Effects of high-quality nursing care on quality of life, survival, and recurrence in patients with advanced nonsmall cell lung cancer.

BACKGROUND: Postoperative nursing can improve the quality of life (QoL) and functional prognosis for lung cancer patients. The purpose of this study was to evaluate the effects of high-quality nursing on inflammation and prognosis in postoperative patients with advanced nonsmall cell lung cancer (NSCLC). METHODS: A total of 372 patients with NSCLC were enrolled between the May 2014 and June 2016. Patients were randomly received high-quality nursing (n = 192) or normal nursing (n = 180). Symptom management, QoL, hospital stay, inflammatory score, survival time, recurrence rate, symptoms, anxiety, depression scale and psychological distress were assessed at baseline and 5-year follow up. RESULTS: High-quality nursing significantly shortened hospital stay, improved postoperative inflammation, symptom management, QoL compared to patients received normal nursing. Compare with normal nursing, high-quality nursing decreased anxiety, depression scale and psychological distress for postoperative patients with advanced NSCLC. Outcomes showed that high-quality nursing increased the survival time and decreased recurrence rate for postoperative patients with advanced NSCLC. CONCLUSION: In conclusion, data in the current study indicate that high-quality nursing can decrease inflammation and improve prognosis for the postoperative patients with NSCLC.

The Effects of the Respiratory Rehabilitation Program on Perceived Self-Efficacy and Dyspnea in Patients with Lung Cancer.

PURPOSE: This study aims to examine the effects of the respiratory rehabilitation program on perceived self-efficacy and dyspnea in patients with lung cancer. METHODS: This is a quasi-experimental research study with a two-group repeated measures design with the pretest and post-test at Week 4 and Week 8. The theory of self-efficacy by Bandura was used as the conceptual framework. The sample consisted of patients with non-small-cell lung cancer Stage 4 who visited the oncology clinic in a university hospital. Twenty-eight patients were enrolled and equally allocated to the control group and experimental group. The control group received routine nursing care only, whereas the experimental group received the respiratory rehabilitation program. The program comprised dyspnea educating, breathing exercise, using handheld fans, effective coughing, respiratory strengthening training, and follow-up by phone in the third and sixth week. Data for perceived self-efficacy and dyspnea were collected before the program start and reassessment in the fourth and eighth week. Instrumentation was composed of the respiratory rehabilitation program, demographic data, perceived self-efficacy assessment for respiratory rehabilitation, and the Cancer Dyspnea Scale. Data were analyzed using descriptive statistics and one-factor repeated measures analysis of variance and by comparing means between groups. RESULTS: The result revealed that almost all of the patients in the sample were men, and the mean age of the experimental group and control group was 65.80 years (standard deviation = 8.80) and 73.00 years (standard deviation = 7.60), respectively. There was significant different in the mean score of perceived self-efficacy and dyspnea between the experimental group and the control group (p < .050). CONCLUSION: Based on the findings of the study, the respiratory rehabilitation program should be used to promote self-efficacy and relieve dyspnea in patients with lung cancer.

Durvalumab Immunotherapy: Nursing Management of Immune-Related Adverse Events During the Journey of Patients With Stage III Non-Small Cell Lung Cancer.

BACKGROUND: When resection is not an option, platinum-based chemoradiotherapy (CRT) has been the historic standard of care in non-small cell lung cancer (NSCLC). Prognosis remains poor with CRT alone. Durvalumab has shown significant improvement (versus placebo) in progression-free and overall survival in patients with unresectable stage III NSCLC without progression following CRT. OBJECTIVES: This article aims to provide an overview of the efficacy and safety outcomes with durvalumab in patients with stage III NSCLC and identify management strategies for potential adverse events (AEs). METHODS: A review of published literature and guidelines was performed to evaluate durvalumab clinical outcomes and AE management strategies. FINDINGS: Durvalumab has established efficacy in patients with unresectable stage III NSCLC and is now the standard of care following CRT. Nurses need to be trained to recognize potential immune-related AEs in patients treated with immune checkpoint inhibitors.

