Quality of Life and Meaning of Illness of Women With Lung Cancer

Tackling Non-Small Cell Lung Cancer in Young Adults: From Risk Factors and Genetic Susceptibility to Lung Cancer Profile and Outcomes

Lung cancer has traditionally been associated with advanced age; however, its increasing incidence among young adults raises concerning questions regarding its etiology and unique considerations for this population. In contrast to the older population, the onset of lung cancer at younger age may be attributed to a complex interplay of incompletely understood individual susceptibility and prevalent environmental risk factors beyond tobacco smoke exposure, such as radon gas and air pollution, which are widespread globally. Consequently, this leads to distinct clinical and molecular profiles, requiring a tailored approach. Furthermore, a diagnosis of cancer represents a threatening event during the prime years of a young person's life, prompting concern about career development, social aspects, fertility aspirations, and physical independence. This poses significant additional challenges for health care professionals in a field that remains underexplored. This comprehensive review recognizes lung cancer in young adults as a distinct entity, exploring its clinical and molecular characteristics, diverse predisposing factors, and priorities in terms of quality of life, with the aim of providing practical support to oncologists and enhancing our understanding of this under-researched population.

Lung Cancer in Women: The Past, Present, and Future

Lung cancer is the leading cause of cancer death for women in multiple countries including the United States. Women are exposed to unique risk factors that remain largely understudied such as indoor pollution, second-hand tobacco exposure, biological differences, gender differences in tolerability and response to therapy in lung cancer, and societal gender roles, that create distinct survivorship needs. Women continue to lack representation in lung cancer clinical trials and are typically treated with data generated from majority male patient study populations, which may be inappropriate to extrapolate and generalize to females. Current lung cancer treatment and screening guidelines do not incorporate sex-specific differences and physicians also often do not account for gender differences when choosing treatments or discussing survivorship needs. To best provide targeted treatment approaches, greater representation of women in lung cancer clinical trials and further research is necessary. Clinicians should understand the unique factors and consequences associated with lung cancer in women; thus, a holistic approach that acknowledges environmental and societal factors is necessary.

Quality of life after treatment with immune checkpoint inhibitors for lung cancer; the impact of age

INTRODUCTION

Immune checkpoint inhibitors (ICIs) have revolutionized lung cancer treatment. However, it remains unclear as to whether changes in Health-Related Quality-of-Life (HRQoL) are associated with the age of lung cancer patients treated using ICIs. This study aimed to evaluate this possible association and to compare ICI-treated patients' HRQoL scores with normative data of an age-matched non-cancer general population.

METHODS

Lung cancer patients from the OncoLifeS data-biobank were included if they were treated with ICIs, irrespective of other treatments, at the University Medical Center Groningen between 2015 and 2021 and had completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTCQLQ-C30), both at the start of ICI treatment and after six months. Association of age as a continuous variable (per 10 years) and changes in HRQoL scores between baseline and 6 months was assessed using multivariable regression analyses. Clinical relevance of differences in HRQoL scores between OncoLifeS and the general population was classified into trivial, small, medium, and large, for three age groups (<60, 60-69 and ≥ 70 years).

RESULTS

151 patients were included with a mean age of 65.8 years. An increase in age per 10 years was associated with a larger decrease in the summary HRQoL score(β = -3.28,CI95%-6.42;-0.14), physical(β = -4.8, CI95% -8.71;-0.88), cognitive(β = -4.51,CI95%-8.24;-0.78), role functioning(β = -5.41,CI95%-10.78;-0.05), symptom burden(β = -3.66,CI95%-6.6;-0.73), and smaller negative changes in financial difficulties(β = 6.5 95 % CI 3.16; 9.85). OncoLifeS HRQoL scores were lower than those of the general population and differences were most often classified as large and medium.

CONCLUSION

Older lung cancer patients experience larger deteriorations in most HRQoL domains after 6 months of ICI treatment. Also, these patients showed significantly lower HRQoL scores compared to the general population.

Associations of meaning of illness with psychosocial, clinical, and immunological characteristics in patients with Leptomeningeal metastasis

Background

Leptomeningeal metastasis (LM) creates symptoms related to both the disease within the nervous system and treatment toxicities. Biologic processes, such as inflammation and behavioral processes, such as the meaning ascribed to illness (Meaning of Illness: MoI), can impact physical and psychosocial symptoms. The aim of this study was to understand the relationships among MoI, physical and psychosocial symptoms, and inflammation in patients with LM.

Methods

Thirty enrolled participants completed the MD Anderson Symptom Inventory-Brain Tumor with spine experimental symptoms added. Meaning of illness, quality of life (QoL), and depression were captured by validated instruments. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α in serum and cerebrospinal fluid (CSF) were measured by ELISA. Correlations were performed to assess relationships among the variables.

Results

Participants were primarily white (73%), female (63%). Median age was 54 years (34–83). Breast (50%) and lung (20%) were most common diagnosis. Higher MoI scores were associated with better QoL (p < .01) and fewer depressive symptoms (p < .01). All CSF samples contained IL-6 and all but one sample had elevated IL-6. Higher levels of IL-6 in the CSF were associated with greater symptom burden (p < .01) and interference of symptoms in daily life (p = .02) but not MoI.

