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M. Duffy
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MS26 - Exploring the Diverse Impact that the Thoracic Oncology Nurse Can Make... (ID 43)
- Event: WCLC 2013
- Type: Mini Symposia
- Track: Nurses
- Presentations: 4
- Moderators:M. Duffy, D. Borthwick
- Coordinates: 10/30/2013, 14:00 - 15:30, Bayside 105, Level 1
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MS26.1 - Symptom Clusters (ID 584)
14:05 - 14:25 | Author(s): A. Molassiotis
- Abstract
- Presentation
Abstract
Symptom clusters is a relatively new field of study, recognizing that patients are often experience multiple concurrent symptoms and some of them may be interlinked. Understanding these clusters may improve the management of unrelieved symptoms in patients with lung cancer. A symptom cluster is defined as two or more symptoms that are related to each other and that occur together (Kim et al, 2005; Molassiotis et al, 2010). A small amount of research has highlighted over the past decade the different symptom clusters that are reported by patients with lung cancer. Brown et al (2011) have shown a five-symptom cluster that includes fatigue, breathlessness, cough, pain and anorexia, present in 64% of women with lung cancer. Henoch et al (2009) identified three clusters, including a pain cluster (pain, nausea, bowel issues, appetite loss, fatigue); a mood cluster (mood, outlook, concentration, insomnia), and a respiratory cluster (breathing, cough). The latter respiratory cluster has also been shown with our own work and it was stable at various assessments over the first 12 months from diagnosis (Molassiotis et al, 2010). Depression, fatigue and pain is another one (Fox & Lyon, 2006) as is pain, fatigue and insomnia (Hoffman et al, 2007). On the clinical level, it is suggested that physicians and oncology nurses should think in terms of these naturally clustering symptoms when recommending plans for symptom management, in order to be more effective in the overall management of a larger spectrum of symptoms. However, all these studies have some methodological shortcoming, as many of the identified clusters reflect the measurement symptom tool used each time, some have small sample sizes and are often secondary analyses. Patients who experience symptom clusters are more distressed and have more severe symptom-reporting than those who experience single symptoms, and they form a particular group of patients in need of more careful intervention. More recently we have carried out a qualitative study with 19 patients and their caregivers assessed at diagnosis, and 3, 6 and 12 months post-diagnosis. We have identified, for a first time using such methodology and the patients experience, a consistent and stable symptom cluster of fatigue, breathlessness and cough, which we called it ‘respiratory distress’ symptom cluster (Molassiotis et al, 2011). Two other messages came out clearly from this study: a) that the patients’ symptom experiences and coping efforts need to be understood within the context of a panorama of symptoms which frequently co-occur and which may interact in complex ways. This suggests that it may therefore be potentially problematic within the lung cancer population to determine a patient's experience of a single symptom in isolation given the complex array of symptoms that patients may experience. b) cough, which is under-represented in research within this population, may play an important role in shaping the patients' symptom experience, and may be linked with breathlessness more strongly than we currently think. Also both breathlessness and cough lead to anxiety and emotional distress. How do we improve the symptom cluster experience? We need to develop symptom interventions that are moving from a reductionist model of focusing on a single symptom to understanding the clinical usefulness and relationships of symptoms through symptom clusters and developing interventions that affect all symptoms in the cluster. This area is still in its infancy and there are only a couple of ongoing trials with such more ‘complex’ interventions. How do these broader interventions look like? Complementary therapies may be good ‘candidates’ for such an approach; indeed, we have carried out a trial using acupuncture to manage cancer-related fatigue in breast cancer patients, and we have seen that many patients reported also reductions in hot flushes and joint pains too. Mindfulness therapy may be a good option for the common mood-related symptom cluster. Educational interventions could also be appropriate approaches. However, how one structures and develops a new intervention to attend to clusters of symptoms needs significant thinking and energy. Our team is currently testing a new such intervention focusing on the respiratory distress symptom cluster. However, to ‘shape’ the intervention we followed several steps: Through patient and caregiver interviews (Ellis et al, 2012) important implications for patient participation and adherence to the intervention were identified, including the perceived relevance of potential techniques; appreciable benefits in the short-term; convenience; patient preferences; timing of the intervention; venue; caregiver involvement; the provider of the intervention, and contact with other patients. Through health care professionals’ focus group