Research roundup.

Synopses of a selection of recently published research articles of relevance to palliative care.

Should Physicians New to a Case Counsel Patients and Their Families to Change Course at the End of Life?

Although new cancer therapies have changed the prognosis for some patients with advanced malignancies, the potential benefit for an individual patient remains difficult to predict. This uncertainty has impacted goals-of-care discussions for oncology patients during critical illness. Physicians need to have transparent discussions about end-of-life care options that explore different perspectives and acknowledge uncertainty. Considering a case of a new physician's objections to an established care plan that prioritizes comfort measures, we review physician practice variation, clinical momentum, and possible moral objections. We explore how to approach such conflict and discuss whether and when it is appropriate for physicians new to a case to challenge established goals of care.

Feasibility and Acceptability of a Dignity Therapy/Life Plan Intervention for Patients With Advanced Cancer.

PURPOSE/OBJECTIVES: To determine the feasibility and acceptability of a dignity therapy/life plan intervention in the outpatient oncology setting.
. RESEARCH APPROACH: Pilot descriptive study.
. SETTING: Outpatient clinic in a tertiary oncology center. 
. PARTICIPANTS: 18 patients within 12 months after diagnosis undergoing treatment for advanced pancreatic cancer or non-small cell lung cancer.
. METHODOLOGIC APPROACH: Patients received dignity therapy, consisting of a focused life review/values clarification interview session and two subsequent sessions to produce a generativity document, which they can use later as they wish. Participants also wrote a life plan, in which they listed future hopes and dreams. Intervention feasibility and acceptability for patients and oncology clinician satisfaction were assessed.
. FINDINGS: Among the 18 patients completing the intervention, almost all felt it was worthwhile, would do it again, had their expectations met or exceeded, would recommend it to others, and said the timing was just right.
. INTERPRETATION: This psychosocial intervention was found to be feasible and acceptable to patients with cancer undergoing active treatment.
. IMPLICATIONS FOR NURSING: Nurses may be in an ideal position to offer a dignity therapy/life plan intervention to patients with advanced cancer during treatment.

A Home-based Exercise Intervention for Non-Small Cell Lung Cancer Patients Post-Thoracotomy.

OBJECTIVES: There are no evidenced-based rehabilitative guidelines for postsurgical non-small cell lung cancer (NSCLC) patients. This qualitative study provides evidence on the acceptability of an effective postsurgical exercise intervention targeting the self-management of cancer-related fatigue to fill this gap. DATA SOURCES: Qualitative perspective of 37 individuals randomized to a 6-week exercise program following hospital discharge post-thoracotomy for NSCLC. CONCLUSION: Postsurgical NSCLC participants found this rehabilitative exercise intervention highly acceptable because it removed traditional barriers to exercise. IMPLICATION FOR NURSING PRACTICE: A highly acceptable and effective solution for meeting the unmet rehabilitative support needs of NSCLC patients has broader implications for extension to other vulnerable, aging, deconditioned populations.

The Impact of Hospice Services in the Care of Patients with Advanced Stage Nonsmall Cell Lung Cancer.

INTRODUCTION: Prior research has shown that advanced stage nonsmall cell lung cancer (NSCLC) patients enrolled in hospice care receive less aggressive treatment at the end of life (EOL) without compromising survival. Our purpose was to profile the continuum of care of these patients, exploring the connection between hospice enrollment and quality indicators for excellence in EOL cancer care. METHODS: One hundred ninety-seven deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified. A retrospective review was conducted, collecting data from electronic medical records regarding antitumor treatment, postdiagnosis hospital visits and admissions, hospice referrals and enrollments, and circumstances surrounding the patient's death. Patients were grouped by their status of hospice enrollment, and the remainder of the measures compared accordingly. RESULTS: There was no significant difference found in total number of postdiagnosis hospital admissions between the patients who were enrolled in hospice and those who were not. However, the group who received hospice services had a significantly lower number of hospitalizations (p < 0.001), emergency department visits (p < 0.01), and intensive care unit admissions in the last 30 days of life (p < 0.001). The number of lines of chemotherapy received did not differ significantly between the groups. Median survival, measured by the length of time between diagnosis and death, was significantly longer for hospice patients (p = 0.02). CONCLUSIONS: This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized EOL oncological care and a significantly longer median survival.

