Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

WYSIWIS revised: early experiences with multiuser interfaces

WYSIWIS (What You See Is What I See) is a foundational abstraction for multiuser interfaces that expresses many of the characteristics of a chalkboard in face-to-face meetings. In its strictest interpretation, it means that everyone can also see the same written information and also see where anyone else is pointing. In our attempts to build software support for collaboration in meetings, we have discovered that WYSIWIS is crucial, yet too inflexible when strictly enforced. This paper is about the design issues and choices that arose in our first generation of meeting tools based on WYSIWIS. Several examples of multiuser interfaces that start from this abstraction are presented. These tools illustrate that there are inherent conflicts between the needs of a group and the needs of individuals, since user interfaces compete for the same display space and meeting time. To help minimize the effect of these conflicts, constraints were relaxed along four key dimensions of WYSIWIS: display space, time of display, subgroup population, and congruence of view. Meeting tools must be designed to support the changing needs of information sharing during process transitions, as subgroups are formed and dissolved, as individuals shift their focus of activity, and as the group shifts from multiple parallel activities to a single focused activity and back again.