Quality of life in 650 lung cancer survivors 6 months to 4 years after diagnosis

Applications of Hypnosis as an Adjuvant in Oncological Settings: A Systematic Review

Previous research has shown promising results in using hypnosis to treat various symptoms and side effects of medical treatments. The objective was to identify studies that use hypnosis as an adjuvant to evidence-based treatments to evaluate its benefits in patients with cancer. The search identified 873 articles published between 2000 and February 2021, of which 22 were selected using the principles of the PRISMA. Apart from 1 study, all studies showed that interventions improved the measured variables compared to a control group. Most studies showed that hypnosis has positive effects on reducing anxiety, pain, nausea, fatigue, drug use, and length of hospital stays. Hypnosis also improves depressive symptoms, insomnia, hot flashes, well-being, and quality of life, and helps increase adherence to treatment. When used by qualified professionals as an adjuvant to well-established treatments, hypnosis improves symptoms caused by oncological interventions and the disease itself. In addition, hypnosis has no side effects.

Maximizing quality of life remains an ultimate goal in the era of precision medicine: exemplified by lung cancer

An ultimate goal of precision medicine in lung cancer treatment is to restore patient health with maximized quality of life (QOL). Results from Mayo Clinic studies show that a significant improvement in fatigue, dyspnea, and pain scales could lead to better overall QOL. Although treatments and guidelines for clinical implementation to alleviate these key symptoms are available, few cancer patients receive adequate therapy, mostly because of limitations in current care delivery systems and unclear clinicians’ roles. For optimal care of lung cancer survivors in different subpopulations, three barriers must be overcome: physicians’ lack of knowledge, unwarranted practice variation, and uncertainty regarding care provider roles. Appropriate culturally adapted, tested and validated tools for QOL measures must be developed, rather than directly translating existing tools between different languages and across cultures or diverse subpopulations. Finally, lack of sensitive, adequate, and relevant tools in measuring health-related QOL (HRQOL) has long been an issue for effective data collection, demanding a global consensus on a set of core components that reflect the needs of all critical parties for the best cure and care, supporting patients to achieve optimal HRQOL.

Emotional Problems, Quality of Life, and Symptom Burden in Patients With Lung Cancer

OBJECTIVES

Lung cancer is associated with a greater symptom burden than other cancers, yet little is known about the prevalence of emotional problems and how emotional problems may be related to the physical symptom burden and quality of life in newly diagnosed patients with lung cancer. This study aimed to identify the patient and disease characteristics of patients with lung cancer experiencing emotional problems and to examine how emotional problems relate to quality of life and symptom burden.

PATIENTS AND METHODS

A total of 2205 newly diagnosed patients with lung cancer completed questionnaires on emotional problems, quality of life, and symptom burden.

RESULTS

Emotional problems at diagnosis were associated with younger age, female gender, current cigarette smoking, current employment, advanced lung cancer disease, surgical or chemotherapy treatment, and a lower Eastern Cooperative Oncology Group performance score. Additionally, strong associations were found between greater severity of emotional problems, lower quality of life, and greater symptom burden.

CONCLUSION

Certain characteristics place patients with lung cancer at greater risk for emotional problems, which are associated with a reduced quality of life and greater symptom burden. Assessment of the presence of emotional problems at the time of lung cancer diagnosis provides the opportunity to offer tailored strategies for managing negative mood, and for improving the quality of life and symptom burden management of patients with lung cancer.

Chest wall resection for non-small cell lung cancer: A case-matched study of postoperative pulmonary function and quality of life

BACKGROUND

To assess the pulmonary function and quality of life (QOL) after chest wall resection for non-small cell lung cancer.

MATERIAL AND METHODS

One hundred and thirty-five patients (cases) who underwent pulmonary resection with chest wall removal were identified from January 1997 to December 2015. Propensity score matching (1:3) was applied to balance known confounders for pulmonary function and QOL between the cases and the control group who underwent pulmonary resection without chest wall invasion. Matched analyses were performed to compare perioperative mortality and morbidity, postoperative pulmonary function, overall QOL, and specific symptoms.

