Reaffirming Adverse Events Related to Lung Cancer Survivors' Target Therapies and Their Apparent Effects on Fear of Cancer Progression, Anxiety, and Depression.

BACKGROUND: Most advanced non-small-cell lung cancer (NSCLC) patients received targeted therapies of epidermal growth factor receptor tyrosine kinase inhibitors. However, few studies reported the relationships between adverse events (AEs) and psychological distress. OBJECTIVES: The aims of this study were to (1) examine the differences in the incidence of AEs, fear of progression (FoP), anxiety, and depression among 3 generations of epidermal growth factor receptor tyrosine kinase inhibitors (first, gefitinib and erlotinib; second, afatinib; third, osimertinib) and (2) examine the difference in levels of FoP, anxiety, and depression between the presence and absence of AEs in NSCLC patients. METHODS: This study used a cross-sectional study design. Patients with NSCLC (N = 120) were recruited from a medical center in northern Taiwan. Adverse events, FoP, anxiety, and depression were assessed by questionnaires. RESULTS: The incidence rates of photosensitivity, mouth and throat sores, and diarrhea were significantly high in the gefitinib, erlotinib, and afatinib groups, respectively. A lesser proportion of patients experienced AEs in the osimertinib group, compared with those in the gefitinib and erlotinib, and afatinib groups. The incidence rates of FoP, anxiety, and depression were 13.8% to 26.0%, 24.1% to 40.4%, and 17.6% to 40.0%, respectively. Patients with photosensitivity, paronychia, and alopecia had significantly higher levels of FoP, anxiety, and depression. CONCLUSION: This study confirmed the priorities of care among 3 generations of epidermal growth factor receptor tyrosine kinase inhibitors in NSCLC patients, using both the Common Terminology Criteria for Adverse Events (CTCAE 4.03) and PRO-CTCAE 1.0. Photosensitivity, paronychia, and alopecia were associated with higher levels of FoP, anxiety, and depression. Therefore, these AEs require further management. IMPLICATIONS FOR PRACTICE: Our study suggests a follow-up to address AEs and psychological distress.

Association between dermatologic adverse events and quality of life in lung cancer patients treated with epidermal growth factor receptor-tyrosine kinase inhibitors.

PURPOSE: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are frequently associated with dermatologic adverse events (dAEs), having great impacts on patients' health-related quality of life (HRQoL) and treatment adherence. We aimed to examine the association between various dAEs and HRQoL in patients treated with EGFR-TKI therapy. METHODS: This was a cross-sectional study including 132 non-small-cell lung cancer (NSCLC) patients treated with gefitinib, erlotinib, afatinib, or osimertinib in Taiwan. The severity level of dAEs was graded by NCI-CTCAE v4.03 and PRO-CTCAE ITEMS v1.0. All participants answered the Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitors (FACT-EGFRI-18) HRQoL questionnaire. RESULTS: The clinician-reported severity of pruritus, photosensitivity, alopecia, and Karnofsky performance status was associated with HRQoL (ß = - 6.773, p = 0.046; ß = - 5.250, p = 0.032; ß = - 8.121, p = 0.001; ß = 0.327, p = 0.002; respectively). The clinician-reported severity of all dAEs except paronychia had negative correlations with HRQoL. The symptom gradings of CTCAE and PRO-CTCAE had positive correlation. CONCLUSIONS: The severity of pruritus, photosensitivity, and alopecia was associated with HRQoL of patients receiving EGFR-TKI therapy. Using patient-reported outcome measurements helps clinicians to capture the actual impact of symptoms on physical, social-emotional, and functional well-being.

[The Physical and Psychological Impacts and Supportive Care Needs of Patients With Cancer Undergoing Immunotherapy and Their Family Caregivers].