Conclusions

MoI was associated with QoL and depression. High levels of IL-6 in the CSF were associated with more severe symptoms. This study provides the groundwork for future research, including interventional studies to improve QoL in patients with LM.

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Ascribing positive meaning to illness is associated with higher reported QoL in patients with LM.

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High IL-6 in the CSF was associated with increased symptom burden but not depressive symptoms.

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Fostering meaning in patients with LM may help mood, reduce inflammation, and improve symptoms.

Patient-Reported Outcomes with Selpercatinib Among Patients with RET Fusion-Positive Non-Small Cell Lung Cancer in the Phase I/II LIBRETTO-001 Trial

BACKGROUND

LIBRETTO-001 is an ongoing, global, open-label, phase I/II study of selpercatinib in patients with advanced or metastatic solid tumors. We report interim patient-reported outcomes in patients with RET fusion-positive non-small cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) version 3.0 at baseline (cycle 1, day 1), approximately every other 28-day cycle until cycle 13, and every 12 weeks thereafter. Data were evaluated through cycle 13 as few patients had reached later time points. A change of ≥10 points from baseline in domain scores was considered clinically meaningful.

RESULTS

Among 253 selpercatinib-treated patients, 239 were categorized into subgroups by prior therapy: treatment-naïve (n = 39), one prior line of therapy (n = 64), or two or more prior lines of therapy (n = 136). The QLQ-C30 was completed by >85% of patients at each time point. Most patients overall and in each subgroup maintained or improved in all health-related quality of life (HRQoL) domains during treatment. The percentage of patients who experienced clinically meaningful improvements ranged from 61.1% to 66.7% for global health status, 33.3% to 61.1% for dyspnea, and 46.2% to 63.0% for pain. The 61.1% of patients with improved dyspnea had two or more prior lines of therapy; median time to first improvement was 3.4 months. At the first postbaseline evaluation (cycle 3), 45.9% of all patients reported a ≥ 10-point reduction in pain.

CONCLUSION

In this interim analysis, the majority of patients with RET fusion-positive NSCLC remained stable or improved on all QLQ-C30 subscales at each study visit, demonstrating favorable HRQoL as measured by the QLQ-C30 during treatment with selpercatinib.

IMPLICATIONS FOR PRACTICE

Patients with non-small cell lung cancer (NSCLC) generally experience greater symptom burden and lower health-related quality of life (HRQoL) as the disease progresses. In a phase I/II trial, improvements in HRQoL were observed in over 60% of patients with advanced RET fusion-positive NSCLC who received selpercatinib, a highly selective RET inhibitor. More than one third of patients reported a reduction in dyspnea during study participation, and nearly half reported a reduction in pain by the first follow-up assessment.

Improving Social Support to Increase QoL in Lung Cancer Patients

Lung cancer is the most common cause of cancer deaths in the world. According to the World Health Organization, over 2 million new lung cancer cases were reported worldwide in 2018, and there were 1.76 million deaths from the disease. Due to its non-specific symptoms, the disease is usually detected at an advanced stage, which gives few treatment options and a short survival rate after diagnosis. That is why improving QoL in the last months of a patient's life is enormously important. The purpose of this study was to analyse original papers in order to determine whether an increase in social support is important in improving QoL for lung cancer patients. Both the direct influence of social support on QoL and indirect influences such as stigma or depression, etc. were taken into consideration. We conducted a review of 22 papers published in English in the period 2005-2020, which were selected using the following keywords: lung cancer, social support, quality of life. Evidence was found for the connections between the improvement of social support and an increase in the QoL of lung cancer patients. It is crucial, and worth whatever effort is required, to increase social support for lung cancer patients, as it is one of the most important factors in improving QoL. According to the studies, a good QoL and minimalised symptoms of the disease are much more important for lung cancer patients than the length of their life.

Lung cancer stigma: A concept with consequences for patients

BACKGROUND

Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared with other cancer populations. Lung cancer stigma (LCS) may in part explain these findings.

AIM

We investigated the prevalence of patient-perceived lung cancer stigma (LCS) and its relationships to symptom burden/severity, depression, and deficits in health-related quality of life (HR-QoL).

METHODS

In this descriptive, observational, and cross-sectional study, 201 participants were sent questionnaires. These included the Cataldo Lung Cancer Stigma Scale (CLCSS), the Lung Cancer Symptom Scale, the Centre for Epidemiologic Studies-Depression Scale, and the Quality of Life Inventory.

RESULTS

Participants were on average 69 years old, 52% women, 95% ever smokers, and 18.5% current smokers. The mean total CLCSS score was 53.1 (SD = 14.1; range = 31-94). LCS was significantly correlated with younger age (P < .001), greater social deprivation (P < .05), being unemployed (P < .001), depression (P < .001), symptom burden (P < .001), and HR-QoL deficits (P < .001). Symptom burden explained 18% of variance in LCS (P < .001). LCS explained 8.5% and 14.3% of the variance in depression (P < .001) and HR-QoL (P < .001), respectively.

CONCLUSION

Patients with lung cancer are vulnerable to LCS. Symptom burden can directly contribute to greater perceived LCS. Greater perceived LCS can be directly related to greater levels of depression and lower HR-QoL. A tailored approach is required to screen for LCS and implement interventions to enhance the psychosocial well-being of patients with perceived LCS.

