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S. Kim
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ES 03 - Current Topics for Nurses & Allied Health (ID 512)
- Event: WCLC 2017
- Type: Educational Session
- Track: Nursing/Palliative Care/Ethics
- Presentations: 5
- Moderators:Anne Fraser, S. Kim
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 313 + 314
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ES 03.01 - IASLC Immunotherapy Guidelines (ID 7592)
15:45 - 16:05 | Presenting Author(s): Kimberly Ann Rohan
- Abstract
- Presentation
Abstract:
Immunotherapy has become a large part of care for patients with lung cancer and has a very different side effect profile than what Allied Health Care Professionals are use to managing. To that end, the nursing and allied health care research committee of IASLC has developed Immunotherapy Side Effect Guidelines to assist the AHCP in assessing and managing their patients on immunotherapy. This presentation will review these guidelines and discuss implementation in the treatment setting.
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ES 03.02 - Pulmonary Rehabilitation (ID 7593)
16:05 - 16:25 | Presenting Author(s): Catherine L Granger
- Abstract
- Presentation
Abstract:
This presentation will outline the rationale, role and evidence supporting pulmonary rehabilitation for people with lung cancer. Lung cancer is associated with high disease burden and physical hardship. Individuals with lung cancer experience complex symptoms, which can include dyspnoea, fatigue and pain. These frequently lead to a cycle of inactivity and functional decline. Individuals with lung cancer are less physically active than similar aged healthy peers at time of diagnosis, with less than 40% meeting the physical activity guidelines [1]. Following diagnosis, physical activity levels are lowest whilst patients undergo treatment and do not recover back to pre-treatment levels within six months [1]. Progressive functional decline occurs over this time, with reduction in exercise capacity and muscle strength [1]. In lung cancer, reduced exercise performance is associated with poorer functional independence, worse cancer treatment tolerability and higher all-cause mortality [2]. People with lung cancer, who are less physically active, have worse symptoms, and poorer exercise capacity and health-related quality of life (HRQoL) compared to those who are more active [1]. There is a strong need for pulmonary rehabilitation for this patient group [3]. There are well-established guidelines regarding exercise for people with cancer [4]. The guidelines state that people with cancer should engage in 30 minutes of moderate intensity physical activity on five or more days of the week and muscle strengthening exercises at least twice a week. This is supported by research which demonstrates that exercise is associated with improved exercise capacity, physical function, muscle strength, HRQoL, symptoms and depression in many cancer types [4]. The evidence for pulmonary rehabilitation specifically in non-small cell lung cancer (NSCLC) is growing rapidly [3, 5, 6]. Studies consistently demonstrate that pulmonary rehabilitation and exercise training is safe in lung cancer [3]. Pulmonary rehabilitation can be applied at any stage along the disease spectrum. The majority of evidence currently exists in the pre- and post-operative settings, however there is now growing evidence for pulmonary rehabilitation in advanced stage disease [3]. Prehabilitation is exercise training delivered before treatment. This is a relatively new concept in lung cancer. A recent Cochrane review [5] of exercise training for patients before surgery for NSCLC, included five randomised controlled trials (RCTs), and found pre-operative exercise training compared to usual care (no exercise) was associated with a 67% reduced risk of patients developing a postoperative pulmonary complication, fewer days that patients needed an intercostal catheter (mean difference MD -3.33 days, 95%CI -5.35 to -1.30); shorter post-operative hospital stay (MD -4.24 days, 95%CI -5.43 to -3.06) and improvement in exercise capacity (6-minute walk test MD 18.23m, 95%CI 8.50 to 27.96 m). Recently Licker and colleagues found that preoperative high-intensity interval training and resistance training improved exercise performance, as compared with an exercise and lifestyle advice group who experienced deterioration in exercise capacity while waiting for surgery [7]. The Cochrane review concluded the overall quality of evidence is low and more high-quality trials are needed [5]. Pulmonary rehabilitation following treatment with curative intent is associated with improvements in exercise capacity, muscle function and fatigue [3]. The Cochrane review of exercise training after lung resection included three RCTs, and found significant improvements in exercise capacity in favour of the intervention compared to usual care (no exercise) (6-minute walk test MD 50m, 95% CI 15 to 85) [6]. More recently, Edvardsen and colleagues found a 20-week high intensity endurance and resistance training program compared to usual care, commencing 5-7 weeks post-operatively, was associated with improved exercise capacity, quadriceps muscle strength and mass, and physical function [8]. There is less evidence published to date on pulmonary rehabilitation in advanced disease, however the early evidence suggests that exercise may be effective at increasing exercise capacity, function and HRQoL, and reducing symptoms [3] There are a number of current RCTs in progress at the moment specifically investigating exercise in inoperable