RESULTS

Perioperative mortality and morbidity did not differ significantly between cases and controls, but the hospital stay was longer in cases than in controls (mean, 12.8 vs 8.9days; p<0.001), The decline of postoperative pulmonary forced vital capacity (FVC) and the percentage of predicted FVC (FVC%) was more obvious in cases than in controls at 6 months and 2 years after surgery, but there was no obvious decline in the forced expiratory volume in one second (FEV1), the percentage of predicted FEV1 (FEV1%), the diffusion capacity of the lung for carbon monoxide (DLCO) and the percentage of predicted DLCO (DLCO%) in cases compared with controls. No significant difference was observed between the two groups in scores for overall QOL, pain, fatigue, cough, dyspnea, appetite, hemoptysis, lung cancer symptoms, and normal activities.

CONCLUSIONS

When chest wall resection is inevitable, it does not worse the QOL and pulmonary function of patients who underwent pulmonary resection with chest wall removal obviously compared with patients underwent pulmonary resection without chest wall invasion.

A consensus statement on the gender perspective in lung cancer

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

Impact of symptom burden in post-surgical non-small cell lung cancer survivors

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.

Spiritual well-being in lung cancer survivors

PURPOSE

Spiritual well-being (SWB) among lung cancer survivors has not been well-delineated. Additionally, little is known about how SWB is affected over the trajectory of the disease process. The aims of this study were to examine the SWB of individuals with a diagnosis of lung cancer, to assess the stability of SWB over time, and to identify the factors associated with SWB.

METHODS

A prospective cohort of patients with lung cancer first seen at the Mayo Clinic over a 10-year period of time was included in this study. Study entry was at the time of diagnosis or referral to the Mayo Clinic, and participation involved annual survey using the Functional Assessment in Chronic Illness Therapy-Spiritual Well-being, Medical Outcome Short Form 8, and Quality of Life (QOL) Linear Analog Scale Assessment. Associations were explored using Fisher's exact test, chi-squared test, Kruskal-Wallis test, and Spearman correlations. Linear regression was used to explore multivariate relationships.

RESULTS

There were 1,578 participants over a 10-year period of time. Group SWB scores were relatively high and stable over a 10-year period of time ([Formula: see text], standard deviation = 14.47-18.46, possible scale of 0-100). However, individual scores varied widely across almost the entire scale (2.1-100) and revealed a chaotic trajectory for SWB. Males, current smokers, and those with higher pack-years experienced lower SWB compared to females, nonsmokers, and those with lower pack-years (p < 0.0001, 0.0455, and 0.0004, respectively). SWB was strongly associated with overall QOL.

CONCLUSIONS

SWB is an individualistic experience that can change dramatically over time for cancer survivors. Ongoing assessments are important.

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

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

Physical activity level and quality of life in long term lung cancer survivors

PURPOSE

Lung cancer is associated with a multitude of challenges, and lung cancer survivors report significantly lower quality of life (QOL) than other cancer survivors.

METHODS

This study aimed to examine the relationship between physical activity level and QOL in a large sample of long term lung cancer survivors (N=1937). Average age at diagnosis was 65 years, 92% were Caucasian, and 51% male. Surveys were completed at lung cancer diagnosis and then average 4.2 years post-diagnosis.

RESULTS

Most survivors reported having a sedentary lifestyle at both timepoints. However, 256 survivors reported a change in physical activity level from diagnosis to follow-up. Decreased physical activity (n=140) was associated with decreased overall, mental, physical, emotional, social, and spiritual QOL (all ps<.001) and decreased symptom control as seen in reported pain, dry coughing, coughing with phlegm, shortness of breath, and level of fatigue (all ps<.05). In contrast, increased physical activity (n=116) was associated with improved QOL (all ps<.05), and improved symptom control as seen in frequency and severity of pain (p<.01). For all participants, those engaging in regular physical activity (30 min or more per day, at least five days per week) reported significantly higher QOL scores (all ps<.001), and better symptom control than more sedentary survivors.

