Understanding immunotherapy for the treatment of non-small cell lung cancer.
British journal of nursing (Mark Allen Publishing)
Patients diagnosed with advanced non-small-cell lung cancer (NSCLC) (either squamous or non-squamous) have previously had limited treatment options after progression on chemotherapy. With the emergence of new drugs, particularly in the immuno-oncology setting, this is now changing. Recent clinical trial evidence demonstrates that compared with docetaxel, patients who received nivolumab had better overall survival and also significantly fewer grade 3-4 adverse events. This article reviews the clinical trial data for nivolumab and provides an overview of how this drug works. The adverse event profile of nivolumab is assessed and compared to that of docetaxel. The important role that nurses can play in supporting patients on nivolumab is also discussed.
[The effectiveness of care bundles in maintaining the skin integrity and reducing the incidence density of pressure ulcers in lung cancer inpatients].
Lin Wen-Ling,Tseng Chien-Hua,Chung Yi-Jen,Chuang Hsin-Chu,Lin Yun-Lan,Chang Pi-Hua
Hu li za zhi The journal of nursing
BACKGROUND & PROBLEMS:Pressure ulcers are tissue defects that form on the skin as a result of progressive skin damage. Pressure ulcers are a skin-integrity-related care issue and an important clinical indicator of care quality, especially for lung cancer inpatients who face rapidly deteriorating health conditions due to multiple symptoms and the side effects of treatment. Treating severe pressure ulcers may consume considerable manpower, time, and medical resources. Pressure ulcers may be avoided or effectively treated when nurses conduct proper skin assessments and care for wounds properly. PURPOSE:This project evaluates the efficacy of skin care bundles in terms of reducing the incidence density of pressure ulcers in lung cancer inpatients. RESOLUTION:Data gathered between January 2010 and March 2011 showed unstable incidence density for pressure ulcers. The average pressure-ulcer incidence density in lung cancer inpatients was 2.09%, which was 8-times higher than the average for all patients. Using evidence-based care bundles for pressure ulcer prevention, we trained nurse staffs to incorporate these bundles into their clinical daily care of lung cancer patients in our hospital. RESULTS:During the study period between November 2011 and January 2012, the pressure-ulcer incidence density gradually fell to 0.55%. The incidence density continued to fall to 0.33% over the subsequent 8 months. CONCLUSIONS:We used the concept of "care bundles" to establish a standard skin-care protocol for advanced lung cancer inpatients. This protocol improved the clinical ability of nursing staffs and effectively maintained skin care quality in lung cancer patients.
The effects of supportive care interventions on depressive symptoms among patients with lung cancer: A metaanalysis of randomized controlled studies.
Hsieh Chia-Chen,Hsiao Fei-Hsiu
Palliative & supportive care
OBJECTIVE:Our aim was to examine the effect of supportive care interventions on depressive symptoms in patients with lung cancer. METHOD:We searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and the Chinese Electronic Periodical Services (CEPS) from their inception until September of 2015. We included randomized controlled trial studies that compared standard care with supportive care interventions. The standardized mean difference (SMD) (Cohen's d) was calculated to estimate the effect of interventions. Subgroup analysis was conducted to identify possible sources of heterogeneity. RESULTS:A total of 1,472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = -0.74, CI 95% = -1.07 to -0.41), and the effects could be maintained at weeks 4, 8, and 12 of follow-up. Three types of supportive care interventions were identified: psychotherapy combined with psychoeducation, psychoeducation alone, and an exercise program. Both psychotherapy combined with psychoeducation and exercise significantly improved depressive symptoms, while psychoeducation alone did not yield significant effects. The moderating effects indicated that greater improvements in depressive symptoms were found in lung cancer patients with a severe level of depressive symptoms at baseline. SIGNIFICANCE OF RESULTS:Personalized supportive care interventions can be developed based on the main causes of depressive symptoms. Psychotherapy combined with psychoeducation can target the causes of depressive symptoms, including both physical distress and psychological trauma due to lung cancer, while exercise programs can effectively improve depressive symptoms for lung cancer patients with impaired respiratory function.
Which patients are assessed by lung cancer nurse specialists? A national lung cancer audit study of over 128,000 patients across england.
Khakwani Aamir,Hubbard Richard B,Beckett Paul,Borthwick Diana,Tod Angela,Leary Alison,White John,Tata Laila J
Lung cancer (Amsterdam, Netherlands)
BACKGROUND:Lung cancer nurse specialists (LCNS) are integral to the multidisciplinary clinical team, providing personalised physical and psycho-social interventions, and care management for people with lung cancer. The National Institute of Health and Care Excellence (NICE) recommend that all patients have access to a LCNS. We conducted a national study assessing whether there is variation in access to and timing of LCNS assessment. METHODS:The National Cancer Action Team's LCNS workforce census in England was linked with patient and hospital Trust data from the English National Lung Cancer Audit. Multivariate logistic regression was used to assess features associated with LCNS assessment. RESULTS:128,124 lung cancer patients were seen from 2007 to 2011. LCNS assessment confirmation was 'yes' in 62%, 'no' in 6% and 'missing' in 32%. Where (in clinic versus ward) and when (before versus after diagnosis) patients were assessed by a LCNS also varied. Older patients with poor performance status, early cancer stage, and comorbidities were less likely to be assessed; there was no difference with sex or socioeconomic group. Patients receiving any anti-cancer treatment were more likely to be assessed. Assessment was lower in Trusts with high annual patient numbers (odds ratio=0.58, 95% confidence interval 0.37-0.91) and where LCNS caseload>250 (0.69, 0.41-1.16, although not statistically significant), but increased where workload was conducted mostly by band 8 nurses (2.22, 1.22-4.02). CONCLUSION:LCNS assessment varied by patient and Trust features, which may indicate unmet need for some patients. The current workforce needs to expand as well as retain experienced LCNSs.
A meta-analysis of comprehensive care on quality of life in patients with lung cancer.
Wang Xiang,Cao Haili
Journal of cancer research and therapeutics
OBJECTIVE:The aim of this meta-analysis was to evaluate the efficacy of comprehensive care on quality of life in patients with lung cancer. METHODS:The clinical studies about comprehensive care on quality of life in patients with lung cancer were searched in the Medline, PubMed, EMBASE, CNKI, and WANFANG databases. The score of society function, emotional function, somatic function, cognitive function was collected in each of the included studies. And the data were pooled by Stata version 11.0 software. RESULT:Finally, three clinical studies including 536 cases were included in this meta-analysis. Significant statistical heterogeneity was existed in the three papers (P < 0.05). The data were pooled by random effect model. The combined results showed that the quality of life for lung cancer patients can be significantly improved in the aspects of society function (standardized mean difference [SMD] =0.41, 95% confidence interval [CI]: 0.10-0.71), emotional function (SMD = 0.45, 0.12-0.78), somatic function (SMD = 0.98, 95% CI: 0.51-1.44), and cognitive function (SMD = 0.64, 95% CI: 0.44-0.83). CONCLUSION:Quality of life for lung cancer patients can be significantly improved through comprehensive care.
Understanding patients' values and preferences regarding early stage lung cancer treatment decision making.
Sullivan Donald R,Eden Karen B,Dieckmann Nathan F,Golden Sara E,Vranas Kelly C,Nugent Shannon M,Slatore Christopher G
Lung cancer (Amsterdam, Netherlands)
INTRODUCTION:With advances in treatments among patients with lung cancer, it is increasingly important to understand patients' values and preferences to facilitate shared decision making. METHODS:Prospective, multicenter study of patients with treated stage I lung cancer. At the time of study participation, participants were 4-6 months posttreatment. Value clarification and discrete choice methods were used to elicit participants' values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes. RESULTS:Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65% were male, 68 (60%) received SBRT and 46 (40%) received surgery. More participants valued independence and quality of life (QOL) as "most important" compared to survival or cancer recurrence. Most participants (83%) were willing to accept lung cancer treatment with a 2% chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86%) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49% of participants preferred the alternative lung cancer treatment than what they received. CONCLUSIONS:Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients' values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients' goals. Clinicians need more resources to engage in high quality communication during lung cancer treatment discussions.
Integrating nurse-facilitated advance care planning for patients newly diagnosed with advanced lung cancer.