or advanced lung cancer. The specific exercise training prescription in lung cancer has varied in the studies completed to date. It is likely that a combination of aerobic and resistance training is required for maximum effect to target both skeletal muscle function and cardiorespiratory fitness; both of which contribute to poor exercise performance in lung cancer [9]. Similarly, the duration of programs (weeks to months) and delivery (inpatient, outpatient, home based) has varied. Further research is required to confirm the optimal timing, prescription and delivery of pulmonary rehabilitation for people with lung cancer. In most countries, pulmonary rehabilitation is not currently part of routine clinical practice for people with lung cancer. As the evidence base grows our next challenge is to translate findings into clinical practice [10]. 1. Granger, C., et al., Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer, 2014. 83(2):292-299. 2. Jones, L.W., et al., Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer. Lung Cancer, 2012. 76(2):248-252. 3. Granger, C., Physiotherapy management of lung cancer. Journal of Physiotherapy, 2016. 62(2):60-67. 4. Schmitz, K., et al., ACSM roundtable on exercise guidelines for cancer survivors. Medicine Science Sports Exercise, 2010. 42(7):1409-1426. 5. Cavalheri, V. and C. Granger, Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database of Systematic Reviews, 2017(6). 6. Cavalheri, V., et al., Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database of Systematic Reviews, 2015(7). 7. Licker, M., et al., Short-Term Preoperative High-Intensity Interval Training in Patients Awaiting Lung Cancer Surgery: A Randomized Controlled Trial. J Thorac Oncol, 2017. 12(2):323-333. 8. Edvardsen, E., et al., High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax, 2015. 70(3):244-250. 9. Burtin, C., et al., Lower-limb muscle function is a determinant of exercise tolerance after lung resection surgery in patients with lung cancer. Respirology, 2017. 22(6):1185-1189. 10. Granger, C.L., et al., Barriers to Translation of Physical Activity into the Lung Cancer Model of Care. A Qualitative Study of Clinicians' Perspectives. Ann Am Thorac Soc, 2016. 13(12):2215-2222.
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ES 03.03 - Allied Health: The Missing Link in Comprehensive Cancer Care (ID 7594)
16:25 - 16:45 | Presenting Author(s): Kahren White
- Abstract
- Presentation
Abstract:
While lung cancer care internationally is spoken about in terms of being multidisciplinary, how far does this go in practice, to having comprehensive multidisciplinary involvement of all appropriate medical, nursing and allied health professionals as part of standard lung cancer care? There are an increasing number of allied health professionals internationally who specialise in oncology, with an increase in the evidence base for interventions. I propose that the involvement of allied health professionals as part of standard lung cancer care will lead to improved comprehensive multidisciplinary care, with improved quality of life and function for people living with a lung cancer diagnosis. The core allied health professions include occupational therapy, physiotherapy, exercise physiology, dietetics, speech pathology, social work and psychology. Some countries have other professions that fit into the allied health disciplines, such as physician’s assistant and respiratory therapist. This presentation will focus on the disciplines found primarily in Australia and the UK. Occupational Therapy focuses on enabling ongoing participation in chosen everyday activities. In curative treatment, the occupational therapist has a key role in pre-habilitation, assisting the individual to reach optimum function prior to treatment, and rehabilitation following treatment, to facilitate the persons return to previous chosen and meaningful roles. In metastatic disease, the occupational therapist focuses on enabling continued participation in chosen and meaningful roles. In the acute hospital setting the focus is often on what functional level the individual needs to be at to be able to safely manage the tasks of personal care, meal preparation and other personal and community activities of daily living at home following discharge. While these aspects of function are important, it is key to allow the person living with lung cancer to identify the roles and tasks that they find meaningful and important to participate in. A person may choose to have community assistance with personal care and meal preparation, as this ensures they have the energy to participate in activities that lead to improved engagement and quality of life. Physiotherapy is concerned with identifying and maximising quality of life and movement potential in the areas of promotion, prevention, treatment/intervention, habilitation and rehabilitation[1]. Physiotherapists have a key role in working with people living with lung cancer prior to and following their treatment for lung cancer. There is a growing body of evidence that suggests exercise following treatment for lung cancer is associated with improvements in physical and psychological outcomes[2]. Exercise physiologists are newer members of the lung cancer multidisciplinary team. In Australia, we are seeing as increasing use of exercise physiologists in the private hospital and pulmonary rehabilitation setting. Their role is of smaller scope than physiotherapists, focusing on prescribing and supervising exercise programs to improve exercise capacity, with the aim of improving function and quality of life. Dieticians are key members of the lung cancer