The humanistic burden of advanced non-small cell lung cancer (NSCLC) in Europe: a real-world survey linking patient clinical factors to patient and caregiver burden

Purpose

Advanced non-small cell lung cancer (aNSCLC) impacts the lives of patients and their caregivers. This analysis examined the association between patient clinical characteristics and patient and caregiver humanistic burden.

Methods

Data for patients with aNSCLC and their informal caregivers in France, Germany and Italy, were collected between May 2015 and June 2016 via chart review and patient and caregiver surveys. Patients and caregivers completed validated instruments to evaluate their health state (EuroQol-5-dimensions-3-levels [EQ-5D-3L]), work and activity impairment (Work Productivity Activity Impairment [WPAI]) and health-related quality of life (HRQoL; European Organisation for Research and treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]). Caregivers also completed the Zarit Burden Interview (ZBI). Univariate and regression analyses were stratified by patient Eastern Cooperative Group Performance Status (ECOG-PS 0, 1, 2 or 3/4).

Results

In total, 1030 patients and 427 accompanying informal caregivers participated. Regression analyses indicated that patients reported lower EQ-5D-3L utility index, EQ-VAS and EORTC QLQ-C30 global health status and greater work and activity impairment with worsening ECOG-PS (all p < 0.05). Caregivers also reported greater activity impairment and higher ZBI scores with worsening ECOG-PS of the patient they were providing care for (all p < 0.05).

Conclusions

As patients’ functionality deteriorates as measured by the ECOG-PS, so do their outcomes related to health utility, work productivity, activity impairment and HRQoL. This deterioration is also reflected in increased caregiver burden and activity impairment. There is a need for interventions to maintain patients’ physical function to relieve the humanistic burden of both patients and caregivers.

Electronic supplementary material

The online version of this article (10.1007/s11136-019-02152-6) contains supplementary material, which is available to authorized users.

Preparing Cancer Patients and Family Caregivers for Lung Surgery: Development of a Multimedia Self-Management Intervention

The surgical treatment of lung malignancies often results in persistent symptoms, psychosocial distress, and decrements in quality of life (QOL) for cancer patients and their family caregivers (FCGs). The potential benefits of providing patients and FCGs with preparatory education that begins in the preoperative setting have been explored in multiple medical conditions, with positive impact observed on postoperative recovery, psychological distress, and QOL. However, few studies have explored the benefits of preparatory educational interventions to promote self-management in cancer surgery, including lung surgery. This paper describes the systematic approach used in the development of a multimedia self-management intervention to prepare cancer patients and their FCGs for lung surgery. Intervention development was informed by (1) contemporary published evidence on the impact of lung surgery on patients and FCG, (2) our previous research that explored QOL, symptoms, and caregiver burden after lung surgery, (3) the use of the chronic care self-management model (CCM) to guide intervention design, and (4) written comments and feedback from patients and FCGs that informed intervention development and refinement. Pilot-testing of the intervention is in process, and a future randomized trial will determine the efficacy of the intervention to improve patient, FCG, and system outcomes.

Quality of life of patients with gastrointestinal cancers undergoing chemotherapy

PURPOSE

Findings regarding changes in the quality of life (QOL) of patients with gastrointestinal cancers (GI) undergoing chemotherapy (CTX) are inconclusive. Purpose was to evaluate for changes in QOL scores of patients with GI cancers over two cycles of CTX.

METHODS

Patients (n = 397) completed disease-specific [i.e., Quality of Life-Scale-Patient Version (QOL-PV)] and generic [12-item Medical Outcomes Study Short Form Survey (SF-12)] measures of QOL a total of six times over two cycles of CTX. Changes in these QOL scores were evaluated using bootstrapped multilevel regression with full information maximum likelihood estimation. Treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, GI cancer diagnosis (i.e., colon/rectum/anal vs. other), and CTX regimen were evaluated as covariates in the conditional models for each of the QOL scores.

RESULTS

During the second cycle of CTX, QOL-PV scores decreased in the week following CTX administration, and then increased the following week. For both cycles of CTX, the physical component summary and mental component summary scores of the SF-12 decreased in the week following CTX administration and then increased the following week. Increased time from cancer diagnosis and a higher number of prior cancer treatments resulted in worse QOL-PV and SF-12 scores at enrollment.

CONCLUSIONS

While changes in QOL scores over the two CTX cycles were statistically significant, the differences were not clinically meaningful. Future studies need to determine the optimal timing of QOL assessments to assess changes associated with cancer treatments.

Factor Structure and Psychometric Properties of the Brief Illness Perception Questionnaire in Turkish Cancer Patients

OBJECTIVE

The main aim of this study was to investigate the factor structure and psychometric properties of the Brief Illness Perception Questionnaire (BIPQ) in Turkish cancer patients.

METHODS

This methodological study involved 135 cancer patients. Statistical methods included confirmatory or exploratory factor analysis and Cronbach alpha coefficients for internal consistency.

RESULTS

The values of fit indices are within the acceptable range. The alpha coefficients for emotional illness representations, cognitive illness representations, and total scale are 0.83, 0.80, and 0.85, respectively.

CONCLUSIONS

The results confirm the two-factor structure of the Turkish BIPQ and demonstrate its reliability and validity.

A consensus statement on the gender perspective in lung cancer

Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women.

