse events was similar between groups, and corticosteroids were generally well tolerated. The withdrawal rates for the two studies were 15% and 36%. Reasons for withdrawal included lost to follow-up, participant or carer (or both) refusal, and death due to disease progression. We downgraded the quality of evidence for these secondary outcomes by three levels from high to very low due to serious study limitations, inconsistency and imprecision.Neither study examined participant satisfaction with treatment. AUTHORS' CONCLUSIONS There are few studies assessing the effects of systemic corticosteroids on cancer-related dyspnoea in adults with cancer. We judged the evidence to be of very low quality that neither supported nor refuted corticosteroid use in this population. Further high-quality studies are needed to determine if corticosteroids are efficacious in this setting.
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Affiliation(s)
- Alison Haywood
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Maddocks M, Reilly CC, Jolley C, Higginson IJ. What Next in Refractory Breathlessness? Breathlessness? Research Questions for Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971403000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Matthew Maddocks
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK
| | - Charles C. Reilly
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Caroline Jolley
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J. Higginson
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Greer JA, MacDonald JJ, Vaughn J, Viscosi E, Traeger L, McDonnell T, Pirl WF, Temel JS. Pilot Study of a Brief Behavioral Intervention for Dyspnea in Patients With Advanced Lung Cancer. J Pain Symptom Manage 2015; 50:854-60. [PMID: 26166181 DOI: 10.1016/j.jpainsymman.2015.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/07/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Dyspnea is a common symptom in patients with advanced cancer that interferes with functional ability and quality of life (QOL). Although few evidence-based treatments for dyspnea exist, prior studies show support for nonpharmacological interventions that include elements of cognitive-behavioral therapy. OBJECTIVES To examine the feasibility and utility of delivering a brief behavioral intervention for dyspnea in patients with lung cancer. METHODS For this single-group pilot study, eligible patients included those with advanced lung cancer (Stage III or IV non-small cell or extensive-stage small cell lung cancer) receiving outpatient cancer treatment who reported at least moderate breathlessness. The manualized intervention consisted of two sessions in which nurse practitioners taught participants breathing and relaxation techniques within the infusion clinic and encouraged home practice. Participants completed measures of breathlessness (Modified Medical Research Council Dyspnea Scale), QOL (Functional Assessment of Cancer Therapy-Lung Trial Outcome Index), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale) at baseline and within six weeks after enrollment. RESULTS Of the 32 patients enrolled in the study (56.3% females; mean age 63.34 [SD] = 7.96 years), 84.4% (N = 27) completed all study procedures. Comparing the baseline to postassessments, we found significant improvements in Modified Medical Research Council Dyspnea Scale (P < 0.001), Functional Assessment of Cancer Therapy-Lung Trial Outcome Index (P = 0.01), and Hospital Anxiety and Depression Scale-depression subscale (P < 0.001) scores. CONCLUSION In this sample of patients with advanced lung cancer and dyspnea, we observed a high completion rate for the two-session behavioral intervention. Patients also reported improvements in dyspnea, QOL, and mood. Follow-up randomized controlled trials are needed to examine the efficacy of brief behavioral interventions for cancer-related dyspnea.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA.
| | - James J MacDonald
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Jeanne Vaughn
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Elene Viscosi
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Traeger
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa McDonnell
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
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Von Roenn JH. Advance Care Planning: Ensuring That the Patient's Voice Is Heard. J Clin Oncol 2013; 31:663-4. [DOI: 10.1200/jco.2012.46.8181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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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.
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Affiliation(s)
- Susan Magasi
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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