Life In Lung Cancer Patients Research Articles

1442 - Survival Prediction in Ambulatory Stage III/ IV Non Small Cell Lung Cancer Patients Using the Palliative Performance Scale, Ecog and Lung Cancer Symptom Scale

ABSTRACT Objectives Patients with advanced NSCLC have a life expectancy of less than one year, therefore, it is important to maximize their quality of life and to find a tool that gives the patients more accurate means of survival prediction. Materials The Palliative Performance Scale has been designed and used for patients with far advanced disease for predicting survival probabilities. It has five functional dimensions: ambulation, activity level and evidence of disease, self-care, oral intake, and level of consciousness. It is scored in 11 levels from PPS 0 % to PPS 100% in 10 percent increments- PPS 0% represents death and PPS 100% represents fully ambulatory and healthy status. PPS has been shown to be an effective tool in life expectancy prognostication in palliative and hospice patients. The value of PPS in ambulatory cancer patients has not been examined to date. The Lung Cancer Symptom Scale is a tool designed to measure the quality of life of lung cancer patients. It evaluates six major symptoms associated with lung malignancies and their affect on overall symptomatic distress and activity. We evaluated 62 adult patients with stage III or IV NSCLC in the thoracic oncology clinic. All of them had ECOG 1 or greater at the time of baseline evaluation. Symptoms and performance status were evaluated at baseline for 62 patients, of those 54 patients followed- up after 4 week using LCCS, PPS and ECOG. Results and conclusions 54 patients completed baseline and follow-up measures. The mean age for patients was 63.7 years. 63% were receiving active chemotherapy at the time of evaluation. Seventeen patients died. Mean (range) baseline measures score were as follows: LCSS 6.18(1-14); PPS 66.6(40-90) and 1.82(1-4) for the ECOG. Censored survival times were calculated from the enrollment of the first subject for 380 days. The last subject was recruited 357 days after the first subject. A proportional hazardous model was computed for survival status. Hazards ratios for death were 1.25(p= 0.013) for LCCS, 2.12(p= 0.027) for the ECOG and 1.02 for PPS (p= 0.49). The LCCS performed best as a predictor of prognosis in this study. Further analysis will include an assessment of association between symptom clusters and biomarkers. The PPS only functioned well as a predictor of survival time in patients receiving active treatment for advanced cancer. Disclosure All authors have declared no conflicts of interest.

The 12th National Lung Cancer Academic Conference in China.

The 12th National Lung Cancer Academic Conference was held in Wu Han, China in 2011. The content of the conference involved recent research achievements and progress in the field of lung cancer, including the epidemiology of lung cancer and molecules, new methods and technology for early-screening, molecular biology, pharmacogenomics, pathological and medical imaging, "individual therapy" based on molecular markers, surgery, radiation therapy, chemical treatment, and molecular target therapy. The theme of the Conference was "A focus on the quality of life of lung cancer patients in order to optimize individual treatment therapy." Many highly-respected domestic and foreign lung cancer expert specialists reported the latest achievements of their original clinical multi-center studies and clinical convert research work, as well as their prospective study results in the field of lung cancer basic and clinical research, including the complete revelation of lung cancer basic research in China, the latest results in clinical transformation, clinical treatment experience, and scientific research achievements. The conference substantially influenced China's future basic and clinical research on lung cancer, and contributed to the improvement of diagnostic and therapeutic levels on lung cancer in China.

The Peter Brojde Lung Cancer Centre: A Model of Integrative Practice

The generally poor prognosis and poor quality of life for lung cancer patients have highlighted the need for a conceptual model of integrative practice. Although the philosophy of integrative oncology is well described, conceptual models that could guide the implementation and scientific evaluation of integrative practice are lacking. The present paper describes a conceptual model of integrative practice in which the philosophical underpinnings derive mainly from integrative oncology, with important contributions from Traditional Chinese Medicine (TCM) and the discipline of nursing. The conceptual model is described in terms of its purpose, values, concepts, dynamic components, scientific evidence, clinical approach, and theoretical underpinnings. The model argues that these components delineate the initial scope and orientation of integrative practice. They serve as the needed context for evaluating and interpreting the effectiveness of clinical interventions in enhancing patient outcomes in lung cancer at various phases of the illness. Furthermore, the development of relevant and effective integrative clinical interventions requires new research methods based on whole-systems research. An initial focus would be the identification of interrelationship patterns among variables that influence clinical interventions and their targeted patient outcomes.

Strength and endurance training in the treatment of lung cancer patients staged IIIA/IIIB/IV.

