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Lee G, Ahn A, Lee D, Kim TE, Kong S, Kang D, Kim HK, Shim YM, Cho J. Lung cancer-specific symptoms and fear of cancer recurrence among recurrence-free non-small cell lung cancer survivors. Support Care Cancer 2024; 32:322. [PMID: 38695959 DOI: 10.1007/s00520-024-08505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Lung cancer survivors have more psychosocial problems, including depression and anxiety disorder, than other cancer survivors. Lung cancer-specific symptoms, such as cough, dyspnea, or pain in chest, might increase FCR among survivors. We aimed to evaluate the association between lung cancer-specific symptoms and FCR among recurrence-free non-small cell lung cancer (NSCLC) survivors. METHODS This is a cross-sectional study. Recurrence-free NSCLC survivors were recruited from January to October 2020 at a tertiary hospital in Seoul, Korea. We measured FCR using the Korean version of FCRI-SF and categorized them into three groups: non-clinical FCR (nFCR, < 13), subclinical FCR (sFCR, 13 to 21), and clinical FCR (cFCR, ≥ 22). Lung cancer-specific symptoms were measured using the Korean version of EORTC QLQ-LC13 and EORTC QLQ-C30. RESULTS A total of 727 survivors were enrolled. One-third (30.8%) of survivors reported sFCR, and 19.7% had cFCR. In a multivariate analysis, survivors with severe pain in chest were 4.7 times (95% CI: 2.4-9.0) more likely to experience cFCR compared to those without it. Mild dyspnea (OR 1.7, 95% CI: 1.1-2.7) and mild dysphagia (OR 2.4, 95% CI: 1.3-4.4) were associated with cFCR. Survivors with sFCR (Coef. - 6.3, 95% CI: - 9.8, - 2.8) and cFCR (Coef. - 11.3, 95% CI: - 15.5, - 7.2) had poorer quality of life compared to survivors with nFCR. CONCLUSION NSCLC survivors were experiencing lung cancer-specific symptoms even a few years after treatment, which were associated with cFCR, resulting in poor HRQoL. It is necessary to develop a lung cancer-specific symptom checklist and use it during even long-term surveillance.
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Affiliation(s)
- Genehee Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, South Korea
| | - Alice Ahn
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, 77341, USA
| | - Dongok Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
| | - Tae Eun Kim
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
| | - Sunga Kong
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, South Korea
| | - Danbee Kang
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, 06351, South Korea
| | - Hong Kwan Kim
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Young Mog Shim
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Juhee Cho
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, 06351, South Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, South Korea.
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, 06351, South Korea.
- Departments of Health, Behavior, and Society and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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Wang XQ, Qiao Y, Duan PB, Du SZ, Yang LH. Efficacy and safety of moxibustion on cancer-related fatigue: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:508. [PMID: 37548752 DOI: 10.1007/s00520-023-07977-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The goal of this research was to review the literature from randomized controlled trials (RCTs) on the impacts of moxibustion on cancer-related fatigue (CRF) as well as provide credible evidence to guide clinical practice. METHODS Three English electronic medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials on the effect of moxibustion on CRF were included in this systematic review. Study selection, data extraction, and validation were all carried out independently by two reviewers. The revised Cochrane Risk of Bias tool was used to assess the quality of the RCTs (RoB 2.0). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to assess effect sizes in individual RCTs and pooled effect sizes in meta-analyses. Data were meta-analyzed using Stata (version 14.0). RESULTS In a random-effects meta-analysis of 24 RCTs with 1894 participants, the aggregated standardized mean difference (SMD) revealed a statistically significant association between moxibustion and alleviation from cancer-related fatigue (SMD = - 1.66, 95% CI = - 2.05, - 1.28, p = 0.000). Pooled results, however, show significant heterogeneity (I2 = 92.5%), and the evidence is insufficient to determine whether this association varies systematically by measuring tools and moxibustion modalities. Furthermore, evidence ranging from very low to low showed that moxibustion had an immediate positive effect on patients with CRF. CONCLUSION Moxibustion may have a therapeutic effect on cancer-related fatigue. However, further large-scale, multicenter, high-quality RCTs on moxibustion for fatigue relief and safety are still needed because of the handful of studies included and the low methodological quality.
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Affiliation(s)
- Xiao-Qing Wang
- Surgical Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, China
| | - Yue Qiao
- Surgical Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, China
| | - Pei-Bei Duan
- Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, China.
| | - Shi-Zheng Du
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, 210046, Jiangsu, China
| | - Li-Hua Yang
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, 210029, Jiangsu, China
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Kim JY, Shin YK, Seol GH. Incidence and risk factors for pressure injury in hospitalized non-small cell lung cancer patients: A retrospective observational study. J Tissue Viability 2023:S0965-206X(23)00065-7. [PMID: 37263818 DOI: 10.1016/j.jtv.2023.05.008] [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: 01/02/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Abstract
AIM This study aimed to identify the incidence and risk factors for pressure injury in patients hospitalized for non-small cell lung cancer (NSCLC). METHODS This retrospective observational study was conducted in 645 adults who were hospitalized for NSCLC. Clinicopathological characteristics were compared between NSCLC patients with pressure injury and those without pressure injury. RESULTS Among total 645 patients, 180 patients showed pressure injury with an incidence of 27.9%. Patients with pressure injury showed increased serum C-reactive protein (CRP) levels (P < 0.001), increased neutrophil-lymphocyte ratio (P = 0.002), and increased platelet-lymphocyte ratio (P = 0.001) more often. Increase in serum CRP levels at the time of admission was the major risk factor for development of pressure injury in NSCLC patients (OR = 2.20; 95% CI [1.40-3.45]; P = 0.001). Also, among major inflammatory markers, serum CRP levels at the time of admission showed weak negative correlation with the period from admission to the development of pressure injury (r = -0.216, P = 0.004). CONCLUSION By checking serum CRP levels at the time of admission, the NSCLC patients at high risk for the development of pressure injury can be identified in advance and the occurrence of pressure injury can be reduced by applying more active preventive nursing care. CLINICAL TRIAL REGISTRATION NUMBER KCT0006570.
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Affiliation(s)
- Jae-Yeon Kim
- Department of Basic Nursing Science, School of Nursing, Korea University, Seoul, Republic of Korea
| | - You Kyoung Shin
- Department of Basic Nursing Science, School of Nursing, Korea University, Seoul, Republic of Korea
| | - Geun Hee Seol
- Department of Basic Nursing Science, School of Nursing, Korea University, Seoul, Republic of Korea; BK21 FOUR Program of Transdisciplinary Major in Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea.
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Sullivan DR, Iyer AS, Enguidanos S, Cox CE, Farquhar M, Janssen DJA, Lindell KO, Mularski RA, Smallwood N, Turnbull AE, Wilkinson AM, Courtright KR, Maddocks M, McPherson ML, Thornton JD, Campbell ML, Fasolino TK, Fogelman PM, Gershon L, Gershon T, Hartog C, Luther J, Meier DE, Nelson JE, Rabinowitz E, Rushton CH, Sloan DH, Kross EK, Reinke LF. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement. Am J Respir Crit Care Med 2022; 206:e44-e69. [PMID: 36112774 PMCID: PMC9799127 DOI: 10.1164/rccm.202207-1262st] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.
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Hassett MJ, Wong S, Osarogiagbon RU, Bian J, Dizon DS, Jenkins HH, Uno H, Cronin C, Schrag D. Implementation of patient-reported outcomes for symptom management in oncology practice through the SIMPRO research consortium: a protocol for a pragmatic type II hybrid effectiveness-implementation multi-center cluster-randomized stepped wedge trial. Trials 2022; 23:506. [PMID: 35710449 PMCID: PMC9202326 DOI: 10.1186/s13063-022-06435-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many cancer patients experience high symptom burden. Healthcare in the USA is reactive, not proactive, and doctor-patient communication is often suboptimal. As a result, symptomatic patients may suffer between clinic visits. In research settings, systematic assessment of electronic patient-reported outcomes (ePROs), coupled with clinical responses to severe symptoms, has eased this symptom burden, improved health-related quality of life, reduced acute care needs, and extended survival. Implementing ePRO-based symptom management programs in routine care is challenging. To study methods to overcome the implementation gap and improve symptom control for cancer patients, the National Cancer Institute created the Cancer-Moonshot funded Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS Symptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) is one of three research centers that make up the IMPACT Consortium. SIMPRO, a multi-disciplinary team of investigators from six US health systems, seeks to develop, test, and integrate an electronic symptom management program (eSyM) for medical oncology and surgery patients into the Epic electronic health record (EHR) system and associated patient portal. eSyM supports real-time symptom tracking for patients, automated clinician alerts for severe symptoms, and specialized reports to facilitate population management. To rigorously evaluate its impact, eSyM is deployed through a pragmatic stepped wedge cluster-randomized trial. The primary study outcome is the occurrence of an emergency department treat-and-release event within 30 days of starting chemotherapy or being discharged following surgery. Secondary outcomes include hospitalization rates, chemotherapy use (time to initiation and duration of therapy), and patient quality of life and satisfaction. As a type II hybrid effectiveness-implementation study, facilitators and barriers to implementation are assessed throughout the project. DISCUSSION Creating and deploying eSyM requires collaboration between dozens of staff across diverse health systems, dedicated engagement of patient advocates, and robust support from Epic. This trial will evaluate eSyM in routine care settings across academic and community-based healthcare systems serving patients in rural and metropolitan locations. This trial's pragmatic design will promote generalizable results about the uptake, acceptability, and impact of an EHR-integrated, ePRO-based symptom management program. TRIAL REGISTRATION ClinicalTrials.gov NCT03850912 . Registered on February 22, 2019. Last updated on November 9, 2021.
