A Qualitative Study on the Psychological Experience of Lung Cancer Patients During the Perioperative Period

Lung cancer patients with chronic obstructive pulmonary disease are at an increased risk of respiratory and cardiovascular complications after pulmonary resection. The objective of the present study was to evaluate the clinical effects of low-dose human atrial natriuretic peptide (hANP) on postoperative cardiopulmonary complications in untreated chronic obstructive pulmonary disease patients undergoing lung cancer surgery. Of 824 patients who underwent an elective pulmonary resection procedure for lung cancer in two specialized thoracic centres between 2008 and 2011, 202 consecutive patients who had airflow limitation before surgery were included in this retrospective study. The results were compared between patients who did and those who did not receive hANP during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. Postoperative haemodynamics, white blood cell (WBC) counts and C-reactive protein (CRP) levels were also examined. Furthermore, propensity score matching analysis was used to reduce treatment selection bias from patient characteristics. The incidence of postoperative cardiopulmonary complications was significantly lower in the hANP group than in the control group (14 vs 36%, P < 0.01). The propensity score matching analysis confirmed the significantly decreased frequency of postoperative cardiopulmonary complications in the hANP group. Patients in the hANP group showed significantly lower WBC counts and serum CRP levels postoperatively. Treatment with hANP during the perioperative period had a prophylactic effect against postoperative cardiopulmonary complications in chronic obstructive pulmonary disease patients undergoing lung cancer surgery.

Purpose/Objectives: The purpose of the study was to investigate experiences and perceptions of lung cancer patients who have a smoking habit and to provide health care professionals with more insights into the complexities of these people's motivations, rationalities, guilt, self-blame, and stigma in Qatar. Methodology: Descriptive phenomenology was used to explore the lived experiences of smoker with lung cancer. An in-depth unstructured conversational style interview was used as a method for data collection. The study was conducted in the inpatient, outpatient, and day care units at the National Center for Cancer Care and Research (NCCCR). Purposive sampling was used to recruit five lung cancer patients who smoke. Colaizzi's (1978) method was used to analyze data. Findings: Participants described five related themes: (a) smoking is not the only cause of lung cancer, (b) acute self-awareness of smoking as an addiction (c) self-blame related to lung cancer diagnosis, (d) smoking cessation clinics are not useful, and (e) nurses and physicians are not supportive during treatment. Participants did not believe that there was a connection between personal smoking behaviors and developing lung cancer. They believed some patients are diagnosed with lung cancer without a smoking history and other environmental agents or lifestyle factors can cause lung cancer. Participants claimed smoking is an addiction, and they smoked to relieve their stress and anxiety. The majority of participants in this study experienced feelings of self-blame for being engaged in smoking behavior that increased their risk of lung cancer. Participants said the smoking cessation clinic was not useful because the physician did not listen to their experiences and instead would gave them nicotine replacement therapy (NRT) tablets and discharged them from the clinic without proper consultation. Participants believed that physicians should counsel their patients about smoking cessation. Also, they suggested counselling, educational materials, and peer support groups would be more helpful resources than pharmacology therapy in quitting smoking. Conclusion: The current study describes the lived experiences of smokers with lung cancer in Qatar. The findings of this study would be helpful for nurses and physicians to know why patients continue to smoke after their lung cancer diagnosis. It is important to understand the lived experiences of smokers with lung cancer in order to help them to quit smoking. Health care professionals working within the smoking cessation clinic would likely be more effective if they understand the lived experiences of lung cancer patients who continue to smoke. Understanding the lived experiences of lung cancer patients with smoking habit also increases their physical and psychological wellbeing and provides them with the opportunity to know their cancer therapies and to cooperate with their treatments. These findings are important for nursing because nurses are expected to provide an integrated approach to care for their patients. It is important for nurses to ensure smokers with lung cancer do not experience additional burdens from their perceptions that could have a negative impact on their quality of life. Nurses should also avoid criticizing smokers with lung cancer and supporting them to quit smoking. Key Word: Lived experiences, perceptions, lung cancer, lung sarcoma, cigarette smoking, and smoker