New, science-based cancer treatments have proliferated in recent years. Immunotherapy provides new hope for prolonging survival in patients with advanced-stage cancers. However, patients with cancer must not only face their disease progression, physical, and psychological symptoms, but also deal with the side effects and efficacy of immunotherapy. Patients with cancer may experience complex emotions such as fear, anxiety, depression, or uncertainty relatively frequently and may have many unmet care needs specific to immunotherapy. However, articles on the physical and psychological impacts and supportive care needs experienced by patients with advanced-stage cancers undergoing immunotherapy and their family caregivers are limited in the literature. Thus, this paper was developed to present (1) a brief introduction to cancer immunotherapy; (2) the physical and psychological impacts experienced by patients with cancer undergoing immunotherapy and their caregivers; (3) the status of the supportive care needs of patients and family caregivers during the immunotherapy process; and (4) an assessment of and intervention to address the supportive care needs of these patients with cancer and their caregivers. We hope this article will help clinical healthcare providers understand the physical and psychological impacts and supportive care needs of advanced patients with cancer and their family caregivers during the immunotherapy process. Furthermore, we suggest that appropriate medical care be provided or developed in the future to improve their quality of life during the immunotherapy process and to enhance clinical practices.

Effects of exercise interventions on social and cognitive functioning of men with prostate cancer: a meta-analysis.

PURPOSE: Exercise is beneficial for prostate cancer patients' physical functioning; however, effects on social and cognitive functioning are inconsistent. This meta-analysis of exercise interventions for prostate cancer patients had two aims: the primary aim was to evaluate the effects of exercise interventions on social functioning; the secondary aim was to consider additional outcomes of cognitive functioning as well as adverse events. METHODS: Electronic databases (Embase, MEDLINE, PubMed, PsycINFO, and the Chinese database Airti Library) were searched for relevant papers (1987-2019), which included hand searching. After careful inspection, 10 relevant randomized controlled trials were analyzed using Comprehensive Meta-Analysis software; pooled means determined social and cognitive functioning. RESULTS: Meta-analysis of summary scores (fixed-effects model) showed an overall beneficial effect of exercise on social functioning (Hedges' g = 0.35, 95% CI [0.193, 0.515], p < 0.001) and cognitive functioning (Hedges' g = 0.35, 95% CI [0.123, 0.575], p < 0.01) in men with prostate cancer when compared to controls. Intervention durations of 12-16 and 24-48 weeks that provided supervised aerobic exercise combined with resistance exercise sessions had a small to medium effect on social functioning compared to controls. One exercise group experienced one serious, but non-fatal, adverse event due to a higher exercise intensity (50-75% VO2max). DISCUSSION AND RECOMMENDATIONS: To the best of our knowledge, this is the first meta-analysis to examine the effects of exercise interventions on cognitive functioning among prostate cancer patients. We suggest further research be conducted to confirm these findings.

Psychological distress, social support, self-management ability and utilization of social resources for female patients with cancer in Oncology Outpatient Settings in Taiwan.

Oncology outpatient care centers generally subjugate patients' psychosocial needs to their physical care requirements. Consequently, the patients' self-management (SM) ability and utilization of social resources are essential in regulating their psychological distress (anxiety and depression). The study aims were (1) to examine the prevalence and severity of psychological distress in female cancer patients in outpatient settings in Taiwan and (2) to identify the major factors of psychological distress. Female cancer patients were recruited from oncology outpatient settings in Taiwan. Patients completed the questionnaires of anxiety, depression, social support, and utilization of social resources, and SM ability. In total, 116 patients were included. A total of 17.2% and 21.6% of the patients were at risk of anxiety and depression, respectively. Patients' mean anxiety and depression scores were 4.2 (SD = 4.1) and 4.1 (SD = 4.0), respectively. The patients' physical function, attendance of social support groups, degree of social support, and SM ability had a significant effect on their anxiety and depression. Patients' anxiety was intensified by the presence of comorbidity. Health professionals in oncology outpatient care centers should assess the patients' physical function, comorbidity, SM ability, and social support/engagement in order to reduce their psychological distress and devise appropriate follow-up interventions.

A Correlational Study of Skin Toxicity and Quality of Life in Patients With Advanced Lung Cancer Receiving Targeted Therapy.