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Affiliation(s)
- Michael J Hassett
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Sandra Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Don S Dizon
- Lifespan Cancer Institute and Brown University, Providence, RI, USA
| | | | - Hajime Uno
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christine Cronin
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Lung cancer remains a leading cause of cancer related mortality worldwide. Despite numerous advances in treatments over the past decade, non-small cell lung cancer (NSCLC) remains an incurable disease for most patients. The optimal treatment for all patients with locally advanced, but surgically resectable, NSCLC contains at least chemoradiation. Trimodality treatment with surgical resection has been a subject of debate for decades. For patients with unresectable or inoperable locally advanced disease, the incorporation of immunotherapy consolidation after chemoradiation has defined a new standard of care. For decades, the standard of care treatment for advanced stage NSCLC included only cytotoxic chemotherapy. However, with the introduction of targeted therapies and immunotherapy, the landscape of treatment has rapidly evolved. This review discusses the integration of these innovative therapies in the management of patients with newly diagnosed NSCLC.
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Affiliation(s)
- Meagan Miller
- Indiana University School of Medicine, Indianapolis, IN 46208, USA
| | - Nasser Hanna
- Indiana University School of Medicine, Indianapolis, IN 46208, USA
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Prasetya RA, Metselaar-Albers M, Engels F. Concomitant use of analgesics and immune checkpoint inhibitors in non-small cell lung cancer: A pharmacodynamics perspective. Eur J Pharmacol 2021; 906:174284. [PMID: 34174268 DOI: 10.1016/j.ejphar.2021.174284] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/20/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022]
Abstract
The invention of immunotherapy, such as immune checkpoint inhibitors (ICIs) for advanced-stage non-small cell lung cancer (NSCLC), has become a new standard of care for a defined group of NSCLC patients. However, the possible impacts of ICI interactions with analgesics for alleviating cancer-related pain are unclear and lack clinical evidence. Many studies have indicated that opioids detrimentally affect the immune system, possibly harming patients of ongoing immunotherapy. Opioids may repress the immune system in various ways, including impairing T cell function, upregulating immunosuppressor Treg cells, and interrupting intestinal microflora composition that disrupts the entire immune system. Furthermore, opioids can influence tumor progression and metastasis directly as opioid receptors are overexpressed in several types of NSCLC. In contrast, another analgesic acting on cyclooxygenase (COX) inhibition (i.e., NSAIDs) may be a candidate for adjuvant therapy since COX-2 is also expressed in the tumor cells of NSCLC patients. In addition, COX-2 is associated with tumor proliferation and metastasis. Therefore, both prospective and retrospective studies should confirm the advantages and disadvantages of the concurrent use of analgesics and ICIs in a clinical setting.
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Affiliation(s)
- Rahmad Aji Prasetya
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Clinical Pharmacy, Akademi Farmasi Surabaya, Surabaya, Indonesia.
| | - Marjolein Metselaar-Albers
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ferdi Engels
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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8
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Frass M, Lechleitner P, Gründling C, Pirker C, Grasmuk‐Siegl E, Domayer J, Hochmair M, Gaertner K, Duscheck C, Muchitsch I, Marosi C, Schumacher M, Zöchbauer‐Müller S, Manchanda RK, Schrott A, Burghuber O. Homeopathic Treatment as an Add-On Therapy May Improve Quality of Life and Prolong Survival in Patients with Non-Small Cell Lung Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blind, Three-Arm, Multicenter Study. Oncologist 2020; 25:e1930-e1955. [PMID: 33010094 PMCID: PMC8108047 DOI: 10.1002/onco.13548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023] Open
Abstract
LESSONS LEARNED Conventional medicine and homeopathy work well together. Quality of life improves with additive homeopathy in patients with non-small cell lung cancer (NSCLC). Survival improves with additive homeopathy in patients with NSCLC. BACKGROUND Patients with advanced non-small cell lung cancer (NSCLC) have limited treatment options. Alongside conventional anticancer treatment, additive homeopathy might help to alleviate side effects of conventional therapy. The aim of the present study was to investigate whether additive homeopathy might influence quality of life (QoL) and survival in patients with NSCLC. METHODS In this prospective, randomized, placebo-controlled, double-blind, three-arm, multicenter, phase III study, we evaluated the possible effects of additive homeopathic treatment compared with placebo in patients with stage IV NSCLC, with respect to QoL in the two randomized groups and survival time in all three groups. Treated patients visited the outpatients' centers every 9 weeks: 150 patients with stage IV NSCLC were included in the study; 98 received either individualized homeopathic remedies (n = 51) or placebo (n = 47) in a double-blinded fashion; and 52 control patients without any homeopathic treatment were observed for survival only. The constituents of the different homeopathic remedies were mainly of plant, mineral, or animal origin. The remedies were manufactured by stepwise dilution and succussion, thereby preparing stable Good Manufacturing Practice grade formulations. RESULTS QoL as well as functional and symptom scales showed significant improvement in the homeopathy group when compared with placebo after 9 and 18 weeks of homeopathic treatment (p < .001). Median survival time was significantly longer in the homeopathy group (435 days) versus placebo (257 days; p = .010) as well as versus control (228 days; p < .001). Survival rate in the homeopathy group differed significantly from placebo (p = .020) and from control (p < .001). CONCLUSION QoL improved significantly in the homeopathy group compared with placebo. In addition, survival was significantly longer in the homeopathy group versus placebo and control. A higher QoL might have contributed to the prolonged survival. The study suggests that homeopathy positively influences not only QoL but also survival. Further studies including other tumor entities are warranted.
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Affiliation(s)
- Michael Frass
- Medical University of Vienna, Department of Medicine I, Clinical Division of Oncology and Institute for Homeopathic ResearchViennaAustria
- Scientific Society for Homeopathy (WissHom)KoethenGermany
| | | | | | - Claudia Pirker
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Erwin Grasmuk‐Siegl
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Julian Domayer
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | | | - Cornelia Duscheck
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | - Ilse Muchitsch
- Austrian Chamber of Pharmacists, Department Vienna, HomResearch, Interdisciplinary Homeopathic Research GroupViennaAustria
| | - Christine Marosi
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | | | - Sabine Zöchbauer‐Müller
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | - Raj K. Manchanda
- Central Council for Research in Homeopathy, Ministry of AYUSH, Government of India and LMHI, West DelhiDelhiIndia
| | - Andrea Schrott
- StatistikAmbulanz, Consulting Company, LeobendorfAustria
| | - Otto Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for Lung Health, Otto Wagner Hospital and Sigmund Freud University, Medical SchoolViennaAustria
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Assessment of the psychosocial and economic impact according to sex in non-small cell lung cancer patients: an exploratory longitudinal study. BMC Psychol 2020; 8:123. [PMID: 33228796 PMCID: PMC7685640 DOI: 10.1186/s40359-020-00489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Little is known about the impact of sex on lung cancer patients from the psychological, economic and social perspectives. This study was designed to explore the psychosocial and economic impact according to sex of metastatic non-small cell lung cancer (mNSCLC) in patients and caregivers. Methods Exploratory study of two cohorts of patients starting first-line treatment for mNSCLC. The following questionnaires were administered at baseline, 4 months later and following the first and second disease progression: APGAR, relationship impact scale, DUKE-UNC scale, economic impact in patients and caregiver, and Zarit scale. It was planned to include 1250 patients to get an 80% possibility of detecting as significant (p < 0.05) effect sizes less than 0.19 between men and women. Univariate comparisons were made between the tests applied to men and women. Overall survival was estimated with Kaplan–Meier method. Cox analyses were done to estimate hazard ratios (HRs) with 95% CI. Results 333 patients were included. Most families reported to continue being functional despite the lung cancer diagnosis. Regardless of sex, they did not perceive changes in their partner relationship. Most patients felt their social support was normal. Roughly 25% of people reported a worsening in their economic situation, without remarkable differences by sex. Statistically significant differences were found between both groups regarding the caregiver’s relationship to the patient (more parents were the caregiver in females than in males, p < 0.0001) and the caregiver’s employment situation (more employed caregivers in females) (p < 0.0001). Most caregivers of both sexes considered that taking care of their relative did not pose a significant burden.
