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C. Miaskowski



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    O25 - Stigma and Nihilism (ID 139)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O25.01 - Reliability of and Correlates with a Measure of Lung Cancer Stigma in Norwegian Patients Who Underwent Lung Cancer Surgery (ID 2017)

      16:15 - 16:25  |  Author(s): C. Miaskowski

      • Abstract
      • Presentation
      • Slides

      Background
      In HIV, cancer, and other diseases, stigma is known to have a negative impact on patient outcomes. Regardless of smoking status, lung cancer patients feel stigmatized because their disease is strongly associated with smoking. In addition, higher levels of lung cancer stigma (LCS) are associated with higher levels of depression and poorer quality of life (QOL). Previous studies have measured LCS in heterogeneous samples of patients at various stages of their disease and treatment. The purpose of this study was to evaluate LCS levels in a homogenous sample of patients 5 months after lung cancer surgery and to identify correlates of LCS.

      Methods
      Patients were recruited from three university hospitals in Norway. They completed a number of self-report questionnaires and the Cataldo Lung Cancer Stigma Scale (CLCSS). The CLCSS is a 31-item scale with each item rated on a 4-point Likert scale (i.e., strongly disagree to strongly agree). Descriptive statistics were used to present demographic and clinical characteristics. Reliability of the CLCSS was assessed using Cronbach’s alpha. Multiple regression analysis was done to identify characteristics associated with higher levels of LCS.

      Results
      Findings from this study provide data on the first time use of the CLCSS in a Norwegian sample of patients with lung cancer. Cronbach's alpha for the total CLCSS score was 0.95. The sample consisted of 121 (57.1%) men and 91 (42.9%) women who had a mean age of 66.1 years (SD=8.3, range 30 to 87). The mean stigma score was 44.0 (SD=13.8) with a range of 31 to 109 (a higher score, indicates higher level of stigma). Bivariate analysis of demographic and clinical characteristics revealed that patients with a higher level of stigma were younger (r = -.18, p =.01), more likely to live in a small town compared to rural areas (p=.04), had smoked until the time of surgery (p=.008), and had higher levels of depression (r = .24, p˂.001). Marital status was included in the multivariate analysis, because it approached significance in the bivariate analysis (p=.07). In the multivariate analysis, marital status (p=.002) and depression (p=.006) remained significant. The final multivariate model explained 13.5% of the variance in stigma scores. Marital status and depression symptom scores uniquely explained 3.6% and 4.6% of the variance of stigma, respectively. Patients who were married and patients who reported higher depression scores reported higher stigma scores.

      Conclusion
      The CLCSS is a valid measure of stigma in Norwegian patients with lung cancer. The majority of the patients (97%) reported stigma scores below 75.7, the mean score obtained in a United States sample. However, 3% of the sample had a stigma score of >75.7. In a Norwegian sample of lung cancer patients, being married and having a higher mean score on the Center for Epidemiological Studies-Depression Scale (i.e., 27.3 (SD=13.4)) were associated with higher LCS.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-023 - Changes in Symptom Occurrence Rates and Severity Ratings Before and Following Lung Cancer Surgery (ID 2005)

      09:30 - 09:30  |  Author(s): C. Miaskowski

      • Abstract

      Background
      Knowledge about symptoms is an important outcome to evaluate following lung cancer surgery because patients want information about the usual course of recovery of their physical and mental health. Patients need information at hospital discharge about when they need to contact their clinician if symptoms persist. Because to our knowledge only three studies have evaluated the occurrence of symptoms in patients prior to and following lung cancer surgery, the purpose of this study was to evaluate for changes in symptom occurrence ratings and severity scores from the preoperative period to 1 month after surgery using a multidimensional symptom assessment scale (i.e., Memorial Symptom Assessment Scale (MSAS)).

      Methods
      Patients were recruited from three university hospitals in Norway. They completed a number of self-report questionnaires prior to and again at 1 month following surgery. The questionnaires provided information on demographic and clinical characteristics and symptoms. Patients’ medical records were reviewed for disease and treatment information. Descriptive statistics were used to present demographic and clinical characteristics. McNemar's test was used to evaluate for changes over time in symptom occurrence rates. Paired t-tests were done to evaluate for changes in severity scores for patients who reported severity scores either preoperatively, postoperatively, or on both occasions. Because the severity ratings were skewed, 1000 bootstrapped samples were taken for each analysis to provide unbiased estimates.

      Results
      The sample consisted of 129 (57%) men and 99 (43%) women who had a mean age of 65.8 years (SD=8.5, range 30 to 87). The total number of symptoms increased significantly from the preoperative ( =9.4, SD=7.2) to the postoperative ( =13.1, SD=6.8, p˂.001) assessment. Of the 11 symptoms that occurred in more than 50% of the patients at 1 month, 8 of them increased significantly from the preoperative to the postoperative period. Eight of the symptoms increased in both their occurrence rates and severity scores (i.e., lack of energy, pain, feeling bloated, lack of appetite, shortness of breath, feeling drowsy, dry mouth, sweats). Only one symptom had a significant reduction in its severity score, namely cough. Four symptoms were experienced by more than 80% of the patients at the 1 month assessment, namely: shortness of breath (85.5 %), lack of energy (83.8%), pain (83.8%), and feeling drowsy (82.5%).

      Conclusion
      Findings from this study suggest that patients experience a high number of symptoms after surgery. These findings can be used to educate patients about the normal course of postoperative recovery. In addition, clinicians need to assess for these symptoms and develop effective interventions to improve symptom management for this vulnerable group of patients.