team, however they are often not embedded within the multidisciplinary team. Given that cancer cachexia is a common symptom in lung cancer, affecting functional status, treatment tolerance and survival[3] we should be seeing an increase of dieticians within the lung cancer multidisciplinary team internationally. Speech pathologists provide expert assessment and treatment of swallowing and communication disorders. There is a growing body of evidence in the treatment for head and neck cancer, however there is currently no published speech pathology research in the lung cancer space. People living with lung cancer may require the specialist input of a speech pathologist due to dysphagia, as a result of treatment or disease, or speech difficulties caused by brain metastasis. Social Work and Psychology are key members of the lung cancer multidisciplinary team, as studies have demonstrated the prevalence of distress in lung cancer patients to be high[4,5]. All lung cancer patients should have their psychosocial needs regularly screened, with appropriate referrals for support made to ensure these needs are met. Psychologists and social workers need to be embedded within the lung cancer multidisciplinary team to ensure appropriate screening and intervention of patients. Lung cancer multidisciplinary teams need to utilise their allied health professionals to ensure comprehensive care is offered, and received, by patients who are living with a lung cancer diagnosis. There is a paucity of evidence and research into allied health interventions that may benefit people living with lung cancer. It is critical that allied health professionals build on the evidence and continue to research the efficacy of interventions used to optimise quality of life and function for people living with lung cancer. References: WORLD CONFEDERATION OF PHYSICAL THERAPY 2011. Policy statement: Description of physical therapy. World Federation of Physical Therapy. GRANGER CL 2016. Physiotherapy management of lung cancer. Journal of Physiotherapy, 62, 60-67. PERCIVAL C, HUSSAIN A, ZADORA-CHRZASTOWSKA S, WHITE G, MADDOCKS M & WILCOCK A 2013. Providing nutritional support to patients with thoracic cancer: Findings of a dedicated rehabilitation service. Respiratory Medicine, 107, 753-761. STEINBERG T, ROSEMAN M, KASYMJANOVA G, DOBSON S, LAJEUNESSE L, DAJCZMAN E, KREISMAN H, MACDONALD N, AGULNIK J, COHEN V, ROSBERGER Z, CHASEN M & SMALL D 2009. Prevalence of emotional distress in newly diagnosed lung cancer patients. Support Care Cancer, 17, 1493-1497. ZABORA J, BRINTZENHOFESZOC K, CURBOW B, HOOKER C & PIANTADOSI S 2001. The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19-28.
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ES 03.04 - Mesothelioma: Beyond the Basics (ID 7595)
16:45 - 17:05 | Presenting Author(s): Mary Hesdorffer | Author(s): Gleneara Elizabeth Bates
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Abstract:
Beyond the basics: The status and future directions of mesothelioma treatments Background: While prognostic factors for pleural and peritoneal mesothelioma have been investigated over the last decade, the characterization of molecular alterations in pleural mesothelioma may lead to a better understanding of tumorigenesis and targeted chemotherapeutic treatments for these tumors. In a recent study examining mutation burden outcome of non-small cell lung cancer, Rizvi et al. found that smokers had more mutations, correlated higher mutation load, and better clinical outcome to immune-targeted therapies than non-smokers. This has yet to been fully elucidated for MPM. Method: A systematic review of literature published from October 2009 – July 2017 was done using PubMed. Discussion: Various studies have shown patients with a history of smoking and asbestos exposure have a greater mutation burden than non-smokers. Despite non-small cell lung cancer studies suggesting that patients with greater mutational burden have better clinical outcomes to immune-targeted therapies, this population of MPM patients typically is excluded from these trials. To date there has not been a study showing that MPM patients with multiple malignancies should be precluded from participating in immunotherapy trials. Participatory groups in immunotherapy must be reshaped to include this subset of MPM patients to better grasp the role that multiple malignancies play with regards to appropriate treatment measures. It is notable that several large mesothelioma trials have not successfully made it pass Phase 2. This suggests that the correct population has not been identified. Perhaps early data showing promising results are merely a synergistic effect between study agents and tumor burden and should be reconsidered. Rather than potentiating study agents effects, increased tumor burden may be an independent factor in patient response. Conclusion: Elucidation of the role of tumor burden may improve the effectiveness and utility of novel MPM which retains its attractiveness despite the current sparse and narrow body of supporting data. Instead of observing treatment by individual case, there must be a shift in treatment observation to account for populations of similar characteristics (i.e. multiple malignancies). With no cure for mesothelioma on the horizon, evaluating the study populations will be imperative to understanding the effectiveness of these new treatments.
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ES 03.05 - Case Presentation (ID 7596)
17:05 - 17:25 | Presenting Author(s): Yun Hee Ham
- Abstract
- Presentation
Abstract not provided
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