Meaning Construction in Palliative Care: The Use of Narrative, Ritual, and the Expressive Arts

Individuals and families make sense of the world and their experiences through a process of meaning construction. Narrative is an important means of constructing meaning. The diagnosis of life-threatening or life-altering illness often forces revision in the life narrative and the reconstruction of meaning. This article discusses the process of meaning construction and highlights the use of narrative, the expressive arts, and ritual to create meaning and connection. All members of the palliative care team play an important role in helping patients and families tell the stories of their illness and their lives and find meaning and purpose at the end of life. The use of rituals is discussed along with verbal and art-based methods for eliciting patient and family narratives. The relationships among patient, family, and practitioner are seen as powerfully therapeutic and potentially transformative for all involved.

Phenotypic and molecular characteristics associated with various domains of quality of life in oncology patients and their family caregivers

PURPOSE

Not all oncology patients and their family caregivers (FCs) experience the same quality of life (QOL). The purposes of this study were to identify latent classes of oncology patients (n = 168) and their FCs (n = 85) with distinct physical, psychological, social, and spiritual well-being trajectories from prior to through 4 months after the completion of radiation therapy and to evaluate for demographic, clinical, and genetic characteristics that distinguished between these latent classes.

METHODS

Using growth mixture modeling, two latent classes were found for three (i.e., physical, psychological, and social well-being) of the four QOL domains evaluated.

RESULTS

Across these three domains, the largest percentage of participants reported relatively high well-being scores across the 6 months of the study. Across these three QOL domains, patients and FCs who were younger, female, belonged to an ethnic minority group, had children at home, had multiple comorbid conditions, or had a lower functional status, were more likely to be classified in the lower QOL class. The social well-being domain was the only domain that had a polymorphism in nuclear factor kappa beta 2 (NFKB2) associated with latent class membership. Carrying one or two doses of the rare allele for rs7897947 was associated with a 54 % decrease in the odds of belonging to the lower social well-being class [OR (95 % CI) = .46 (.21, .99), p = .049].

CONCLUSIONS

These findings suggest that a number of phenotypic and molecular characteristics contribute to differences in QOL in oncology patients and their FCs.

Palliative care and spiritual well-being in lung cancer patients and family caregivers

BACKGROUND

Spiritual well-being is an important dimension of quality of life (QOL) and is a core component of quality oncology and palliative care. In this analysis, we aimed to describe spiritual well-being outcomes in a National Cancer Institute (NCI)-supported Program Project that tested the effectiveness of an interdisciplinary palliative care intervention in lung cancer patients and their family caregivers (FCGs).

METHODS

Patients undergoing treatments for NSCLC and their FCGs were enrolled in a prospective, quasi-experimental study. Patients and FCGs in the intervention group were presented at interdisciplinary care meetings and received four educational sessions that included one session focused on spiritual well-being. Spiritual well-being for patients was measured using the FACIT-Sp-12, and FCG spiritual well-being was measured using the COH-QOL-FCG spiritual well-being subscale. Multivariate analysis of covariance was undertaken for subscale and item scores at 12 weeks, controlling for baseline, by religious affiliations (yes or no) and group assignment.

RESULTS

Religiously affiliated patients reported better scores in the Faith subscale and items on finding strength and comfort in faith and spiritual beliefs compared to non-affiliated patients. Non-affiliated patients had better scores for feeling a sense of harmony within oneself. By group, patients who received the intervention had significantly better scores for the Meaning/Peace subscale.

CONCLUSIONS

Our findings support the multidimensionality of spiritual well-being that includes constructs such as meaning and faith for lung cancer patients and FCGs with or without religious affiliations. Palliative care interventions should include content that targets the spiritual needs of both patients and FCGs. Copyright © 2015 John Wiley & Sons, Ltd.

[Influence of tobacco smoking on quality of life in patients with lung cancer]

Tobacco smoking is the leading cause of lung cancer. This cancer is the most specific indicator of the effects of tobacco on health. Regardless of the type of lung cancer and the stage of the disease, continued smoking has a negative impact on its development and its treatment. For this reason, smoking cessation is an essential step in the management of patients with lung cancer who smoke. It has been clearly demonstrated that quality of life is worse in smokers than in non-smokers. The aim of this general review is to study the relationship between tobacco use and quality of life specifically in patients with lung cancer. Among the twelve studies selected, six of them clearly demonstrate a deleterious effect of continued smoking tobacco or a beneficial effect of smoking cessation on the quality of life in patients with lung cancer. These findings should lead clinicians to offer support to smokers with lung cancer in order to assist them to quit smoking.

The effect of gender on health-related quality of life and related factors in post-lobectomy lung-cancer patients

PURPOSE

While studies have documented gender differences by histologic type among lung cancer patients, the effect of these differences on the health-related quality of life (HRQoL) of post-lobectomy lungcancer patients and related factors remain uncertain. This study examines gender-specific HRQoL and related factors in post-lobectomy lung-cancer patients.

METHODS

A cross-sectional study design was applied. A convenience sample of 231 post-lobectomy lungcancer patients was recruited from the thoracic surgery outpatient departments of two teaching hospitals in Taipei, Taiwan from March to December 2012. Patients performed a spirometry test and completed instruments that included a Beck Depression Inventory-II, an Interpersonal Support Evaluation List, and the symptom and function scales of the Quality of Life Questionnaire. Data analysis used descriptive statistics, including mean and standard deviations, frequency, and percentage values. Independent-sample Student's t-tests and multivariate analyses were used for comparative purposes.