interviews (Wagland et al, 2012) it was clear that to have a successful intervention we had to consider also staffing time and space, and there was a recognition that the preference of most patients to make as few hospital visits as possible also complicated the teaching of such interventions. Moreover, it was recognized that there may only be a small window of opportunity in which to effectively teach lung cancer patients a novel non-pharmacological intervention as the period between diagnosis and the onset of severe symptoms is often short. Finally, we assessed patient preferences for the intervention components through a discrete choices experiment (Molassiotis et al, 2012). After this work, we developed the intervention that includes primarily diaphragmatic breathing exercises, cough suppression exercises, and acupressure (main intervention) together with anxiety management, vocal hygiene, and energy conservation techniques, delivered through two educational sessions as a self-management strategy that involves both patients and caregivers. Currently we are testing this intervention in a pilot trial aiming to explore the impact of this novel non-pharmacological supportive intervention on symptom distress, coping and service utilisation in patients with lung cancer and their caregivers, and to test the feasibility of carrying out a trial using this intervention, including practical and logistical issues of providing the intervention in practice. The trial has currently recruited 60/100 patients and is envisaged to complete recruitment by the end of 2013. Preliminary findings from the trial will be presented.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MS26.2 - Exploration of the Nurse Role in Follow Up Care (ID 585)
14:25 - 14:45 | Author(s): L. Darlison
- Abstract
- Presentation
Abstract not provided
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MS26.3 - Exercise and Lung Cancer Survivorship (ID 586)
14:45 - 15:05 | Author(s): S. Corcoran
- Abstract
- Presentation
Abstract
An estimated 225,000 men and woman will be diagnosed with lung cancer in 2013 (NCI-SEER Data). Approximately 80% of lung cancer patients will be diagnosed with non-small cell lung cancer (NSCLC), and an estimated 25% will present with early-stage or operable disease (Jones 2009). The overall 5 year survival rate for lung cancer is 16%. However, if detected early the survival rate is 53% (ACS 2010). Improvements in surgical techniques, coupled with more effective chemotherapy regimens, have led to significant survival gains for patients with operable disease (Jones 2009). With improved survival rates, long-term treatment sequelae and quality of life (QOL) are gaining increasing attention in terms of post-treatment management of early stage patients. For patients with inoperable or more advanced disease, measures to improve symptoms and QOL are also being evaluated. An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life (NCI- Survivorship Definitions 2004). Lung cancer survivors may experience a myriad of long-term and late effects related to their diagnosis and treatment exposures. Symptoms may include dyspnea, fatigue, decreased physical endurance, depression, inability to sleep and weight loss (Anderson 2011). Anticipated age-related losses in physical function and comorbidities such as chronic obstructive pulmonary disease (COPD), ischemic heart disease and hypertension can add to post treatment complications, long term effects and overall recovery. Exercise therapy continues to gain recognition as an effective intervention in cancer rehabilitation. While early studies mainly focused on breast cancer survivors, a growing number of studies have been conducted over the past several years evaluating exercise following a lung cancer diagnosis in the post treatment setting. A review of literature suggests lung cancer patients are good candidates for pulmonary rehabilitation following treatment. Peddle-McIntyre et al describe progressive resistance exercise training, or PRET, as an intervention that has been successful in improving muscular strength, body composition, physical fitness, physical function and QOL in some cancer survivor groups citing, however, that no studies have focused solely on lung cancer survivors. Their prospective study including early stage NSCLS survivors who had undergone surgical resection preliminarily revealed significant improvement in muscle strength, muscular endurance and peak inspiratory pressure. The 6-minute walk distance (6MWD), regarded as a prognostic indicator in certain chronic illnesses, also demonstrated improvements suspected to correlate with preserving body function and delaying onset of mobility limitations. Several studies have demonstrated the benefits of exercise in COPD patients, who are known to experience respiratory symptoms comparable to lung cancer patients. A prospective study conducted by Anderson et al utilized an established COPD rehabilitation program in lung cancer patients to evaluate impact on fitness and QOL. Patients who had undergone pulmonary surgery as well as those who were surgically ineligible (comprising the majority of participants) were included in the study. Interventions included supervised exercise in the clinic setting and instruction on home exercising. Walking was the main element. Results showed improved physical fitness and performance