Is Video-Assisted Thoracic Surgery Lobectomy Better? Quality of Life Considerations

Propofol is widely used in clinical anesthesia due to its advantages of rapid onset and less adverse reactions. This study focused on the role of propofol in the balance of Th17/Treg in elderly patients with lung cancer during perioperative period. Patients undergoing lung cancer surgery were anesthetized by propofol or sevoflurane. Veinal blood was collected at different time points to evaluate the changes of Th17/Treg cell. Propofol better maintained the balance of Th17/Treg in vivo. The peripheral blood of patients with lung cancer was collected in vitro before surgery. Cluster of differentiation (CD)4+ T cells were obtained and then treated with propofol at different concentrations and γ-aminobutyric acid A (GABAA) receptor antagonists. Propofol affected Th17/Treg cell balance by increasing Th17 cells, decreasing Treg cells, thus elevating Th17/Treg ratio, and inhibited invasion and migration of lung cancer cells through GABAA receptor, which was counteracted by GABAA receptor inhibitors. Subsequently, tumor in situ model of lung cancer in aged mice was established. Propofol anesthetized mice had lower change of Th17/Treg ratio, higher survival rate and less metastasis. In brief, propofol regulated balance of Th17/Treg in elderly patients undergoing lung cancer surgery through GABAA receptor. Additionally, propofol could inhibit metastasis of lung cancer.

BackgroundThe COVID-19 pandemic has had an enormous impact on the experiences of patients across all health disciplines, especially those of cancer patients. The study aimed to understand the experiences of cancer patients who underwent surgery during the first two waves of the pandemic at Guy’s Cancer Centre, which is a large tertiary cancer centre in London.MethodsA mixed-methods approach was adopted for this study. Firstly, a survey was co-designed by the research team and a patient study group. Patients who underwent surgery during the COVID-19 pandemic were invited to take part in this survey. Results were analysed descriptively. Three discussion groups were then conducted to focus on the main themes from the survey findings: communication, COVID-19 risk management and overall experience. These discussion groups were transcribed verbatim and underwent a thematic analysis using the NVivo software package.ResultsOut of 1657 patients invited, a total of 250 (15%) participants took part in the survey with a mean age of 66 (SD 12.8) and 52% females. The sample was representative of a wide range of tumour sites and was reflective of those invited to take part. Overall, the experience of the cancer patients was positive. They felt that the safety protocols implemented at the hospital were effective. Communication was considered key, and patients were receptive to a change in the mode of communication from in-person to virtual.ConclusionsDespite the immense challenges faced by our Cancer Centre, patients undergoing surgery during the first two waves of the COVID-19 pandemic had a generally positive experience with minimal disruptions to their planned surgery and ongoing care. Together with the COVID-19 safety precautions, effective communication between the clinical teams and the patients helped the overall patient experience during their surgical treatment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-024-08528-w.

INTRODUCTION: Racial disparities in lung cancer mortality may be impacted by differences in patient experiences with care, an important quality of cancer care indicator. Therefore, the objectives of our study are to examine whether there are racial disparities in patient experiences with care among lung cancer patients and to determine whether these disparities are associated with mortality. MATERIALS AND METHODS: We used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS®) that links SEER cancer registry data with CAHPS surveys of Medicare beneficiaries. We identified individuals ≥65 years old who were diagnosed with lung cancer and completed a CAHPS survey at least six months after cancer diagnosis. We examined composite scores (through three domains of patient-centeredness, timeliness, and realized access) and global ratings of care. We conducted multivariable linear regression models to assess the association between race and patient composite and global ratings of care. Multivariable Cox proportional hazards models were used to determine the association between patient composite and global ratings and mortality after cancer diagnosis. RESULTS: This study consisted of 2,603 lung cancer patients. For black patients, a 1-unit increase in their ability to get all needed care (HR: 0.99, 95% CI 0.98-0.99) and care coordination (0.97, 0.94-0.99) was associated with lower risk of mortality. For Hispanic (0.85, 0.74-0.99), Asian (0.75, 0.61-0.92) and white (0.94, 0.88-0.99) patients, a 1-unit increase in their rating of their specialist was associated with lower risk of mortality. Asians reported lower adjusted mean scores with their ability to get care quickly (B: -4.25, 95% CI: -8.19, -0.31), get needed care (-7.06, (-10.51, -3.61)), get needed drugs (-9.06, (-13.04, -5.08)), and rating of their overall health care (-0.39 (-0.68, -0.1)) compared to non-Hispanic white patients. Similarly, Hispanics reported lower adjusted mean score with their ability to get needed care (-5.21, (-9.03, -1.39)). We did not observe differences in patient experiences with care for black patients compared to those of white patients. CONCLUSION: There are racial disparities in patient experiences of care among Medicare lung cancer patients, and these disparities contribute to lung cancer mortality in different ways. More research is needed to determine how medical care experiences in lung cancer patients can influence receipt of patient care and reduce risk of lung cancer mortality. Citation Format: Emily Chan, Elizabeth A. David, Megan Eguchi, Myles Cockburn, Albert J. Farias. Racial differences in lung cancer patient experiences with medical care and their association with cancer mortality: A SEER-CAHPS study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2025.