Conclusions This study provides a preliminary insight into sex-related characteristics in the management of advanced NSCLC and its impact on the emotional, social and economic burden of patients and their caregivers, and recall the high priority of researching in cancer from a sex perspective. Nevertheless, due to the low recruitment rate and the relevant loss of patients during the follow-up, it was difficult to find differences by sex.
Trial registration ClinicalTrials.gov identifier: NCT02336061. Ethics committee Comité Ético de Investigación Clínica del Hospital Clínic de Barcelona, Spain. Reference number: HCB/2014/0705.
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Lestuzzi C, Annunziata MA, Nohria A, Muzzatti B, Bisceglia I, Ewer MS. Cancer patients in cardiology: how to communicate with patients with special psychological needs and manage their cardiac problems in daily clinical practice. J Cardiovasc Med (Hagerstown) 2020; 21:286-291. [PMID: 31977538 DOI: 10.2459/jcm.0000000000000936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Cancer patients are increasingly referred for cardiology evaluations. These patients differ from those routinely seen in cardiology clinics because of their psychological burden and because the therapies and cancer itself can cause cardiac symptoms. A humane approach is critical to managing these patients. Cardiologists may see patients who are newly diagnosed with cancer or are in various phases of treatment; these patients may or may not have preexisting cardiac disease, and may develop cardiotoxicity from chemoimmunotherapy or radiotherapy. Each of these situations presents unique communication challenges for cardiologists. Although some oncology centers provide training in communication skills for their personnel, including cardiologists, this training is not widely available to physicians in general hospitals or private practice. This article examines the psychological aspects of cardio-oncology. It offers practical suggestions on how to best communicate with cancer patients in different phases of oncology care, and discusses when professional psychological help is needed.
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Affiliation(s)
- Chiara Lestuzzi
- Cardiology and Cardio-Oncology Rehabilitation Unit, Cardiology Department, AAS5
| | | | - Anju Nohria
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital.,Cardio-Oncology Program, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Barbara Muzzatti
- Psychology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Irma Bisceglia
- Cardiovascular Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Michael S Ewer
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chiang KY, Ho JCM, Chong P, Tam TCC, Lam DCL, Ip MSM, Lee YCG, Lui MMS. Role of early definitive management for newly diagnosed malignant pleural effusion related to lung cancer. Respirology 2020; 25:1167-1173. [PMID: 32249488 DOI: 10.1111/resp.13812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The advent of effective anti-cancer therapy has brought about uncertainty on the benefit of early definitive measures for newly diagnosed MPE from lung cancer. This study aims to investigate the outcomes of MPE in this setting. METHODS Lung cancer patients with MPE at first presentation to a tertiary care hospital were followed up till death or censored from 2011 to 2018. Early MPE control measures included chemical pleurodesis or IPC before or shortly after oncological treatment. Predictors of time to MPE re-intervention were identified with Cox proportional hazard analyses. RESULTS Of the 509 records screened, 233 subjects were eligible. One hundred and twenty-seven subjects received oral targeted therapy as first-line treatment and 34 (26.8%) underwent early definitive MPE control measures. Early MPE control measures in addition to targeted therapy, as compared to targeted therapy alone, significantly reduced the subsequent need of MPE re-intervention (23.5% vs 53.8%, P = 0.002). Similar benefits from MPE control measures were found in groups receiving systemic anti-cancer therapy or best supportive care (0% vs 52%, P = 0.003; 18% vs 56.7%, P = 0.024, respectively). In the group with targetable mutations, both early MPE control measures (HR: 0.25, 95% CI: 0.12-0.53, P < 0.001) and the use of targeted therapy (HR: 0.22, 95% CI: 0.10-0.46, P < 0.001) were independently associated with longer time to MPE re-interventions. CONCLUSION Early MPE control measures in lung cancer has additional benefits on reducing the need and prolonging the time to MPE re-intervention, independent of anti-cancer therapies.
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Affiliation(s)
- Ka-Yan Chiang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - James Chung-Man Ho
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Peony Chong
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Terence Chi-Chun Tam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - David Chi-Leung Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Mary Sau-Man Ip
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Yun-Chor Gary Lee
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Macy Mei-Sze Lui
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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12
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Smith TG, Troeschel AN, Castro KM, Arora NK, Stein K, Lipscomb J, Brawley OW, McCabe RM, Clauser SB, Ward E. Perceptions of Patients With Breast and Colon Cancer of the Management of Cancer-Related Pain, Fatigue, and Emotional Distress in Community Oncology. J Clin Oncol 2019; 37:1666-1676. [PMID: 31100037 PMCID: PMC6804889 DOI: 10.1200/jco.18.01579] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Pain, fatigue, and distress are common among patients with cancer but are often underassessed and undertreated. We examine the prevalence of pain, fatigue, and emotional distress among patients with cancer, as well as patient perceptions of the symptom care they received. PATIENTS AND METHODS Seventeen Commission on Cancer-accredited cancer centers across the United States sampled patients with local/regional breast (82%) or colon (18%) cancer. We received 2,487 completed surveys (61% response rate). RESULTS Of patients, 76%, 78%, and 59% reported talking to a clinician about pain, fatigue, and distress, respectively, and 70%, 61%, and 54% reported receiving advice. Sixty-one percent of patients experienced pain, 74% fatigue, and 46% distress. Among those patients experiencing each symptom, 58% reported getting the help they wanted for pain, 40% for fatigue, and 45% for distress. Multilevel logistic regression models revealed that patients experiencing symptoms were significantly more likely to have talked about and received advice on coping with these symptoms. In addition, patients who were receiving or recently completed curative treatment reported more symptoms and better symptom care than did those who were further in time from curative treatment. CONCLUSION In our sample, 30% to 50% of patients with cancer in community cancer centers did not report discussing, getting advice, or receiving desired help for pain, fatigue, or emotional distress. This finding suggests that there is room for improvement in the management of these three common cancer-related symptoms. Higher proportions of talk and advice among those experiencing symptoms imply that many discussions may be patient initiated. Lower rates of talk and advice among those who are further in time from treatment suggest the need for more assessment among longer-term survivors, many of whom continue to experience these symptoms. These findings seem to be especially important given the high prevalence of these symptoms in our sample.
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Affiliation(s)
| | | | | | - Neeraj K. Arora
- Patient‐Centered Outcomes Research Institute, Washington, DC
| | - Kevin Stein
- Emory University, Atlanta, GA
- Cancer Support Community, Washington, DC
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13
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Steffen LE, Cheavens JS, Vowles KE, Gabbard J, Nguyen H, Gan GN, Edelman MJ, Smith BW. Hope-related goal cognitions and daily experiences of fatigue, pain, and functional concern among lung cancer patients. Support Care Cancer 2019; 28:827-835. [PMID: 31152302 DOI: 10.1007/s00520-019-04878-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/16/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. METHODS Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between 2014 and 2015. RESULTS Adjusting for covariates and the previous day's symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. CONCLUSIONS Increases in hope pathways thinking may be associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.