as measured by the Incremental Shuttle Walk Test (ISWT), Endurance Shuttle Walk Test (ESWT) and spirometry after the exercise intervention. Pulmonary function and self reported QOL, however, did not demonstrate improvement. Spruit et al (2006) conducted a non-randomized clinical trial in patients who had a history of surgery, chemotherapy and/or radiotherapy evaluating an inpatient rehabilitation program on pulmonary function, 6MWD and peak cycling load. Patients were trained in daily cycling, walking, weight training, and gymnastics (focusing on flexibility and mobility). No change was seen in pulmonary function post intervention. However, significant improvements were seen in the 6MWD and peak cycling load. Symptom scores for dyspnea and fatigue also improved significantly. In focusing on patients with newly diagnosed advanced NSCLC with good performance status, Temel et al conducted a study to determine feasibility of implementing a twice weekly physical therapy (PT) run program using aerobic exercise (bicycle and treadmill) and weight training. Functional capacity as measured by the 6-minute walk test (6MWT), muscle strength, QOL and lung cancer symptoms and fatigue were evaluated. Results included no significant post intervention improvement in QOL or fatigue. Lung cancer symptoms, though, were significantly improved. Additionally, no deterioration in the 6MWT or muscle strength were reported. Lastly, Jones et al (2008) studied the effects of aerobic cycle training on changes in VO2peak and QOL among post surgery NSCLC patients. Results included increased VO2peak, improved QOL and decreased fatigue. Exercise therapy is becoming increasingly acknowledged as an integral component of cancer rehabilitation. The limited literature focusing on lung cancer survivors at different stages post diagnosis support exercise training as safe and well tolerated (Jones 2009). Adherence and ability to complete prescribed programs remains an issue, not surprisingly, for this patient population. While studies thus far have other limitations, they illustrate the need for large randomized trials to better determine the timing, support and specific interventions that will optimally benefit lung cancer survivors. References Available as a separate documentOnly Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MS26.4 - Stigma & Nihilism - International Nursing Perspective (ID 587)
15:05 - 15:25 | Author(s): M.E. San Martín
- Abstract
- Presentation
Abstract not provided
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Author of
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O26 - Support and Palliation II (ID 140)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Nurses
- Presentations: 1
- Moderators:J. White, Y. Lai
- Coordinates: 10/29/2013, 16:15 - 17:45, Bayside 104, Level 1
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O26.04 - DISCUSSANT (ID 4010)
16:45 - 17:00 | Author(s): M. Duffy
- Abstract
- Presentation
Abstract not provided
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P1.08 - Poster Session 1 - Radiotherapy (ID 195)
- Event: WCLC 2013
- Type: Poster Session
- Track: Radiation Oncology + Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P1.08-012 - Significant association between radiation induced oesophagitis, neutropenia and V20 in patients with non-small cell lung cancer (ID 1518)
09:30 - 09:30 | Author(s): M. Duffy
- Abstract
Background
Radiation induced oesophagitis (RIO) is frequently associated with high dose thoracic radiation therapy (RT). Although RIO is uncommonly life threatening, it is a distressing toxicity associated with pain, decreased oral intake and can significantly impact on patient’s quality of life. The aim of this retrospective analysis was to assess the rates of acute and late RIO and investigate the association of RIO with radiation dosimetrics and neutropenia.Methods
Criteria for inclusion of patient data included a pathological confirmation of non-small cell lung cancer (NSCLC), treatment with concurrent chemotherapy and radical or high dose palliative RT at our centre between 03/04 and 08/07. Exclusion criteria included previous thoracic RT, RT alone, treatment breaks of > five days, inconsistent radiation dose per fraction and hyper-fractionated RT. Acute and late RIO and neutropenia were scored using the Common Toxicity Criteria for Adverse Events (CTCAE v3.0) criteria. Using Focal (Computerized Medical Systems CMS, St Louis, MO, USA), the outer muscular border of the oesophagus was delineated from the cricoid (superior border) to the gastro-oesophageal junction (inferior border) on CT derived images, using pre-defined soft-tissue window/level settings. Dosimetric data was derived from Xio (CMS) plans (three-dimensional conformal RT (3DCRT) with 6MV photons), including the oesophageal length and volume, maximum and mean doses, percentage of oesophagus receiving 20 to 60 Gy (in 5 Gy increments) and percentage length of oesophagus (whole and partial circumference) receiving 20 to 60 Gy (10 Gy increments). Assessment of potential prognostic factors with respect to acute oesophagitis was done using Wilcoxon rank sum test and Spearman’s correlation. Acute oesophagitis and acute neutropenia reaction were dichotomised as grade 0+1 vs. grade 2+3+4. The association of acute oesophagitis with acute neutropenia was examined using Barnard’s test.Results
