RESUMEN
PURPOSE: Thoracic-cancer (TC) patients have an extensive toll taken in terms of health-related quality of life (HRQL). Integrative Oncology (IO) is recognized as a valid complement to any Standard-Therapy treatment to improve outcomes in TC patients. The objective of this pilot-study was to evaluate the effect of adding IO (acupuncture, Cognitive-Behavior Therapy and mindfulness) in terms of depression, anxiety and HRQL. METHODS: TC patients who attended the Thoracic Oncology-Unit from July to September 2018 were invited to participate. A total of 16 patients were included in the study, 8 patients were required to attend 5 weekly sessions of IO and 8 patients were invited as controls. Anxiety, depression and HRQL were measured at baseline and after completing 5 sessions of IO or 5 weeks, using the HADS scale and the QLQ-C30 scale. RESULTS: A total of 8 patients in the IO group attended the 5 sessions and 8 patients were followed as controls. Compliance with the therapies was high, none of the patients dropped out from the study. A tendency for improvement in anxiety, fatigue, pain and dyspnea was observed in patients attending IO, though not statistically significant likely due to sample size. CONCLUSIONS: IO therapies are well accepted among TC patients. Larger studies are necessary with robust sample sizes to improve conclusions regarding outcome improvements.
Asunto(s)
Ansiedad/terapia , Oncología Integrativa , Calidad de Vida/psicología , Neoplasias Torácicas , Depresión/terapia , Humanos , Proyectos Piloto , Neoplasias Torácicas/psicología , Neoplasias Torácicas/terapiaRESUMEN
PURPOSE: Quality of life (QoL) is an important factor in patient care. This analysis is focused on QoL before and after radio(chemo)therapy in patients with thoracic carcinomas, as well as on its influence on clinical follow-up and survival, and the correlation with treatment-related toxicities. MATERIALS AND METHODS: The analysis included 81 patients with intrathoracic carcinoma receiving radio(chemo)therapy. For analysis of QoL, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the lung cancer-specific supplement (EORTC QLQ-LC13) were used. QoL data were collected before radiation treatment (RT), and 6 weeks, 12 weeks, 6 months, and 12 months after RT. Other factors were additionally analyzed, including clinical outcome, survival, and side effects. RESULTS: The functional scales showed maximum values or at least a recovery 12 weeks after RT. Symptoms with a high mean symptom score (> 40) at all appointments were fatigue, dyspnea, and coughing. Insomnia, peripheral neuropathy, appetite loss, dyspnea (from QLQ-LC13), and all pain parameters had an intermediate mean score (10-40). There were low mean scores of < 10 for nausea and vomiting, diarrhea, sore mouth, and hemoptysis. There was a significant correlation between clinical dysphagia and radiation pneumonitis with the associated symptom scales. None of the QoL scores had a significant influence on local and distant control or survival. CONCLUSION: 12 weeks after RT the QLQ-C30 functional scales show the highest scores or at least a temporary recovery. The symptom scales accurately reflect the common symptoms and treatment-related toxicities. QoL did not prove to be a significant predictor for local and distant control or survival.
Asunto(s)
Calidad de Vida/psicología , Traumatismos por Radiación/mortalidad , Traumatismos por Radiación/psicología , Radioterapia Conformacional/psicología , Neoplasias Torácicas/psicología , Neoplasias Torácicas/radioterapia , Anciano , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Hipofraccionamiento de la Dosis de Radiación , Traumatismos por Radiación/prevención & control , Radioterapia Conformacional/estadística & datos numéricos , Factores de Riesgo , Tasa de Supervivencia , Neoplasias Torácicas/epidemiología , Resultado del TratamientoRESUMEN
PURPOSE: Persistent smoking after a cancer diagnosis has adverse effects. Most smoking cessation interventions focus on individual behaviors; however, family members who smoke are major barriers to success. This article describes challenges and lessons learned related to recruitment and retention to a longitudinal, dyadic-centered smoking cessation intervention study for individuals confronting a new diagnosis of thoracic cancer and their family members who smoke. METHODS: A prospective, one-group repeated measures, mixed-method feasibility study measured recruitment, retention, adherence, and acceptability over a 6-month period in a thoracic surgery clinic at a university cancer center. A multidisciplinary, multi-component decision aid-"Tobacco Free Family"-was used to intervene with the dyads. Study recruitment occurred preoperatively with a thoracic surgery team member assessing smoking status. RESULTS: During the 6-month recruitment period, 50 patients who smoked were screened, and 18 eligible families were approached to participate. Sixteen participants (8 dyads) enrolled. Patients were all male, and participating family members were all female-either spouses or long-term girlfriends. Others types of family members declined participation. CONCLUSION: Recruitment was lower than anticipated (44%), retention was high (100%), and maximizing convenience was the most important retention strategy. Oncology nurses can assess the smoking status of patients and family members, facilitate understanding about the benefits of cessation, refer those willing to stop to expert resources, and help motivate those unwilling to quit. Research is needed to continue developing strategies to help patients with thoracic cancer and their families facing surgery as an impetus for stopping smoking. Novel intervention delivery and communication need further exploration.