CONCLUSIONS

Results indicate a significant association between change in physical activity and QOL and symptom control for long term lung cancer survivors, and research exploring interventions designed to improve activity level for lung cancer survivors is further warranted.

SNPs in PTGS2 and LTA predict pain and quality of life in long term lung cancer survivors

PURPOSE

Lung cancer survivors report the lowest quality of life relative to other cancer survivors. Pain is one of the most devastating, persistent, and incapacitating symptoms for lung cancer survivors. Prevalence rates vary with 80-100% of survivors experiencing cancer pain and healthcare costs are five times higher in cancer survivors with uncontrolled pain. Cancer pain often has a considerable impact on quality of life among cancer patients and cancer survivors. Therefore, early identification, and treatment is important. Although recent studies have suggested a relationship between single nucleotide polymorphisms (SNPs) in several cytokine and inflammation genes with cancer prognosis, associations with cancer pain are not clear. Therefore, the primary aim of this study was to identify SNPs related to pain in lung cancer survivors.

PATIENTS AND METHODS

Participants were enrolled in the Mayo Clinic Lung Cancer Cohort upon diagnosis of their lung cancer. 1149 Caucasian lung cancer survivors (440 surviving <3 years; 354 surviving 3-5 years; and 355 surviving >5 years) completed study questionnaires and had blood DNA samples available. Ten SNPS from PTGS2 and LTA genes were selected based on the serum-based studies in the literature. Outcomes included pain, and quality of life as measured by the SF-8.

RESULTS

Of the 10 SNPs evaluated in LTA and PTGS2 genes, 3 were associated with pain severity (rs5277; rs1799964), social function (rs5277) and mental health (rs5275). These results suggested both specificity and consistency of these inflammatory gene SNPs in predicting pain severity in lung cancer survivors.

CONCLUSION

These results provide support for genetic predisposition to pain severity and may aid in identification of lung cancer survivors at high risk for morbidity and poor QOL.

Genetic variations and patient-reported quality of life among patients with lung cancer

PURPOSE

Recent evidence has suggested a relationship between the baseline quality of life (QOL) self-reported by patients with cancer and genetic disposition. We report an analysis exploring relationships among baseline QOL assessments and candidate genetic variations in a large cohort of patients with lung cancer.

PATIENTS AND METHODS

QOL data were provided by 1,299 patients with non-small-cell lung cancer observed at the Mayo Clinic between 1997 and 2007. Overall QOL and subdomains were assessed by either Lung Cancer Symptom Scale or Linear Analog Self Assessment measures; scores were transformed to a scale of 0 to 10, with higher scores representing better status. Baseline QOL scores assessed within 1 year of diagnosis were dichotomized as clinically deficient (CD) or not. A total of 470 single nucleotide polymorphisms (SNPs) in 56 genes of three biologic pathways were assessed for association with QOL measures. Logistic regression with training/validation samples was used to test the association of SNPs with CD QOL.

RESULTS

Six SNPs on four genes were replicated using our split schemes. Three SNPs in the MGMT gene (adjusted analysis, rs3858300; unadjusted analysis, rs10741191 and rs3852507) from DNA repair pathway were associated with overall QOL. Two SNPs (rs2287396 [GSTZ1] and rs9524885 [ABCC4]) from glutathione metabolic pathway were associated with fatigue in unadjusted analysis. In adjusted analysis, two SNPs (rs2756109 [ABCC2] and rs9524885 [ABCC4]) from glutathione metabolic pathway were associated with pain.

CONCLUSION

We identified three SNPs in three glutathione metabolic pathway genes and three SNPs in two DNA repair pathway genes associated with QOL measures in patients with non-small-cell lung cancer.