History taking and physical assessment in holistic palliative care.

In carrying out a holistic palliative care assessment the palliative care clinical nurse specialist needs to develop the knowledge and skill of history taking and health assessment to make safe and competent decisions with patients regarding the future management of their care. This article examines this process in making a differential diagnosis with particular reference to the respiratory physical examination of a patient with a history of lung cancer using the Calgary-Cambridge Model. The model gives structure to the preparation, history taking, and physical examination (inspection, palpation, percussion and auscultation) before explaining, planning and closing the consultation, while considering the palliative patient's and family's individual wishes and goals.

Understanding immunotherapy for the treatment of non-small cell lung cancer.

Patients diagnosed with advanced non-small-cell lung cancer (NSCLC) (either squamous or non-squamous) have previously had limited treatment options after progression on chemotherapy. With the emergence of new drugs, particularly in the immuno-oncology setting, this is now changing. Recent clinical trial evidence demonstrates that compared with docetaxel, patients who received nivolumab had better overall survival and also significantly fewer grade 3-4 adverse events. This article reviews the clinical trial data for nivolumab and provides an overview of how this drug works. The adverse event profile of nivolumab is assessed and compared to that of docetaxel. The important role that nurses can play in supporting patients on nivolumab is also discussed.

Programmed Death-1 Inhibition in Cancer With a Focus on Non-Small Cell Lung Cancer: Rationale, Nursing Implications, and Patient Management Strategies.

BACKGROUND: Programmed death-1 (PD-1) immune checkpoint inhibitors are novel immuno-oncology agents. Unlike chemotherapy or targeted agents, which inhibit tumor cell proliferation or induce tumor cell death, immune checkpoint inhibitors are designed to stimulate a patient's own immune system to eliminate tumors. As a result of their mechanism of action, PD-1 pathway inhibitors are associated with adverse events (AEs) with immunologic etiologies, termed immune-mediated AEs (imAEs). These include skin and gastrointestinal AEs, and endocrine, hepatic, renal, and respiratory AEs, including pneumonitis. Most imAEs can be effectively managed with treatment interruption/discontinuation and/or steroids or other immunosuppressive agents. A specialist consult may be required in some cases, and endocrine imAEs may require permanent hormone replacement therapy. OBJECTIVES: This article provides an overview of PD-1 inhibitors, including the potential mechanism of action, key clinical trial data, and strategies for managing patients who may receive PD-1 inhibitors for the treatment of non-small cell lung cancer. METHODS: Information in the article comes from PubMed literature searches and the author's experience with these agents in clinical trials. FINDINGS: Oncology clinicians must thoroughly assess baseline functioning and symptoms and be vigilant for imAEs, which require prompt diagnosis and management. A good understanding of the clinical profile of PD-1 pathway inhibitors is instrumental in helping clinicians manage patients receiving these new therapies.

A Structured Nursing Intervention to Address Oral Chemotherapy Adherence in Patients With Non-Small Cell Lung Cancer.