Asunto(s)
Familia/psicología , Promoción de la Salud/métodos , Motivación , Cese del Hábito de Fumar/psicología , Neoplasias Torácicas/prevención & control , Neoplasias Torácicas/psicología , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias Torácicas/cirugía , Estados UnidosRESUMEN
The recent development in optimising palliative care standards in thoracic oncology is associated with an increased demand in specialized communication skills. Standardised and integrated assessments of the palliative care need of the patient is met by limited health care resources. The model of communication described in this article emphasizes the need to structure palliative distress assessment of the patient. Communication pathways are shown as a platform to evaluate and support patient and caregivers. Standards to establish algorithms of communication in palliative care will improve the very important interaction between patient and caregivers.
Asunto(s)
Cuidadores/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Modelos Organizacionales , Cuidados Paliativos/organización & administración , Relaciones Médico-Paciente , Estrés Psicológico/terapia , Neoplasias Torácicas/terapia , Cuidadores/psicología , Comunicación en Salud , Humanos , Cuidados Paliativos/psicología , Estrés Psicológico/diagnóstico , Estrés Psicológico/psicología , Cuidado Terminal/organización & administración , Cuidado Terminal/psicología , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/psicología , Resultado del TratamientoRESUMEN
PURPOSE: Complementary and alternative medicine (CAM) use has been increasing among cancer patients. This study characterizes the use of CAM among patients with thoracic malignancies. METHODS: This cross sectional study was conducted at a National Cancer Institute-designated comprehensive cancer center among adult patients diagnosed with thoracic malignancies. The primary outcome was a self-reported use of CAM, defined as the use of any type of CAM beyond routine vitamin/mineral supplementation alone. A logistic regression model was developed to explore predictors of CAM use. RESULTS: A total of 108 patients completed a standardized survey (59% response rate). Overall, 42% of respondents reported the use of at least one type of CAM. Users and non-users of CAM did not differ based upon demographics, diagnosis, staging, smoking status, quality of life, or perceived understanding of cancer diagnosis. In the multivariate analysis, patients who reported feeling fearful about their future were four times more likely to be CAM users when compared to those who did not specify this emotion (odds ratio=4.18; 95% CI=1.23-14.12; p=0.02). Commonly cited reasons for CAM use were to support one's self, boost immunity, and for improvements in emotional and/or spiritual well-being. CONCLUSIONS: Prevalence of CAM use among cancer patients in this study was similar to the general US population. Feeling fearful about the future was associated with CAM use. Results suggest that patients may be turning to CAM as a therapeutic adjunct to actively cope with emotional distress surrounding the cancer experience.
Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Neoplasias Torácicas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapias Complementarias/psicología , Estudios Transversales , Recolección de Datos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Motivación , Análisis Multivariante , Oportunidad Relativa , Autoinforme , Neoplasias Torácicas/psicología , Estados UnidosRESUMEN
PURPOSE: The aim of the study was to compare timing and decision-makers of do-not-resuscitate (DNR) orders between patients with end-stage thoracic cancer and non-cancer respiratory diseases in a Japanese acute care hospital. METHODS: This study retrospectively reviewed the medical records of patients who died between January 2008 and March 2013 in the Department of Respiratory Medicine of Osaka Police Hospital, a teaching and acute care hospital. We compared the decision-making process, especially timing and decision-maker, of DNR orders between patients with thoracic cancer and patients with non-cancer respiratory diseases. RESULTS: There were 300 cancer patients and 147 non-cancer patients. Cancer patients were significantly younger, were hospitalized more frequently and for longer, were more likely to have a DNR order placed earlier and decided in advance of last admission, and were more likely to have normal cognitive function at the time of the DNR order than non-cancer patients. Spouses of cancer patients were more likely to participate in DNR discussion. Only approximately 6 % of patients participated in DNR discussion in both groups. Cancer patients less frequently received aggressive treatment at the end of life (EOL) and were more likely to die in general wards than in intensive care units. CONCLUSIONS: Our study found that most Japanese patients, with or without cancer, who died in an acute care respiratory department, were not included in DNR discussions and that familial surrogates usually made the DNR decision at the EOL.