Ólafsdóttir Kristin Lara,Jónsdóttir Helga,Fridriksdóttir Nanna,Sigurdardóttir Valgerdur,Haraldsdóttir Erna
International journal of palliative nursing
BACKGROUND:Advance care planning (ACP) is well recognised as an important component of palliative care. However, there is still a need to explore ways in which it can become a part of routine practice, ensuring a timely and person-centred discussion. OBJECTIVES:To explore patients newly diagnosed with advanced lung cancer and their family members' experiences of engaging in a person-centred and structured ACP discussion facilitated by palliative care nurses in an outpatient oncology clinic at the University Hospital of Iceland. METHODS:An exploratory qualitative design employing semi-structured interviews and thematic analysis. The intervention included a structured ACP discussion, aided by a booklet. RESULTS:Key themes emerged describing families' and patients' experiences and highlighted that the timing and approach of the ACP discussion was appropriate and helpful, even though the discussion was sensitive and difficult. Using a routine approach with a flexible structure normalised the discussion and made it easier for the patients to take the lead in the discussion. CONCLUSIONS:ACP discussion can be part of an integrated palliative care and oncology service if implemented in a systematic way.
Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention.
Sun Virginia,Raz Dan J,Erhunmwunsee Loretta,Ruel Nora,Carranza Jacqueline,Prieto Rosemary,Ferrell Betty,Krouse Robert S,McCorkle Ruth,Kim Jae Y
Contemporary clinical trials
OBJECTIVE:To describe the study protocol of the Multimedia Self-Management (MSM) intervention to prepare patients and family caregivers (FCGs) for lung cancer surgery. DESIGN:The study is a five-year, single site, randomized controlled trial of 160 lung cancer surgery FCG and patient dyads (320 total participants), comparing intervention and attention control arms. SETTING:One National Cancer-Institute (NCI) designated comprehensive cancer center in Southern California. PARTICIPANTS:Patients who are scheduled to undergo lung cancer surgery and their FCGs are enrolled as dyads only. INTERVENTION:Based on the Chronic Care Self-Management Model (CCM), the intervention is a nurse-led, caregiver-based, multimedia care program for lung cancer surgery. Its primary focus is to help FCGs develop self-management skills related to their caregiving role through goal setting, proactive planning, building problem-solving skills, and accessing family support services. The intervention also supports dyads to prepare for surgery and post-operative recovery at home. It includes videos, print, web-based, and post-discharge telephone support. MAIN OUTCOME MEASURES:FCG and patient psychological distress and QOL; FCG burden and preparedness for caregiving; FCG and patient healthcare resource use (in-home nursing care, urgent care/ER visits, readmissions). ANALYSIS:Repeated measures ANCOVA statistical design will be used, removing variances prior to examining mean squares for the group by occasion interactions, and co-varying the baseline scores. In addition, structured equation modeling (SEM) will assess whether mediating and moderating factors are associated with outcomes. ClinicalTrials.gov Identifier: NCT03686007.
[A Preliminary Study to Investigate Frailty in Advanced Lung Cancer Patients Before Receiving Immunotherapy].
Lu Yi-An,Luo Yung-Hung,Tsay Pei-Kwei,Liu Hsueh-Erh
Hu li za zhi The journal of nursing
BACKGROUND:Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty. PURPOSE:This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy. METHODS:A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured. RESULTS:The ratio of frailty was 17.3%, with comorbidities (p = .023), body mass index (p = .004), Eastern Cooperative Oncology Group Status (p < .001), activities of daily living status (p < .001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE:In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.
End-of-Life Health Care Utilization Between Chronic Obstructive Pulmonary Disease and Lung Cancer Patients.
Kuo Lou-Ching,Chen Jin-Hua,Lee Chih-Hsin,Tsai Ching-Wen,Lin Chia-Chin
Journal of pain and symptom management
CONTEXT:At the end of life, chronic obstructive pulmonary disease (COPD) and lung cancer (LC) patients exhibit similar symptoms; however, a large-scale study comparing end-of-life health care utilization between these two groups has not been conducted in East Asia. OBJECTIVES:To explore and compare end-of-life resource use during the last six months before death between COPD and LC patients. METHODS:Using data from the Taiwan National Health Insurance Research Database, we conducted a nationwide retrospective cohort study in COPD (n = 8640) and LC (n = 3377) patients who died between 1997 and 2013. RESULTS:The COPD decedents were more likely to be admitted to intensive care units (57.59% vs 29.82%), to have longer intensive care unit stays (17.59 vs 9.93 days), and to undergo intensive procedures than the LC decedents during their last six months; they were less likely to receive inpatient (3.32% vs 18.24%) or home-based palliative care (0.84% vs 8.17%) and supportive procedures than the LC decedents during their last six months. The average total medical cost during the last six months was approximately 18.42% higher for the COPD decedents than for the LC decedents. CONCLUSION:Higher intensive health care resource use, including intensive procedure use, at the end of life suggests a focus on prolonging life in COPD patients; it also indicates an unmet demand for palliative care in these patients. Avoiding potentially inappropriate care and improving end-of-life care quality by providing palliative care to COPD patients are necessary.
Integrated Onco-Palliative Care Associated With Prolonged Survival Compared to Standard Care for Patients With Advanced Lung Cancer: A Retrospective Review.
King Jonathan D,Eickhoff Jens,Traynor Anne,Campbell Toby C
Journal of pain and symptom management
CONTEXT:Lung cancer is the leading cause of cancer-related death in the U.S. A large randomized controlled trial in advanced lung cancer found a survival advantage with an early palliative care (EPC) intervention compared to standard oncologic care. OBJECTIVES:We performed retrospective analysis of our partially integrated onco-palliative care lung cancer clinic to evaluate overall survival and resource utilization. METHODS:All outpatients with advanced lung cancer cared for within our institution from 2007 to 2011 were identified. Overall survival, clinical trial participation, hospice enrollment and length of stay, and chemotherapy utilization were calculated for patients treated with EPC and compared to standard oncologic care. RESULTS:Two hundred seven patients with advanced lung cancer were identified; 82 received EPC. EPC patients had a survival advantage (11.9 vs. 10.1 months, P = 0.031), were more likely to participate in clinical trials (29% vs. 19%, P = 0.014), and median hospice length of stay was longer (38.5 vs. 24 days, P = 0.032). No difference in chemotherapy utilization or hospice enrollment was seen between the groups. CONCLUSION:EPC in advanced lung cancer was associated with a nearly two-month survival advantage compared to standard oncologic care. This finding provides supportive evidence to previously published reports of survival benefit with EPC intervention. Clinical trial participation rates in advanced lung cancer are lacking, and we found more frequent clinical trial participation in the early PC group. No differences were seen in chemotherapy utilization or hospice enrollment. EPC patients' longer hospice length of stay did not compromise survival.
Interprofessional Perspectives on Providing Spiritual Care for Patients With Lung Cancer in Outpatient Settings.
Siler Shaunna,Mamier Iris,Winslow Betty W,Ferrell Betty R
Oncology nursing forum
PURPOSE:To explore palliative care and oncology clinicians' perspectives on current challenges and facilitating factors in meeting the spiritual needs of patients with lung cancer and family caregivers. This study was conducted in preparation for a community-based lung cancer palliative care intervention. PARTICIPANTS & SETTING:19 oncology and palliative care clinicians in three outpatient Kaiser Permanente sites in southern California. METHODOLOGIC APPROACH:This multisite qualitative study used focus group and key informant interviews. Data were analyzed using content analysis methodology, and a team approach was used to validate findings. FINDINGS:Clinicians described facilitating factors (interprofessional team support, assessment of spiritual needs, clinician-provided spiritual support, and provision of culturally respectful spiritual care) and challenges (related to providing culturally respectful spiritual care by respecting the patients' spiritual and cultural beliefs in an open way and in advocating for the patients' wishes) they encountered when addressing patient and caregiver spiritual needs. IMPLICATIONS FOR NURSING:This study demonstrated the need to provide nurses with practical tools, education, and a supportive environment to address patients' and family caregivers' spiritual concerns.
CAPACITY: A physical activity self-management program for patients undergoing surgery for lung cancer, a phase I feasibility study.