PURPOSE/OBJECTIVES: To evaluate a nurse-led intervention to enhance medication knowledge and adherence using the Multinational Association for Supportive Care in Cancer Oral Agent Teaching Tool (MOATT). DESIGN: Longitudinal, descriptive feasibility study. SETTING: An ambulatory thoracic oncology disease center located at the Dana-Farber Cancer Institute in Boston, MA. SAMPLE: 30 adult patients with lung cancer who received the oral agent erlotinib. METHODS: Structured, nurse-led education sessions using the MOATT were provided, with a 72-hour follow-up telephone contact. Participants completed a Knowledge Rating Scale (KRS) and adapted Morisky Medication Adherence Scale-8 (MMAS-8) at the end of the first cycle of oral chemotherapy. MAIN RESEARCH VARIABLES: Knowledge and adherence; feasibility. FINDINGS: Twenty-seven participants completed the study outcome measures reporting high knowledge levels and MMAS-8 scores. Structured, nurse-led education and follow-up monitoring sessions ranged from 14-30 minutes. Several participants also initiated contact for assistance with prescription procurement and symptom management. Participants reported a median of two side effects. CONCLUSIONS: The structured, nurse-led teaching, using the MOATT tool, and follow-up nurse contacts were feasible as integrated into the thoracic oncology setting. Adherence and knowledge outcomes were encouraging. Additional studies should include objective adherence measures and strategies for delivering supportive care to patients at home. IMPLICATIONS FOR NURSING: Structured teaching with patients is important to enhance proper oral anticancer medication knowledge and adherence, including follow-up monitoring of administration and side effects at 72 hours.

Transition from hospital to daily life: a pilot study.

PURPOSE: To assess the effect of nurse-led systematic rehabilitation counseling performed before discharge to prevent concerns in the hospital-to-home gap in rehabilitation of lung cancer patients after surgery. DESIGN AND METHOD: A quasi-experimental intervention study. One hundred twenty patients with operable non-small cell lung cancer admitted for surgery participated. Outcome was assessed by a validated self-rating questionnaire. The intervention was performed at the Department of Thoracic Surgery, University Hospital of Copenhagen, Denmark. RESULTS: Following nurse-led rehabilitation counseling, results showed that significantly more patients were offered physical rehabilitation, were aware of where to seek help after discharge, and experienced support to get back to daily life. CONCLUSIONS: A systematic rehabilitation counseling obliges some of the concerns lung cancer patients might have in the transition from hospital to daily life. CLINICAL RELEVANCE: Despite promising results, there is still a need to improve support for patients with lung cancer requiring rehabilitation.

Family caregivers' distress levels related to quality of life, burden, and preparedness.

OBJECTIVE: Family caregivers (FCGs) caring for loved ones with lung cancer are at risk for psychological distress and impaired quality of life (QOL). This study explores the relationship between FCGs' distress, per the distress thermometer (DT) and FCGs' QOL, burden, and preparedness. The purpose is to identify types of problems unique to FCGs in cancer care. METHODS: Family caregivers of patients diagnosed with non-small cell lung cancer were recruited from an adult outpatient setting at a comprehensive cancer center. Questionnaires included demographic information, City of Hope QOL Scale-Family Version, Caregiver Burden Scale, FCG preparedness, and DT. Baseline data were utilized for this analysis. RESULTS: Of the FCGs (N = 163), 68% were spouses, 64% female, and 34% worked full-time. FCG age ranged from 21 to 88 years with a mean of 57 years. FCGs cared for patients with non-small cell lung cancer stage I-III (44%) and stage IV (56%). Psychological distress (DT mean = 4.40) was moderate. DT scores were highly correlated with seven of the eight explanatory variables. Secondary principal components analysis of the explanatory variables combined correlated variables into three constructs identified as self-care component, FCG role component, and FCG stress component. Simultaneous multiple regression of distress onto the three components showed they accounted for 49% of the variance in distress. CONCLUSION: This exploration of FCGs' concerns associated with elevated distress scores, as measured by the DT, helped identify three component problem areas. These areas warrant further psychosocial assessment and intervention to support FCGs as they care for the patient with cancer.

Exploring hope and healing in patients living with advanced non-small cell lung cancer.