9033 Background: This RCT tested the effect of a specially designed strength and endurance training on the independence in activities of daily living and quality of life in lung cancer patients staged IIIA/IIIB/IV while receiving palliative chemotherapy. The aim was to break the vicious circle created through the connection of physical inactivity and the worsening of symptoms and side effects. Methods: Between August 2010 and December 2011 lung cancer patients staged IIIA/IIIB/IV with a good performance status receiving an inpatient palliative chemotherapy treatment at the Vivantes Hospital Neukölln/Berlin, were randomized into an intervention and control group. The Barthel Index and the EORTC QLQ-C30/ LC13 questionnaire were used for evaluation. The Six-Minute-Walk-Test and stair walking in combination with the Modified Borg Scale have been used to test the patient’s endurance capacity. Furthermore muscle strength was examined. Non-parametrical data were statistically analyzed with the Wilcoxon and Mann-Whitney-U test. For parametric data student t- tests were used. A significance level of p< .05 was accepted. Results: Out of 46 patients, who signed the informed consent, 29 patients completed the trial (18= Intervention group, 11= Control group). Significant differences between the groups were detectable in the Barthel Index (IGmean(SD)=92.08 (15.15); CGmean=81.67 (14.98); p=.041), and in single scores of the EORTC QLQ C-30/LC-13 questionnaire (Physical Functioning p=.025; Haemoptysis p=.019, Pain in Arms or Shoulder p=.048, Peripheral Neuropathy p=.050, Cognitive functioning p=.050). Significant differences were found between the groups concerning the 6MWT, stair walking and strength capacity (IG>CG). Additionally the level of dyspnoea decreased significantly in the IG while performing submaximal walking activities. Conclusions: The training program has a positive impact on the patient’s independence in carrying out activities of daily living. Although it does not have a significant impact on the patient’s quality of life, single factors can be significantly improved. Moreover it has a positive effect on the patient’s endurance and strength capacity. The dyspnoea perception is improved.

Development and Validation of the Quality-of-Life Assessment System for Lung Cancer Based on Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) has many unique features. Thequality-of-life (QoL) instrument for lung cancer based on Traditional Chinese Medicine (QLASTCM-Lu) was the first self-reported instrument specifically developed to assess the quality of life from the perspective of TCM. Structured group methods and theory in developmental rating scale were employed to establish a general and a specific module, respectively. Quantitative and qualitative data from 240 lung cancer patients were collected to assess the psychometric properties. The three identified scales of the QLASTCM-Lu (correspondence between man and universe, unity of the body and spirit, and lung cancer specific module) and the total score demonstrated excellent psychometric properties. Test-retest reliability of all domains ranged from 0.93 to 0.96, and internal consistency α ranged from 0.86 to 0.93. Correlation and factor analysis demonstrated good construct validity. Significant differences in the QLASTCM-Lu scales and total score were found among groups differing in TCM syndrome, supporting the clinical sensitivity of the QLASTCM-Lu. Statistically significant changes were found for each scale and the total score. Responsiveness of the QLASTCM-Lu was greater than that of QLQ-LC43. The QLASTCM-Lu is a psychometrically sound and clinically sensitive measure of quality of life for lung cancer patients, which can be applied to both TCM therapy and Western medicine therapy.

Early Palliative Care Improves Quality of Life for Lung Cancer Patients

Topics in Pain Management: July 2011 - Volume 26 - Issue 12 - p 9-10 doi: 10.1097/01.TPM.0000399680.82691.d7

Perceived health in lung cancer patients: the role of positive and negative affect

To examine the association of affective experience and health-related quality of life in lung cancer patients, we hypothesized that negative affect would be positively, and positive affect would be negatively, associated with perceived health. A sample of 133 English-speaking lung cancer patients (33% female; mean age=63.68years old, SD=9.37) completed a battery of self-report surveys. Results of our secondary analysis indicate that trait negative affect was significantly associated with poor physical and social functioning, greater role limitations due to emotional problems, greater bodily pain, and poor general health. Positive affect was significantly associated with adaptive social functioning, fewer emotion-based role limitations, and less severe bodily pain. In a full model, positive affect was significantly associated with greater levels of social functioning and general health, over and above the effects of negative affect. Reduction of negative affect is an important therapeutic goal, but the ability to maintain positive affect may result in greater perceived health. Indeed, engagement in behaviors that result in greater state positive affect may, over time, result in dispositional changes and enhancement of quality of life.