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Affiliation(s)
- Laurie E Steffen
- Social Sciences & Health Policy - PHS, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | | | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Huynh Nguyen
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Gregory N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Bruce W Smith
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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14
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Dómine M, Massuti B, Puente J, Calles A, Esteban E, Triguboff E, Afonzo YS, Gironés R, Aparisi F, Oramas J. Observational Prospective Study to Determine the Evolution of the Symptomatic Profile of Metastatic Non-Small Cell Lung Cancer (NSCLC) Patients and Its Relation to the Control of the Disease. Adv Ther 2019; 36:1497-1508. [PMID: 30963512 DOI: 10.1007/s12325-019-00931-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the evolution of disease-related symptoms and its relationship with the control of the disease in first-line treatment in patients with metastatic non-small cell lung cancer (NSCLC). METHODS This was an observational, prospective, national and multicentre study with two visits in which the following were collected: (1) baseline visit: sociodemographic and clinical variables (2) visit after completing the 4-6 chemotherapy cycles: criteria for ending treatment, control of the disease and clinical variables. Ad hoc questionnaires were collected to assess the frequency of symptoms (evaluated by the patient), and quality-of-life questionnaires to assess the intensity of symptoms (using the Lung Cancer Symptom Scale, LCSS), and interference in the patient's daily life, assessed by the patient and by the investigator. RESULTS A total of 155 patients were included. Patients predominantly described tiredness (24.1%) and pain (23.9%) as the symptoms that appeared "frequently or continuously". A statistically significant decrease in scores for symptoms of cough (15.4 points), dyspnoea (8.5 points), pain (9.5 points) and discomfort related to their illness (9 points) was observed between visits. Patients who achieved a complete or partial response showed a statistically significant reduction in the cough, dyspnoea, pain and disconfort frequency. Regarding the intensity, cough was the only symptom that showed a statistically significant decrease for both the patient and the investigator. Tiredness/asthenia and pain were the symptoms with the greatest interference in daily life at baseline according to the patient; however, according to the investigator, they were mood and quality/quantity of sleep, although none of them were significant. But changes in the score of the interference questionnaire between visits were not statistically significantly related to the control of the disease. However, average score according to both investigator and patients showed a significant correlation with ECOG status. CONCLUSION The first-line treatment of NSCLC is correlated with an improvement in the symptomatic evolution of advanced NSCLC patients. FUNDING Roche.
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Affiliation(s)
- Manuel Dómine
- Hospital Universitario Fundación Jiménez Díaz, IIS- FJD, Madrid, Spain.
| | | | | | - Antonio Calles
- Hospital General Universitario Gregorio Marañón / Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
| | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Juana Oramas
- Hospital Universitario de Canarias, La Laguna, Spain
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15
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Higginson IJ, Hart S, Silber E, Burman R, Edmonds P. Symptom Prevalence and Severity in People Severely Affected by Multiple Sclerosis. J Palliat Care 2019. [DOI: 10.1177/082585970602200306] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim This study sought to assess symptom severity and prevalence in people severely affected by multiple sclerosis (MS). Methods We collected data on symptoms and problems of patients as self-reported to trained interviewers on standardized questionnaires (including the Palliative Outcome Scale MS symptom checklist, POS-MSS). Results 52 patients were included, mean age 53 years; 26 had secondary progressive MS, 23 had primary progressive MS, three had other forms; 32/52 were unable to walk independently. Patients reported a mean of nine (median=8.5, mode=12) symptoms. Six symptoms affected more than 50% of patients: problems using legs, problems using arms, fatigue/lack of energy, spasms, pain, and feeling sleepy. Higher levels of disability were correlated with greater symptom severity for nine symptoms (Spearman rho ranged 0.28–0.56, p<0.05). Conclusion Many symptoms in people severely affected by MS are as highly prevalent and severe as those experienced by patients with advanced cancer. Increased disability is associated with increased severity for some symptoms.
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Affiliation(s)
- Irene J. Higginson
- Department of Palliative Care, Policy and Rehabilitation, Kings’ College London, School of Medicine, London
| | - Sam Hart
- Department of Palliative Care, Policy and Rehabilitation, Kings’ College London, School of Medicine, London
| | - Eli Silber
- Department of Neurology, King's College Hospital, Denmark Hill, London
| | - Rachel Burman
- Department of Palliative Care, Policy and Rehabilitation, Kings’ College London, School of Medicine, London, England, UK
| | - Polly Edmonds
- Department of Palliative Care, Policy and Rehabilitation, Kings’ College London, School of Medicine, London, England, UK
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16
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Bouchard LC, Aaronson N, Gondek K, Cella D. Cancer symptom response as an oncology clinical trial end point. ACTA ACUST UNITED AC 2018; 3:35-46. [PMID: 31020045 DOI: 10.1080/23809000.2018.1483193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction A critical challenge in oncology is interpreting clinical trial results to inform clinical decision making. Clinical trials typically focus on overall survival (OS) and progression-free survival (PFS) as primary endpoints, which do not reflect early signs of meaningful patient benefit or harm. Cancer symptom response (CSR) can provide information about early treatment response, and studies show that CSR predicts long-term health outcomes. Areas covered CSR requires careful consideration of its measurement and interpretation to facilitate integration into clinical practice. We describe considerations for the evaluation, analysis, and interpretation of CSR in clinical trials. To illustrate the potential clinical value of CSR, we performed a retrospective analysis of a three-arm randomized cooperative-group clinical trial. Expert commentary Evaluation of CSR provides a meaningful assessment of early cancer treatment effects. It can act as an early signal of disease progression and death and thus can identify which patients with stable disease will have a more favorable prognosis. Future research will include development of methods for more accurate assessment of CSR, reduction of the number of symptoms used as signals for disease progression or survival by tumor type, and statistical methods that effectively correct for missing data and informative censoring.
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Affiliation(s)
- Laura C Bouchard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Neil Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kathleen Gondek
- Outcomes Research and Epidemiology, Shire Pharmaceuticals, Cambridge, MA USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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17
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Brahmer JR, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, Gottfried M, Peled N, Tafreshi A, Cuffe S, O'Brien M, Rao S, Hotta K, Zhang J, Lubiniecki GM, Deitz AC, Rangwala R, Reck M. Health-related quality-of-life results for pembrolizumab versus chemotherapy in advanced, PD-L1-positive NSCLC (KEYNOTE-024): a multicentre, international, randomised, open-label phase 3 trial. Lancet Oncol 2017; 18:1600-1609. [DOI: 10.1016/s1470-2045(17)30690-3] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/23/2022]
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18
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Thomas M, Spigel DR, Jotte RM, McCleod M, Socinski MA, Page RD, Gressot L, Knoble J, Juan O, Morgensztern D, Isla D, Kim ES, West H, Ko A, Ong TJ, Trunova N, Gridelli C. nab-paclitaxel/carboplatin induction in squamous NSCLC: longitudinal quality of life while on chemotherapy. LUNG CANCER-TARGETS AND THERAPY 2017; 8:207-216. [PMID: 29138610 PMCID: PMC5679693 DOI: 10.2147/lctt.s138570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Longitudinal data on the impact of treatment on quality of life (QoL) in advanced non-small cell lung cancer (NSCLC) are limited. In this palliative setting, treatment that does not deteriorate QoL is key. Here we report longitudinal QoL in patients with squamous NSCLC, receiving ≤4 cycles of nab-paclitaxel/carboplatin combination chemotherapy. Methods Patients received nab-paclitaxel 100 mg/m2 days 1, 8, 15 + carboplatin area under the curve 6 mg•min/mL day 1 (q3w) for four cycles. QoL was assessed by the Lung Cancer Symptom Scale (LCSS) and Euro-QoL-5 Dimensions-5 Levels (EQ-5D-5L) at baseline and each cycle (day 1). Results Two-hundred and six lesion-response-evaluable patients completed baseline + ≥1 postbaseline QoL assessment and were QoL evaluable. LCSS average total score and symptom burden index improved from baseline throughout four cycles. In the LCSS pulmonary symptoms score, 46% of patients reported clinically meaningful improvement (≥10 mm visual analog scale) from baseline. Individual EQ-5D-5L dimensions remained stable/improved in ≥83% of patients; ≈33% reported complete resolution of baseline problems at least once during four cycles. Generally, responders (unconfirmed complete/partial response) had higher scores vs nonresponders. Conclusion In patients with squamous NSCLC, four cycles of nab-paclitaxel/carboplatin demonstrated clinically meaningful QoL improvements, with greater benefits in responders vs nonresponders.
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Affiliation(s)
- Michael Thomas
- Department of Thoracic Oncology/Internal Medicine, Thoraxklinik im Universitätsklinikum Heidelberg.,Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | | | - Robert M Jotte
- Department of Medical Oncology/Hematology, Rocky Mountain Cancer Centers, Denver, CO
| | | | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth
| | | | | | - Oscar Juan
- Department of Medical Oncology, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Daniel Morgensztern
- Department of Medical Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dolores Isla
- Department of Medical Oncology, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Edward S Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Howard West
- Thoracic Oncology Program, Swedish Cancer Institute, Seattle, WA
| | - Amy Ko
- Celgene Corporation, Summit, NJ, USA
| | | | | | - Cesare Gridelli
- Department of Oncology/Hematology, S.G. Moscati Hospital, Avellino, Italy
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19
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Chandrasekar D, Tribett E, Ramchandran K. Integrated Palliative Care and Oncologic Care in Non-Small-Cell Lung Cancer. Curr Treat Options Oncol 2016; 17:23. [PMID: 27032645 PMCID: PMC4819778 DOI: 10.1007/s11864-016-0397-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Palliative care integrated into standard medical oncologic care will transform the way we approach and practice oncologic care. Integration of appropriate components of palliative care into oncologic treatment using a pathway-based approach will be described in this review. Care pathways build on disease status (early, locally advanced, advanced) as well as patient and family needs. This allows for an individualized approach to care and is the best means for proactive screening, assessment, and intervention, to ensure that all palliative care needs are met throughout the continuum of care. Components of palliative care that will be discussed include assessment of physical symptoms, psychosocial distress, and spiritual distress. Specific components of these should be integrated based on disease trajectory, as well as clinical assessment. Palliative care should also include family and caregiver education, training, and support, from diagnosis through survivorship and end of life. Effective integration of palliative care interventions have the potential to impact quality of life and longevity for patients, as well as improve caregiver outcomes.
