Change in quality of life of stage IA lung cancer patients after sublobar resection and lobectomy.

BACKGROUND: Few studies have examined the differential impact of sublobar resection (SL) and lobectomy (L) on quality of life (QoL) during the first postoperative year. METHODS: We used a prospective cohort of Stage IA lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) from the Initiative for Early Lung Cancer Research on Treatment. QoL was measured before surgery, and within 4, 6, and 12 months post-surgery using three validated instruments: SF-12 [physical (PCS) and mental health (MCS)], FACT-LCS (lung-cancer-symptoms), and the PHQ-4 (anxiety and depression subscales). Locally weighted smoothing curve (LOWESS) was fitted to identify the best interval knot for the change in the QoL trend post-surgery. After adjusting for demographic and clinical variables, an adjusted piecewise linear mixed effects model was developed to estimate differences in baseline and 12-month scores, and rates of change for each QoL measure. RESULTS: SL resection was performed in 127 (63.2%) and L in 74 (36.8%) patients. LOWESS plots suggested that the shift of QoL (interval knot) was at 2 months post-surgery. Decreases in PCS scores were less severe for SL than L patients 2 months post-surgery (-0.18 vs. -2.30, P=0.02); while subsequent improvements were observed for both groups (SL: +0.29 vs. L: +0.74, P=0.06). SL patients reported significantly better scores a year post-surgery compared to baseline (P=0.003), while L patients did not. Anxiety decreased at similar rates for both SL and L patients within 2 months post-surgery (P=0.18), then stabilized for the remaining months. MCS and depression scores remained stable in both groups throughout. QoL scores were lower for women than for men, but only significantly worse for the lung-cancer-symptoms (P=0.003) and anxiety (P=0.04). CONCLUSIONS: SL patients fared better in physical health and lung cancer symptoms than L patients. The first two postoperative months showed the most significant change which suggests targeting postoperative intervention during that time.

Massage therapy in the breast imaging department: repurposing an ancient anxiety reducing method.

BACKGROUND: Massage therapy's ability to mitigate breast imaging associated anxiety has not been previously studied. Anxiety is, however, often cited as a harm of screening mammography with few options offered to diminish anxiety other than not screening. Reducing anxiety may improve compliance, and reduce breast cancer mortality and morbidity. A complimentary massage therapy program evaluated patient acceptance, anxiety perception and perceived value of massage. METHODS: Over 10 weeks, verbal agreement was obtained from 113 breast imaging patients who desired a hand or shoulder/neck massage. Licensed massage therapists performed massages before, and/or during, or after, or in between imaging tests. After the massage, questionnaires assessed patients' self-rated perceptions of anxiety before and after massage on a scale from 0 to 10. Participants' age-group, reason for appointment, self-rated value of massage service, and willingness to return to and willingness to refer to the facility were reported. Changes in perceived average anxiety were estimated using a linear mixed effects model. Fisher's exact test was used to evaluate associations among categorical variables. RESULTS: A significant decrease in perceived anxiety was observed following massage (d = -3.2, p < 0.001). 107/108 (99%) of respondents reported an improved patient experience with massage. 84/106 (79%) reported willingness to pay at least $5 for massage service. CONCLUSION: Massage therapy improves the patient experience and decreases perceptions of anxiety. It may be associated with improved breast imaging compliance. Patients' willingness to pay for the service may defray some cost of a massage program.

Progression of probable UIP and UIP on HRCT.

PURPOSE: To determine patterns of progression of probable Usual Interstitial Pneumonitis (UIP). METHODS: This HIPPA compliant, IRB-approved study draws patients from our Fibrosis Registry. All patients with a consensus diagnosis of Idiopathic Pulmonary Fibrosis (IPF) were included. Most recent CT scans and all earlier CT scans were reviewed to determine the fibrosis grade in each lobe based on probable UIP (pUIP) findings of ground glass opacities, traction bronchiolectasis and reticulations or UIP findings of subpleural basilar predominant fibrosis with honeycombing (HC) and absence of features that would suggest an alternative diagnosis. RESULTS: 103 patients with a working diagnosis of IPF are the focus of this report. Among the 68 with pUIP on the initial CT, 32 (47%) progressed; median time to progression was 51 months. The risk of HC progression, adjusted for gender, of patients with emphysema was 2.53 times higher than patients without emphysema (HR = 2.53, 95% CI: 1.06-6.02). Among the 35 with HC on the initial CT scan, 20 (57%) progressed to more advanced HC; median time to progression was 31 months. Increased pulmonary artery size was significantly associated with an elevated risk for more advanced HC progression (HR = 1.16, 95% CI: 1.04-1.31). CONCLUSION: Ground glass opacities, traction bronchiolectasis and reticulations, a "Probable UIP Pattern" by ATS criteria progressed to UIP in 47% of patients on follow-up imaging.

Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation.

INTRODUCTION: To maximize the benefits of computed tomographic screening for lung cancer, optimal treatment for small, early lung cancers is needed. Limiting the extent of surgery spares lung tissue, preserves pulmonary function, and decreases operative time, complications, and morbidities. It also increases the likelihood of resecting future new primary lung cancers. The goal is to assess alternative treatments in a timely manner. METHODS: The focus sessions with patients and physicians separately highlighted the need to consider their perceptions. Literature reviews and analyses of treatment results using large databases were performed to formulate critical questions about long-term treatment outcomes, recurrence, and quality of life of alternative treatments. Based on these analyses, the investigators developed a prospective multi-institutional cohort study, the Initiative for Early Lung Cancer Research for Treatment, to compare treatments for stage I NSCLC. HIPAA compliant institutional review board approval was obtained and we performed a feasibility study of the first 206 surgical patients. RESULTS: Lobectomy was performed in 89 (43.2%) patients, and sublobar resection was performed in 117 (56.7%) patients. Mediastinal lymph node resection was performed in 173 (84.0%) patients, 8 had N1 and 3 N2 lymph node metastases. Patients stated that both the surgeon's opinion (93%) and the patient's own opinion (93%) were extremely important, followed by the patients' view that the chosen procedure would provide the best quality of life (90%). CONCLUSIONS: It was feasible to obtain pre- and postsurgical information from patients and surgeons. We anticipate statistically meaningful results about treatment alternatives in 3 to 5 years.