Quality of life and symptom burden among long-term lung cancer survivors

INTRODUCTION

Information is limited regarding health-related quality of life (QOL) status of long-term (greater than 5 years) lung cancer survivors (LTLCS). Obtaining knowledge about their QOL changes over time is a critical step toward improving poor and maintaining good QOL. The primary aim of this study was to conduct a 7-year longitudinal study in survivors of primary lung cancer which identified factors associated with either decline or improvement in QOL over time.

METHODS

Between 1997 and 2003, 447 LTLCS were identified and followed through 2007 using validated questionnaires; data on overall QOL and specific symptoms were at two periods: short-term (less than 3 years) and long-term postdiagnosis. The main analyses were of clinically significant changes (greater than 10%) and factors associated with overall QOL and symptom burden for each period and for changes over time.

RESULTS

Three hundred two (68%) underwent surgical resection only and 122 (27%) received surgical resection and radiation/chemotherapy. Recurrent or new lung malignancies were observed in 84 (19%) survivors. Significant decline or improvement in overall QOL over time were reported in 155 (35%) and 67 (15%) of 447 survivors, respectively. Among the 155 whose QOL declined, significantly worsened symptoms were fatigue (69%), pain (59%), dyspnea (58%), depressed appetite (49%), and coughing (42%). The symptom burden did not lessen among the 67 who reported improvement in overall QOL, suggesting that survivors had adapted to their compromised physical condition.

CONCLUSIONS

LTLCS suffered substantial symptom burden that significantly impaired their QOL, indicating a need for targeted interventions to alleviate their symptoms.

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

BACKGROUND

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

OBJECTIVE

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

INCLUSION CRITERIA

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

SEARCH STRATEGY

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

METHODOLOGICAL QUALITY

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

DATA COLLECTION

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

DATA SYNTHESIS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATION FOR PRACTICE

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

IMPLICATIONS FOR RESEARCH

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

Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls

PURPOSE

We explored covariates of the quality of life (QOL) in non-small-cell lung cancer (NSCLC) patients and made a comparison with healthy controls.

METHODS

We assessed the QOL of 220 consecutive NSCLC patients at a university hospital. The QOL data were measured by the brief version of the World Health Organization's Quality of Life and by utility using the standard gamble method. We selected demographically matched healthy controls from the 2001 National Health Interview Survey for comparison. Multiple linear regression models were constructed to explore significant factors of QOL after controlling for covariates.

RESULTS

Patients with more advanced stages of NSCLC had poorer scores than did the healthy controls in the physical and psychological domains. Patients with disease duration of longer than 1 year tended to report higher physical and environment QOL than did those with NSCLC diagnosed for less than 1 year. Insight into one's own illness was associated with a higher utility, better social support, and improved financial resources.

CONCLUSIONS

QOL was significantly associated with staging and duration of NSCLC. Disease insight appears to be a positive factor for operable NSCLC patients of the Taiwanese culture, which implies that clinicians should respect patient autonomy in diagnosis disclosure.

Relationship between cytokine gene single nucleotide polymorphisms and symptom burden and quality of life in lung cancer survivors

BACKGROUND

Previous research has demonstrated that many lung cancer survivors report difficulties with symptom control and experience a poor quality of life (QOL). Although recent studies have suggested a relationship of single nucleotide polymorphisms (SNPs) in several cytokine genes with cancer susceptibility and prognosis, associations with symptom burden and QOL have not been examined. The current study was conducted to identify SNPs related to symptom burden and QOL outcomes in lung cancer survivors.

METHODS

All participants were enrolled in the Mayo Clinic Lung Cancer Cohort following diagnosis of lung cancer. A total of 1149 Caucasian lung cancer survivors completed questionnaires and had genetic samples available. The main outcome measures were symptom burden as measured by the Lung Cancer Symptom Scale and health-related QOL as measured by the Short-Form General Health Survey.

RESULTS

Twenty-one SNPs in cytokine genes were associated with symptom burden and QOL outcomes. Our results suggested both specificity and consistency of cytokine gene SNPs in predicting outcomes.

CONCLUSIONS

These results provide support for genetic predisposition to QOL and symptom burden and may aid in identification of lung cancer survivors at high risk for symptom management and QOL difficulties.