Granger Catherine L,Irving Louis,Antippa Phillip,Edbrooke Lara,Parry Selina M,Krishnasamy Meinir,Denehy Linda
Lung cancer (Amsterdam, Netherlands)
OBJECTIVES:Physical activity is important in lung cancer, yet the majority of patients do not meet minimum weekly recommended activity levels. The objectives of this study were to determine the: 1) feasibility and 2) exploratory effectiveness of a physical activity self-management program aiming to increase physical activity levels of patients undergoing surgery for lung cancer. MATERIALS AND METHODS:Prospective case series including patients with operable lung cancer. The physical activity self-management program, based on international cancer physical activity guidelines, commenced pre-operative (if recruitment occurred ≥7 days before surgery) or post-operative if not, and continued until 8-weeks after surgery. The program included prescription of an unsupervised home aerobic exercise program, taught in an initial face-to-face consultation and followed-up with weekly telephone consultations. This was supplemented with patient education, behaviour change techniques and provision of an activity monitor. The primary endpoint was program feasibility including consent rate and number of consultations delivered. In addition, self-reported physical activity levels, self-efficacy for physical activity, health-related quality of life (HRQoL) and mood was assessed pre- and 8-weeks post-operative. RESULTS:The consent rate was 89%. Thirty-seven patients (54% male, mean age 66 ± 10 years) were included. Only six participants commenced the program before surgery, with most (n = 31) commencing post-operatively. The median [IQR] number of consultations was 4 [3-6] per participant. There was no change in physical activity levels (total estimated mets/week pre-operative median [IQR] 1066 [0-2772], 8 weeks post-operative 924 [346-1752], p = 0.545) or sedentary time (television viewing hours/day pre-operative 4.5 [2.0-9.5], 8-weeks 4.0 [3.0-5.0], p = 0.527) after surgery. CONCLUSION:The physical activity program was feasible when implemented in the post-operative setting. Participants in this feasibility study demonstrated maintenance in physical activity levels 8-weeks after surgery, compared with published literature reporting decline after surgery. A randomised controlled trial is warranted to further investigate potential effectiveness of this intervention.
Psychosocial interventions for informal caregivers of lung cancer patients: A systematic review.
Kedia Satish K,Collins Andy,Dillon Patrick J,Akkus Cem,Ward Kenneth D,Jackson Bianca M
OBJECTIVE:Caregivers of patients with lung cancer often face physical, emotional, and financial distress, which not only negatively affects the caregivers' mental health and quality of life but may also impact patients' well-being. The purpose of this systematic review is to examine the content, delivery, and efficacy of psychosocial interventions targeting caregivers of lung cancer patients. METHODS:Studies included in this systematic review assessed psychosocial interventions for caregivers of lung cancer patients that were published in English between January 2009 and December 2017. These interventions focused on burden, mental health, quality of life, self-efficacy, and/or coping as outcome measures. CINAHL, PubMed, PsycInfo, Science Direct, and Web of Science databases were searched using the terms (lung cancer OR lung neoplasms OR thoracic cancer) AND (caregiver OR caregiving) AND (intervention OR program) to systematically review the relevant literature on this topic. RESULTS:From the 22 studies included in this systematic review, interventions were classified into four categories: communication-based interventions, coping skills training interventions, multicomponent interventions, and stress reduction interventions. The majority of the interventions (especially communication-based and multicomponent) led to improvement, albeit not always statistically significant, in one or more outcomes; however, the most frequently reported improvements included, burden, distress, anxiety, depression, overall quality of life, self-efficacy, and coping abilities. CONCLUSIONS:The unmet needs of informal caregivers of lung cancer patients have a significant impact on their mental health and quality of life, but this burden can be alleviated by psychosocial interventions that offer appropriate support, education, and resources.
Effectiveness of an interdisciplinary palliative care intervention for family caregivers in lung cancer.
Sun Virginia,Grant Marcia,Koczywas Marianna,Freeman Bonnie,Zachariah Finly,Fujinami Rebecca,Del Ferraro Catherine,Uman Gwen,Ferrell Betty
BACKGROUND:Family caregivers (FCGs) experience significant deteriorations in quality of life while caring for patients with lung cancer. In this study, the authors tested the effectiveness of an interdisciplinary palliative care intervention for FCGs of patients diagnosed with stage I through IV nonsmall cell lung cancer. METHODS:FCGs who were identified by patients as their primary caregivers were enrolled in a prospective, quasi-experimental study in which the usual care group was accrued first followed by the intervention group. FCGs in the intervention group were presented at interdisciplinary care meetings, and they also received 4 educational sessions organized in the physical, psychological, social, and spiritual domains. The sessions included self-care plans to support the FCG's own needs. Caregiver burden, caregiving skills preparedness, psychological distress, and FCG quality of life were assessed at baseline and after 12 weeks using validated measures. RESULTS:In total, 366 FCGs were included in the primary analysis. FCGs who received the interdisciplinary palliative care intervention had significantly better scores for social well being (5.84 vs 6.86; P < .001) and had lower psychological distress scores (4.61 vs 4.20; P = .010) at 12 weeks compared with FCGs in the usual care group. FCGs in the intervention group also had significantly less caregiver burden compared with FCGs in the usual care group (P = .008). CONCLUSIONS:An interdisciplinary approach to palliative care in lung cancer resulted in statistically significant improvements in FCG's social well being and psychological distress and in less caregiver burden.
A Structured Nursing Intervention to Address Oral Chemotherapy Adherence in Patients With Non-Small Cell Lung Cancer.
Boucher Jean,Lucca Joan,Hooper Catherine,Pedulla Lillian,Berry Donna L
Oncology nursing forum
PURPOSE/OBJECTIVES:To evaluate a nurse-led intervention to enhance medication knowledge and adherence using the Multinational Association for Supportive Care in Cancer Oral Agent Teaching Tool (MOATT). DESIGN:Longitudinal, descriptive feasibility study. SETTING:An ambulatory thoracic oncology disease center located at the Dana-Farber Cancer Institute in Boston, MA. SAMPLE:30 adult patients with lung cancer who received the oral agent erlotinib. METHODS:Structured, nurse-led education sessions using the MOATT were provided, with a 72-hour follow-up telephone contact. Participants completed a Knowledge Rating Scale (KRS) and adapted Morisky Medication Adherence Scale-8 (MMAS-8) at the end of the first cycle of oral chemotherapy. MAIN RESEARCH VARIABLES:Knowledge and adherence; feasibility. FINDINGS:Twenty-seven participants completed the study outcome measures reporting high knowledge levels and MMAS-8 scores. Structured, nurse-led education and follow-up monitoring sessions ranged from 14-30 minutes. Several participants also initiated contact for assistance with prescription procurement and symptom management. Participants reported a median of two side effects. CONCLUSIONS:The structured, nurse-led teaching, using the MOATT tool, and follow-up nurse contacts were feasible as integrated into the thoracic oncology setting. Adherence and knowledge outcomes were encouraging. Additional studies should include objective adherence measures and strategies for delivering supportive care to patients at home. IMPLICATIONS FOR NURSING:Structured teaching with patients is important to enhance proper oral anticancer medication knowledge and adherence, including follow-up monitoring of administration and side effects at 72 hours.
Effects of cognitive education on the perceived control and symptom distress of lung cancer patients receiving chemotherapy: A randomised controlled trial.
Tan Xing,Xiong Haihan,Gui Sijie,Wan Yanping,Yan Wenjing,Wang Dian,Tong Lingling,Zeng Guqing
European journal of cancer care
AIM:A randomised controlled trial (RCT) was implemented to verify the feasibility and acceptability of cognitive education in the format of mind maps for increasing perceived control and decreasing the symptom distress of lung cancer patients who were receiving chemotherapy. METHODS:A total of 136 lung cancer patients who were receiving chemotherapy were randomised using stratified blocks (1:1 ratio, from March 2016 to April 2017). The intervention group was given cognitive education in the format of mind maps. The control group was provided conventional education. The primary outcomes were perceived control, including cancer experience and cancer efficacy; the secondary outcomes included symptom distress (arising from fatigue, distress, sleep disturbance, poor appetite, drowsiness, shortness of breath, etc.). The Mann-Whitney U test, chi-squared test, two-sample t test and repeated measurement analysis of variance were used. RESULTS:Ninety-four patients completed the final study. The results of the repeated measurement analysis of variance indicated that at the 8th or 12th week following cognitive education intervention in the format of mind maps, the cancer experience, cancer efficacy (except personal efficacy) and symptom distress (arising from fatigue, distress, sleep disturbance, and sadness and its total scores) of the patients in the intervention group were considerably improved compared with those of the control group (p < 0.05). The longer the intervention was, the higher the level of the patients' perceived control was and the lower the degree of patient symptom distress was (p < 0.05). CONCLUSIONS:Our findings suggest that cognitive education in the format of mind maps could improve perceived control and decrease the symptom distress of lung cancer patients who were receiving chemotherapy and that it was feasible and acceptable. Cognitive education in the format of mind maps was found to be an effective teaching tool for lung cancer patients who were receiving chemotherapy.