Asunto(s)
Toma de Decisiones , Enfermedades Respiratorias/psicología , Enfermedades Respiratorias/terapia , Órdenes de Resucitación/psicología , Neoplasias Torácicas/psicología , Neoplasias Torácicas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Japón , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE: To analyze the short-term efficacy and patients' subjective perception of the use of lidocaine 5 % patches for painful scars (post-thoracotomy and post-mastectomy) and pain caused by chest wall tumors. METHODS: This is a prospective, descriptive, non-controlled, non-randomized, open-label study of patients seen in the palliative care outpatient clinic. Demographic data, variables relating to the severity of the pain, and concomitant therapy both at the start and end of treatment, the need for interventional anesthetic techniques (IAT), patients' subjective perception and treatment-related side effects were all recorded. RESULTS: Twenty patients were included with a mean follow-up of 29.2 days. The treatment led to a statistically significant clinical improvement in pain severity. There was no clinically significant opioid dose escalation during the treatment period. Only three patients required IAT to relieve the pain. Sixty five percent of patients were very satisfied with the therapy. No systemic or local adverse events were reported. CONCLUSIONS: The addition of lidocaine 5 % patches is effective in the short term for the treatment of neuropathic cancer pain accompanied by allodynia, whether deriving from a painful scar or chest wall tumor. These findings need to be confirmed by randomized controlled trials with larger samples.
Asunto(s)
Neoplasias de la Mama/complicaciones , Lidocaína/administración & dosificación , Neuralgia/tratamiento farmacológico , Cuidados Paliativos/métodos , Neoplasias Torácicas/complicaciones , Toracotomía/efectos adversos , Anestésicos Locales/administración & dosificación , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Cicatriz/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Mastectomía/efectos adversos , Persona de Mediana Edad , Neuralgia/etiología , Neuralgia/psicología , Proyectos Piloto , Estudios Prospectivos , Neoplasias Torácicas/psicología , Neoplasias Torácicas/cirugía , Parche TransdérmicoAsunto(s)
Necesidades y Demandas de Servicios de Salud , Servicios de Información/estadística & datos numéricos , Evaluación de Necesidades , Educación del Paciente como Asunto , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/psicología , Encuestas de Atención de la Salud , Humanos , India , Estudios Prospectivos , Encuestas y Cuestionarios , Centros de Atención TerciariaRESUMEN
The question raised by the title calls for a balanced answer. As a matter of fact, like in many clinical situations in which an illness threatens the patient's survival, the singularity of each case makes any attempt of generalization simplistic. Writing about the speficity of the psychological undertaking in thoracic oncology has to avoid two pitfalls: denying any psychosociological specificity of thoracic cancerology, and thus not providing the reader's understanding with anything which could help them read the most frequent problematics. And secondly turn clinical qualitative data into generalities stuck on each case, and rejecting the singularity of the sick person as a subject. As we attempt to avoid both traps, the three next points will be tackled: the announcement of cancer is prototypical of a trauma, and calls up an intense affect of anguish. This affect can be read through social representations, which intervene within the exchange doctor - sick person. The subjectivation of this relation cannot be understood without taking the environment into account, and especially what the affected person knows about cancer owing to their belonging to a socius. In the traumatic atmosphere thus created, the rereading of the phenomenons - cropping up between a somatic symptom experienced by the patient and a traumatic language revolving around the compulsory term "cancer" - is achieved according recurrent thematic lines. As we do not wish to reach the exhaustiveness of the significant unities, neither their reassembly, we will limit ourselves to the development of one main line: that of the relation to time, to temporality, and to presentism.
