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M. Duffy
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NU03 - Supporting Patients Receiving Treatment (ID 275)
- Event: WCLC 2016
- Type: Nurses Session
- Track: Nurses
- Presentations: 3
- Moderators:V. Beattie, M. Duffy
- Coordinates: 12/06/2016, 11:00 - 12:30, Schubert 5
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NU03.01 - Supporting Patients Undergoing Radical Treatments EPD – MARS Study (ID 6465)
11:00 - 11:20 | Author(s): A.M. Tod
- Abstract
- Presentation
Abstract:
Background Malignant pleural mesothelioma (MPM) is an aggressive cancer of the lining of the chest wall and lung, its aetiology lies in asbestos exposure. With over 2,500 people diagnosed each year, the UK has the highest incidence of mesothelioma in the world. Chemotherapy is an established treatment for MPM but response rates are variable, evidence is lacking in new drug therapies and mortality remains high (in the UK half of patients die within 8.5 months of diagnosis) (Maggioni 2016, HSCIC 2015). Surgery is therefore an important option. Very little robust, randomised controlled trial evidence (RCT) exists regarding surgical interventions for mesothelioma and many studies are observational (Cao et al 2014). This has prompted global variations in surgical approaches (Mclean 2013). Extended Pleurectomy Decortication (EPD) is a surgery for patients considered to have resectable MPM. EPD involves the removal of the lining of the chest wall, lining of the lung, with the sac of the heart and / or diaphragm (as required to achieve complete tumour removal) but leaving the lung in-situ. However, evidence on survival or symptom improvement benefits of this surgery is limited (Cao et al 2014, Teh et al 2011). Challenges in surgical research are the lack of clinical trials and few patients choosing to enter RCTs for surgery (Treasure & Morton, 2012, Horton 1996). Potential explanations for this include restrictive trial regulation, patients declining randomisation, and difficulties in recruitment practice such as presenting trial arm options neutrally (Treasure & Morton 2012). The Mesothelioma and Radical Surgery 2 (MARS 2) Trial, a UK based study, will evaluate whether EPD can improve the length and / or quality of life in patients with surgically treatable disease and its cost-effectiveness. It will randomise participants to chemotherapy or chemotherapy plus surgery. The feasibility stage has demonstrated the ability to recruit and randomise to this study and the plan is to proceed to full trial. This paper presents findings from a nested qualitative patient experience sub-study within MARS 2 that investigated patient experience of the study interventions. It more specifically identifies the support and information needs for people regarding i) the interventions (surgery and chemotherapy) and ii) trial recruitment, consent and participation. This paper focuses on the findings related to support needs of the trial interventions. A summary of results will be provided along with reflections on the implications for future practice. Methods An in-depth longitudinal qualitative study with interviews of 16 participants randomised to chemotherapy (n=8) and chemotherapy + surgery (n=8). Interviews were conducted after randomisation (but before surgery in the surgical cohort). Surgical patients had an additional interview post-surgery. Framework analysis methods were used (Ritchie and Lewis, 2014). Follow-up interviews were at 6 and 12 months post-randomisation. This paper presents findings up to and including the 6 months follow-up. Results Participants reported being well informed about their illness, but had struggled to absorb and understand the extent of information delivered at diagnosis. This was influenced by the range of significant subjects that were covered in a number of consultations with different healthcare staff providing distinct specialist services. The topics discussed included diagnostic information about mesothelioma, treatment options and consequences, trials processes and logistics, and legal and financial information regarding classification of MPM as an industrial disease. Despite feeling well informed about their treatment some participants reported not being prepared for the full extent of the problems they experienced. Both chemotherapy and surgery were challenging treatments although they were associated with different physical effects. Adverse consequences of treatment were described including neutropenic sepsis and dehydration post chemotherapy, and bleeding, prolonged pneumothorax and infection post-surgery. For most participants pain and breathlessness were experienced post-surgery while nausea, anorexia, taste changes and constipation were associated with chemotherapy. Fatigue that impacted on daily living was experienced by both groups. Interventions to manage the consequences of treatment were recounted; some had been recommended by healthcare staff while others had been developed by patients from their own initiative. Participants reported struggling to cope with the effect of treatment whilst trying to deal with the broader context of coming to terms with their illness. Uncertainty was expressed in relation to