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.

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.

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.

An eHealth system supporting palliative care for patients with non-small cell lung cancer: a randomized trial.

BACKGROUND: In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC). METHODS: In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale. RESULTS: Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study. CONCLUSIONS: The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation.

[The non-surgical treatment of lung cancer]. / Le traitement non chirurgical du cancer du poumon.

Advances in the treatment of lung cancer concern mainly non-small cell cancers. Surgery, radiotherapy or drugs are offered alone or in combination depending on the patient and the extent of the disease. Involved in their implementation, the oncology nurse supports the patient throughout his or her treatment pathway.

[Thoracic surgery for lung cancer]. / La chirurgie thoracique du cancer du poumon.

There are two main types of lung cancer. The reference treatment for small cell lung cancer is chemotherapy combined or not with radiotherapy. Generally multimodal, the treatment for non-small cell cancer combines surgery, chemotherapy and radiotherapy. A major procedure for patients, surgery is a stage in their fight against the cancer.

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.

The patient with cancer-related dyspnea.

Dyspnea can be challenging to manage because it often is exacerbated by anxiety. Patient positioning and relaxation and breathing techniques can help.

Research roundup.

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

Overview of stereotactic body radiotherapy and the nursing role.

Stereotactic body radiotherapy (SBRT) is a rapidly emerging technology that enhances radiation therapy delivery. It allows for tightly conformed treatment fields and accurate delivery even with moving targets in the body. SBRT currently is used most commonly in treatment of medically inoperable stage I non-small cell lung cancers, as well as lung, liver, and spinal metastases. Studies to date are encouraging for increased local control with acceptable patient tolerance. This article familiarizes nurses with the use of this new technology and proposes the potential nursing role in maximizing patient preparation and follow-up care.

Surgical management of non-small cell lung cancer.

OBJECTIVES: To provide an overview of the surgical management of early stage non-small cell lung cancer (NSCLC) and its impact on survival and quality of life. DATA SOURCES: Published articles, book chapters, websites, and research studies. CONCLUSION: The primary treatment choice for early stage NSCLC is surgical resection. Advances have been made in all phases of care from diagnosis to rehabilitation, including better technology for staging, less invasive surgical techniques, and intra-operative and post-operative care that focuses on decreasing complications and improving survival and quality of life. New indications for the addition of adjuvant therapy to surgery can improve disease-free and long-term survival in a disease where the 5-year survival of stage I and II can be less than 50% and overall survival regardless of stage only 15%. IMPLICATIONS FOR NURSING PRACTICE: As health care educators and caregivers, nurses should be informed of the advancements in staging and surgical technique associated with early stage NSCLC and its impact on survival and quality of life.

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.

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.

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.

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.