Longitudinal changes in function, symptom burden, and quality of life in patients with early-stage lung cancer.

BACKGROUND: Emerging evidence supports the integration of palliative care concurrently with disease-focused care in patients with serious illnesses, such as lung cancer. This paper describes how longitudinal changes in physical function, symptom burden, and QOL of patients with early-stage non-small cell lung cancer (NSCLC) informed the development of an interdisciplinary, tailored palliative care intervention. METHODS: Patients with early stage (I-IIIB) NSCLC were accrued into the usual care phase (Phase 1) of an NCI-funded Program Project Grant. Baseline and longitudinal (up to 52 weeks post-accrual) physical function, symptoms, and QOL were assessed in the thoracic ambulatory clinics of one NCI-designated Comprehensive Cancer Center. Outcome measures included geriatric assessments, psychological distress, symptoms, and QOL. The association between disease stage (I-II vs. III) and longitudinal changes in these domains was evaluated. RESULTS: A total of 103 patients were accrued. Stage I-II patients were significantly more likely to complete the study (p = 0.005). The stages (I-II vs. III) were equivalent at baseline on all demographic variables, clinical, and functional status. Physical function fluctuated longitudinally and was higher at 6 and 24 weeks than at baseline and 12 weeks. There was a longitudinal decrease in total number of symptoms (p < 0.001). Physical and social/family QOL fluctuated longitudinally (p < 0.001 and p = 0.016, respectively). CONCLUSIONS: Patients with early-stage NSCLC report a significant longitudinal decrease in physical QOL, and fluctuations in objective and subjective measures of physical function over time were observed regardless of disease stage category. An interdisciplinary palliative care intervention is currently being tested to decrease symptom burden and improve QOL.

How accurately can we predict forced expiratory volume in one second after major pulmonary resection?

Standard formulas for predicting postoperative forced expiratory volume in 1 second (po-FEV1) do not consider bronchi obstructed by tumor or chronic obstructive pulmonary disease, e.g., Formula 1 [ppo-FEV1 = (pre-opFEV,) x (# segments remaining)/(# of total segments)] whereas Formula 2 [ppo-FEV1 = (pre-opFEV,) x (# segments remaining)/(# of total unobstructed segments)] does. A retrospective chart review was conducted to determine accuracy of predicting po-FEV1, at a comprehensive cancer center. Predicted po-FEV, was calculated using different formulas and analyzed using regression analysis and Pearson correlation. We found good correlation between po-FEV1 and predicted po-FEV1 using Formulas 1 and 2. In patients with tumor airway obstruction or chronic obstructive pulmonary disease, predictive accuracy decreased for both formulas. Prediction of FEV1 in patients undergoing pulmonary resection was generally accurate, but major errors were observed in some cases; therefore, better predictive formulas are needed in patients with airway obstruction by tumor or chronic obstructive pulmonary disease.

NCCN task force report: positron emission tomography (PET)/computed tomography (CT) scanning in cancer.

The use of positron emission tomography (PET) is increasing rapidly in the United States, with the most common use of PET scanning related to oncology. It is especially useful in the staging and management of lymphoma, lung cancer, and colorectal cancer, according to a panel of expert radiologists, surgeons, radiation oncologists, nuclear medicine physicians, medical oncologists, and general internists convened in November 2006 by the National Comprehensive Cancer Network. The Task Force was charged with reviewing existing data and developing clinical recommendations for the use of PET scans in the evaluation and management of breast cancer, colon cancer, non-small cell lung cancer, and lymphoma. This report summarizes the proceedings of this meeting, including discussions of the background of PET, possible future developments, and the role of PET in oncology.

Employee attitudes and smoking behavior at the City of Hope National Medical Center smoke-free campus.

Since 1989, City of Hope National Medical Center (COH), located in Duarte, California, and a member of the National Comprehensive Cancer Network, has prohibited smoking anywhere on the 100-acre campus. Because little published information is available on smoke-free campuses (SFCs), we investigated the attitudes of COH employees toward the SFC and attempted to answer the question of whether a difference in employee smoking behavior occurred and was attributable to the SFC policy. An anonymous survey was sent to all 2787 campus employees using both Web-based data entry and scannable paper forms. Employees with network access were contacted by e-mail and those without computers were contacted in person. Respondents were asked questions regarding their attitudes toward the SFC and about their smoking history and current smoking behavior. A total of 1356 responses (48.7%) were received. One hundred (7.4%) respondents were current smokers, 242 (17.8%) were ex-smokers, and 1014 (74.8%) were nonsmokers. Smokers and ex-smokers smoked a mean of 2.4 fewer cigarettes (95% CI, 1.8 to 3.1; P < .0001) on workdays than on days off, with evidence of a small amount of compensatory smoking (one cigarette per day). Of the smoking employees, 61.6% believed that the SFC reduced their cigarette consumption, and 42.2% quit smoking while employed at COH between 1989 and 2002. Of all respondents, 92.6% supported the COH SFC policy. High acceptance was consistent across gender, ethnicity, job type, and educational level. COH's SFC policy is strongly supported by employees and may decrease cigarette consumption and facilitate smoking cessation among smoking employees. This information may be useful to NCCN and other medical centers in assessing current and planning future campus smoking policies.

Systematic postoperative radiologic follow-up in patients with non-small cell lung cancer for detecting second primary lung cancer in stage IA.

HYPOTHESIS: Systematic postoperative evaluation of patients with non-small cell lung cancer will identify treatable second primary lung cancer and local recurrences. DESIGN: Retrospective review from January 1, 1996, to December 31, 2000. The follow-up protocol included an annual computed tomographic examination of the chest with interval chest radiography every 4 months for 2 years and every 6 months for 3 additional years. SETTING: A National Cancer Institute-designated comprehensive cancer center. PATIENTS: One hundred twenty-four patients with resected non-small cell lung cancer. MAIN OUTCOME MEASURES: Number and size of second primary and locally recurrent tumors, secondary surgical procedures, and survival of patients who underwent resection. RESULTS: The median diameter of resected second primary tumors detected by computed tomography was 14 mm (range, 8-28 mm) and by chest radiography was 26.5 mm (range, 23.0-35.0 mm) (P<.001). Of 14 patients with second primary lung cancer treated surgically, 9 were without evidence of disease at a median of 20 months (range, 4-56 months), 2 were alive with disease at 13 and 37 months, 2 died of unrelated causes but without evidence of disease at 7 and 35 months, and 1 died intraoperatively of a cardiac arrhythmia. CONCLUSIONS: Systematic follow-up of non-small cell lung cancer, including annual computed tomography, detects second primary lung cancer in stage IA. Limited pulmonary resections are often feasible in these patients. Locally recurrent lung cancer is infrequently resectable.