Wedge resection and thermal cautery for malignant pleural effusion caused by lung cancer under vats

To discuss the treatment effect of wedge resection and thermal cautery of pleura for patients with malignant pleural effusion (MPE) caused by lung cancer under VATS. 37 patients with MPE underwent wedge resection and thermal cautery of pleura under VATS, from June 2005 to December 2008. Postoperative tumor markers level was contrasted with the preoperative, and the control rate of pleural effusion and survival rate of the patients were compared with control group, including 25 patients undergoing intrapleural chemotherapeutics in the same period. In the group, the control rate of pleural effusion was 100%, but 60% in control group (P = 0.005). The 1-year survival rate of the group and the control group was 78.38% and 60% respectively (P = 0.003). CEA and CA-125 were descended obviously in postoperative day 7 in the group(P = 0.002);in control group, there were no significant change of CEA and CA125 after treatment (P = 0.797). Wedge resection and thermal cautery of pleura under VATS can reduce tumor burden of patients with MPE to the maximum, and control MPE effectively and improve the quality of life for lung cancer patients with MPE.

Quality of life of lung cancer patients receiving outpatient chemotherapy.

An increasing number of cancer patients receive outpatient chemotherapy as an alternative to inpatient chemotherapy. The aim of this study was to investigate whether quality of life (QOL) during outpatient chemotherapy was better than QOL prior to hospital discharge, and to explore possible related factors prior to hospital discharge that affected the QOL of lung cancer patients who received outpatient chemotherapy. Lung cancer inpatients who were scheduled for outpatient chemotherapy were assessed two times (prior to hospital discharge and during outpatient chemotherapy) using the Functional Assessment of Cancer Therapy-Lung and Hospital Anxiety and Depression Scale. A total of 40 patients completed all assessments, both prior to hospital discharge and during outpatient chemotherapy. In the present study, QOL during outpatient chemotherapy was not significantly different when compared with the QOL prior to hospital discharge, and predictors prior to hospital discharge for a better QOL of patients during outpatient chemotherapy included better social, emotional and physical well-being. These results suggest that medical staff, in particular those involved in outpatient chemotherapy, need to recognize social and emotional as well as physical well-being prior to hospital discharge, regardless of cancer-related factors and the personal characteristics of the patients.

Depression May Mediate the Relationship between Sense of Coherence and Quality of Life in Lung Cancer Patients

Lung cancer patients generally experience high levels of physical and psychological distress and decreased quality of life (QOL). Sense of coherence (SOC) has been conceptualized as a personality orientation reflecting the degree to which an individual perceives their world as comprehensible, manageable and meaningful. The present study investigated the associations of SOC with QOL in lung cancer. It also examined potential psychological mediators by which SOC may exert its influences on QOL. Fifty-six participants with non-small cell lung cancer were administered self-report assessments of SOC, QOL and psychological distress. Results revealed that SOC was positively associated with QOL and this relationship may be mediated by depressive symptoms. The current study supports the notion that SOC may be a protective factor with regard to psychological adjustment and QOL in cancer survivors.

Lessons Learned from a Prospective Study of Quality of Life in Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy: The Earlier, the Better!

Analyzing data from a prospective study of fatigue and Quality Of Life (QOL) in medically inoperable early stage lung cancer patients (pts) treated with stereotactic body radiotherapy (SBRT) revealed unexpected symptoms from some pts at first follow-up, prompting a review on the study's ability to provide accurate assessment of the outcomes of interest.

Efficacy of perioperative administration of long-acting bronchodilator on postoperative pulmonary function and quality of life in lung cancer patients with chronic obstructive pulmonary disease. Preliminary results of a randomized control study

Long-acting bronchodilators are recommended as a first-line treatment for chronic obstructive pulmonary disease (COPD), although their effects for postoperative lung cancer patients with COPD are still not well known. A prospective randomized trial was used to examine the efficacy of bronchodilators on postoperative pulmonary function and quality of life (QOL). Twenty lung cancer patients with COPD who had lobectomies were randomized. A control group (n = 10) did not receive bronchodilators. An experimental group (n = 10) received tiotropium and salmeterol. Patients were divided into two COPD grades: stage I COPD and stage II-III COPD. Results for pulmonary function, 6-minute walking test, and the St. George's Respiratory Questionnaire (SGRQ) were compared. Diaphragmatic motion on dynamic magnetic resonance imaging was also analyzed. The patient demographics were similar in the two groups. Except for pulmonary function results at 2 weeks, no other parameters were significantly different. However, in stage II-III COPD, forced expiratory volume in 1 second, forced vital capacity, inspiratory capacity, the total score of the SGRQ, and diaphragmatic motion in the experimental group (n = 5) were significantly better than those in the control group (n = 4) at various time points (all P < 0.05). The daily inhalation of bronchodilators was effective for maintaining the respiratory function and QOL in lung cancer patients with moderate to severe COPD.

