MS17.01 Unmet needs and QOL of Lung Cancer Survivors

Abstract

Patients with lung cancer are living longer and more are being cured of their disease with advances in surgery, radiotherapy, systemic therapy and earlier detection through screening programs1,2. However, these treatments can result in physical disability, psychological morbidity and increased care needs. Lung cancer patients frequently have unmet survivorship needs and these needs are often complex. In addition, lung cancer patients are less likely than other cancer patients to utilize supportive services3. This session will review the magnitude of unmet needs in lung cancer survivors, the nature of these unmet needs and potential mitigating interventions. The majority of lung cancer survivors report unmet needs and often patients experience multiple unmet needs. In one study, the mean number of unmet needs per patient was 7.6. The most common domains of unmet needs are in the psychological domain followed by the physical and the health system and information domains. Patients with more advanced disease and those with increased symptoms are more likely to have unmet needs. The nature of common unmet needs include fears of the cancer returning, fatigue, facing an uncertain future, coordination of medical care, completing house work and having information on managing health4. Addressing and mitigating the unmet survivorship needs in lung cancer patients is a complex undertaking. There are patient and caregiver factors, cancer center factors and systems level factors which must be addressed. This session will explore the role physical activity, survivorship care plans and self-management approaches to mitigate unmet needs and promote improvements in quality of life. Increased physical activity has been shown to have a significant impact on improving quality of life in lung cancer survivors5. Increased physical activity is also associated with improving cancer related fatigue6. The Institute of Medicine has recommended that each cancer survivor receive a survivorship care plan. These survivorship care plans should include all aspects of their cancer diagnosis and treatment, contact information for the cancer team, information on prognosis, recommended surveillance activities for treatment related toxicity and cancer recurrence, recommendations for healthy behaviors and any additional supportive resources7. Finally, employing effective self-management programs for lung cancer survivors can be an effective strategy to reduce unmet needs8. There are other critical issues faced by lung cancer survivors. Surveillance for secondary cancers is an important aspect of survivorship care as patients cured of one lung cancer are at risk of developing a subsequent malignancy. Patients who survive with lung cancer can face significant financial toxicity and returning to work can be challenging. Resources to assist patients to return to work are an integral part of cancer survivorship programs. Finally, assisting lung cancer patients who use tobacco products to quit is critical, not only to improve cancer outcomes including disease control and survival, but also to improve quality of life and to reduce morbidity from other tobacco related conditions such as cardiovascular. These three topics will be covered in greater detail in other presentations in this session. 1. Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Dec 10 2010;28(35):5153-5159. 2. Mery CM, Pappas AN, Bueno R, et al. Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest. Jul 2005;128(1):237-245. 3. Brown NM, Lui CW, Robinson PC, Boyle FM. Supportive care needs and preferences of lung cancer patients: a semi-structured qualitative interview study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. Jun 2015;23(6):1533-1539. 4. Giuliani ME, Milne RA, Puts M, et al. The prevalence and nature of supportive care needs in lung cancer patients. Current oncology. Aug 2016;23(4):258-265. 5. Sloan JA, Cheville AL, Liu H, et al. Impact of self-reported physical activity and health promotion behaviors on lung cancer survivorship. Health and quality of life outcomes. Apr 29 2016;14:66. 6. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. The Cochrane database of systematic reviews. Aug 15 2012(8):CD008465. 7. Hewitt M GS, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, D.C: Institute of Medicine and National Research Council; 2005. 8. Reb A, Ruel N, Fakih M, et al. Empowering survivors after colorectal and lung cancer treatment: Pilot study of a Self-Management Survivorship Care Planning intervention. European journal of oncology nursing : the official journal of European Oncology Nursing Society. Aug 2017;29:125-134. unmet needs, survivorship, quality of life