treatment plans (exacerbated by the logistics surrounding participation in a clinical trial), severity and duration of side effects, rehabilitation and recovery and treatment outcomes. Participants employed a number of strategies to help with coping. These included ‘playing things down’, ‘weighing the balance’, ‘managing expectations’, ‘taking control’ ‘manning up’ and ‘trust in the doctor and/or treatment’. Many of these strategies facilitated staying positive, maintaining hope and finding comfort which was important to participants. Family members played a key role in coping. A diverse range of healthcare staff provided information, advice and practical interventions across the care pathway from community, surgical, respiratory and oncology services. Discussion Patient’s perspectives on the experience of receiving radical surgery and/or chemotherapy for mesothelioma were identified by the study. This provided valuable insights into their impact on patient’s feelings about their illness and treatment and how they coped with the challenges they were presented with. Multiple sources of uncertainty were expressed by participants. The contribution of healthcare staff to supporting coping and providing information and advice was appraised positively by participants. However, we identified that fragmentation could occur due to the diverse services involved in providing care with no single point of contact or co-ordination. Conclusion Understanding the patient’s perspective of the challenges associated with treatment, alongside their strategies for coping, provides insights for the services that can support patients undergoing arduous treatments for mesothelioma. The study reveals ways to facilitate strategies to help patients manage the condition, as well as treatment side-effects. Interventions to reduce uncertainty have been identified as a priority for service improvement.
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NU03.02 - eHealth and Remote Patient Monitoring and Supportive Care in Thoracic Oncology (ID 6467)
11:20 - 11:40 | Author(s): R. Maguire
- Abstract
- Presentation
Abstract:
Lung cancer is the commonest cancer worldwide with 1.6 million people diagnosed each year. People with lung cancer experience a high level of supportive care needs and many of these needs are unmet. Systematic supportive care is therefore vital in this patient group. Patient Reported Outcome Measures (PROMs) can be used to identify the supportive care needs of people with lung cancer and the collection of PROMs data is reported to have a number of positive effects on patient outcomes. Enhancing the utility of PROMs within clinical practice is the use of health technologies that have the ability to collect PROM data remotely from patients in their own homes and send this information in ‘real time’ immediately to relevant health/social care professionals for subsequent intervention. The Advanced Symptom Management System is one of the most evolved remote patient monitoring systems in cancer care. This presentation will initially focus on remote patient monitoring within the context of lung cancer before considering the implications for the future and the ultimate vision of connected health for all.
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NU03.03 - Supportive Care in Patients Receiving Systemic Therapy (ID 6468)
11:40 - 12:00 | Author(s): T. Cufer
- Abstract
- Presentation
Abstract:
Introduction Systemic therapy (ST) with chemotherapy (Cht), targeted agents or immunotherapy (IT) represents the mainstay therapy for patients with advanced lung cancer; while adjuvant systemic therapy is recommended in a majority of patients with operable and locally advanced disease. The goal of ST is to prolong life without compromising quality of life (QoL). Despite the ability of ST to prolong life or even cure patients, QoL and life span might be compromised due treatment toxicity. In addition, uncontrolled adverse events (AEs) might lead to treatment interruption or discontinuation. Therefore, effective management of adverse events of anti-cancer drugs, the so-called “supportive care to systemic therapy” is extremely important for a true benefit, i.e. treatment effectiveness in a routine practice. During the last decade several improvements in prevention, treatment and amelioration of ST AEs been achieved. To implement them in everyday clinic practice a good understanding of adverse events, supportive care measures and professional skills of all team members are needed. Registered nurses, specialized in the oncology, the so called “oncology nurses” are key providers of supportive care in everyday clinical practice. Supportive care for prevention and treatment of adverse events Chemotherapy-induced nausea and vomiting (CINV) has been a priority in the supportive care of cancer patients ever since the first use of Cht (1). The introduction of 5-HT3 and NK1 antagonists into anti-emetic therapy resulted in much better control of CINV in lung cancer patients receiving highly emetogenic, platinum-based therapy. With proper use of available drugs complete control of vomiting could be achieved in up to 90% of these patients. However, despite the efficacy of new anti-emetic therapies a proper us of