BACKGROUND: Oral targeted therapy is increasingly used worldwide to treat patients with advanced lung cancer. The adverse skin toxicity that is associated with treatment with epidermal growth factor receptor inhibitors often results in acneiform rash, dry skin (xerosis), pruritus, and paronychia, which may cause discomfort in patients and affect their quality of life. PURPOSE: This study was designed to explore changes in skin toxicity and quality of life (measured overall by three subscales) as well as the correlation between skin toxicity and overall quality of life over a 3-month period for patients with advanced lung cancer receiving oral targeted therapy. METHODS: This study used a longitudinal research design. Baseline data were collected before initiating targeted therapy. Data for the effects of targeted therapy on skin toxicity and quality of life were collected at 2, 4, 8, and 12 weeks after therapy initiation. Data on skin toxicity were collected using the Common Terminology Criteria for Adverse Events Version 4.03, and quality of life was measured using the Chinese version of the Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitor-18 questionnaire. Demographic and clinical data were analyzed using descriptive statistics, and Spearman's rank correlation coefficient was used to measure the correlation between skin toxicity and quality of life. RESULTS: Thirty-two patients participated in this study. The symptoms of skin toxicity that increased over the 3-month study period included xerosis and paronychia, whereas acneiform rash and pruritus fluctuated during this period. Over the study period, more than 70% of the participants exhibited symptoms of skin toxicity. Skin toxicity was the greatest and quality of life was the lowest, respectively, at the end of the study. All of the symptoms of skin toxicity were significantly correlated with quality of life, although each varied over time (r = .36-.61, p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study indicate that healthcare providers should consider the impact of skin toxicity on quality of life in patients with advanced lung cancer who are receiving oral targeted therapy. These findings may be used to design interventional measures for skin and medical care to improve quality of life in patients with advanced lung cancer.

Meta-analysis: Exercise intervention for sleep problems in cancer patients.

BACKGROUND: Sleep problems cause physical and mental distress and may influence the survival of cancer patients. OBJECTIVES: This study aimed to explore the efficacy of exercise intervention to improve sleep in cancer patients. METHODS: Published papers from 1980 to 2018 were searched. RESULTS: The major findings included (a) exercise intervention had small positive effects on enhancing total subjective sleep quality (TSSQ; g = 0.38, 95% CI = 0.21-0.54) and objective sleep onset latency (g = 0.21, 95% CI = 0.01-0.41). (b) The characteristics in subgroups in regarding the small to large effects of an exercise programme on sleep were identified. First, the groups of a home-based exercise and a supervised exercise combined with a home-based exercise had a medium effect on TSSQ than the usual group. Second, interventions with aerobic exercise, especially the 4- to 8-week programmes and those with weekly volume of 80-149 min per week for cancer patients with ongoing or completed treatment also had a medium to large positive effect on TSSQ. Finally, patients with breast cancer and haematologic malignancies contributed a small effect in this meta-analysis. CONCLUSIONS: Maintaining regular aerobic exercises, even of different durations and weekly volumes, benefits patient sleep quality.

[Clinical care of lung cancer patients with body image changes after targeted therapy].

Lung cancer has a relatively short survival prognosis and advanced disease progression. Therefore, targeted therapy has become one of the most frequent treatments of this disease. Targeted therapy has several features that effectively extend the survival period; is easy to apply and use; and has fewer side effects than chemotherapy. Therefore, this therapy approach has become the preferred choice of patients with advanced lung cancer. However, current targeted therapies like Iressa and Tarceva produce side effects such as skin dryness and acneiform eruption that may bother patients. These side effects may further cause patient concern over negative changes in their body image, and these concerns may influence their work and social lives. Additionally, some patients treated with targeted therapy worry about their chances of survival if they reduce or stop the medication to avoid the side effects. Consequently, patients may struggle with both physical and psychological impacts, and may have problems sustaining a good quality of life. This article focuses on delivering relevant information to patients receiving targeted therapy who suffer from dermatological toxicity and damage to their body image. We demonstrate an assessment tool and information to help patients cope with physical and psychosocial issues through daily skin care routines, mental / psychological supports, and cognitive behavior therapy. These measures may help patients rebuild a positive self-concept. We plan to develop further associated training to provide professionals / care providers with the appropriate knowledge and skills to care for cancer patients in a resource-limited environment so that they may improve the quality of nursing care for patients with body image changes.

Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment.

OBJECTIVE: This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression. METHODS: For this cross-sectional study, 106 patient-FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self-report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self-Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models. RESULTS: This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self-efficacy in managing symptoms. CONCLUSION: Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care.