Shark cartilage does not prolong the life of lung cancer patients

Lu C, Lee JJ, Komaki R, Herbst RS, Feng L, Evans WK, Choy H, Desjardins P, Esparaz BT, Truong MT, Saxman S, Kelaghan J, Bleyer A, Fisch MJ. Chemoradiotherapy with or without AE‐941 in stage III non‐small cell lung cancer: a randomized phase III trial. J Natl Cancer Inst 2010; 102: 859–65.

Effects of collaborative care model for the negative mood and quality of life of lung cancer patients

Objective To study the effects of collaborative care model on the negative mood and the quality of life of lung cancer patients. Methods Sixty patients were randomized into the observation group and the control group with 30 cases in each.The control group only received usual care,the observation group Was treated with collaborative care,encouraging patients and their families to participate in health care.Using SDS、SAS、activities of daily living(ADL)scale and St.George's Respiratory Question-naire(SGRQ)to evaluate the effects ofthe patients in both groups on admission and one months after the discharge.Results One months after the discharge,the scores of anxiety and depression among the observation group were lower than those of the control group;ADL grade and quality of life score in the observation group compared with the control group were significantly improved,the difference was statistically significant. Conclusions Application of collaborative care management can improve the state of anxiety and depression,reduce hospitalization time and medical costs as well as improve quality of life. Key words: Collaborative care model; Lung cancer; Anxiety; Depression; Quality of life

The validity and reliability of the Turkish version of the Quality of Life Index [QLI] (Cancer version)

Purpose Quality of life always has become an important concern in the health care of cancer patients. This descriptive study was planned to assess the validity and reliability of the Turkish version of Quality of Life Index – Cancer version in the assessment of the quality of life of lung cancer patients. Method The validity and reliability of the scale was performed in two phases. Phase I focused on construction of the Turkish version of the instrument and pilot testing. The scale was translated using the back-translation technique. Five nursing experts reviewed the translation for inconsistencies with the original English form. The comprehensiveness and clarity of the scale was assessed with 20 patients. Phase II included factor analysis and psychometric assessment of the scale. The final version of the scale was pretested with 154 cancer patients. Results According to the recommendations of the expert panel, some items were revised and modified, and the Turkish version of the scale was created. The content validity index (CVI) was 97%. Patients cited that this questionnaire was easy to read and understood. Differently from the original QLI scale, factor analysis was changed the domain of some items. Test–retest coefficients for items were between 0.63 and 0.95 ( p < 0.05). The scale showed high internal reliability, Cronbach’s alpha values for domain varied between 0.63 and 0.85 and was 0.89 for the tool. Conclusion The Turkish version of the QLI was sufficient and suitable tool in evaluating the quality of life of lung cancer patients in Turkey.

Clinician perceptions of care difficulty and quality of life for lung cancer patients: Results from the ECOG SOAPP study (E2Z02).

9102 Background: Emerging evidence suggests that lung cancer patients experience disparities in medical care compared to other cancer patients. This may be due to providers' perceptions that lung cancer patients are more difficult to care for and have a poorer quality of life (QOL). Methods: Participants included clinicians treating breast (n = 1543), colorectal (n = 717), prostate (n = 320), and lung (n = 522) cancer patients enrolled in the Eastern Cooperative Oncology Group (ECOG) study of Symptom Outcomes and Practice Patterns (SOAPP; Protocol E2Z02). Data included clinicians' written responses to questions about patient QOL and difficulty of care. Analyses focused on repeated measures (baseline and 28-35 day follow-up) analysis of covariance (ANCOVA) with planned comparisons for reports of lung cancer v. other cancer (breast, prostate, and colorectal) patients. Results: After controlling for relevant patient factors (sex, race/ethnicity, current status/stage of disease, metastatic sites, performance status, weight loss, current treatment, number of moderate/severe symptoms) and institution type, clinicians reported greater difficulty in care for lung cancer patients compared to other cancer patients (p < .01). After adding patients' baseline reports of QOL as a covariate (in addition to the above factors), clinicians also estimated a lower QOL for lung cancer patients (p < .001). Conclusions: Even after controlling for a number of relevant patient and disease factors, clinicians reported higher difficulty of care and lower QOL for lung cancer patients compared to patients with other common solid tumors. These data generate the hypothesis that providers have more pessimistic attitudes about lung cancer care, which could lead to disparities in treatment. Further research is needed to confirm these findings and explore potential explanations for these clinician perceptions related to lung cancer patients. No significant financial relationships to disclose.