Introduction: Among women, ovarian cancer is the eighth most frequent cancer globally and the fifth leading cause of cancer-related deaths in women. Ovarian cancer is termed the "silent killer" because of its slow onset and unclear symptoms. Most of the advanced cases of ovarian cancer were found due to poor screening. The main objective of this study was to understand the emotional experiences, coping and resilience of patients undergoing ovarian cancer treatment. Methods: This qualitative study employs a phenomenological approach to explore the life experiences of ovarian cancer patients. An in-depth interview was conducted among patients undergoing cancer treatment. A total of 11 participants were included in this study. Thematic analysis was done. Results: The analysis of the data revealed eight main themes and 32 sub-themes that were characterized based on the experiences of cancer patients: 1) Misconceptions about symptoms, 2) Barriers in accessing healthcare, 3) Physical struggles, 4) Emotional turmoil, 5) Social issues, 6) Hope giving factors, 7) Sacrifice for family well-being, and 8) Emotional resilience. Conclusion: One of the key findings of this study is the importance of accepting unexpected health realities. This study shows the emotional journey of accepting difficult realities and mainly trusting medical professionals to guide one through treatment. Develop targeted educational campaigns to raise awareness about the symptoms of ovarian cancer and dispel common misconceptions.

Propofol may help to protect against ischaemic acute kidney injury (AKI); however, research on this topic is sparse. The current study aimed to investigate whether there were differences in the incidence of postoperative AKI after lung resection surgery between patients who received propofol-based total intravenous anaesthesia (TIVA) and those who received sevoflurane-based inhalational anaesthesia. A retrospective observational study. A single tertiary care hospital. Medical records of patients aged 19 years or older who underwent curative lung resection surgery for nonsmall cell lung cancer between January 2005 and February 2018 were examined. After propensity score matching, the incidence of AKI in the first 3 postoperative days was compared between patients who received propofol and those who received sevoflurane. Logistic regression analyses were also used to investigate whether propofol-based TIVA lowered the risk of postoperative AKI. The analysis included 2872 patients (1477 in the sevoflurane group and 1395 in the propofol group). After propensity score matching, 661 patients were included in each group; 24 (3.6%) of the 661 patients in the sevoflurane group developed AKI compared with 23 (3.5%) of the 661 patients in the propofol group (95% confidence intervals of difference in incidence -0.019 to 0.022, P = 0.882). The logistic regression analyses revealed that the incidence of AKI was not different in the two groups (odds ratio 0.96, 95% confidence interval 0.53 to 1.71, P = 0.882). In this retrospective study, no significant difference was found in the incidence of postoperative AKI after lung resection surgery between patients who received propofol-based TIVA and those who received sevoflurane-based inhalational anaesthesia. Considering the methodological limitation of this retrospective study, further studies are required to confirm these results.