RESULTS

This study confirmed a significant gender effect on HRQoL and HRQoL-related factors such as marital status, religious affiliation, smoking status, histologic type, symptoms, pulmonary function, depression, and family support. Moreover, multivariate analysis found gender to be a significant determinant of the HRQoL aspects of physical functioning, emotional functioning, and cognitive functioning. Finally, results indicated that factors other than gender were also significant determinants of HRQoL.

CONCLUSION

Gender impacts the HRQoL and related factors of postoperative lung-cancer patients. Therefore, gender should be considered in assessing and addressing the individual care needs of these patients in order to attain optimal treatment outcomes.

Lung cancer stigma, anxiety, depression, and quality of life

This study investigated lung cancer stigma, anxiety, depression, and quality of life (QOL) and validated variable similarities between ever and never smokers. Patients took online self-report surveys. Variable contributions to QOL were investigated using hierarchical multiple regression. Patients were primarily White females with smoking experience. Strong negative relationships emerged between QOL and anxiety, depression and lung cancer stigma. Lung cancer stigma provided significant explanation of the variance in QOL beyond covariates. No difference emerged between smoker groups for study variables. Stigma may play a role in predicting QOL. Interventions promoting social and psychological QOL may enhance stigma resistance skills.

The role of inner strength in quality of life and self-management in women survivors of cancer

The role of inner strength in quality of life (QOL) and self-management, primary variables in the Theory of Inner Strength, were examined with demographic and clinical characteristics in 107 women with cancer. The strongest predictors of QOL were depressive symptoms, inner strength, and time since diagnosis, respectively, accounting for 82% of the variance in QOL. When depressive symptoms were excluded due to multicollinearity, 64% of variance in QOL was explained by inner strength, time since diagnosis, and comorbidities, with inner strength the strongest predictor. The strongest predictors of self-management were depressive symptoms and inner strength, accounting for 17% of the variance. Results contribute to theory development and suggest the value of supporting inner strength to enhance QOL in cancer survivors.

Illness appraisals and depression in the first year after HIV diagnosis

Illness appraisals provide important context to help understand the way individuals cope with chronic illness. In the present study, a qualitative approach to the analysis of HIV diagnosis experience narratives in a sample of 100 people newly diagnosed with HIV revealed five groups that differed in their initial illness appraisals: HIV as Chronic Illness, Concern about Dying, Stigmatization, Threat to Identity, and Other Threats Overshadow HIV. When compared on quantitatively measured depressive mood, the groups differed on level and trajectory over the course of the first year post-diagnosis. Although the experience of living with HIV has changed significantly with the advent of effective Antiretroviral Therapies (ART), there were a number of similarities between the appraisals of this group of participants who were diagnosed post ART and groups who were diagnosed before ART became widely available. Posttest counselors and other HIV service providers should take individual differences in illness appraisals into account in order to help newly HIV-positive clients manage their healthcare and cope adaptively with their diagnosis.

Palliative care in patients with lung cancer

Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time.

Development of a nursing model for life adjustment in patients with lung cancer in Japan

The aim of this study was to obtain basic data about the support for life adjustment in lung cancer patients in Japan. We identified factors that affect life adjustment in people with lung cancer, developed a model for life adjustment support of lung cancer patients, and investigated its validity. A survey was conducted using self-completed questionnaires, and responses were received by 203 individuals. Analysis of the responses revealed that life adjustment was regulated by six factors associated with positive self-evaluation: stress dissipation, fighting spirit, helplessness/hopelessness, full discussion with doctor about treatment, clarity of thought, and support network size. A model search with covariance structure analysis was conducted. The resulting model was revealed to have a goodness-of-fit index of 0.963, an adjusted goodness-of-fit index of 0.930, a comparative fit index of 0.974, and a root mean square error of approximation of 0.040. The findings suggest that improvements in quality of life can be expected by combining a positive self-evaluation in lung cancer patients and interventions to raise self-adjustment ability with the use of this Model, although it requires further testing.

Lung cancer patients' beliefs about complementary and alternative medicine in the promotion of their wellness

PURPOSE

Cancer patients are increasingly turning to complementary and alternative medicine (CAM) because they believe that conventional treatments are not optimizing their overall wellness. However, the relationship between CAM use, wellness, and patient beliefs has received little attention in the nursing literature. This study aimed to understand lung cancer patients' beliefs about CAM use in promoting their own wellness.

METHOD

An interpretive qualitative design guided the study. Semi-structured interviews were conducted with 12 adult lung cancer outpatients who used CAM. An inductive approach to analysis was taken; this included immersion in the data, open coding, categorization of similar codes, and identification of emerging patterns and themes.

RESULTS

The patients' beliefs about CAM use in promoting their own wellness were the result of an ongoing adaptive process of belief modification and reformation/transformation that began with their cancer diagnosis. This evolution of patient beliefs comprised four main themes: processing the initial upheaval of beliefs into a life change; developing beliefs that motivated CAM use; validating their new beliefs; and synthesizing these experiences and belief changes into a personal philosophy/meaning of "wellness with cancer."