PURPOSE/OBJECTIVES: To explore the experience and meaning of hope in relation to the healing process of patients living with stage IIIb or IV non-small cell lung cancer. RESEARCH APPROACH: Interpretative qualitative study design. SETTING: Peter Brojde Lung Cancer Centre in the Jewish General Hospital in Montreal, Quebec, Canada. PARTICIPANTS: 12 English- and French-speaking patients, aged 36-78 years. METHODOLOGIC APPROACH: One 60-90-minute semistructured interview per participant was conducted. An inductive approach to data analysis was taken, involving immersion in the data, coding, classifying, and creating linkages. FINDINGS: Four main themes emerged: (a) the morass of shattered hope, (b) tentative steps toward a new hope paradigm, (c) reframing hope within the context of a life-threatening illness, and (d) strengthening the link between hope and wellness. CONCLUSIONS: Patients described a process where hope was diminished or lost entirely, regained, and reshaped as they learned to live and grow following their diagnosis. INTERPRETATION: This study adds to the literature by describing the dynamic nature of hope as well as factors facilitating or hindering the hope process. It demonstrates how finding meaning, a structural component of healing, can be used to envision a new hopeful future. This study suggests hope and healing cannot exist in isolation, and highlights the importance of understanding the fluctuating nature of hope in patients with advanced lung cancer to foster it, therefore promoting healing.

Precision medicine in oncology standard of care.

OBJECTIVES: To review the histologic subtypes and staging of non-small cell lung cancer and metastatic melanoma, as well as the molecular markers used to direct standard therapy. DATA SOURCES: Book chapters and journal articles from medical and nursing literature, as well as published clinical guidelines. CONCLUSION: Patients with metastatic non-small cell lung cancer and metastatic melanoma have had a paucity of treatment options, most fraught with toxicity with limited benefit. Increased understanding of tumor genetics and molecular markers has expanded the treatment options for these patients, often providing them with durable responses and improved quality of life. IMPLICATIONS FOR NURSING PRACTICE: To provide education and support to their patients, nurses caring for these patients need to understand the role that genetics and molecular markers play in directing these therapies.

A pilot study of the feasibility and outcomes of yoga for lung cancer survivors.

PURPOSE/OBJECTIVES: To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL). DESIGN: This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy. SETTING: A community-based cancer support center in the midwestern United States. SAMPLE: 7 adults who had completed initial treatment for stages I-IIIa NSCLC. METHODS: A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis. MAIN RESEARCH VARIABLES: Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants. FINDINGS: Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time. CONCLUSIONS: Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship. IMPLICATIONS FOR NURSING: Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors.

Quality of life and related factors in patients with newly diagnosed advanced lung cancer: a longitudinal study

PURPOSE/OBJECTIVES: To examine the changes in quality of life (QOL), symptoms, self-efficacy for coping with cancer, and factors related to those changes in patients with newly diagnosed advanced lung cancer. DESIGN: Longitudinal and correlational. SETTING: Oncology inpatient wards and outpatient departments of a medical center in northern Taiwan. SAMPLE: 101 patients newly diagnosed with stage IIIB or IV lung cancer. METHODS: Questionnaires were used to assess patients' QOL, symptoms, and self-efficacy before treatment and at one and three months following treatment. Factors related to the changes in global QOL and five functional dimensions were analyzed using six generalized estimating equation models. MAIN RESEARCH VARIABLES: QOL, symptoms, and self-efficacy for coping with cancer. FINDINGS: Patients reported moderate levels of global QOL, symptom severity, and self-efficacy for coping with cancer. They also reported high physical and cognitive functions, but relatively low role and social functions. Factors were significantly related to the most functional dimensions, including self-efficacy, fatigue, pain, sleep difficulties, and demographic- and disease-related factors. Self-efficacy was the most robust factor for predicting QOL. CONCLUSIONS: Patients with advanced lung cancer experience a compromised global QOL and relatively low social and role functioning during the first three months following cancer diagnosis. Levels of self-efficacy and symptoms significantly affected changes in QOL and functioning. IMPLICATIONS FOR NURSING: Applying a systematic assessment of changes in QOL and developing comprehensive interventions with self-efficacy training and symptom management are strongly recommended for clinical care to improve the QOL of patients with advanced lung cancer.