[Assessment of the clinical symptoms and treatment tolerance in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy and pulmonary rehabilitation]. / Ocena stanu klinicznego I tolerancji leczenia u chorych na niedrobnokomórkowego raka pluca poddanych chemioterapii pierwszorzutowe i rehabilitacji oddechowej.

UNLABELLED: In Poland lung cancer is the most commonly occurring cancer type, both in men and women. Among the most important concerns related to this disease are clinical symptoms caused by deteriorating physical condition and intolerance to chemotherapy. The aim of this work was the assessment of the clinical symptoms and treatment tolerance in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy and pulmonary rehabilitation. MATERIALS AND METHODS: 90 patients with inoperable NSCLC have undergone the examination. This included 69 men and 21 women aged between 46-75 years (average age 61.5 +/- 8.2 years). These were divided into 3 groups: group 1--30 patients undergoing standard chemotherapy; group II--30 patients undergoing standard chemotherapy and pulmonary rehabilitation; group Ill--30 patients undergoing standard chemotherapy and pulmonary rehabilitation with additional vitamin C supplementation. Clinical symptoms intensification was assessed using the ESAS scale (Edmonton Symptom Assessment System), by comparing the initial score with that after 6 weeks of chemotherapy in each individual. RESULTS: In groups II and III, where pulmonary rehabilitation was carried out, the intensification of the clinical symptoms and lowering of the tolerance for the treatment after 6 weeks of first-line chemotherapy were significantly lower (p < 0.05) than in group I. CONCLUSIONS. Pulmonary rehabilitation significantly limits the side effects of chemotherapy and the deterioration of the state of patients with NSCLC. Simultaneous supplementation with ascorbic acid increases the positive effects of pulmonary rehabilitation in those patients.

Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service.

PURPOSE: Guidelines recommend screening patients with cancer to identify their rehabilitation needs. To help quantify this area of need and associated workload from an occupational therapy perspective in patients with thoracic cancer, we report the experiences of a dedicated rehabilitation service. METHODS: Consecutive patients were screened soon after diagnosis using items associated with occupational performance in the Sheffield Profile for Assessment and Referral for Care questionnaire. Those reporting predetermined levels of distress underwent a full occupational therapy evaluation; this generated a problem list from which individualised goals and interventions were instigated. RESULTS: Of 540 patients screened, 273 (51 %) reported levels of distress which warranted a full occupational therapy assessment. Of these, 260 (95%) reported a total of 681 problems (median of 4 [2-5] per patient). Mostly these lay within the domain of self care (553, 78%) in the categories of transfers, functional mobility and bathing/showering. A total of 646 goals (median of 2 [1-3] per patient) were formulated, resulting in 652 individual interventions, most frequently the provision of equipment (79%) or advice (32%) and referral to another professional/agency (23%). Patients considered that most goals were achieved (98%) and that the provision of equipment was useful (97%). CONCLUSIONS: About half of patients with thoracic cancer screened have occupational therapy needs around the time of diagnosis. Problems are mostly in the area of self-care, with equipment provision the most frequent intervention provided. Future work should examine the efficacy of occupational therapy interventions further.

Prospective external convergence evaluation of two different quality-of-life instruments in lung resection patients.

OBJECTIVES: The interpretation of studies on quality of life (QoL) after lung surgery is often difficult owing to the use of multiple instruments with inconsistent scales and metrics. Although a more standardized approach would be desirable, the most appropriate instrument to be used in this setting is still largely undefined. The aim of the study was to assess the respective ability of two validated QoL instruments (European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30/L13 and Short Form (36) Health Survey (SF-36)) to detect perioperative changes in QoL of patients submitted to pulmonary resection for non-small-cell lung cancer (NSCLC). METHODS: A prospective study on 33 consecutive patients (May 2009-December 2009) was submitted to pulmonary resection. All patients completed both EORTC QLQ-C30 with lung module 13 and SF-36 pre- and postoperatively (3 months). Preoperative changes of all SF-36 and EORTC scales were assessed by using the Cohen's effect-size method. External convergence between different instruments (SF-36 vs EORTC) was assessed by measuring the correlation of scales evaluating the same concepts (physical, psychosocial, and emotional). The correlation coefficients between standardized perioperative changes (effect sizes) of objective functional parameters (forced expiratory volume in 1s (FEV1) and diffusion lung capacity for carbon monoxide (DLCO)) and SF-36 or EORTC scales were also investigated. RESULTS: A poor correlation (r < 0.5) was detected between most of the scales of the two instruments measuring the same QoL concepts, indicating that they may be complementary in investigating different aspects of QoL. Only the SF-36 and EORTC social functioning scales and the SF-36 mental health and EORTC emotional functioning scales had a correlation coefficient >0.5. In general, EORTC was more sensitive in detecting physical or emotional declines but was more conservative in detecting improvements. Both SF-36 and EORTC showed poor correlations (r < 0.5) between perioperative changes in QoL and FEV1 or DLCO, confirming that objective parameters cannot be surrogates to the subjective perception of QoL. In particular, there was a poor correlation between perceived changes in dyspnea and objective changes in FEV1 or DLCO. CONCLUSIONS: EORTC behaved similarly to SF-36 in assessing perioperative changes in generic QoL scales, but, with the use of its lung module, provided a more detailed evaluation of specific symptoms. For this reason, EORTC should be regarded as the instrument of choice for measuring QoL in the thoracic surgery setting.

[Thoracic surgery for non-small cell lung cancer. Cost-benefit of its management in specialized intermediate care]. / Chirurgie thoracique pour cancer du poumon non à petites cellules. Coût-bénéfice d'une prise en charge en soins intermédiaires spécialisés.

In 1989, we reorganized acute and rehabilitation cares for patients operated for non small cell lung cancer (NSCLC) in order to decrease costs by setting up a specialised intermediate care unit (SICU). This report deals with the postoperative complications and the total cost of these cares (SICU, acute and rehabilitation cares) as well as their cost/benefit. From 1990 to 1994, we performed 95 thoracotomies, 7 exploratory and 88 with lung resection (24 pneumonectomies, 8 bilobectomies, 48 lobectomies and 8 segmentectomies or wedge resections). The postoperative staging was I in 52, II in 17, III a in 15, S III b in 2, IV in 2. Patients 30-days postoperative mortality was 2/95 (2.1%). We had in 11 patients respiratory complications (12%; 3 bronchopleural fistulas, 3 pneumonias, 3 pneumothorax > 7 days, 1 empyema, 1 chronic hypoxemia), in 15 patients cardiac arrhythmias which were easily controlled by medication and in 2 general complications (1 hemiplegia, 1 transitory stupor state). The total duration of hospital stay, including SICU, acute and rehabilitative cares, was 32 +/- 10 (3-70) days with a mean total cost of 14,722 Sfr. per case. In conclusion, surgery for NSCLC can be safely performed in intermediate cares without intensive care unit at low costs and with a low morbidity and mortality provided they are staffed by a specialised and well trained team.