CONCLUSIONS

CAM, as a strategy to promote wellness, played an integral role in the experience of wellness with cancer. Patients' experiences with CAM were governed by their underlying beliefs; thus, clinicians should consider their patient's beliefs when discussing CAM strategies. Given the importance of recommendations health professionals should also offer guidance and open discussion of CAM with patients and tailor CAM to their needs.

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

BACKGROUND

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

OBJECTIVE

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

INCLUSION CRITERIA

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

SEARCH STRATEGY

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

METHODOLOGICAL QUALITY

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

DATA COLLECTION

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

DATA SYNTHESIS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATION FOR PRACTICE

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

IMPLICATIONS FOR RESEARCH

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

Lung cancer stigma, depression, and quality of life among ever and never smokers

PURPOSE

In 2010, lung cancer is expected to be the leading cause of cancer death in both men and women. Because survival rates are increasing, an evaluation of the effects of treatment on quality of life (QOL) is an important outcome measure. In other diseases, stigma is known to have a negative impact on health status and QOL and be amenable to intervention. This is the first study to compare levels of lung cancer stigma (LCS) and relationships between LCS, depression, and QOL in ever and never smokers.

METHOD

A total of 192 participants with a self-report diagnosis of lung cancer completed questionnaires online.

RESULTS

Strong associations in the expected directions, were found between LCS and depression (r = 0.68, p < 0.001) and QOL (r = -0.65, p < 0.001). No significant differences were found in demographic characteristics or study variables between ever smokers and never smokers. A simultaneous multiple regression with 5 independent variables revealed an overall model that explained 62.5% of the total variance of QOL (F5,168 = 56.015, P < 0.001).

CONCLUSIONS

After removing age, gender, and smoking status, depression explained 22.5% of the total variance of QOL (F4,168 = 100.661, p < 0.001). It is expected that depression and LCS would share some of the explanation of the variance of QOL, the correlation between LCS and depression is 0.629 (p < 0.001), however, LCS provides a unique and significant explanation of the variance of QOL over and above that of depression, age, gender, and smoking status, by 2.1% (p < 0.001).

Experiences of self-blame and stigmatisation for self-infliction among individuals living with COPD

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major health problem estimated to become the third leading cause of death and the fifth leading cause of disability by 2020. Tobacco control is the most effective protective intervention, and it serves as a key element in patient counselling. However, a focus on tobacco control may cause unintended and adverse effects to individuals who already suffer from the disease.

AIM

The current study aims to understand how patients with COPD experience daily life in a society with heavy emphasis on tobacco control.

METHOD

The design was longitudinal and descriptive. The sample included thirteen men and five women with COPD, recruited from pulmonary rehabilitation units. Data were collected by means of qualitative interviews and analysed using qualitative content analysis with search for meanings.

FINDINGS

The main theme was a feeling of being exiled in the world of the healthy, because of self-blame and society's stigmatisation of COPD as a self-inflicted disease. The participants experienced feelings of disgrace through subtle blame and a lack of support from their social network, health care encounters and larger society. This seemed to increase illness-related strain and a need for defensive actions.

LIMITATIONS

A small convenience sample, local cultural influence, the study's wide scope and lack of health professionals' views must be considered.

CONCLUSION

This study illuminates the challenge of how to combine health advice on smoking cessation with nonblaming psycho-social support throughout the course of COPD. An awareness of the potential for stigma, the nature of nicotine dependence and broadened causal explanations for the disease may improve the ability of caregivers to address patient strain and its negative association with coping and well-being. Dilemmas in health communication concerning COPD patients' experience of stigma and negative emotional response should be further explored.

Perceived health in lung cancer patients: the role of positive and negative affect

PURPOSE

To examine the association of affective experience and health-related quality of life in lung cancer patients, we hypothesized that negative affect would be positively, and positive affect would be negatively, associated with perceived health.

METHODS

A sample of 133 English-speaking lung cancer patients (33% female; mean age = 63.68 years old, SD = 9.37) completed a battery of self-report surveys.

RESULTS

Results of our secondary analysis indicate that trait negative affect was significantly associated with poor physical and social functioning, greater role limitations due to emotional problems, greater bodily pain, and poor general health. Positive affect was significantly associated with adaptive social functioning, fewer emotion-based role limitations, and less severe bodily pain. In a full model, positive affect was significantly associated with greater levels of social functioning and general health, over and above the effects of negative affect.

CONCLUSIONS

Reduction of negative affect is an important therapeutic goal, but the ability to maintain positive affect may result in greater perceived health. Indeed, engagement in behaviors that result in greater state positive affect may, over time, result in dispositional changes and enhancement of quality of life.

Measuring stigma in people with lung cancer: psychometric testing of the cataldo lung cancer stigma scale

PURPOSE/OBJECTIVES

to develop an instrument to measure the stigma perceived by people with lung cancer based on the HIV Stigma Scale.

DESIGN

psychometric analysis.

SETTING

online survey.

SAMPLE

186 patients with lung cancer.

METHODS

an exploratory factor analysis with a common factor model using alpha factor extraction.

MAIN RESEARCH VARIABLES

lung cancer stigma, depression, and quality of life.