The data of 54 patients were eligible for inclusion in this trial. 48 (89%) patients had acute RIO of at least grade 1 (95% CI [78% to 95%]) and five patients (9%) had late RIO of at least grade 1 (95% CI [4% to 20%]). There was a statistically significant correlation between the grade of acute RIO, oesophagus V20 (r=0.303, p=0.026) and length oesophagus receiving 20Gy (whole circumference) (r=0.319, p=0.019). The mean (SD) maximum dose to the oesophagus was 50.2 Gy (18) (r=0.143, p=0.302) and the mean (SD) mean oesophageal dose was 20.8 Gy (10.8) (r=0.269, p=0.049). The maximum grade of acute oesophagitis was significantly associated with acute neutropenia (p=0.035).Conclusion
Acute neutropenia, mean oesophageal dose and the volume and length of oesophagus receiving low radiation doses were significantly associated with acute RIO in our patient cohort. No association was demonstrated between RIO and maximum radiation dose.
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P2.24 - Poster Session 2 - Supportive Care (ID 157)
- Event: WCLC 2013
- Type: Poster Session
- Track: Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.24-045 - Enhancing psychological services for people with lung cancer (ID 2656)
09:30 - 09:30 | Author(s): M. Duffy
- Abstract
Background
Background: Lung cancer patients have a higher level of disease burden, higher unmet psychosocial needs and lower uptake of psychological services compared with other cancer groups. The Department of Clinical Psychology, in collaboration with the lung cancer service at PeterMac, revised the model of psychological care to optimise access and improve psychosocial well-being.Methods
Method: This revised model of care involved realigning the Psychology Outpatient Clinic to run in parallel with the Lung Outpatient Clinic. The aims were to: 1) provide a timely and early intervention service; 2) increase patient access to psychology services; 3) reduce the burden of accessing psychology services; and 4) assess psychological needs of patients and provide appropriate psychological interventions. Patient demographics, uptake, referral information and session data were collected for a three month period and compared to data from the same period in the previous year.Results
Results: Our sample included a total of 37 patients with lung cancer. The results indicated that the revised model of service delivery led to: a 21% increase in new lung patient referrals for psychology services; an almost 100% uptake of services; and a 186% increase in the number of scheduled sessions attended by lung patients. The main reasons that patients attended sessions were to address mood fluctuations, loss and grief issues, relationship and existential concerns.Conclusion
Conclusion: The revised model made a significant impact on meeting the previously unmet needs of this patient group through providing timely assessments and interventions. This highlights the potential effectiveness of integrating psychology services within medical cancer streams. We received no funding and there was no duality or conflict of interest
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P2.25 - Poster Session 2 - Nurses (ID 249)
- Event: WCLC 2013
- Type: Poster Session
- Track: Nurses
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.25-002 - How do patients with lung cancer experience radiation induced oesophagitis? (ID 2510)
09:30 - 09:30 | Author(s): M. Duffy
- Abstract
Background
Background Radiation induced oesophagitis (RIO) is a significant toxicity of lung cancer treatment that has profound clinical, social and economic implications. The literature suggests there is minimal evidence to support current analgesic regimes with the exception of systemic analgesia. More information is required to better understand the patient experience of RIO and how it can be managed. Aim To identify the properties and characteristics of RIO experienced by patients having radiotherapy to the chest for lung cancer.Methods
Methods A qualitative exploratory study conducted with patients with lung cancer receiving radiotherapy to the chest. Patients participated in semi-structured interviews exploring their experience of RIO. Interviews were recorded, transcribed and content analysed.Results
Results Twenty six patients participated: six with grade 1; 14 with grade 2 and eight with grade 3 RIO. Patients were interviewed following recovery from grade 3 RIO. Four key domains were identified: 1.Pain descriptors such as “feels raw “, “burning”, “like reflux but worse” were reported 2. Swallowing difficulties varied over time and were described as “felt like there was a blockage, “afraid I would choke,” “unable to get anything through”. 3. Self care efforts employed by the patients to manage these difficulties ranged from diet modification, allowing food and drinks to go cold before eating and eating slowly. 4. An aversion to taking regular analgesia was also evident. The overall impact on participants’ lives was often understated, even in the context of hospital admissions, insertion of nasogastric tubes and poorly controlled pain.Conclusion
Conclusions This study demonstrates the complexity of RIO and suggests clinicians may underestimate the effect and severity of RIO. Given patients appear to continue to experience problems, despite treatment, better prophylaxis and management regimes are required.
