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.

Implementing Lung Cancer Screening and Prevention in Academic Centers, Affiliated Network Offices and Collaborating Care Sites.

Lung cancer is one of the deadliest and yet largely preventable neoplasms. Smoking cessation and lung cancer screening are effective yet underutilized lung cancer interventions. City of Hope Medical Center, a National Cancer Institute (NCI)- designated comprehensive cancer center, has 27 community cancer centers and has prioritized tobacco control and lung cancer screening throughout its network. Despite challenges, we are implementing and monitoring the City of Hope Tobacco Control Initiative including 1) a Planning and Implementation Committee; 2) integration of IT, e.g., medical records and clinician notification/prompts to facilitate screening, cessation referral, and digital health, e.g., telehealth and social media; 3) clinician training and endorsing national guidelines; 4) providing clinical champions at all sites for site leadership; 5) Coverage and Payment reform and aids to facilitate patient access and reduce cost barriers; 6) increasing tobacco exposure screening for all patients; 7) smoking cessation intervention and evaluation-patient-centered recommendations for smoking cessation for all current and recent quitters along with including QuitLine referral for current smokers and smoking care-givers; and 8) establishing a Tobacco Registry for advancing science and discoveries including team science for basic, translation and clinical studies. These strategies are intended to inform screening, prevention and treatment research and patient-centered care.

Maintaining oxygenation via demand oxygen delivery during rest and exercise.

BACKGROUND: Oxygen-conserving devices have been the foundation of highly portable oxygen systems that enable hypoxemic chronic lung disease patients to live active lives. Pulsing demand oxygen delivery systems (DODS) can adequately oxygenate most patients at rest and usually during exercise. However, some patients desaturate during exercise at DODS settings equivalent to continuous-flow oxygen. OBJECTIVE: Determine if design enhancements of the Oxymatic 401 DODS (including increased sensitivity, earlier inspiratory delivery, larger pulse volume, modified pulse contour, and higher settings) better maintain blood oxygen saturation (measured via pulse oximetry [S(pO2)]) in patients who severely desaturate during exercise. METHODS: We compared patients receiving DODS oxygen and patients receiving continuous-flow oxygen, during both rest and iso-exercise. SETTING: This study was conducted in the Pulmonary Rehabilitation Program at Mission Hospital, Regional Medical Center, Mission Viejo, California. SUBJECTS: We studied 10 patients with chronic lung disease and difficulty maintaining exercise S(pO2) with DODS. Nine patients had chronic obstructive pulmonary disease and one had restrictive lung disease. The group's (mean +/- SD) demographic and physiologic values included: age 67 +/- 7 y, forced expiratory volume in the first second 0.79 +/- 0.3 L, forced vital capacity 1.7 +/- 0.7 L, and S(pO2) 88%. INTERVENTIONS: Resting S(pO2) was measured during continuous oxygen flow and during DODS, at identical settings. S(pO2) was allowed to stabilize at each level before recording. During treadmill exercise at identical work loads we measured continuous flow and DODS S(pO2) at the same settings. If the DODS S(pO2) was less than during the equivalent continuous flow, the DODS setting was increased for another treadmill trial. RESULTS: At rest the DODS was equivalent to continuous flow: S(pO2) was 93.7 +/- 2.1% with DODS and 93.8 +/- 1.9% with continuous flow. During exercise at corresponding settings DODS S(pO2) was 90.5 +/- 3.8% and continuous-flow S(pO2) was 93.1 +/- 3.1%. Six subjects had S(pO2) > 90%, with 4 of them achieving equivalency. At higher DODS settings S(pO2) became equivalent: 92.5 +/- 2.8%. The DODS oxygen-use efficiency advantage was 6.7-fold at rest and 5.6-fold during exercise, except with subjects who required a higher exercise DODS setting, with whom the DODS advantage was 4.3-fold. CONCLUSIONS: The redesigned Oxymatic 401 DODS maintains adequate S(pO2) during rest and exercise, but some patients require the higher delivery settings. We recommend that all patients prescribed DODS undergo exercise evaluation with the prescribed DODS to ensure efficacy and determine the DODS settings required to maintain S(pO2) at the prescribed limits.