A patient navigation program is a model of care which entails trained personnel providing individualized and assistive care to adult oncology patients to help the patients overcome barriers. A further aim of the program is to achieve continuity of care as patients experience the complex healthcare system. Patient navigation is a new model of care in many institutions, and as such the experiences of patients in the patient navigation program remains inconclusive. The review seeks to understand the experiences of adult patients in patient navigation programs and how patient navigators impact the challenges patients encounter in the cancer care continuum. Participants of interest were adult cancer patients more than 18 years of age who are receiving or have received cancer care and are in a patient navigation program or had been in a hospital patient navigation program. Types of intervention(s)/phenomena of interest: The phenomenon of interest was the experiences of adult cancer patients who used patient navigation programs in hospital including how patient navigators impact on the challenges patients encounter in the cancer care continuum. Types of studies: This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, action research and exploratory studies. The review includes patient navigation programs within a hospital setting. Types of outcome: The review sought to understand the experiences of patients with cancer in patient navigation programs in the hospital. A three-step search strategy was used. An initial search to identify keywords was undertaken in PubMed and Science Direct followed by an expanded search using all identified keywords and index terms specific to each included database. The reference lists of included papers were then searched for any other relevant studies. Each paper was assessed independently by two reviewers for methodological quality using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction and synthesis was conducted using standardized data extraction and synthesis tools from JBI-QARI. The 17 unequivocal and credible findings of included studies were categorized according to similarity of meaning and developed into three synthesized findings. Three papers were included in the review. The three synthesized findings from the 17 findings extracted from the papers were: (1) Emotional empowerment: patient navigators need to be present with patients at key phases of the cancer care continuum and assure patients of their accessibility; (2) Knowledge empowerment: patient navigators need to explore and manage the needs and expectations of patients so that the healthcare team and patient have the same understanding of treatment goals and plans; and (3) Bridging the gaps: patient navigators need to ensure practical assistance is provided for patients to ensure continuity of care even at the completion of the treatment regimen. The presence of a patient navigator provides strong support to the patients when experiencing disruption from cancer diagnosis and treatment. The emotional isolation they experience lessens with the assurance that there is always a consistent and constant contact point they can fall back on. The logistic and practical help given by the navigators allows patients to take time to process information and make sense of what is happening.

Patients with lung cancer surgery often suffer pain after discharge. However, there is limited evidence to describe the pain experience from the qualitative investigation. This study was designed to describe the pain experience of lung cancer patients during home recovery after surgery and to provide evidence for developing pain management strategies. This qualitative descriptive study recruited 35 patients who had received lung resection and were discharged by purposive sampling from May to July 2022. Mobile phone interviews were conducted to collect views on patients' pain experience after discharge. The interviews were audio-recorded and converted verbatim into standard text, and the data were iteratively thematic analyzed. A thematic framework was identified for three themes: perception and impact of pain, coping styles for pain, and unmet needs for pain. Whether short or long-term after discharge, patients complain that they suffer from different degrees and types of pain, causing them a "double burden" physically and mentally. The lack of knowledge about pain may lead them to adopt very different coping styles and desire professional continuous pain management. This study may help clarify the status of pain problems that patients face after lung cancer surgery and provides multiple dimensions of pain assessment and management objectives for quantitative research. We call on medical staff to pay attention to patients' perspectives and related needs after discharge and formulate targeted management strategies to reduce pain and improve their quality of life.

In order to evaluate clinicopathological features associated with liver metastases from lung cancer, we reviewed our experience of lung cancer patients seen in our division. Of the 1073 lung cancer patients diagnosed between October 1976 and May 2002, 62 (5.8%) patients had liver metastasis. The incidence of liver metastasis was 17.5% in small-cell lung cancer (SCLC) patients, whereas the incidence in non-small-cell lung cancer patients was 3.8%. Of the 62 patients, 17 had sole liver metastasis, and the remaining 45 had synchronous spread to the liver and one or more other organs. Six of 12 squamous cell carcinoma patients and 10 of 28 SCLC patients had sole liver metastasis. However, 19 of 20 adenocarcinoma patients showed liver metastasis with one or more other organs. In morphological liver metastasis, 26 of the 28 SCLC patients had multiple nodules, whereas 16 of the 34 non-small-cell lung cancer patients had a solitary liver nodule (p = 0.0006). Liver is a possible site of extrathoracic spread of disease for some patients with lung cancer, especially with SCLC. When the histological types are squamous cell carcinoma or SCLC, it would also be considered likely that an isolated liver mass represents a metastasis even though there is no metastatic disease elsewhere.