Burden, emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study.
Tan J-Y,Molassiotis A,Lloyd-Williams M,Yorke J
European journal of cancer care
This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty-three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver-reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index-Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient-reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non-anxious and non-depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non-depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.
Nurse-Delivered Symptom Assessment for Individuals With Advanced Lung Cancer.
Flannery Marie,Stein Karen F,Dougherty David W,Mohile Supriya,Guido Joseph,Wells Nancy
Oncology nursing forum
OBJECTIVES:To assess an intervention derived from self-regulation theory (SRT) to promote well-being for individuals with advanced lung cancer. SAMPLE & SETTING:45 adults with advanced lung cancer who were receiving chemotherapy at an ambulatory cancer center. METHODS & VARIABLES:Participants were randomized to the intervention group or usual care control group. Feasibility assessment focused on recruitment, retention, design, methods, and fidelity. Outcome measures of quality of life, symptoms, and distress were collected at four time points. The main research variables were symptoms, quality of life, and distress. RESULTS:The participation rate was 79%, and the retention rate was 62%. Participant loss was most often because of progressive disease and occurred early in the study. High fidelity was noted for delivery of the intervention as planned and outcome data collection by telephone. The mean number of interventions delivered was 5.5 of a planned 8. A high level of acceptability was reported for participants completing the intervention. IMPLICATIONS FOR NURSING:Although delivering the SRT-derived intervention with fidelity was possible, feasibility findings do not warrant intervention replication in this population.
A Home-based Exercise Intervention for Non-Small Cell Lung Cancer Patients Post-Thoracotomy.
Hoffman Amy J,Brintnall Ruth Ann
Seminars in oncology nursing
OBJECTIVES:There are no evidenced-based rehabilitative guidelines for postsurgical non-small cell lung cancer (NSCLC) patients. This qualitative study provides evidence on the acceptability of an effective postsurgical exercise intervention targeting the self-management of cancer-related fatigue to fill this gap. DATA SOURCES:Qualitative perspective of 37 individuals randomized to a 6-week exercise program following hospital discharge post-thoracotomy for NSCLC. CONCLUSION:Postsurgical NSCLC participants found this rehabilitative exercise intervention highly acceptable because it removed traditional barriers to exercise. IMPLICATION FOR NURSING PRACTICE:A highly acceptable and effective solution for meeting the unmet rehabilitative support needs of NSCLC patients has broader implications for extension to other vulnerable, aging, deconditioned populations.
Real-world lung cancer screening decision-making: Barriers and facilitators.
Lowenstein Margaret,Vijayaraghavan Maya,Burke Nancy J,Karliner Leah,Wang Sunny,Peters Melissa,Lozano Amy,Kaplan Celia P
Lung cancer (Amsterdam, Netherlands)
OBJECTIVE:To explore 1) attitudes and priorities among physicians and patients that inform shared decision-making about lung cancer screening in real-world settings and 2) physician and patient perceptions of shared decision-making in real-world lung cancer screening (LCS) practice. MATERIALS AND METHODS:We conducted a qualitative study of 12 physicians and 30 patients meeting LCS screening criteria established by the US Preventative Services Task Force (USPSTF) from two academic primary care practices; one university clinic and one safety net clinic. Interview guides focused on knowledge and attitudes about LCS and experiences with patient-physician communication. RESULTS:Physicians offered LCS inconsistently and were ambivalent about screening because of potential harms, including false positive results, incidental findings, and radiation exposure. Physicians felt that they were incorporating shared decision-making into screening, although they acknowledged that challenges with screening communication posed barriers to shared decision-making. Patients were generally accepting of lung cancer screening. They expressed fewer concerns about screening-related harms but more personal or emotional concerns related to lung cancer. Patients perceived limited shared decision-making in their encounters, but were generally satisfied with the more physician-directed decision-making process. CONCLUSION:Physicians and patients expressed different concerns about LCS and different perceptions about the use of shared decision-making. Findings from this real-world population of screening-eligible patients can be used to inform the design of future interventions to facilitate communication and decision-making tailored to perspectives of both physicians and patients.
The Impact of Hospice Services in the Care of Patients with Advanced Stage Nonsmall Cell Lung Cancer.
Duggan Kristy T,Hildebrand Duffus Sara,D'Agostino Ralph B,Petty William J,Streer Nathan P,Stephenson Richard C
Journal of palliative medicine
INTRODUCTION:Prior research has shown that advanced stage nonsmall cell lung cancer (NSCLC) patients enrolled in hospice care receive less aggressive treatment at the end of life (EOL) without compromising survival. Our purpose was to profile the continuum of care of these patients, exploring the connection between hospice enrollment and quality indicators for excellence in EOL cancer care. METHODS:One hundred ninety-seven deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified. A retrospective review was conducted, collecting data from electronic medical records regarding antitumor treatment, postdiagnosis hospital visits and admissions, hospice referrals and enrollments, and circumstances surrounding the patient's death. Patients were grouped by their status of hospice enrollment, and the remainder of the measures compared accordingly. RESULTS:There was no significant difference found in total number of postdiagnosis hospital admissions between the patients who were enrolled in hospice and those who were not. However, the group who received hospice services had a significantly lower number of hospitalizations (p < 0.001), emergency department visits (p < 0.01), and intensive care unit admissions in the last 30 days of life (p < 0.001). The number of lines of chemotherapy received did not differ significantly between the groups. Median survival, measured by the length of time between diagnosis and death, was significantly longer for hospice patients (p = 0.02). CONCLUSIONS:This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized EOL oncological care and a significantly longer median survival.
Factors influencing caregiver burden in families of hospitalised patients with lung cancer.
Seo Ye Ji,Park Heeok
Journal of clinical nursing
AIMS AND OBJECTIVES:To investigate the factors influencing caregiver burden in families of hospitalised lung cancer patients. BACKGROUND:Even though cancer symptoms among hospitalised lung cancer patients are serious and negatively affect caregivers, few research regarding to the factors of caregiver burden in hospitalised lung cancer patient has been carried out. DESIGN:Cross-sectional, descriptive and correlational study. METHODS:A convenience sample of hospitalised lung cancer patients (n = 107) was recruited from K University hospital in South Korea. Family depression, social support and caregiver burden as well as patients' lung cancer symptoms were measured using peer-reviewed and standard measurement tools. Descriptive statistics and parametric tests including stepwise regression were used to analyse the data. The STROBE guideline has been used to report this study. RESULTS:Caregiver burden among the families of hospitalised lung cancer patients was high; the regression model for caregiver burden among participants' families was significant. Depression among families was found to be the most influential factor for caregiver burden, followed by patients' lung cancer symptoms. CONCLUSIONS:This study revealed that family caregivers' depression and patients' lung cancer symptoms were the most significant factors for families' caregiver burden. Future research should be conducted to identify the causes of depression among families of hospitalised lung cancer patients and develop management programmes to address such causes. It is also necessary to investigate the causes of increased caregiver burden that differentiate families of lung cancer patients from other cancer patients and provide education to help such families understand such causes. RELEVANCE TO CLINICAL PRACTICE:Findings from this study show that family's depression and lung cancer symptoms were significant factors for caregivers' burden. Hence, it is suggested for the healthcare providers to find for the best solution/strategies to reduce the caregiver's burden.
Medicare Beneficiaries With Advanced Lung Cancer Experience Diverse Patterns Of Care From Diagnosis To Death.
Schuler Megan S,Joyce Nina R,Huskamp Haiden A,Lamont Elizabeth B,Hatfield Laura A
Health affairs (Project Hope)
Characterizations of average end-of-life care for people with cancer can obscure important differences in patients' experiences. Using Medicare claims data for 14,257 patients diagnosed with extensive-stage small-cell lung cancer in the period 1995-2009, we used latent class analysis to identify classes of people with different care patterns. We characterized care trajectories from diagnosis to death using time spent in five care settings-home, hospital inpatient unit (acute), hospital intensive care unit (ICU), postacute skilled nursing facility, and hospice-and transitions across these settings. We identified four classes of patients: 66 percent spent the time primarily at home, 11 percent were primarily in hospice, 17 percent were largely in an acute setting, and 6 percent were largely in an ICU. Patients in these classes differed significantly in terms of baseline clinical characteristics, survival length, time spent in hospice, site of death, and spending. The findings show substantial heterogeneity in patterns of care for patients with advanced cancer, which should be accounted for in efforts to improve end-of-life care.