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Affiliation(s)
- Divya Chandrasekar
- />Hospice and Palliative Medicine, Stanford University School of Medicine, 2502 Galahad Court, San Jose, CA 95122 USA
| | - Erika Tribett
- />General Medical Disciplines, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, MC 5475, Stanford, CA 94305 USA
| | - Kavitha Ramchandran
- />Outpatient Palliative Medicine, Stanford Cancer Institute, Medical School Office Building, 1265 Welch Road MC 5475, Stanford, CA 94305 USA
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Serena A, Castellani P, Fucina N, Griesser AC, Jeanmonod J, Peters S, Eicher M. The role of advanced nursing in lung cancer: A framework based development. Eur J Oncol Nurs 2015; 19:740-6. [PMID: 26059323 DOI: 10.1016/j.ejon.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Advanced Practice Lung Cancer Nurses (APLCN) are well-established in several countries but their role has yet to be established in Switzerland. Developing an innovative nursing role requires a structured approach to guide successful implementation and to meet the overarching goal of improved nursing sensitive patient outcomes. The "Participatory, Evidence-based, Patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing" (PEPPA framework) is one approach that was developed in the context of the Canadian health system. The purpose of this article is to describe the development of an APLCN model at a Swiss Academic Medical Center as part of a specialized Thoracic Cancer Center and to evaluate the applicability of PEPPA framework in this process. METHOD In order to develop and implement the APLCN role, we applied the first seven phases of the PEPPA framework. RESULTS This article spreads the applicability of the PEPPA framework for an APLCN development. This framework allowed us to i) identify key components of an APLCN model responsive to lung cancer patients' health needs, ii) identify role facilitators and barriers, iii) implement the APLCN role and iv) design a feasibility study of this new role. CONCLUSIONS The PEPPA framework provides a structured process for implementing novel Advanced Practice Nursing roles in a local context, particularly where such roles are in their infancy. Two key points in the process include assessing patients' health needs and involving key stakeholders.
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Affiliation(s)
- A Serena
- Institute of Higher Education and Research in Health Care, University of Lausanne, Switzerland; University Hospital Center of Lausanne, Switzerland; University of Applied Arts and Sciences Western Switzerland, School of Health Fribourg, Switzerland.
| | - P Castellani
- University Hospital Center of Lausanne, Switzerland.
| | - N Fucina
- University Hospital Center of Lausanne, Switzerland.
| | - A-C Griesser
- University Hospital Center of Lausanne, Switzerland.
| | - J Jeanmonod
- University Hospital Center of Lausanne, Switzerland.
| | - S Peters
- University Hospital Center of Lausanne, Switzerland.
| | - M Eicher
- Institute of Higher Education and Research in Health Care, University of Lausanne, Switzerland; University of Applied Arts and Sciences Western Switzerland, School of Health Fribourg, Switzerland.
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21
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Patel MI, Moore D, Milstein A. Redesigning Advanced Cancer Care Delivery: Three Ways to Create Higher Value Cancer Care. J Oncol Pract 2015; 11:280-4. [PMID: 25991638 DOI: 10.1200/jop.2014.001065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors believe their cancer care model constructed from quality-improving strategies has potential to help US clinicians respond effectively to an urgent policy imperative.
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22
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Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Gallagher ER, Prigerson HG, Temel JS. Perceptions of health status and survival in patients with metastatic lung cancer. J Pain Symptom Manage 2014; 48:548-57. [PMID: 24680623 DOI: 10.1016/j.jpainsymman.2013.10.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/09/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Cognitive awareness of having a terminal illness is associated with critical treatment decisions and outcomes. However, little is known about the course and correlates of such perceptions in patients with metastatic lung cancer. OBJECTIVES We explored changes in perceptions of health status over time in patients with metastatic non-small cell lung cancer (NSCLC) and whether awareness of having a terminal illness was associated with survival. METHODS For this secondary analysis of clinical trial data, we assessed perceptions of health status at baseline, 12, 18, and 24 weeks. At each time point, patients with metastatic NSCLC completed a measure of quality of life (Functional Assessment of Cancer Therapy-Trial Outcome Index) and also reported whether they were "relatively healthy," "seriously but not terminally ill," or "seriously and terminally ill." We reviewed patients' medical records to gather data on clinical characteristics. RESULTS At baseline, 49.3% reported being relatively healthy, whereas the remainder self-identified as seriously but not terminally ill (38.2%) or seriously and terminally ill (12.5%). Over multiple assessments, 24.8% reported having a terminal illness. Adjusting for known prognostic factors, patients' time-varying perceptions of health status remained a significant predictor of survival (hazards ratio = 1.50, 95% CI = 1.07-2.09, P = 0.019). CONCLUSION A minority of patients with metastatic NSCLC acknowledged being terminally ill. Those reporting that they were seriously and terminally ill had shorter survival compared with those who did not consider themselves terminally ill, even after adjusting for decline in physical and functional well-being.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA.
| | - William F Pirl
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Alona Muzikansky
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Inga T Lennes
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | | | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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Patel MI, Williams DC, Wohlforth C, Fisher G, Wakelee HA, Blayney DW. Are Patients With Thoracic Malignancies at Risk for Uncontrolled Symptoms? J Oncol Pract 2014; 11:e98-e102. [PMID: 25271246 DOI: 10.1200/jop.2014.001502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer often develop symptoms and contact their oncologists and care teams after normal clinic operating hours. Better understanding of these after-hours telephone calls can inform efforts to improve cancer care and to reduce health care spending. We sought to evaluate after-hours calls at Stanford Cancer Institute (SCI) Thoracic Oncology Clinic. METHODS We retrospectively analyzed content of telephone call notes made to SCI during weekends and from 5 pm to 8 am on weekdays. Chief complaint, caller and patient demographics, patient diagnosis, advice given, and disposition were analyzed. χ(2) tests were used to analyze differences in proportions. RESULTS There were a total of 263 after-hours telephone calls during the 6 months of the study. After exclusions, there were 241 telephone calls for analysis. The majority of calls occurred between 5 pm to 11 pm (n = 175 [73%]; P < .001), followed by daytime calls on weekends (n = 157 [65%]; P < .001). Common symptoms were cough (28%) and dyspnea (27%). Of the calls, 62% (150 patients) resulted in emergency department (ED) referral, and 77% of patients (115 of 150) evaluated in the ED were admitted to the hospital. CONCLUSION Most after-hours telephone calls from patients with lung cancer are related to symptoms. Many patients were referred to the ED and subsequently required hospitalization. Analysis of call content and prior events leading to after-hours calls may predict hospital admissions in this group of patients and can inform development of proactive interventions to improve quality of care and patient-centered outcomes.
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Affiliation(s)
- Manali I Patel
- Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA
| | - Donna C Williams
- Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA
| | - Carla Wohlforth
- Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA
| | - George Fisher
- Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA
| | - Heather A Wakelee
- Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA
| | - Douglas W Blayney
- Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA
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Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med 2014; 35:369-89. [PMID: 24874132 DOI: 10.1016/j.ccm.2014.02.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary rehabilitation (PR) is an important therapeutic intervention that should no longer be considered suitable only for patients with chronic obstructive pulmonary disease (COPD). A strong rationale exists for providing PR to persons with a broad range of respiratory disorders other than COPD. Evidence shows that PR for these patients is feasible, safe and effective. A disease-relevant approach should be undertaken, based on individual patients' needs. Further research is needed to better understand the optimal program content, duration and outcomes measures, to enable diverse patients to achieve maximal benefits of PR.