Does marital status impact survival and quality of life in patients with non-small cell lung cancer? Observations from the mayo clinic lung cancer cohort

PURPOSE

Previous studies have found that marriage is associated with longer survival and better quality of life among lung cancer patients. The present study used the Mayo Clinic Lung Cancer Cohort to re-examine this issue.

METHODS

In total, 5,898 non-small cell lung cancer (NSCLC) patients, who had available information on marital status and who had been enrolled in the Mayo Clinic Lung Cancer Cohort (MCLCC), were the focus of this study. Patients had extensive baseline and follow-up data on cancer stage, cancer treatment, and prognostic factors. All patients had been followed within the MCLCC with at least annual confirmation of vital status and patient-reported quality of life (the Lung Cancer Symptom Scale and the Linear Analogue Scales of Assessment).

RESULTS

The numbers of patients who were married, single, divorced, and widowed at the time of cancer diagnosis were 4,457 (76%), 265 (4%), 440 (7%), and 736 (12%), respectively. No statistically significant difference in survival was observed among these four groups, even after adjusting for a variety of prognostic factors, such as age, gender, and tumor stage. However, exploratory analyses suggested that widowed and divorced patients received less aggressive cancer therapy, and certain patient subgroups, such as stage IA widowed patients, had a shorter survival. Divorced patients reported greater financial concerns, and married and widowed patients reported greater spirituality and better social support.

CONCLUSION

This study did not observe differences in survival or quality of life based on marital status at the time of diagnosis of NSCLC, but subgroup analyses appear to suggest findings worthy of further exploration.

Motivational readiness for physical activity and quality of life in long-term lung cancer survivors

Little is known about the relationship between motivational readiness for physical activity and quality of life (QOL) in long-term lung cancer survivors. Long-term survivors are considered those who are living 5 years or more following a cancer diagnosis. This project examined the relationship between a self-report measure of motivational readiness for physical activity and QOL in a sample of 272 long-term lung cancer survivors. Participants (54% male, average age 70 years old) completed the mailed survey an average of 6 years after being diagnosed with lung cancer. Survey measures included the stage of change for physical activity and a set of single item QOL and symptom scales. Thirty-seven percent of respondents reported they currently engaged in regular physical activity (a total of 30 min or more per day, at least 5 days per week). Kruskal-Wallis tests revealed that those who reported engaging in regular physical activity reported a better overall QOL, better QOL on all five domains of QOL functioning (mental, physical, social, emotional, and spiritual), and fewer symptoms compared to those with a sedentary lifestyle. Physical activity level may have important QOL and symptom management benefits for long-term lung cancer survivors.

Impact of chronic obstructive pulmonary disease on respiratory status and quality of life in newly diagnosed patients with lung cancer

OBJECTIVE AND BACKGROUND

A significant proportion of patients with lung cancer have associated COPD, which is considered an independent risk factor and cause of morbidity and mortality. However, the effect of COPD on respiratory status and quality of life in lung cancer has not been evaluated.

METHODS

Newly diagnosed patients with lung cancer were assessed at diagnosis before starting treatment, for detailed respiratory status, spirometry and World Health Organization-Bref Quality of Life questionnaire in Hindi (WHOQOL-Bref Hindi).

RESULTS

One hundred and sixty patients were studied. Spirometry was abnormal in 92.7% patients, 42% had COPD, and the majority (88.6%) had advanced disease (stage III and IV). Patients scored poorly in all QOL domains, with social domain faring worst. Karnofsky Performance status (KPS) correlated significantly with all QOL domains. No significant differences were found in clinical profile, KPS, or QOL scores between patients with and without COPD. Chest pain and dyspnoea severity (assessed by Medical Research Council) grading and visual analogue scale correlated with physical QOL domain.

CONCLUSION

Patients with lung cancer have a poor QOL that is affected by the severity of respiratory profile and KPS. The presence of COPD does not significantly affect QOL in lung cancer patients.