The Perceived Facilitators and Challenges of Translating a Lung Cancer Palliative Care Intervention Into Community-Based Settings.
Siler Shaunna,Mamier Iris,Winslow Betty
Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association
Despite significant progress in implementing palliative care interventions for patients with cancer, few intervention studies seek health care clinicians' input before implementation of these into the community. The purpose of this study was to explore palliative care and oncology clinicians' perspectives on the perceived facilitators and challenges in meeting the quality-of-life needs of patients with lung cancer and family caregivers in community-based settings. The Reach Effectiveness Adoption Implementation Maintenance model for implementation research was used as a framework. This was a multisite qualitative study using focus group and key informant interviews. Nineteen clinicians addressed useful practices and challenges in the following areas: (a) early palliative care, (b) interdisciplinary care planning, (c) symptom management, (d) addressing psychological and social needs, and (e) providing culturally respectful care, including spiritual care. In preparation for the intervention, specific education needs and organizational challenges were revealed. Challenges included timing and staffing constraints, the need for clinician education on palliative care services to increase organizational buy-in, and education in providing spiritual support for patients and family caregivers. This research allowed investigators to understand perceptions of clinicians as they prepared to integrate palliative care in their settings. Hospice and palliative care nurses can be instrumental in implementing palliative care into community practice.
Quality of life and related factors in patients with newly diagnosed advanced lung cancer: a longitudinal study
Liao Yu-Chien,Shun Shiow-Ching,Liao Wei-Yu,Yu Chong-Jen,Yang Pan-Chyr,Lai Yeur-Hur
Oncology nursing forum
PURPOSE/OBJECTIVES:To examine the changes in quality of life (QOL), symptoms, self-efficacy for coping with cancer, and factors related to those changes in patients with newly diagnosed advanced lung cancer. DESIGN:Longitudinal and correlational. SETTING:Oncology inpatient wards and outpatient departments of a medical center in northern Taiwan. SAMPLE:101 patients newly diagnosed with stage IIIB or IV lung cancer. METHODS:Questionnaires were used to assess patients' QOL, symptoms, and self-efficacy before treatment and at one and three months following treatment. Factors related to the changes in global QOL and five functional dimensions were analyzed using six generalized estimating equation models. MAIN RESEARCH VARIABLES:QOL, symptoms, and self-efficacy for coping with cancer. FINDINGS:Patients reported moderate levels of global QOL, symptom severity, and self-efficacy for coping with cancer. They also reported high physical and cognitive functions, but relatively low role and social functions. Factors were significantly related to the most functional dimensions, including self-efficacy, fatigue, pain, sleep difficulties, and demographic- and disease-related factors. Self-efficacy was the most robust factor for predicting QOL. CONCLUSIONS:Patients with advanced lung cancer experience a compromised global QOL and relatively low social and role functioning during the first three months following cancer diagnosis. Levels of self-efficacy and symptoms significantly affected changes in QOL and functioning. IMPLICATIONS FOR NURSING:Applying a systematic assessment of changes in QOL and developing comprehensive interventions with self-efficacy training and symptom management are strongly recommended for clinical care to improve the QOL of patients with advanced lung cancer.
Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer: A Study Protocol.
Chua Isaac S,Zachariah Finly,Dale William,Feliciano Josephine,Hanson Laura,Blackhall Leslie,Quest Tammie,Curseen Kimberly,Grey Carl,Rhodes Ramona,Shoemaker Laura,Silveira Maria,Fischer Stacy,O'Mahony Sean,Leventakos Kostantinos,Trotter Chardria,Sereno Isabella,Kamdar Mihir,Temel Jennifer,Greer Joseph A
Journal of palliative medicine
Early palliative care (PC) integrated with oncology care improves quality of life (QOL), depression symptoms, illness understanding, and end-of-life (EOL) care for patients with advanced lung cancer. The aims of this trial are to compare the effect of delivering early integrated PC through telehealth versus in-person on patient and caregiver outcomes. We hypothesize that both modalities for delivering early PC would be equivalent for improving patient QOL, communication about EOL care preferences with their oncologist, and length of stay in hospice. For this comparative effectiveness trial, we will enroll and randomize 1250 adult patients with advanced nonsmall cell lung cancer (NSCLC), who are not being treated with curative intent, to receive either early integrated telehealth or in-person PC at 20 cancer centers throughout the United States. Patients may also invite a family caregiver to participate in the study. Patients and their caregivers in both study groups meet at least every four weeks with a PC clinician from within 12 weeks of patient diagnosis of advanced NSCLC until death. Participants complete measures of QOL, mood, and quality of communication with oncologists at baseline before randomization and at 12, 24, 36, and 48 weeks. Information on health care utilization, including length of stay in hospice, will be collected from patients' health records. To test equivalence in outcomes between study groups, we will compute analysis of covariance and mixed linear models, controlling for baseline scores and study site. To ensure that this comparative effectiveness trial and findings are as patient centered and meaningful as possible, we have incorporated a robust patient and stakeholder engagement plan. Our stakeholder partners include (1) patients/families, (2) PC clinicians, (3) telehealth experts and clinician users, (4) representatives from health care systems and medical insurance providers, and (5) health care policy makers and advocates. These stakeholders will inform and provide feedback about every phase of study implementation.
Palliative care and psychosocial care in metastatic non-small cell lung cancer: factors affecting utilisation of services and impact on patient survival.
Duggan Kirsten J,Wiltshire Jennifer,Strutt Rebecca,Boxer Miriam M,Berthelsen Angela,Descallar Joseph,Vinod Shalini K
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
BACKGROUND:Palliative care (PC) and psychosocial care (PSC) are essential services, which can positively impact on quality of life in patients with metastatic lung cancer, when advanced disease and poor prognosis preclude the use of curative therapies. The aims of this study were to describe patterns of PC and PSC and identify factors associated with service utilisation and overall patient survival. METHOD:A retrospective Australian cohort of South Western Sydney residents with newly diagnosed stage IV non-small cell lung cancer (NSCLC) in 2006-2012 was identified from the Local Health District Clinical Cancer Registry. Supplemental information was sourced from the area PC database and hospital medical records. Cox regression models with robust variance identified factors associated with PC and PSC and examined patient survival. RESULTS:A total of 923 patients were identified. Eighty-three per cent of patients were seen by PC, with 67% seen within 8 weeks of diagnosis. PSC utilisation was 82%. Radiotherapy treatment and residential area were associated with both PC and PSC. Increasing age was associated with early PC referral. Median overall survival was 4 months. PC was associated with patient survival; however, the effect varied over time. CONCLUSION:The rate of PC and PSC in our metastatic NSCLC population was high when compared with published data. Despite this, there were gaps in PC and PSC provision in this population, notably with patients not receiving active treatment, and those receiving systemic therapy utilising these services less frequently. PSC and PC contact were not convincingly associated with improved patient survival.
Feasibility of advanced practice nursing in lung cancer consultations during early treatment: A phase II study.
Serena Andrea,Dwyer Andrew,Peters Solange,Eicher Manuela
European journal of oncology nursing : the official journal of European Oncology Nursing Society
PURPOSE:There are limited data on the effectiveness of Advanced Practice Nurses in Lung Cancer (APNLC). Previous studies have demonstrated barriers to investigation including low recruitment and high attrition rates in lung cancer population. The primary aim of this study was to assess the feasibility of APNLC consultations and the ability to collect patient-reported outcome measures (PROMs) during first-line treatment. The secondary aim was to describe changes in self-efficacy for managing lung cancer-related symptoms, symptom intensity/burden and unmet supportive care needs of APNLC patients during first-line treatment. METHODS:An exact single-stage phase II design was applied. We recruited a consecutive sample of newly diagnosed lung cancer patients receiving systemic treatment in a Swiss oncology outpatient center. The intervention consisted of four systematic, alternating face-to-face/telephone consultations during first line-treatment. Feasibility of the study was defined by at least 55% of patients receiving all scheduled APNLC-led consultations and completing PROMs assessments at the three timepoints. RESULTS:In total, 35/46 (76%) (95% CI, 0.61 to 0.87) of patients met the feasibility criteria receiving all scheduled APNLC consultations. Fifty-six percent (26/46) (95% CI, 0.41 to 0.71) completed the PROMs at the three timepoints. Self-efficacy for managing symptoms remained stable, intensity of predominant symptoms increased. Unmet information needs decreased significantly while psychological and sexuality related needs increased over time. CONCLUSION:Results were promising for the feasibility of the APNLC consultation and the ability to collect PROMs. Further investigations are needed to increase the impact of the APNLC consultations on symptom intensity and sexual and psychological needs.