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep, Yale University School of Medicine, 333 Cedar Street, Building LCI-105, New Haven, CT 06520, USA.
| | - Carl Fairburn
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
| | - Rebecca H Crouch
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
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van Ryn M, Phelan SM, Arora NK, Haggstrom DA, Jackson GL, Zafar SY, Griffin JM, Zullig LL, Provenzale D, Yeazel MW, Jindal RM, Clauser SB. Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System. J Clin Oncol 2014; 32:809-15. [PMID: 24493712 PMCID: PMC3940539 DOI: 10.1200/jco.2013.49.4302] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. PATIENTS AND METHODS Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. RESULTS There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. CONCLUSION This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.
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Affiliation(s)
- Michelle van Ryn
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Sean M. Phelan
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Neeraj K. Arora
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - David A. Haggstrom
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - George L. Jackson
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - S. Yousuf Zafar
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Joan M. Griffin
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Leah L. Zullig
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Dawn Provenzale
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Mark W. Yeazel
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Rahul M. Jindal
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Steven B. Clauser
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
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Lee S, Jerng UM, Liu Y, Kang JW, Nam D, Lee JD. The effectiveness and safety of moxibustion for treating cancer-related fatigue: a systematic review and meta-analyses. Support Care Cancer 2014; 22:1429-40. [PMID: 24609979 DOI: 10.1007/s00520-014-2161-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 02/03/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Among cancer patients, cancer-related fatigue (CRF) is one of the most common symptoms and adversely affects physical ability and quality of life even several years after treatment. This study aims to evaluate the current evidence for moxibustion in patients with CRF. METHODS Eighteen databases were searched from their inception to April 2013. All randomized controlled trials (RCTs) of moxibustion for treating CRF without language restriction were considered for inclusion. The risk of bias and reporting quality of each study were assessed using the Cochrane risk of bias tool, Consolidated Standards of Reporting Trials (CONSORT), and Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). Risk ratio (RR) or mean difference (MD) was used to measure the treatment effect with 95 % confidence intervals (CIs) in a random effects model. RESULTS Four RCTs with a total of 374 subjects were included for the review. These four studies compared moxibustion plus routine care with routine care alone. Most studies were determined to have a moderate to high risk of bias with low reporting quality. An indirect moxa stick was used in two studies, an indirect ginger cake-separated moxa was used in one study, and in one remaining study, both moxibustion methods were used. Meta-analysis showed the favorable effects of moxibustion on the response rate (RR, 1.73; 95 % CI, 1.29 to 2.32; p=.0003; heterogeneity, I (2)=15 %, p=.32). Burning with a mild blister after moxibustion was reported in one study. CONCLUSIONS Because of a high risk of bias and low reporting quality of the studies included in this review, it is difficult to draw the conclusion that moxibustion is an effective and safe treatment for patients with CRF. Further rigorous research will be necessary to evaluate whether moxibustion has beneficial effects on CRF. TRIAL REGISTRATION PROSPERO. Unique identifier: CRD42013004501.
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Affiliation(s)
- Seunghoon Lee
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
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Abstract
Patients with lung cancer have high mortality and high morbidity. Lung cancer-related symptoms and problems such as dyspnea, fatigue, pain, and cachexia that begin in the early phase later result in poor physical functioning, psychosocial, and quality of life status. In addition, advancing age is associated with significant comorbidity. These patients may benefit from multidisciplinary therapy to reduce the perceived severity of dyspnea and fatigue and increase physical functioning and quality of life. Based on management of symptoms and problems such as dyspnea, physical inactivity, cancer-related fatigue, respiratory secretions, pain, and anxiety–depression of these patients, it is thought that physiotherapy techniques can be used on advanced lung cancer patients following a comprehensive evaluation. However, well-designed, prospective, and randomized-controlled trials are needed to prove the efficacy of physiotherapy and pulmonary rehabilitation in general for patients with advanced lung cancer.
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Affiliation(s)
- Sevgi Ozalevli
- Dokuz Eylul University, School of Physical Therapy and Re-habilitation, Izmir, Turkey
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28
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Lowery AE, Krebs P, Coups EJ, Feinstein MB, Burkhalter JE, Park BJ, Ostroff JS. Impact of symptom burden in post-surgical non-small cell lung cancer survivors. Support Care Cancer 2013; 22:173-80. [PMID: 24018910 DOI: 10.1007/s00520-013-1968-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/27/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors. METHODS A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden. RESULTS Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54). CONCLUSIONS Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.
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Affiliation(s)
- Amy E Lowery
- School of Medicine, University of Pittsburgh, 5115 Centre Ave, Suite 140, Pittsburgh, PA, USA,
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29
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Simoff MJ, Lally B, Slade MG, Goldberg WG, Lee P, Michaud GC, Wahidi MM, Chawla M. Symptom Management in Patients With Lung Cancer. Chest 2013; 143:e455S-e497S. [DOI: 10.1378/chest.12-2366] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Bovio G, Fonte ML, Baiardi P. Prevalence of upper gastrointestinal symptoms and their influence on nutritional state and performance status in patients with different primary tumors receiving palliative care. Am J Hosp Palliat Care 2013; 31:20-6. [PMID: 23354771 DOI: 10.1177/1049909112474713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate the relationship between gastrointestinal symptoms, nutritional balance, and performance status in patients receiving palliative care for advanced cancers originating in different sites. We studied a total of 105 patients. Upper gastrointestinal symptoms, Eastern Cooperative Oncology Group Performance Status score (ECOG-PS), dietary intakes, anthropometric measures, and some serum proteins were determined. Unintentional weight loss, alterations in anthropometric measures, and highest number of symptoms were greater in patients with lung and stomach cancer. No differences were found in ECOG-PS according to cancer site. Patients with gastric or lung cancer have most evidence of protein-calorie malnutrition and a higher prevalence of upper gastrointestinal symptoms. The performance status is not affected by tumor site. Early nutritional support should be planned for all patients with cancer, especially for patients with gastric or lung cancer.
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Affiliation(s)
- Giacomo Bovio
- 1Metabolic-Nutritional Unit and Palliative Care Unit, Salvatore Maugeri Foundation, IRCCS, Rehabilitation Institute of Pavia, Pavia, Italy
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Carlson LE, Waller A, Groff SL, Bultz BD. Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems-secondary outcomes of a randomized controlled trial. Psychooncology 2012; 22:1880-8. [PMID: 23147718 DOI: 10.1002/pon.3223] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 10/10/2012] [Accepted: 10/13/2012] [Indexed: 11/08/2022]
Affiliation(s)
| | - Amy Waller
- Department of Psychosocial Resources; Tom Baker Cancer Centre; Calgary; Alberta; Canada
| | - Shannon L. Groff
- Department of Psychosocial Resources; Tom Baker Cancer Centre; Calgary; Alberta; Canada
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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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Cameron P, Ellis PM, Pond GR, Goffin JR. Do beta-blockers alter dyspnea and fatigue in advanced lung cancer? A retrospective analysis. Palliat Med 2012; 26:797-803. [PMID: 21844136 DOI: 10.1177/0269216311415454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dyspnea is common in lung cancer and may be partially attributable to increased ventilatory drive due to muscle weakness. The sympathetic component of this pathway might be mitigated by β-blockers. METHODS A retrospective review of new patients with stage III-IV non-small lung cancer or any small cell lung cancer was undertaken to assess the impact of β-blocker use on dyspnea and fatigue. Data were abstracted for clinical characteristics, β-blocker use, and pre-treatment Edmonton Symptom Assessment System dyspnea and fatigue scores. RESULTS Of 348 patients assessed, 202 met eligibility criteria. The median age was 67, 55.4% were female, 18.8% had chronic obstructive pulmonary disease (COPD), and 5.9% had active coronary artery disease. Over 60% of patients scored 4/10 or higher on their dyspnea and fatigue scores. While dyspnea and fatigue were moderately associated, no association was found between β-blocker use and either symptom. Recorded dosages of β-blockers were low. COPD was associated with dyspnea and fatigue, while anemia was associated with fatigue. CONCLUSIONS Dyspnea and fatigue are prevalent and increased in the presence of COPD and anemia. No association between β-blocker use and dyspnea or fatigue scores was observed. This may be attributable to inadequate dosing or to retrospective bias.
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Gay EB, Weiss SP, Nelson JE. Integrating palliative care with intensive care for critically ill patients with lung cancer. Ann Intensive Care 2012; 2:3. [PMID: 22339793 PMCID: PMC3306209 DOI: 10.1186/2110-5820-2-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/16/2012] [Indexed: 01/22/2023] Open
Abstract
With newer information indicating more favorable outcomes of intensive care therapy for lung cancer patients, intensivists increasingly are willing to initiate an aggressive trial of this therapy. Concerns remain, however, that the experience of the intensive care unit for patients with lung cancer and their families often may be distressing. Regardless of prognosis, all patients with critical illness should receive high-quality palliative care, including symptom control, communication about appropriate care goals, and support for both patient and family throughout the illness trajectory. In this article, we suggest strategies for integrating palliative care with intensive care for critically ill lung cancer patients. We address assessment and management of symptoms, knowledge and skill needed for effective communication, and interdisciplinary collaboration for patient and family support. We review the role of expert consultants in providing palliative care in the intensive care unit, while highlighting the responsibility of all critical care clinicians to address basic palliative care needs of patients and their families.