Study on cancer-related fatigue of lung cancer patients receiving chemotherapy and its impact on the quality of life

Objective To explore the incidence and severity of cancer-related fatigue (CRF),and to analyze the correlation between CRF and quality of life in lung cancer patients receiving chemotherapy.Methods This was a cross-sectional study.72 lung cancer patients receiving chemotherapy were investigated by the Piper Fatigue Scale (PFS) and the 36-item short form of the Medical Outcomes Study questionnaire (SF-36).Results The rate of fatigue for lung cancer patients receiving chemotherapy was 76.4%.The incidence of moderate and severe fatigue in total fatigue,behavior/severity dimension,affective dimension,sensory dimension was 68.1%,63.9%,76.4% and 65.3% respectively.The incidence of mild and moderate fatigue in coguitive/mood dimension was 41.7%.The fatigue dimension scores ranked in a descending order,affective,behavior/severity,sensory and cognitive/mood.There was significant negative correlation between CRF and quality of life for lung cancer patients receiving chemotherapy.Conclusions In lung cancer patients receiving chemotherapy,the incidence and degree of fatigue was high.CRF and QOL affect each other.The health care providers should take measures to alleviate lung cancer patients' fatigue in order to improve the QOL of them. Key words: Lung cancer,Chemotherapy; Cancer-related fatigue; Quality of life

Health-related quality of life in lung cancer patients in Serbia: correlation with socio-economic and clinical parameters

The objective of this study was to assess health-related quality of life (HRQoL) in patients with advanced non-small cell lung cancer (NSCLC). In Serbia, there is the lack of available data on HRQoL in lung cancer patients. The special attention in our study has been paid on relationships between socio-economic factors and HRQoL. This cross-sectional study was undertaken in group of 100 NSCLC patients with advanced stage diseases. HRQoL was measured using three standard instruments: 36-item Short Form Health Survey, EORTC QLQ-C30 and its Lung Cancer module (EORTC QLQ-LC13). Unexpected, highly educated patients reported significantly worse social functioning (P=0.044), and higher degree of financial difficulties (P=0.047), in comparison with less-educated. Also unusual, unemployed patients had significantly better HRQoL in all domains and significantly lower symptom distress. Significantly better overall HRQoL (P=0.043), social (P=0.024), emotional (P=0.001) and mental functioning (P=0.011) were observed in patients treated with chemotherapy in comparison with newly diagnosed ones. In addition, the most prominent side effects of chemotherapy were nausea and vomiting, and all QoL domains correlated significantly with them. Patients who undergo active treatment improve their HRQoL but chemotherapy-induced emesis adversely affects many HRQoL domains. Additionally, HRQoL is highly dependent on patient's socio-economic characteristic.

Sleep disturbances and quality of life in lung cancer patients undergoing chemotherapy

This study described the sleep disturbances of 115 lung cancer patients undergoing their fourth cycle of chemotherapy and examined the impact of sleep disturbances on quality of life and functional performance status while controlling for pain, depression, fatigue, and dyspnea. Sleep disturbance and quality of life were assessed by the Pittsburg Sleep Quality Index (PSQI), and European Organization for Research and Treatment Quality of Life Questionnaire-Cancer 30 (EORTC), respectively. Data were also collected on covariates of sleep disturbance: performance status, pain, fatigue, depression and dyspnea. Patients' mean PSQI global scores for days with chemotherapy (6.86+/-3.83) and for days without chemotherapy (6.23+/-3.47) were both higher than the cut-off of 5, indicating poor quality of sleep during the fourth cycle of chemotherapy. After controlling for covariates, sleep disturbance was significantly associated with impaired cognitive function (EORTC) and poorer functional status. Our results suggest that clinicians should routinely assess sleep problems in lung cancer patients.

Prise en charge des nausées et vomissements en oncologie thoracique

Nausea and vomiting are frequent symptoms that deteriorate the quality of life of lung cancer patients. They are most often iatrogenic and related to chemotherapy based on platinum salts; they can also be evidence of metastasis to the brain or hypercalcemia. Understanding the physiopathological mechanisms at work can make it possible to adopt effective therapeutic measures that are specific to each etiological context.