FINDINGS

four factors emerged: stigma and shame, social isolation, discrimination, and smoking. Inspection of unrotated first-factor loadings showed support for a general stigma factor. Construct validity was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas ranging from 0.75-0.97 for the subscales (0.96 for stigma and shame, 0.97 for social isolation, 0.9 for discrimination, and 0.75 for smoking) and 0.98 for the 43-item Cataldo Lung Cancer Stigma Scale (CLCSS) provided evidence of reliability. The final version of the CLCSS was 31 items. Coefficient alpha was recalculated for the total stigma scale (0.96) and the four subscales (0.97 for stigma and shame, 0.96 for social isolation, 0.92 for discrimination, and 0.75 for smoking).

CONCLUSIONS

the CLCSS is a reliable and valid measure of health-related stigma in this sample of people with lung cancer.

IMPLICATIONS FOR NURSING

the CLCSS can be used to identify the presence and impact of lung cancer stigma and allow for the development of effective stigma interventions for patients with lung cancer.

Palliative care in lung cancer

Advancements in the surgical and medical treatment of lung cancer have resulted in more favorable short-term survival outcomes. After initial treatment, lung cancer requires continued surveillance and follow-up for long-term side effects and possible recurrence. The integration of quality palliative care into routine clinical care of patients with lung cancer after surgical intervention is essential in preserving function and optimizing quality of life through survivorship. An interdisciplinary palliative care model can effectively link patients to the appropriate supportive care services in a timely fashion. This article describes the role of palliative care for patients with lung cancer.

Measuring stigma in people with lung cancer: psychometric testing of the cataldo lung cancer stigma scale

PURPOSE/OBJECTIVES

to develop an instrument to measure the stigma perceived by people with lung cancer based on the HIV Stigma Scale.

DESIGN

psychometric analysis.

SETTING

online survey.

SAMPLE

186 patients with lung cancer.

METHODS

an exploratory factor analysis with a common factor model using alpha factor extraction.

MAIN RESEARCH VARIABLES

lung cancer stigma, depression, and quality of life.

FINDINGS

four factors emerged: stigma and shame, social isolation, discrimination, and smoking. Inspection of unrotated first-factor loadings showed support for a general stigma factor. Construct validity was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas ranging from 0.75-0.97 for the subscales (0.96 for stigma and shame, 0.97 for social isolation, 0.9 for discrimination, and 0.75 for smoking) and 0.98 for the 43-item Cataldo Lung Cancer Stigma Scale (CLCSS) provided evidence of reliability. The final version of the CLCSS was 31 items. Coefficient alpha was recalculated for the total stigma scale (0.96) and the four subscales (0.97 for stigma and shame, 0.96 for social isolation, 0.92 for discrimination, and 0.75 for smoking).

CONCLUSIONS

the CLCSS is a reliable and valid measure of health-related stigma in this sample of people with lung cancer.

IMPLICATIONS FOR NURSING

the CLCSS can be used to identify the presence and impact of lung cancer stigma and allow for the development of effective stigma interventions for patients with lung cancer.

The meaning and significance of routine follow-up in lung cancer - a qualitative study of patients' experiences and interpretations

PURPOSE

Questions have been raised about the benefits of routine follow-up for patients with lung cancer and a number of studies have now explored alternative models of care for this patient group. This study explores the experiences of lung cancer patients attending routine follow-up and illustrates factors which might influence patients' interpretations of the meaning and significance of follow-up.

METHOD

This qualitative study was undertaken to gain insight into patients' experiences of attending routine follow-up clinics after treatment completion. A purposive sample of ten patients was interviewed, including patients of both genders, different lung cancer types, treatment intent, treatment received, performance status and experience of follow-up.

RESULTS

Analysis of the transcripts revealed patients' confidence and faith in their consultants and the importance of having a connection with the oncology department. The meaning and significance of follow-up is constructed by what they bring to the consultation (anxiety, vulnerability, uncertainty, symptoms) as well as what happens within that consultation (reassurance, relief, encouragement). Although some participants were anxious about attending, all express expectation and desire for follow-up to continue. Many were, however, prepared to consider nurse-led follow-up.

CONCLUSION

Although small, this study highlights the significance that patients with lung cancer attach to attending follow-up clinics and the need to consider patients' experiences in the design of future follow-up care and also consideration should be given to complementary and innovative approaches to follow-up.

Assessment of symptom control in patients with cancer in Northwestern Turkey

AIM

The main purpose of this cross-sectional study was to compare symptoms occurring before and after chemotherapy treatment and to investigate the factors affecting those symptoms. The secondary purpose was to determine the most commonly occurring symptoms experienced by the patients with cancer after chemotherapy.

METHODS

Fifty inpatients and outpatients receiving chemotherapy for the first time with various cancer diagnoses and hospitalized in the oncology unit of Trakya University Medical Faculty Hospital between July 2006 and April 2007 were attended to the study. Data were collected using the Edmonton Symptom Assessment Scale (ESAS).

RESULTS

It was discovered that symptoms of fatigue, nausea, loss of appetite, impaired sense of well-being, changes in skin and nails, stomatitis and numbness in hands among chemotherapy patients increased by a statistically significant margin after treatment (p<0.05). Post-chemotherapy symptoms increased markedly (p<0.05) among patients within groups determined by age, gender, marital status, stage of cancer and date of diagnosis. Cross-group comparisons of post-chemotherapy participants analyzed in terms of marital status, clinical stage of disease, and date of diagnosis revealed that fewer symptoms (drowsiness and shortness of breath) increased compared to other symptoms measured along with treatment (p<0.05).