anti-emetics and other preventive measures are vital. Chemotherapy-induced neutropenia with febrile neutropenia (FN) as its ultimate and most serious complication are often observed in patients receiving Cht. The risk of FN can be predicted by assessing patient characteristics and mylotoxicity of the Cht regimen; and granulocyte-colony-stimulating factors (G-CSF) can be used to prevent it (2). Even thought, most of the regimens for lung cancer do not classify to high, i.e. more than 20% risk of febrile neutropenia, the primary prophylaxis with G-CSF is often necessary due to high comorbidity index, poor PS or extensive disease often present in lung cancer patients. In case of FN, a risk-base approach provided by MASCC helps us to decide which patients need hospitalization and which can be treated by antimicrobial therapy at home (3). Oral mucositis and diarrhea related to mucosal damage are frequent complications of Cht as well as targeted therapy with TKIs that can significantly affect patient’s QoL and the ability to deliver full doses and complete therapy. Oral care protocols are essential components in prevention and treatment of stomatitis, while intensive local therapy protocols with antibiotics, anesthetics and/or corticosteroids help to ameliorative symptoms (4). Diarrhea is quite common in lung cancer patients receiving Cht with an even higher occurrence in patients treated with TKIs (5). It could be life threatening in elderly, fragile patients and in patients with concurrent neutropenia, thus requiring a rapid and effective control. When dietary strategy does not work, or when patients present with severe grade 3/4 diarrhea pharmacologic intervention with loperamide or even somatostatin analogues should be initiated quickly. Skin changes (rash, dry skin, paronychia) are the most frequent AEs associated with targeted therapy for lung cancer next to diarrhea. Even though, they are usually mild or moderate they hava negative impact on patient’s QoL and might lead to dose modifications or even discontinuation. Prophylactic measures with regular use of moisturizing products, sunshine protection and careful skin hygiene are necessary. In case of severe but still localized changes topical corticosteroids/antibiotics are indicated while a severe and prolonged toxicity usually requires TKIs dose interruptions (6). Fatigue is a common symptom reported in up to 80% of LC patients. In most cases it is impossible to distinguish to what extend it is the adverse event of ST and to what of disease. It is increasingly reported in patients receiving targeted therapy or immunotherapy, and major improvements in recognition and treatment of fatigue have been achieved recently (7). Immunotherapy with checkpoint inhibitors (CPIs) represents a novel approach. By breaking of immune self-tolerance it might lead to autoimmune/inflammatory adverse events, designated as immune-related adverse events (irAEs), mainly including rash, diarrhea, hepatitis and endocrinopathies (8). Although most of irAEs are of low grade, some of them progress rapidly and prompt medical attention with treatment interruption and the administration of glucocorticoids is critical. Implications for nursing Oncology nurses should have in-depth knowledge on adverse events of systemic therapy and must be familiar with the supportive care protocols. Nursing interventions for prevention and treatment of particular adverse events are presented in Table 1. Oncology nurses play a key role in continuous education of patients, their families and caregivers on adverse events. They are valuable members of the multidisciplinary team performing ongoing assessment of AEs and monitoring of patients and actively discussing potential solutions and improvements with other team members, thus providing a high-quality patient-centered care. Figure 1
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Author of
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OA14 - Nurses in Care for Lung Cancer and in Research (ID 398)
- Event: WCLC 2016
- Type: Oral Session
- Track: Nurses
- Presentations: 1
- Moderators:M. Culligan, M. Nematollahi
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 5
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OA14.08 - Discussant for OA14.05, OA14.06, OA14.07 (ID 7094)
17:15 - 17:30 | Author(s): M. Duffy
- Abstract
- Presentation
Abstract not provided
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P2.07 - Poster Session with Presenters Present (ID 468)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Nurses
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.07-008 - Victorian Comprehensive Cancer Centre Lung Cancer Clinical Audit: Collecting the UK National Lung Cancer Audit data from Hospitals in Australia (ID 4784)
14:30 - 14:30 | Author(s): M. Duffy
- Abstract
Background:
Clinical audit may improve best practice within health. The UK National Lung Cancer Audit (NLCA) collects data from UK hospitals about care of patients with thoracic cancers. We aimed to replicate collection of the NLCA data elements from hospitals caring for patients with thoracic cancers within the Victorian Comprehensive Cancer Centre (VCCC) and associated Western and Central Melbourne Integrated Cancer Service (WCMICS).