Supportive Care Needs of Patients With Lung Cancer in Mainland China: A Cross-Sectional Study.
Zhang Tian,He Hongye,Liu Qunhui,Lv Xiaoqing,Song Yongxia,Hong Jingfang
The journal of nursing research : JNR
BACKGROUND:The diagnosis and treatment of lung cancer necessitate a variety of supportive care needs. To our knowledge, no studies have been conducted that target specifically the supportive care needs of patients with lung cancer in Mainland China. Cross-cultural studies indicate that supportive care needs vary by cultural background. Thus, it is necessary to investigate the supportive care needs of patients with lung cancer in the cultural context of China. PURPOSE:This study aimed to describe the level of supportive care required by patients with lung cancer in China and to examine the relationships between supportive care needs and demographic factors and between supportive care needs and treatment variables. METHODS:A cross-sectional descriptive study design was adopted. Five hundred fifty-four patients with lung cancer were recruited using a convenience sampling method from inpatient departments in four tertiary teaching hospitals that are affiliated with a medical university in Anhui Province, China. The Nursing Professional Social Support Needs Scale and background information list were used as the data collection instruments. A Wilcoxon rank sum test and a Kruskal-Wallis rank sum test were conducted to examine the differences among the professional supportive care needs of patients of different demographic characteristics and under different treatment conditions. RESULTS:Participants self-reported the highest scores in the domain of informational needs (M = 3.67, interquartile range = 1.25). The most common supportive care need was "to be cared for by nurses with skilled venipuncture techniques." There were significant differences in needs across different genders, age groups, educational levels, and income levels (p < .05). Patients with metastasis and other illnesses had greater supportive care needs in terms of total and subscale scores in Stages III and IV (p < .05). CONCLUSIONS:Patients with serious diseases and heavy socioeconomic burdens have greater supportive care needs. Therefore, healthcare providers should improve their awareness and expertise to identify the needs of their patients and to provide supportive care to patients with lung cancer. In addition, patients with high supportive care needs should be identified.
[Dynamic investigation of nutritional risk in patients with malignant tumor during hospitalization].
Zhu M W,Wei J M,Chen W,Yang X,Cui H Y,Zhu S N,Zhang P P,Xiong J,Zheng D F,Song H J,Liang X Y,Zhang L,Xu W Y,Wang H B,Su G Q,Feng L J,Chen T,Wu Y D,Li H,Sun J Q,Shi Y,Tong B D,Zhou S M,Wang X Y,Huang Y H,Zhang B M,Xu J,Zhang H Y,Chang G L,Jia Z Y,Chen S F,Hu J,Zhang X W,Wang H,Li Z D,Gao Y Y,Gui B
Zhonghua yi xue za zhi
To prospectively investigate the changes in nutritional status of patients with malignant tumors during hospitalization by using nutritional risk screening (NRS2002), and to analyze the correlation between the nutritional status and clinical outcomes . This was a prospective and parallel research done by multi-center collaboration from 34 hospitals in China from June to September 2014.Hospitalized patients with malignant tumors inthese departments (Department of Gastroenterology, respiratory medicine, oncology, general surgery, thoracic surgery and geriatrics)were investigated. Only the patients with age≥ 18 years and hospitalization time between 7-30 days were included. During hospitalization, the physical indexes of human bodywere measured, and the NRS 2002 scores, and monitored the nutritional support at the time points of admission and 24 hours before discharge were recorded.And whether there was a nutritional risk in hospitalized patients and its association with clinical outcomes were investigated. A total of 2 402 patients with malignancies were enrolled in this study. Seventy fourpatients who did not complete NRS2002 were eliminated, and 2 328 patients were included. The number of the main diseases was the top five, including 587 cases of colorectal cancer, 567 cases of lung cancer, 564 cases of gastric cancer, 146 cases of esophageal cancer, and 119 cases of liver tumor. At the time of discharge, compared with admission, the BMI, body weight, grip and calf circumferences of patients with malignant tumor were significantly decreased (<0.05). The total protein, albumin, prealbumin and hemoglobin were significantly lower than those at admission (<0.05). In 2 328 patients who were completed nutritional risk screening, the rate of malnutrition at admission was 11.1% (BMI =18.5, 258/2 328) and the rate of malnutrition at discharge was 10.9% (BMI =18.5, 254/2 328), there were no significant differences (χ(2)=0.019 7, =0.888). There were 1 204 patients with nutritional risk at admission (51.7%, NRS2002 score≥3)and 1 352 patients with nutritional risk at discharge (58.1%, NRS2002 score≥3), with significant differences (χ(2)=49.9, <0.001). The incidence of nutritional risk in patients with colorectal, stomach, and lung tumors at discharge was significantly higher than that at admission (<0.05). The infective complications and other complications of patients with nutritional risk were significantly greater than those without nutritional risk at admission and at discharge.ICU hospitalization stay of patients with nutritional risk was increased significantly than those without nutritional risk at admission(=0.042). Hospitalization expenses of patients with nutritional risk was increased significantly than those of patients without nutritional risk at discharge(<0.01). The patients with malignant tumor have a higher incidence rate of malnutrition at both admission and discharge and malnutritionhas correlation with adverse clinical outcomes.The aboveindicators did not improve significantly at discharge.Doctors should pay more attention to the nutritional status (screening and evaluation)of patients before discharge and use appropriate and adequate nutrition support in order to prevent the weight loss and improve the life quality of patients.
Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit.
Prado Patricia Rezende do,Bettencourt Ana Rita de Cássia,Lopes Juliana de Lima
Revista latino-americana de enfermagem
OBJECTIVE:to identify the predicting factors and sensitivity, specificity, positive and negative related value of nursing diagnosis Ineffective Breathing Pattern among patients of an intensive care unit. METHOD:cross-sectional study. A logistic regression was fitted to assess the simultaneous effects of related factors. RESULTS:among the 120 patients, 67.5% presented Ineffective Breathing Pattern. In the univariate analysis, the related factors were: group of diseases, fatigue, obesity and presence of bronchial secretion, and the defining characteristics were: changes in respiratory depth, auscultation with adventitious sounds, dyspnea, reduced vesicular murmurs, tachypnea, cough and use of the accessory musculature to breathe. The mean age of patients with was higher than those without this diagnosis. The defining characteristics reduced murmurs had high sensitivity (92.6%), specificity (97.4%), negative related value (86.4%) and positive related value (98.7%). The related factors of Ineffective Breathing Pattern were the related factors fatigue, age and group of diseases. CONCLUSION:fatigue, age and patients with a group of diseases were related factors of Ineffective Breathing Pattern in this study. Reduced vesicular murmurs, auscultation with adventitious sounds and cough may be defining characteristics to be added in the international classification, as well as the related factors bronchial secretion and group of diseases.
Palliative care and nursing support for patients experiencing dyspnoea.
Sugimura Ayumi,Ando Shoko,Tamakoshi Koji
International journal of palliative nursing
To investigate the association between the type of support provided by nurses for dyspnoea and palliative care practice in Japan, a cross-sectional questionnaire survey was conducted in 2015. Of the 535 questionnaires sent to nurses working at 22 designated cancer hospitals, 344 were returned. The questionnaire assessed the demographic characteristics of the nurses, nursing support for dyspnoea, and palliative care practice measured by the 'Palliative care self-reported practices scale'. Multivariate analysis showed that the domains of palliative care practice influenced the provision of nursing support for patients with dyspnoea. In conclusion, palliative care practice is important for supporting patients with dyspnoea, and nurses should possess the requisite knowledge and skills to deliver this care appropriately.
Evaluation of the Patterns of Care Provided to Patients With COPD Compared to Patients With Lung Cancer Who Died in Hospital.
Hyasat Kais,Sriram Krishna B
The American journal of hospice & palliative care
INTRODUCTION:There is limited information about the end-of-life care provided to patients with end-stage chronic obstructive pulmonary disease (COPD) in comparison to patients with lung cancer. AIM AND METHODS:We compared the end-of-life care provided to patients with COPD versus patients with lung cancer who died in hospital over a 12-month period in our institution. RESULTS:During the study period, 89 patients died due to COPD (n = 34) or lung cancer (n = 55). Compared to patients with lung cancer, patients with COPD received less palliative care services (50% vs 9%, P < .001) and underwent more diagnostic tests and received more life-prolonging measures. CONCLUSION:Toward the end of their life, patients with COPD received fewer symptom-alleviating treatments and palliative care services.