CONCLUSION

We conclude that by considering personal characteristic (i.e. age, gender, etc.) as well as disease-related characteristics (i.e. clinical stage of the disease, etc.), individual nursing care might significantly contribute to the alleviation and management of symptoms.

Smoking cessation: an integral part of lung cancer treatment

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

OBJECTIVE

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

RESULTS

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

CONCLUSION

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

Effects of coaching patients with lung cancer to report cancer pain

The authors have examined the effects of coaching sensory self-monitoring and reporting on pain-related variables in patients with lung cancer. Randomly assigned to coached or not-coached groups, 215 patients have their interactions with their providers audiotaped and complete study measures pre- and postintervention. Of the 151 patients who complete the 4-week study, those coached are more likely than those not coached to give their providers unsolicited sensory pain information and to mention it before their providers ask for it. The mean number of pain parameters discussed during the audiotaped clinic visit is statistically larger at study end for the coached group. Scores for analgesic adequacy, all pain indices except one, anxiety, depression, and catastrophizing coping are not significantly different. Although coaching increases the amount of pain data communicated to providers by patients with lung cancer, the magnitude is small and does not lead to improved adequacy of analgesics prescribed for each patient's pain level.

Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy

The diagnosis of lung cancer in the advanced stage of illness, the poor prognosis associated with the disease, and the side effects of chemotherapy all have an impact on various dimensions of quality of life (QoL).

THE PURPOSE OF THE RESEARCH

The current study was designed to describe the QoL and symptom distress of lung cancer patients undergoing chemotherapy and to explore the relationships between demographic/treatment-related characteristics and QoL.

METHODS AND SAMPLE

The sample consisted of 154 lung cancer patients undergoing chemotherapy. The symptom experiences and QoL of lung cancer patients undergoing chemotherapy were evaluated using the Memorial Symptom Assessment Scale and Quality of Life Index - Cancer Version.

RESULTS

The lung cancer patients had low QoL scores. The scores on the Health and Functioning subscale were the lowest (20.33 ± 5.59), while those of the Family subscale were the highest (27.66 ± 2.77). The most common physical symptoms experienced by lung cancer patients were lack of energy, coughing, pain, lack of appetite, and nausea, while the psychological symptoms were feeling nervous, difficulty sleeping, feeling sad, and worrying. There was a negative relationship between the symptom distress and quality of life scores (r=-0.45; p<0.000). Females and those with low income levels and performance status experienced greater symptom distress.

CONCLUSIONS

Lung cancer patients receiving chemotherapy suffer many limitations due to the symptoms and disruptions to their QoL, arising from both the disease process and its treatment. Lung cancer patients need to be assessed regularly and supported.

Predictive factors in the quality of life of cancer inpatients

The purpose of the study was to determine whether sense of coherence (SOC), and demographic variables (age, gender, race, education, length of illness) predict quality of life (QOL) in cancer inpatients. SOC is the extent to which one finds life comprehensible, manageable, and meaningful. Participants were 49 inpatients (66% female) with various forms of cancer, mostly African American (71%), with a mean age of 54.5 years. The mean QOLS of cancer inpatients (84.6) was lower than a healthy population (90.0), however, their mean item scores indicated that they are mostly satisfied with most areas of QOL except for active forms of past-time and health. The mean SOC score (133.8) was also lower than other groups; however without appropriate norms, it cannot be concluded that cancer inpatients have a weak SOC. Multiple regressions showed that SOC was a significant predictor of QOL, and that the demographic variables were not predictive of QOL, except when combined with SOC. All findings may be limited by demographics of the sample (race, gender, age, severity of illness), and the inability of cross-sectional investigations to determine causality.

Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent

BACKGROUND

Although it is recommended that smokers undergoing surgery for lung cancer quit smoking to reduce post-operative complications, few studies have examined patterns of smoking in the peri-operative period. The goals of this study were to determine: (1) patterns of smoking during post-operative recovery, (2) types of cessation strategies used to quit smoking, and (3) factors related to smoking after lung cancer surgery.

METHODS

Data were collected from 94 patients through chart review, tobacco, health status, and symptom questionnaires at 1, 2, and 4 months after surgery. Smoking status was assessed through self-report and urinary cotinine measurement.

RESULTS

Eighty-four patients (89%) were ever-smokers and 35 (37%) reported smoking at diagnosis. Thirty-nine (46%) ever-smokers remained abstinent, 13 (16%) continued smoking at all time-points, and 32 (38%) relapsed. Ten (46%) of those who relapsed were former-smokers and had not smoked for at least 1 year. Sixteen (46%) of those who were smoking at diagnosis received cessation assistance with pharmacotherapy being the most common strategy. Factors associated with smoking during recovery were younger age and quitting smoking < or =6 months before the diagnosis of lung cancer. Factors that were marginally significant were lower educational level, male gender, lower number of comorbidities, and the presence of pain.

CONCLUSION

Only half of those who were smoking received assistance to quit prior to surgery. Some patients were unable to quit and relapse rates post-surgery were high even among those who quit more than 1 year prior. Innovative programs incorporating symptom management and relapse prevention may enhance smoking abstinence during post-operative care.