Quality of Life and Health Status of Dyads of Women With Lung Cancer and Family Members

PURPOSE/OBJECTIVES

To describe and compare the quality of life (QOL) and health status of dyads of women with lung cancer and their family members and to explore the correlates of family members' QOL.

RESEARCH APPROACH

Descriptive, cross-sectional.

SETTING

Interview, self-report.

PARTICIPANTS

51 dyads consisting of women with lung cancer and their family members.

METHODOLOGIC APPROACH

One-time assessment of family members' and patients' QOL, health status, and demographics and patients' clinical characteristics.

MAIN RESEARCH VARIABLES

Family and patient QOL and health status.

FINDINGS

QOL of the dyads was not significantly related. Poorer physical QOL of family members was associated with older age, comorbid conditions, less education, and alcohol use. Poorer emotional QOL of family members was associated with younger age, depressed mood, and not being a spouse. Fifty-nine percent of family members had comorbid conditions. Significantly more family members continued to smoke and use alcohol.

CONCLUSIONS

The QOL of family members of patients with lung cancer is diminished when their own health status is compromised. Further study is needed.

INTERPRETATION

Additional study is needed to identify family members at risk for diminished QOL and with compromised health status because these factors might affect ability to support patients with lung cancer.

Symptom Clusters and Quality of Life in Survivors of Lung Cancer

PURPOSE/OBJECTIVES

To explore the prevalence and intensity of depression, fatigue, and pain in survivors of lung cancer; to examine the relationship of symptoms in a cluster; and to examine the relationship of the symptom cluster to quality of life (QOL).

DESIGN

Secondary data analysis.

SETTING

Online lung cancer support group.

SAMPLE

51 patients diagnosed with lung cancer.

METHODS

Mailed survey with self-report of depression, fatigue, and pain measured by subscales of the Short-Form 36 Health Status Survey and QOL measured by the Fox Simple QOL Scale. Pearson's correlation and multiple regression analyses were used to examine the possible symptom cluster.

MAIN RESEARCH VARIABLES

Depression, fatigue, pain, and QOL.

FINDINGS

Depression, fatigue, and pain were found in a majority of survivors, with pain being the least common symptom. Fatigue was the most intense of the three symptoms. Two significantly correlated symptoms were depression and fatigue. The cluster explained 29% (p less than 0.01) of the variance in QOL in the lung cancer survivors.

CONCLUSIONS

The data provided preliminary support for the presence of a symptom cluster in patients with lung cancer consisting of depression and fatigue. The cluster had a negative relationship with QOL. Survivors of lung cancer have depression and fatigue that affect QOL.

IMPLICATIONS FOR NURSING

Healthcare providers must assess the potential for symptoms to cluster, adversely affecting key patient outcomes such as QOL. Through increased knowledge of symptom clusters, clinicians will be able to more effectively target the most distressing set of symptoms for intervention.

Determinants of quality of life in patients following pulmonary resection for lung cancer

BACKGROUND

The purpose of the present study was to prospectively measure quality of life (QOL) before and after pulmonary resection for non-small cell lung cancer (NSCLC) and to determine which clinical perioperative variables predicted QOL.

METHODS

Thirty-seven patients undergoing a curative resection for early-stage NSCLC were administered the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire serially. This was used to calculate a Trial Outcome Index (TOI), a measure of QOL.

RESULTS

Perioperative variables associated with worse postoperative TOI included the presence of preoperative dyspnea (coefficient -7.89, 95% confidence interval -12.4 to -3.31, P = .01) and exposure to adjuvant chemotherapy (-14.7, -20.0 to -9.46, P = .001).

CONCLUSIONS

Preoperative dyspnea and postoperative chemotherapy are associated with worse postoperative QOL among patients with resected, early-stage NSCLC. As adjuvant and neoadjuvant therapy protocols become more prevalent for these patients, QOL issues may assume greater importance.

Quality measures for symptoms and advance care planning in cancer: a systematic review

PURPOSE

Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps.

METHODS

English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure.