Predicting acute odynophagia during lung cancer radiotherapy using observations derived from patient-centred nursing care.
Olling Karina,Nyeng Dorte Wendelboe,Wee Leonard
Technical innovations & patient support in radiation oncology
During radiotherapy, lung cancer patients commonly experience pain while swallowing (odynophagia) of food and drink. Observations from patient-centred nursing practice have been used to generate predictive models for odynophagia needing prescription pain medication during external beam lung radiotherapy for non-small cell and small-cell lung cancer. Three multivariate logistic models were evaluated in repeat cross-validation: a manual-stepwise model and two supervised machine learning models. Overall predictive performance was good. Correct classification rates ranged from 0.82 to 0.84, and areas under the receiver operator curve ranged from 0.83 to 0.85. Model sensitivity (range: 0.92-0.97) was higher than model specificity (range: 0.58-0.63). Further validation of the models in clinical context is required. A predictive model for pain medication for odynophagia prior to commencement of radiotherapy would support Radiotherapy Technologists Nurses (RTNs) in directing nursing interventions towards patients at risk.
The challenge of existential issues in acute care: nursing considerations for the patient with a new diagnosis of lung cancer.
Lehto Rebecca H
Clinical journal of oncology nursing
A new diagnosis of lung cancer is a highly threatening experience that raises personally relevant existential issues and brings death-related thoughts and concerns to mind. Those issues can be very disturbing to patients, leading to distress and potentially to a lowered quality of life. The purpose of this article is to present to the practicing oncology nurse the types of existential and death-related concerns that patients with a new diagnosis of lung cancer may have. In addition, the article identifies practical strategies and resources for oncology nurses who can help patients accept and manage the normal but often distressing responses to a life-threatening diagnosis.
Effectiveness of an intervention to improve supportive care for family caregivers of patients with lung cancer: study protocol for a randomized controlled trial.
Aubin Michèle,Vézina Lucie,Verreault René,Simard Sébastien,Desbiens Jean-François,Tremblay Lise,Dumont Serge,Fillion Lise,Dogba Maman Joyce,Gagnon Pierre
BACKGROUND:Family caregivers (FC) often experience higher distress levels than their relative with cancer. Many cancer centers have implemented distress screening programs, but most of them concentrate their efforts on patients, with little attention to their FC. To fill this gap, a pragmatic intervention has been designed to improve supportive care for FC of patients with lung cancer. This article describes the study protocol of a single-center randomized controlled trial to assess its effectiveness. METHODS/DESIGN:A total of 120 lung cancer patients and their FC are randomly assigned to the experimental group (exposed to intervention, N = 60) or to the control group (usual care, N = 60). The intervention includes: (1) systematic FC distress screening and problem assessment near their relative's cancer diagnosis, and every 2 months, (2) privileged contact with an oncology nurse (ON) away from the patient to address FC problems and (3) liaison by the ON with the family physician of FC reporting high distress (thermometer score ≥5/10), or problems relying on FP expertise. In both groups, FC, patient and process-of-care outcomes are measured at baseline and every 3 months, up to 9 months. The primary endpoint is FC distress measured by the Hospital Anxiety and Depression Scale (HADS) and the Psychological Distress Index used in the Quebec Health Survey (PDQHS). Individual interviews with 10 FC and a focus group with the oncology team will be conducted at the study end to further document the effectiveness of the intervention and its impact on quality of life (for FC) and practice organization (for the oncology team). DISCUSSION:This trial will assess the effectiveness of an innovative intervention based on interprofessional collaboration between primary care and oncology care. It targets a population in great need, yet often neglected, and has the potential to clearly improve patient and caregiver experience of cancer care, and reduce the burden of disease. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT02531464 . Registered on 15 July 2015.
Updates on the pathogenesis of advanced lung cancer-induced cachexia.
Zhu Ruifang,Liu Zhihong,Jiao Ran,Zhang Chichen,Yu Qi,Han Shifan,Duan Zhiguang
Advanced lung cancer is becoming a chronic disease threatening human life and health. Cachexia has been recognized as the most common problem associated with advanced lung cancer. Lung cancer-induced cachexia seriously affects patients' quality of life. The present article summarizes the pathogenesis of advanced lung cancer-induced cachexia from three aspects: anorexia, cytokines, and energy and metabolic abnormalities. In addition, the present article proposes corresponding nursing measures based on cachexia pathogenesis to improve the quality of life and survival rate of cachectic patients with advanced lung cancer by combining continuously advancing treatment regimens and effective nursing. The present article also provides references for healthcare professionals when administering related treatments and nursing care.
Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease.
Bailey Cara,Hewison Alistair,Karasouli Eleni,Staniszewska Sophie,Munday Daniel
Journal of clinical nursing
AIMS AND OBJECTIVES:To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital. BACKGROUND:Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated. DESIGN:Qualitative critical incident case study. METHODS:Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients' experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically. RESULTS:Patients were satisfied with their 'emergency' care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of 'spectacular' and 'subtacular' trajectories of care was used to relate the findings to the wider context of health care provision. CONCLUSION:The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute 'spectacular' phase of their admission, more attention needs to be given to the continuing care needs of patients in the 'subtacular' phase. RELEVANCE TO CLINICAL PRACTICE:This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.
Gender-specific differences in care-seeking behaviour among lung cancer patients: a systematic review.
Rana Rezwanul Hasan,Alam Fariha,Alam Khorshed,Gow Jeff
Journal of cancer research and clinical oncology
BACKGROUND:In the literature, men are often described as unwilling to use healthcare services, whereas women as frequent users. We conducted a systematic literature review to examine the gender differences in healthcare utilisation of lung cancer patients. Our aim was to synthesise evidence to assess whether men and women utilise cancer diagnosis and treatments differently. METHODS:The databases of PubMed, Scopus, Web of Science, EBSCO Host, Ovid nursing, and Cochrane was systematically searched. We used pre-defined eligibility criteria to identify peer-reviewed published literature that reported healthcare use of lung cancer patients. Two reviewers independently screened the title, abstract, full texts and retrieved relevant data. RESULTS:A total of 42 studies met the eligibility criteria from 1356 potential studies. In these studies, the most commonly measured healthcare utilisation is surgery (n = 19), followed by chemotherapy (n = 13). All the studies were from developed countries and had a higher percentage of male participants. Substantial evidence of heterogeneity in the use of treatments by gender were found. In relation to diagnosis interval and stage of cancer diagnosis, it was found that women had longer diagnostic intervals. Nonetheless, women tend to get diagnosed at an earlier stage. Furthermore, women had a higher probability of using inpatient cancer-care services and surgical treatments. Conversely, men had greater risks of readmission after surgery and longer length of stay. Lastly, there were no significant gender differences in the likelihood of receiving chemotherapy and radiation therapy. CONCLUSION:This study synthesised evidence of disparities in the use of lung cancer treatments based on gender in developed countries, with no evidence available from least-developed and developing countries. Further studies are required to understand this gender-specific inequality and to design interventions to improve the survival rate of lung cancer patients.
"Age matters"-German claims data indicate disparities in lung cancer care between elderly and young patients.
Walter Julia,Tufman Amanda,Holle Rolf,Schwarzkopf Larissa
BACKGROUND:Although lung cancer is most commonly diagnosed in elderly patients, evidence about tumor-directed therapy in elderly patients is sparse, and it is unclear to what extent this affects treatment and care. Our study aimed to discover potential disparities in care between elderly patients and those under 65 years of age. METHODS:We studied claims from 13 283 German patients diagnosed with lung cancer in 2009 who survived for at least 90 days after diagnosis. We classified patients as "non-elderly" (≤ 65), "young-old" (65-74), "middle-old" (75-84), and "old-old" (≥ 85). We compared receipt of tumor-directed therapy (6 months after diagnosis), palliative care, opioids, antidepressants, and pathologic diagnosis confirmation via logistic regression. We used generalized linear regression (gamma distribution) to compare group-specific costs of care for 3 months after diagnosis. We adjusted all models by age, nursing home residency, nursing care need, comorbidity burden, and area of residence (urban, rural). The age group "non-elderly" served as reference group. RESULTS:Compared with the reference group "non-elderly", the likelihood of receiving any tumor-directed treatment was significantly lower in all age groups with a decreasing gradient with advancing age. Elderly lung cancer patients received significantly fewer resections and radiotherapy than non-elderly patients. In particular, treatment with antineoplastic therapy declined with increasing age ("young-old" (OR = 0.76, CI = [0.70,0.83]), "middle-old" (OR = 0.45, CI = [0.36,0.50]), and "old-old" (OR = 0.13, CI = [0.10,0.17])). Patients in all age groups were less likely to receive structured palliative care than "non-elderly" ("young-old" (OR = 0.84, CI = [0.76,0.92]), "middle-old" (OR = 0.71, CI = [0.63,0.79]), and "old-old" (OR = 0.57, CI = [0.44,0.73])). Moreover, increased age was significantly associated with reduced quotas for outpatient treatment with opioids and antidepressants. Costs of care decreased significantly with increasing age. CONCLUSION:This study suggests the existence of age-dependent care disparities in lung cancer patients, where elderly patients are at risk of potential undertreatment. To support equal access to care, adjustments to public health policies seem to be urgently required.