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Affiliation(s)
- Elizabeth B Gay
- Department of Pulmonary and Critical Care Medicine, University of Virginia Health Systems, Charlottesville, VA
| | - Stefanie P Weiss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
| | - Judith E Nelson
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
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Qiao Y, Qiu X, Zhou Q. [Pulmonary rehabilitation in the management of patients with lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2012; 14:744-8. [PMID: 21924043 PMCID: PMC5999613 DOI: 10.3779/j.issn.1009-3419.2011.09.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
肺康复治疗是对有症状、日常生活能力下降的慢性呼吸系统疾病患者采取的一项有循证医学证据、多学科、全面干预的非药物治疗方法。肺康复治疗在肺癌中的应用还处于探索阶段,但初步的临床研究已显示它能有效地改善肺癌患者的运动耐量和生活质量、减少手术并发症并增加手术机会,具有重要的应用前景。
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Affiliation(s)
- Yanjie Qiao
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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Gaertner J, Wuerstlein R, Ostgathe C, Mallmann P, Harbeck N, Voltz R. Facilitating Early Integration of Palliative Care into Breast Cancer Therapy. Promoting Disease-Specific Guidelines. ACTA ACUST UNITED AC 2011; 6:240-244. [PMID: 21779232 DOI: 10.1159/000329007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that 'Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy'. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining 'green flags' for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital Cologne, Germany
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Yang R, Cheung MC, Pedroso FE, Byrne MM, Koniaris LG, Zimmers TA. Obesity and weight loss at presentation of lung cancer are associated with opposite effects on survival. J Surg Res 2011; 170:e75-83. [PMID: 21704331 DOI: 10.1016/j.jss.2011.04.061] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/25/2011] [Accepted: 04/25/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lung cancer is the second most common neoplasm and the leading cause of cancer deaths in the United States. In cancer, weight loss and obesity are associated with reduced survival. However, the effect of obesity or weight loss at presentation on lung cancer survival has not been well studied. MATERIALS AND METHODS Using an extensive cancer dataset, we identified 76,086 patients diagnosed with lung cancer during the period of 1998-2002, of which 14,751 patients presented with obesity and/or weight loss. We examined the relationship between survival and weight loss or obesity at diagnosis using univariate and multivariate analysis. RESULTS Median survival time (MST) for all lung cancer patients was 8.7 mo. Patients presenting with weight loss (15.8%) had shorter MST versus those who did not (6.4 versus 9.2 mo, P < 0.001) and patients with weight loss had significantly shortened MST for all stages and histologic subtypes. In contrast, obese patients at presentation (5.4%) had longer MST relative to non-obese patients (13.0 versus 8.6 mo, P < 0.001), which was significant across all stages and histologic subtypes. Multivariate analysis revealed that the absence of weight loss was an independent, positive predictor of improved survival (HR = 0.087, P < 0.001), while the absence of obesity was an independent predictor of worsened survival in lung cancer (HR = 1.16, P < 0.001). CONCLUSIONS Our results demonstrate an inverse relationship between survival and weight loss at presentation and a potentially protective effect of obesity in lung cancer survival, which could be due to greater physiologic reserves, thereby prolonging life by slowing the progress of cancer cachexia.
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Affiliation(s)
- Relin Yang
- DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 2011; 29:2319-26. [PMID: 21555700 DOI: 10.1200/jco.2010.32.4459] [Citation(s) in RCA: 478] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. PATIENTS AND METHODS Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. RESULTS We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). CONCLUSION Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.
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Affiliation(s)
- Jennifer S Temel
- Massachusetts GeneralHospital Cancer Center, 55 Fruit Street, Massachusetts General Hospital, Boston, MA 02114, USA.
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Adjei AA, Blumenschein GR, Mandrekar S, Hillman S, Gatzemeier U, Heigener D. Long-term safety and tolerability of sorafenib in patients with advanced non-small-cell lung cancer: a case-based review. Clin Lung Cancer 2011; 12:212-7. [PMID: 21726819 DOI: 10.1016/j.cllc.2011.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 09/27/2010] [Accepted: 10/01/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sorafenib, a small-molecule inhibitor of multiple kinases involved in tumor growth and progression, is approved for the treatment of advanced renal-cell carcinoma and advanced hepatocellular carcinoma. Encouraging activity and good tolerability of daily oral sorafenib, either as a single agent or in combination with gefitinib, have been demonstrated in phase I-II trials in patients with advanced non-small-cell lung cancer (NSCLC). Currently, minimal data are available describing the long-term safety and tolerability of sorafenib in patients with NSCLC. MATERIALS AND METHODS We describe a series of 12 patients with advanced NSCLC (derived from 1 phase I and 2 phase II trials) who achieved long-term (ie, > 12 months) disease control and continued to receive sorafenib alone or in combination with gefitinib beyond the end of the study in which they were enrolled. RESULTS The safety profile of sorafenib administered on a long-term basis did not differ significantly from that seen previously in the shorter term. The majority of adverse events (AEs) were Grade 1-2 in severity. Five of the 12 patients experienced no ≥ Grade 3 AEs. There was no evidence of increased frequency or severity of AEs over time, or of late AEs, and no patient in this series discontinued study treatment because of AEs. CONCLUSION In patients with advanced NSCLC who achieve a prolonged response or stable disease with sorafenib given as a single agent or as part of a combination regimen, sorafenib treatment could be continued until disease progression without major long-term safety or tolerability problems.
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Affiliation(s)
- Alex A Adjei
- Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Standardizing integration of palliative care into comprehensive cancer therapy--a disease specific approach. Support Care Cancer 2011; 19:1037-43. [PMID: 21432009 DOI: 10.1007/s00520-011-1131-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Our comprehensive cancer centre adopted the WHO recommendation literally in the cancer care guidelines to implement the early integration (EI) of palliative care (PC). Evaluation of the first 2 years of this approach revealed that this guideline was too vague to trigger EI. OBJECTIVE As a consequence, an interdisciplinary working group was set up to propose and implement a more effective concept. METHODS An interdisciplinary (PC, oncology, radiotherapy, etc.) working group identified the need to (a) specify the timing of EI and (b) specify PC assignments by (c) providing more clear cut semantic and clinical definitions. As a result of repeated discussion in the different interdisciplinary working groups in charge of developing and consenting a once-yearly update of treatment guidelines [standard operating procedure (SOP)] for each malignancy, the need for disease-specific EI SOPs was identified. RESULTS SOPs were developed for 19 malignancies (a) to identify a disease-specific point in each disease trajectory to initiate EI ("green flags") and to provide (b) a clear delineation and semantic differentiation of PC assignments ["palliative care" vs. "supportive" or "palliative therapies" ("green" vs. "red flags")]. DISCUSSION To date, ASCO and WHO recommendations for EI lack detailed information about timing and infrastructure. The guidelines presented here aim to provide the missing information by reporting our developed and consented interdisciplinary guidelines for EI. CONCLUSION With this concept, the authors provide a framework for realizing EI and hope to initiate a discussion about specific recommendations for EI.
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Jacobsen J, Jackson V, Dahlin C, Greer J, Perez-Cruz P, Billings JA, Pirl W, Temel J. Components of early outpatient palliative care consultation in patients with metastatic nonsmall cell lung cancer. J Palliat Med 2011; 14:459-64. [PMID: 21417739 DOI: 10.1089/jpm.2010.0382] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although palliative care consultation is recommended early in the course of oncology treatment, little evidence exists to guide the nature of this intervention. We describe a clinical practice of early palliative care consultation that improved quality of life, mood, and survival in a randomized clinical trial. METHODS As part of a randomized trial of early palliative care versus standard care in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC), we analyzed documentation of the components of the initial palliative care consultation, self-reported quality of life as measured by the Functional Assessment of Cancer Therapy-Lung Trial Outcome Index (FACT-L TOI), and mood as measured by the Patient Health Questionnaire-9 (PHQ-9). RESULTS Seven palliative care clinicians provided consultation to 67 patients. The median total time spent with patients for the initial visit was 55 minutes (range, 20-120). Consultations focused on symptom management (median, 20 minutes; range, 0-75), patient and family coping (median, 15 minutes; range, 0-78), and illness understanding and education (median, 10 minutes; range, 0-35). Lower quality of life as measured by the FACT-L TOI predicted greater consultation time (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91-0.99). Additionally, lower quality of life scores on the FACT-L TOI (OR = 0.93, 95% CI = 0.88-0.97) and higher depression scores on the PHQ-9 (OR = 1.15, 95% CI = 1.02-1.31) predicted greater time spent on symptom management. CONCLUSIONS Initial palliative care consultation near the time of diagnosis in patients with metastatic NSCLC in this intervention is nearly an hour in length and largely addresses symptom management, patient and family coping, and illness understanding and education. Lower quality of life predicted longer consultations, with more time dedicated specifically to symptom management.