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P3.08 - Poster Session 3 - Radiotherapy (ID 199)
- Event: WCLC 2013
- Type: Poster Session
- Track: Radiation Oncology + Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.08-015 - Dosimetric factors associated with weight loss during radiotherapy treatment for non-small cell lung cancer (ID 2033)
09:30 - 09:30 | Author(s): M. Duffy
- Abstract
Background
Thoracic radiotherapy is associated with significant acute toxicities including oesophagitis, anorexia and fatigue which can impact on the ability to achieve adequate nutritional intake, subsequently leading to weight loss and malnutrition. Malnutrition during cancer treatment is associated with poorer patient and treatment outcomes. Understanding factors associated with weight loss assists with the early identification and intervention of patients at nutritional risk. This study aimed to identify radiotherapy dosimetric factors associated with clinically significant weight loss (greater than or equal to 5%) in patients receiving treatment for non-small cell lung cancer (NSCLC).Methods
A retrospective analysis of an existing cohort of 54 NSCLC patients treated with concurrent chemoradiotherapy for whom oesophageal dose distributions had previously been calculated. Weight change was calculated at any time point from the start up to 90 days from radiotherapy commencement to determine those with clinically significant weight loss. Chi-squared tests, Pearson correlation, Mann-Whitney U-test and logistic regression were used to examine associations.Results
Four patients for whom weight was not available at the start or end of treatment were excluded leaving 50 patients for analysis. The prevalence of clinically significant weight loss was 22% (median weight loss 9.1%, range 5.9 – 22.1). Dosimetric factors associated with clinically significant weight loss were maximum dose to the oesophagus (z= -1.99, p=.046), absolute oesophageal length receiving 40Gy (r=.32, p=.03), 50Gy (r=.36, p=.01) and 60Gy (r=.45, p=.001) to the partial circumference, relative oesophageal length receiving 50Gy (r=.32, p=.02) and 60Gy(r=.44, p=.001) to the partial circumference. The odds of a patient receiving 40Gy (median length 10.6cm), 50Gy (median length 10.2cm) or 60Gy (median length 7.2cm) to the partial oesophagus experiencing clinically significant weight loss were 1.18 (95%CI 1.01,1.37, p=.04), 1.20 (95%CI 1.03,1.41, p=.02) and 1.32 (95%CI 1.09,1.60, p=.005) greater, respectively, than those with less oesophagus in the treatment field. Nine (82%) of the eleven patients who had clinically significant weight loss received a dose of 60Gy to at least 5cm of the partial circumference of the oesophagus.Conclusion
The strongest dosimetric association with clinically significant weight loss was absolute oesophageal length receiving 60Gy to the partial circumference. A previous study identified an association between concurrent chemotherapy and late stage disease (stage III or IV) and clinically significant weight loss. Findings from both studies have been used to develop a model, currently undergoing validation, to assist clinicians in predicting NSCLC radiotherapy patients at high nutritional risk.