Information asymmetry between healthcare providers and patients undergoing lung cancer surgery can result in reduced treatment engagement, lower admission satisfaction, and a greater risk of medical disputes, particularly regarding the transition to the intensive care unit (ICU). This study aims to map the ICU pre-experience pattern by first identifying, along a timeline of key ICU stages, the specific information that patients awaiting lung-cancer surgery and their families require during the peri-ICU period. A qualitative study was conducted by purposive sampling at the Lung Cancer Center of West China Hospital, Sichuan University. Semistructured interviews were held with 36 participants (17 patients and 19 families). The interview transcripts were analyzed by content analysis with NVivo 12.0 software. The analysis identified a structured hierarchy of information needs, comprising 2 first-level themes, 4 second-level themes, and 13 third-level themes. The core finding was that patients' information needs were greater than those of their families. Patients were predominantly concerned about postoperative care and their physical perceptions. In contrast, families focused more on process-oriented information, such as the ICU transfer process and required signatures before admission, as well as the patient's surgical outcomes and treatment process after admission. Patients and their families have comprehensive yet distinct information needs prior to ICU admission. Healthcare providers are their primary information source, underscoring the necessity for a structured, proactive, and patient-centered approach to information delivery. These findings provide a foundational framework for developing an "ICU pre-experience" pattern to mitigate uncertainty and improve nursing quality.

To comprehensively evaluate the effect of accelerated rehabilitation surgical care on perioperative wound infections and complications in patients undergoing lung cancer surgery. A comprehensive computerised search for randomised controlled trials (RCTs) of accelerated rehabilitative surgical care applied to patients undergoing lung cancer surgery was conducted using the Web of Science, PubMed, Cochrane Library, Embase, Wanfang and China National Knowledge Infrastructure databases from inception to September 2023. The literature was screened and evaluated by two investigators, and data were extracted from the final included literature. Stata software (version 17.0) was used for data analysis. Overall, 21 RCTs involving 2187 patients were included, including 1093 cases in the accelerated rehabilitation surgical care group and 1094 cases in the conventional care group. The analyses revealed that patients with lung cancer surgery who implemented accelerated rehabilitation surgical care were significantly less likely to develop postoperative wound infections (odds ratio [OR] = 0.29, 95% confidence interval [CI]: 0.17–0.49, p < 0.001) and postoperative complications (OR = 0.26, 95% CI: 0.20–0.34, p < 0.001) and shortened the hospital length of stay (standardised mean differences [SMD] = −1.93, 95% CI: −2.32 to −1.53, and p < 0.001) compared with conventional care. The effect of accelerated rehabilitation surgical care intervention in the perioperative period of lung cancer surgery patients is remarkable, as it can effectively reduce the incidence of wound infection and complications, shorten hospitalisation time and promote patient recovery.

Patient surveys are increasingly used to obtain feedback about experiences of care to guide changes in the way services are delivered. We compared the experiences of breast and lung cancer patients at diagnosis, in-patient and outpatient care at a Cancer Centre using a locally adapted version of the Picker Institute Cancer Patient Experience Survey. 65% of breast (82/127) and 65% of lung (75/116) cancer patients responded. Both groups reported good experiences at diagnosis, good support from clinical nurse specialists, and had very positive overall views. Breast patients had slightly poorer experiences of hospital stays while lung patients less often received clinical nurse specialist support and information about other support. Both groups reported that written information was not always provided. 84% (132/157) consented to data on the clinical severity of their condition being used to investigate whether this influenced experiences. This study showed that supportive care policies are being implemented at diagnosis and patients value clinical nurse specialist care. Sufficiently large comparative surveys can identify specific areas of performance for services to focus upon in order to improve quality of care. Patients facing poor prognoses can complete surveys and future studies might explore whether disease stage is associated with differing experiences.

BackgroundThe 2021 Chief Medical officer report highlighted that coastal communities in England were bearing a significant health burden, but availability of data on these inequalities was limited. Cancer was identified...