RESULTS

A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific.

CONCLUSION

Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.

Small cell lung cancer: treatment review

Lung cancer was relatively uncommon at the turn of the 20th century, and has increased in prevalence at alarming rates, particularly because of the augmented trend in smoking, so that it is now the most common cause of cancer death in the world. As almost a quarter of these cancers are of small cell in origin, it seems only appropriate that small cell lung cancer receives ample attention, rather than seemingly to have been overlooked over the last 10-15 years. Despite its generally late presentation and high risk of dissemination, it is exceptionally sensitive to chemo-radiotherapy. This review looks at the diverse options of treatment that have been used over the last few years and tries to highlight the best available. As more than 50% of patients diagnosed with lung cancer are over 70 years of age and various studies have shown that older people respond just as well as their younger counterparts, with similar results in response rates, toxicity and outcomes, it is imperative that the older generation are not disregarded in terms of age being a contraindication to therapy.

Objective evaluation of physical function in patients with advanced lung cancer: a preliminary report

PURPOSE

This prospective study was designed in order to compare the most common subjective measurements of physical function in patients with advanced lung cancer with an objective physical functional test (Simmonds Functional Assessment Tool [SFA]).

PATIENTS AND METHODS

One hundred patients agreed to participate and complete the study before or after their outpatient medical oncology appointment. Patients underwent assessment using the Karnofsky, the Brief fatigue Inventory, The Functional Assessment of Cancer Therapy-Lung patients (FACT-L) and the Edmonton Symptom Assessment Scale (ESAS). These results were compared to the SFA tool. The SFA consists of six tasks: tying a belt, putting coins in a cup, reaching above head, standing up/sitting down, reaching forward and walking 50 feet.

RESULTS

Ninety-nine patients completed the study over 8 months: median Karnofsky performance status was 85 (70 to 100), Edmonton Symptom Assessment Scale (ESAS) score (0 to 10) was generally low (0.5 to 2.8). SFA scores were significantly different in patients compared to a control group. The correlation between the subscales of the SFA and the Karnofsky, the Brief Fatigue Inventory, The FACT-L and the ESAS was generally low to moderate (r values: 0.22 to 0.38). There was generally a moderate correlation between the different subjective scales (r values: 0.3 to 0.62).

CONCLUSION

Adherence to the SFA tool was excellent. The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions. These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer. Large trials of objective functional assessment are justified.

Clinical features of 5,628 primary lung cancer patients: experience at Mayo Clinic from 1997 to 2003

STUDY OBJECTIVES

To improve the current understanding of the etiology and natural history of primary lung cancer, we need to study the dynamic changes of clinical presentation and prognosis among a large number of patients with newly diagnosed lung cancer. In this report, we present the clinical features and survival rates up to 5 years of a patient cohort.

DESIGN

We identified 5,628 primary lung cancer patients between 1997 and 2002 and followed them through 2003 using multiple, complementary resources.

MEASUREMENTS AND RESULTS

Of the 5,628 patients, 58% were men with a mean age at lung cancer diagnosis of 66 years, and 42% were women with a mean age at diagnosis of 64 years. Ten percent were < 50 years, and 8% were > 80 years at diagnosis. A tobacco smoking history was present in 89% of patients, and 40% were smoking at the time of diagnosis. The estimated overall 5-year survival rates of patients with non-small cell lung cancer (NSCLC) by disease stage was as follows: IA, 66%; IB, 53%; IIA, 42%; IIB, 36%; IIIA, 10%; IIIB, 12%; and IV, 4%. The 5-year survival rate of patients with small cell lung cancer was 22% for limited disease and 1% for extensive disease. Approximately 50% of all patients are participants in one or more research studies, and nearly 75% of these patients have donated biological specimens for research.

CONCLUSION

The survival rate of this cohort of lung cancer patients was slightly improved compared with earlier reports, particularly for patients with low-stage NSCLC. Our patient and biospecimen resource has enabled us to obtain timely results from clinical and translational research of lung cancer.