[Exploration of the Care Needs of Post-Chemotherapy Lung Cancer Patients and Related Factors].
Chiu Hui-Ying,Lin Yu-Hua,Wang Chin-Chou,Chen Wan-Yi,Chang Huang-Chih,Lin Meng-Chih
Hu li za zhi The journal of nursing
BACKGROUND:Chemotherapy (CT) is the first priority treatment for advanced stage lung cancer. However, symptom distress, impaired ability to conduct daily activities, and post-CT care needs are potential side effects of CT. PURPOSE:To explore the factors related to the care needs of post-chemotherapy lung cancer patients. METHODS:A cross-sectional study was used. One hundred and twenty-one adult patients who had been diagnosed with advanced-stage lung cancer and who had undergone CT using the Platinum and Docetaxel doublet regimen were recruited from a medical center in southern Taiwan. The instruments used included a nursing care needs survey, symptoms distress scale, daily activity interference scale, and patient characteristics datasheet. RESULTS:Participants self-prioritized their emergency management, health consultation, and emotional support activities based on their perceived care needs. The top three post-CT symptoms in terms of severity were: fatigue, appetite change, and sleep disorder. Primary disruptions in daily activities during the post-CT period related to: holding social activities, work, and stair climbing. Significant and positive correlations were found among daily activity interference (r = .30, p < .01), symptoms distress (r = .23, p < .01), and care needs. The regression model indicated daily activity interference as a predictor of care needs, accounting for 10.7% of the total variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE:These results highlight the relationships among care needs, symptom distress, and daily activity interference in post-chemotherapy lung-cancer patients. The present study provides a reference for nursing care to reduce the symptom distress, to enhance the performance of daily activities, and to meet the care needs of lung-cancer patients.
Using patient-reported outcome measures to deliver enhanced supportive care to people with lung cancer: feasibility and acceptability of a nurse-led consultation model.
Kotronoulas Grigorios,Papadopoulou Constantina,Simpson Mhairi F,McPhelim John,Mack Lynn,Maguire Roma
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:Developing new supportive/palliative care services for lung cancer should encompass effective ways to promptly identify and address patients' healthcare needs. We examined whether an in-clinic, nurse-led consultation model, which was driven by use of a patient-reported outcomes (PRO) measure, was feasible and acceptable in the identification of unmet needs in patients with lung cancer. METHODS:A two-part, repeated-measures, mixed-methods study was conducted. Part 1 employed literature reviews and stakeholder focus group interviews to inform selection of a population-appropriate needs assessment PRO measure. In Part 2, lung cancer nurse specialists (CNS) conducted three consecutive monthly consultations with patients. Recruitment/retention data, PRO data, and exit interview data were analysed. RESULTS:The Sheffield Profile for Assessment and Referral to Care was the PRO measure selected based on Part 1 data. Twenty patients (response rate: 26%) participated in Part 2; 13 (65%) participated in all three consultations/assessments. The PRO measure helped patients to structure their thinking and prompted them to discuss previously underreported and/or sensitive issues, including such topics as family concerns, or death and dying. Lung CNS highlighted how PRO-measures-driven consultations differed from previous ones, in that their scope was broadened to allow nurses to offer personalised care. Small-to-moderate reductions in all domains of need were noted over time. CONCLUSIONS:Nurse-led PRO-measures-driven consultations are acceptable and conditionally feasible to holistically identify and effectively manage patient needs in modern lung cancer care. PRO data should be systematically collected and audited to assist in the provision of supportive care to people with lung cancer.
The role of advanced nursing in lung cancer: A framework based development.
Serena A,Castellani P,Fucina N,Griesser A-C,Jeanmonod J,Peters S,Eicher M
European journal of oncology nursing : the official journal of European Oncology Nursing Society
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.
The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK.
Leary Alison,White John,Yarnell Laura
European journal of oncology nursing : the official journal of European Oncology Nursing Society
In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1-10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this.
Barriers to delivering advanced cancer nursing: A workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit.
Stewart Iain,Leary Alison,Tod Angela,Borthwick Diana,Khakwani Aamir,Hubbard Richard,Beckett Paul,Tata Laila J
European journal of oncology nursing : the official journal of European Oncology Nursing Society
PURPOSE:Health services across the world utilise advanced practice in cancer care. In the UK, lung cancer nurse specialists (LCNS) are recognised as key components of quality care in national guidelines, yet access to LCNS contact is unequal and some responsibilities are reportedly left undone. We assess whether any variation in working practices of LCNS is attributable to factors of the lung cancer service at the hospital trust. METHOD:Nationwide workload analysis of LCNS working practices in England, linked at trust level to patient data from the National Lung Cancer Audit. Chi-squared tests were performed to assess whether patient contact, workload, involvement in multidisciplinary teams (MDT), and provision of key interventions were related to 1) the trust's lung cancer service size, 2) LCNS caseload, 3) anti-cancer treatment facilities and 4) lung cancer patient survival. RESULTS:Unpaid overtime was substantial for over 60% of nurses and not associated with particular service factors assessed; lack of administrative support was associated with large caseloads and chemotherapy facilities. LCNS at trusts with no specialty were more likely to challenge all MDT members (80%) compared with those at surgical (53%) or chemotherapy (58%) trusts. The most frequent specialist nursing intervention to not be routinely offered was proactive case management. CONCLUSION:Working practices of LCNS vary according to service factors, most frequently associated with trust anti-cancer treatment facilities. High workload pressures and limited ability to provide key interventions should be addressed across all services to ensure patients have access to recommended standards of care.
Implementation of optimized supportive care and hospital needs along the management of patients with advanced lung cancer.
Lafitte Claire,Etienne-Mastroianni Bénédicte,Fournel Christelle,Natoli Louise,Foucaut Aude-Marie,Girard Nicolas
Lung cancer (Amsterdam, Netherlands)
BACKGROUND:Supportive care in cancer (SCC) have been recommended to be integrated in the management of patients with lung cancer all along the course of the disease. We took advantage of a pilot program of early implementation of optimized SCC, to report the feasibility such program in patients with advanced lung cancer, and correlate patient characteristics and outcomes with the actual use of optimized SCC. METHODS:This study is a retrospective analysis of all consecutive patients with lung cancer treated at our center between 2012 and 2016. Optimized SCC included the intervention of a nurse for the home-hospital network coordination, as well as socio-aesthetics, psychomotricity, art-therapy, adapted physical activity, and also establishment of at-home hospitalization. RESULTS:309 patients were included. Median overall survival was 11.2 months. Unplanned hospitalizations occurred for 276 (89%) patients. The median duration of hospital stay was 19 days. Unplanned hospitalizations more frequently occurred within the first 3 months after the diagnosis of advanced cancer, and in the last 3 months before death. A short - less than 3 months - delay between diagnosis and unplanned hospitalization was associated with poor outcome. 272 (88%) patients received optimized SCC, within a median delay of 8 weeks after diagnosis. Intervention of the nurse for in- and out-patient network coordination was done for 143 (46%) patients, and at-home hospitalization was organized for 78 (25%) patients. The outcome of patients who received optimized SCC was numerically, but not significantly better (median overall survival of 11.8 vs. 6.9 months, p = 0.270). CONCLUSION:Our study provides landmark data to support an early integration of optimized SCC for patients with advanced lung cancer, that includes multimodal supportive care interventions along the course of the disease. This highlights the role of multidisciplinary teams to optimize the management of patients with advanced lung cancer.