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Trastornos de Ansiedad/terapia , Relaciones Médico-Paciente , Medicina de Precisión , Psicoterapia/métodos , Neoplasias Torácicas/terapia , Adulto , Trastornos de Ansiedad/etiología , Cuidadores/psicología , Humanos , Masculino , Persona de Mediana Edad , Rol del Médico/psicología , Medicina de Precisión/métodos , Neoplasias Torácicas/complicaciones , Neoplasias Torácicas/psicologíaRESUMEN
BACKGROUND: Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. OBJECTIVE: We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. METHODS: This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. RESULTS: A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). CONCLUSIONS: Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. IMPLICATIONS FOR PRACTICE: Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.
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Síntomas Conductuales/diagnóstico , Depresión/epidemiología , Evaluación Geriátrica , Neoplasias/cirugía , Complicaciones Posoperatorias/psicología , Estrés Psicológico/diagnóstico , Anciano , Anciano de 80 o más Años , Síntomas Conductuales/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Depresión/diagnóstico , Depresión/psicología , Neoplasias del Sistema Digestivo/patología , Neoplasias del Sistema Digestivo/psicología , Neoplasias del Sistema Digestivo/cirugía , Progresión de la Enfermedad , Fatiga/diagnóstico , Fatiga/epidemiología , Fatiga/fisiopatología , Fatiga/psicología , Femenino , Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/psicología , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Masculino , Neoplasias/patología , Neoplasias/psicología , Dolor/diagnóstico , Dolor/epidemiología , Dolor/fisiopatología , Dolor/psicología , Complicaciones Posoperatorias/fisiopatología , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Perfil de Impacto de Enfermedad , Estrés Psicológico/epidemiología , Neoplasias Torácicas/patología , Neoplasias Torácicas/psicología , Neoplasias Torácicas/cirugía , Factores de TiempoAsunto(s)
Sedación Consciente/métodos , Atención Domiciliaria de Salud , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidado Terminal/métodos , Adolescente , Neoplasias Óseas/psicología , Neoplasias Óseas/terapia , Niño , Estudios de Factibilidad , Femenino , Humanos , Masculino , Neoplasias de la Vaina del Nervio/psicología , Neoplasias de la Vaina del Nervio/terapia , Calidad de Vida , Sarcoma de Ewing/psicología , Sarcoma de Ewing/terapia , Neoplasias Torácicas/psicología , Neoplasias Torácicas/terapiaRESUMEN
OBJECTIVE: To examine whether a group intervention including hypnosis can reduce cancer pain and trait hypnotizability would moderate these effects. DESIGN: This randomized clinical trial examined the effects of group therapy with hypnosis (supportive-expressive group therapy) plus education compared to an education-only control condition on pain over 12 months among 124 women with metastatic breast cancer. MAIN OUTCOME MEASURES: Pain and suffering, frequency of pain, and degree of constant pain were assessed at baseline and 4-month intervals. Those in the treatment group also reported on their experiences using the hypnosis exercises. RESULTS: Intention-to-treat analyses indicated that the intervention resulted in significantly less increase in the intensity of pain and suffering over time, compared to the education-only group, but had no significant effects on the frequency of pain episodes or amount of constant pain, and there was no interaction of the intervention with hypnotizability. Within the intervention group, highly hypnotizable participants, compared to those less hypnotizable, reported greater benefits from hypnosis, employed self-hypnosis more often outside of group, and used it to manage other symptoms in addition to pain. CONCLUSION: These results augment the growing literature supporting the use of hypnosis as an adjunctive treatment for medical patients experiencing pain.