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Affiliation(s)
- Juliet Jacobsen
- Palliative Care Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Reville B, Miller MN, Toner RW, Reifsnyder J. End-of-life care for hospitalized patients with lung cancer: utilization of a palliative care service. J Palliat Med 2011; 13:1261-6. [PMID: 20879874 DOI: 10.1089/jpm.2010.0057] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE High symptom burden and hospital mortality among patients with lung cancer argues for early palliative care intervention. Patient characteristics and discharge dispositions in hospitalized patients with lung cancer receiving usual care were compared to those referred to a new palliative care service. METHODS A retrospective database review of all lung cancer discharges receiving usual care (UC) and palliative care service (PCS) consultation was conducted. Demographics, length of stay, discharge disposition, and mortality were described and compared. Palliative Performance Scale scores were described according to discharge disposition in the PCS group. Disposition of all patients receiving either chemotherapy or surgery was also noted. RESULTS A total of 1476 hospital discharges with a diagnosis of lung cancer occurred between March 15, 2006 and June 30, 2009. Among all discharges, 9% received chemotherapy and 29% had surgery. The PCS was consulted for 8% of all lung cancer patients most commonly to address end-of-life-issues. PCS patients were more likely to be at the end-of-life than UC patients as evidenced by higher hospital mortality (31% versus 7%), higher intensive care (ICU) mortality (67% versus 16%) and more frequent discharge to hospice (41% versus 7%). PCS patients were hospitalized a median of 6 days before a referral was made. Hospitalization was significantly longer for PCS patients (M = 16.3 days, p < 0.001) than UC patients (M = 8.3 days). CONCLUSIONS In the first 3 years of a new palliative care initiative consults for lung cancer patients occurred late in the hospital stay or when death was imminent.
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Affiliation(s)
- Barbara Reville
- Jefferson Palliative Care Service, Thomas Jefferson University, Department of Family & Community Medicine, Philadelphia, Pennsylvania 19107, USA.
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Attributes Contributing to Superior Outcomes in the Surgical Management of Early-Stage Lung Cancer and Examples of Implementing Improvement. Cancer J 2011; 17:57-62. [DOI: 10.1097/ppo.0b013e318209218c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Gaertner J, Wolf J, Ostgathe C, Toepelt K, Glossmann JP, Hallek M, Voltz R. Specifying WHO Recommendation: Moving toward Disease-Specific Guidelines. J Palliat Med 2010; 13:1273-6. [DOI: 10.1089/jpm.2010.0016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
- Clinical Trials Center Cologne, Cologne, Germany
| | - Juergen Wolf
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Karin Toepelt
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Jan-Peter Glossmann
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Raymond Voltz
- Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
- Clinical Trials Center Cologne, Cologne, Germany
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Sanders SL, Bantum EO, Owen JE, Thornton AA, Stanton AL. Supportive care needs in patients with lung cancer. Psychooncology 2010; 19:480-9. [PMID: 19434625 DOI: 10.1002/pon.1577] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The goal of this study was to characterize the prevalence and intensity of supportive care needs and interest in specific supportive care services among individuals with lung cancer. METHOD Participants (n=109) were recruited from two medical centers in Southern California to complete questionnaires on physical and psychological functioning following diagnosis of lung cancer. RESULTS Participants reported the greatest need in the physical and daily living domain, followed by psychological needs, health system and informational needs, and patient care support needs. The most common unmet need was a lack of energy and tiredness (75%). Higher levels of supportive care needs were associated with worse physical functioning (beta=-0.30, p<0.001), greater symptom bother (beta=0.25, p=0.008), lower satisfaction with health care (beta=-0.24, p=0.002), and higher levels of intrusive thoughts about cancer (beta=0.40, p<0.001). The sample was most interested in receiving additional information about their disease and treatment (61.0%), exercise-related information and support (54.3%), and assistance dealing with fatigue (46.7%). Over 91% expressed interest in at least one specific supportive care service, and 51.4% were interested in one or more psychological services. CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS Our findings suggest that lung cancer survivors have many unmet needs. Patients who report higher physical distress and intrusive stress symptoms, or lower satisfaction with their health care, may experience the highest level of supportive care need and intervention.
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Affiliation(s)
- Sharon L Sanders
- Department of Psychology, Loma Linda University, Loma Linda, CA 92350, USA
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Role of pulmonary rehabilitation in the management of patients with lung cancer. Curr Opin Pulm Med 2010; 16:334-9. [DOI: 10.1097/mcp.0b013e32833a897d] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang XS, Shi Q, Lu C, Basch EM, Johnson VE, Mendoza TR, Mobley GM, Cleeland CS. Prognostic value of symptom burden for overall survival in patients receiving chemotherapy for advanced nonsmall cell lung cancer. Cancer 2010; 116:137-45. [PMID: 19852033 DOI: 10.1002/cncr.24703] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patient-reported outcomes have shown independent prognostic value for patients with nonsmall cell lung cancer (NSCLC). However, translating patient-reported outcomes into useful prognostic information for individual patients has been problematic. METHODS A total of 94 patients with advanced NSCLC and an Eastern Cooperative Oncology Group performance status (PS) of 0 to 2 who qualified for chemotherapy rated symptom severity using the M. D. Anderson Symptom Inventory before and after their first chemotherapy cycle. Prognostic values of baseline symptoms and changes in symptom severity were examined by Cox proportional hazards models. RESULTS In multivariate analysis, controlled for demographic and other factors, baseline coughing rated > or =4 independently predicted significantly higher risk for shorter survival (hazards ratio [HR], 8.69; P < .0001). Patients with coughing > or =4 and a PS of 2 were more likely to have shorter survival (HR, 20.6; P < .0001) than patients with coughing <4 and a PS of 0 to 1. A 1-point or greater increase in severity of fatigue (P < .05), shortness of breath, or poor appetite (P < .01) from baseline to the end of the first chemotherapy cycle was also found to be independently associated with higher risk for poor survival. CONCLUSIONS An increased risk for shorter survival was indicated by moderate to severe coughing at baseline or by increased fatigue or shortness of breath during the first chemotherapy cycle in patients with advanced NSCLC. Although cross-validation is needed, these data suggest that an individual patient's symptom severity scores, quickly obtainable in the clinic, might contribute clinically useful information for treatment planning for that patient. Society.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Greer JA, Park ER, Prigerson HG, Safren SA. Tailoring Cognitive-Behavioral Therapy to Treat Anxiety Comorbid with Advanced Cancer. J Cogn Psychother 2010; 24:294-313. [PMID: 21234281 PMCID: PMC3018827 DOI: 10.1891/0889-8391.24.4.294] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with advanced cancer often experience debilitating anxiety symptoms that interfere with quality of life and relate to worse medical outcomes. Although cognitive behavioral therapy (CBT) is an empirically-validated, first-line treatment for anxiety disorders, clinical trials of CBT for anxiety typically exclude patients with medical comorbidities in general, and those with terminal illnesses, such as advanced cancer, in particular. Moreover, CBT has generally targeted unrealistic fears and worries in otherwise healthy individuals with clinically significant anxiety symptoms. Consequently, traditional CBT does not sufficiently address the cognitive components of anxiety in patients with cancer, especially negative thought patterns that are rational but nonetheless intrusive and distressing, such as concerns about pain, disability and death, as well as management of multiple stressors, changes in functional status and burdensome medical treatments. In this paper, we describe a treatment approach for tailoring CBT to the needs of this population. Three case examples of patients diagnosed with terminal lung cancer are presented to demonstrate the treatment methods along with outcome measures for anxiety and quality of life.
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Affiliation(s)
- Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School
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Lennes IT, Lynch TJ. Quality Indicators in Cancer Care: Development and Implementation for Improved Health Outcomes in Non–Small-Cell Lung Cancer. Clin Lung Cancer 2009; 10:341-6. [DOI: 10.3816/clc.2009.n.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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