Methods:
Retrospective audit of patients newly-diagnosed with lung cancer or mesothelioma in 2013 at 6 major VCCC or WCMICS hospitals. The objectives were: to adopt/adapt the NLCA dataset for use in the Australian context; and analyze the findings using descriptive statistics to identify variations in care. Individual data items from the NLCA were tailored to the Australian context in consultation with an expert steering committee. Data was collected from existing datasets including the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited to collect missing data.
Results:
845 patients were diagnosed during 2013. Most were aged 65-80 (55%) and 62% were male. Most had non-small cell lung cancer (81%) with 9% small cell and 2% mesothelioma. Data completeness varied greatly between fields. Headline indicators of clinical care in the table below are compared to NLCA data. A significant area of concern identified was lack of access of many patients to a specialist lung cancer nurse.
Conclusion:
Lung cancer care at participating hospitals appeared to be comparable or better to many of the headline indicators of the NLCA. However, performing the audit retrospectively resulted in significant amounts of missing data for some fields. For future audits, prospective data collection should be harmonized across sites and correlated with survival outcomes. Initiatives to improve access to specialist lung cancer nurses are urgently needed.Benchmark VCCC/WCMICS (%) NLCA-2013 (%) Patients with histological diagnosis 810/845 (96%) (75%) Patients with CT before bronchoscopy 384/492 (78%) (91%) NSCLC patients receiving PET scan 544/748 (73%) (35%) Patients with stage documented 518/845 (61%) (93%) Patients discussed at multi-disciplinary meeting 585/845 (69%) (96%) Patients seen by lung cancer nurse specialist 110/845 (13%) (84%) Lung cancer nurse specialist present at diagnosis 0/845 (0%) (65%) Patients receiving active treatment 643/845 (76%) (60%) Patients treated with surgery 242/845 (29%) (15%) Patients treated with radiotherapy 370/669 (55%) (29%) Patients treated with chemotherapy 327/638 (51%) (70%) Patients seen by specialist palliative care 179/845 (21%) (30%)
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P3.05 - Poster Session with Presenters Present (ID 475)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.05-001 - Psychological Intervention to Treat Distress and Suffering Experienced by People with Lung Cancer Nearing the End-Of-Life (ID 5973)
14:30 - 14:30 | Author(s): M. Duffy
- Abstract
Background:
Despite advances in medical interventions, lung cancer continues to be associated with a poor prognosis with approximately 16% of people with lung cancer living five years post diagnosis. This poor prognosis can contribute to depression, anxiety, death anxiety and existential concerns and fears relating to meaning and purpose of life. There is a growing body of evidence indicating that behavioural and psycho-educational interventions are efficacious in treating depression and anxiety in lung cancer patients, however, little is known about how to psychologically treat suffering and distress nearer to the end-of-life.
Methods:
A comprehensive search using PsycINFO and Medline was undertaken to identify existential and meaning centered psychotherapies that were used towards the end-of-life with people with cancer. As the research in the area is in its infancy, all quantitative study designs and qualitative studies were included. Studies that focused on physical symptom management, dyads and bereavement interventions, measurement of psychological distress or existential concerns were excluded.
Results:
The search yielded a total of 62 articles, of which only 34 examined the use of psychotherapies towards the end-of-life care of people with cancer. The majority of these studies were focused on women with breast cancer, used different outcome measures and included very few, if any, participants with lung cancer. These studies identified and described at least 14 novel psychotherapeutic interventions that could be used towards the end-of-life. These interventions included: Legacy Activities, Life Review Therapy, Meaning-Centred Group Psychotherapy, Individual Meaning-Centred Psychotherapy, Dignity Therapy, Forgiveness Therapy, Meaning-Making Psychotherapy, Outlook Psychotherapy, Supportive Group Interventions, The Healing Journey Intervention, Cognitive Existential Interventions, Re-creating Your Life Therapy, Mindfulness Interventions and Managing Cancer and Living Meaningfully. These interventions varied in the number of sessions and the level of training required to administer the interventions. Some of these interventions were manualized and others were less structured in their approach. Some of these interventions show potential in alleviating distress and suffering, improving life satisfaction, self-esteem and mood.
Conclusion:
There are only a small number of studies that evaluate the efficacy of psychotherapeutic interventions to be used with people with advanced cancer towards the end-of-life. Although results are promising it is difficult to conclude that one intervention is better than another. Further research is required to trial and adapts these interventions for use with people with lung cancer towards the end-of-life.