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Neoplasias Abdominales/psicología , Neoplasias Abdominales/secundario , Neoplasias Óseas/psicología , Neoplasias Óseas/secundario , Neoplasias de la Mama/psicología , Hipnosis , Recurrencia Local de Neoplasia/psicología , Psicoterapia de Grupo/métodos , Apoyo Social , Neoplasias Torácicas/psicología , Neoplasias Torácicas/secundario , Neoplasias Abdominales/patología , Adaptación Psicológica , Adulto , Anciano , Actitud Frente a la Muerte , Entrenamiento Autogénico , Neoplasias Óseas/patología , Neoplasias de la Mama/patología , Terapia Combinada , Progresión de la Enfermedad , Emociones , Femenino , Estudios de Seguimiento , Educación en Salud , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Dolor/psicología , Manejo del Dolor , Dimensión del Dolor , Educación del Paciente como Asunto , Rol del Enfermo , Neoplasias Torácicas/patologíaAsunto(s)
Pueblo Asiatico/etnología , Actitud Frente a la Salud/etnología , Relaciones Familiares/etnología , Neoplasias Torácicas/etnología , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Características Culturales , Clorhidrato de Erlotinib , Femenino , Humanos , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Relaciones Médico-Paciente , Quinazolinas/uso terapéutico , Neoplasias Torácicas/tratamiento farmacológico , Neoplasias Torácicas/psicología , Neoplasias Torácicas/radioterapiaRESUMEN
BACKGROUND: Recent research suggests that patients' appraisal of somatic symptoms is more closely related to emotional variables (particularly negative affect) than to their actual health as determined by external criteria. METHODS: Sixty surgical cancer patients who at the time of a routine follow-up examination filled out the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire-C30, which included a positive/negative affect scale and a scale tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgement on a standardized scale at the end of the examination, and an additional two external physicians later rated the patients based on the findings listed in the medical record. RESULTS: Patients' reports of somatic symptoms were strongly correlated with two measures of negative affect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported symptoms and the examining or external physicians' ratings were considerably weaker (r = 0.31 and r = 0.19). According to a multiple linear regression with 6 predictors, negative affect was the best single predictor of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negative affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect constituted two additional separate factors. CONCLUSIONS: Cancer patients' reporting of somatic symptoms by means of a standardized quality of life questionnaire is closely related to emotional and social distress and is not equivalent to health status as determined from a clinical perspective. Researchers and practitioners have to be aware of this fact when interpreting quality of life data. Furthermore, negative affect deserves attention as an important signal for intervention in tumor follow-up programs.
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Neoplasias Abdominales/psicología , Calidad de Vida , Apoyo Social , Neoplasias Torácicas/psicología , Neoplasias Abdominales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Valores Sociales , Neoplasias Torácicas/cirugíaRESUMEN
Medical ethics have always required patient consent as a prerequisit to therapy. The law concerning the "protection of persons accepting to be subjects in biomedical research" requires specific oral and written information to be given to all patients entering a clinic research project. New effects of the principal of "informed consent", on the physician-patient relationship, are analysed. Fifty patients with bronchial cancer were included in controlled studies from June 1989 to June 1990. These patients were asked to give their informed consent involving 5 different studies (2 Phase II studies investigating tolerance to a new treatment and 3 Phase III studies comparing a new treatment with a reference treatment). The patients were informed beforehand of the possibility of a research treatment and the legal requirement for their signature as well as to the possibilities of replacement solutions in case they refused. Detailed and adapted information concerning the different therapeutic solutions and their predictable side effects were presented before reading the informed consent statement. Of the 50 informed consent statements proposed, 49 were accepted. The principal of informed consent was favourably apprehended by the patients (active participation, notion of protection, information source, possibility of dialogue) and induced conditions of better acceptation by the patient. Nevertheless, it was more difficult to obtain statements of consent for studies comparing a new treatment with a reference treatment than for studies simply proposing a new treatment alone.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de los Bronquios/psicología , Consentimiento Informado/legislación & jurisprudencia , Relaciones Médico-Paciente , Neoplasias Torácicas/psicología , Adulto , Anciano , Neoplasias de los Bronquios/tratamiento farmacológico , Ética Médica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Torácicas/tratamiento farmacológicoRESUMEN
The meaning and impact of serious illness in the therapist is described as it affects the doctor's intrapsychic analytic space, the analyzing field, and the fantasy life of patients. The brief literature on this topic is reviewed with particular reference to what patients should be told about one's illness. The author's experience of serious illness is described as it related to his reaction to his work with patients. Patient material is presented that demonstrates the utility of an abstinent stance even when encountering real and disturbing events. Freud's experience with long-term disability is recalled and the special circumstances posed by major illness for the analytic relationship are discussed. The unparalleled experience provided the patient by one's delicate neutrality at such times reveals to him the true depth of unconscious fantasy and its lasting influence on adult functioning.