Spontaneous reports of most distressing concerns in patients with inoperable lung cancer: at present, in retrospect and in comparison with EORTC-QLQ-C30+LC13 (original) (raw)
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Journal of Clinical Oncology, 2010
Purpose Standardized questionnaires for patient-reported outcomes are generally composed of specified predetermined items, although other areas may also cause patients distress. We therefore studied reports of what was most distressing for 343 patients with inoperable lung cancer (LC) at six time points during the first year postdiagnosis and how these concerns were assessed by three quality-of-life and symptom questionnaires. Patients and Methods Qualitative analysis of patients' responses to the question “What do you find most distressing at present?” generated 20 categories, with 17 under the dimensions of “bodily distress,” “life situation with LC,” and “iatrogenic distress.” Descriptive and inferential statistical analyses were conducted. Results The majority of statements reported as most distressing related to somatic and psychosocial problems, with 26% of patients reporting an overarching form of distress instead of specific problems at some time point. Twenty-seven perc...
European Journal of Oncology Nursing, 2014
Purpose: To explore the influence of symptom clusters and the most distressing concerns on global rating of quality of life (QoL) among patients with inoperable lung cancer (LC) over a three-month period following diagnosis. Methods: Data were derived from a longitudinal study dealing with the symptom experiences of 400 patients with LC at three time points: close to diagnosis and one and three months later. The symptom clusters were derived from a QoL questionnaire using factor analysis, which resulted in three clusters: the Respiratory cluster, the Pain cluster and the Mood cluster. The most distressing concerns were derived from responses to a free listing question ('What is most distressing at present') and were categorised under three dimensions: Bodily distress, Life situation with LC and Iatrogenic distress. Crosssectional, multivariate regression analyses with QoL as a dependent variable were used to determine predictors (symptom clusters and most distressing concerns) at the three time points. Results: All three symptom clusters predicted QoL at each time point. Close to diagnosis, none of the dimensions of most distressing concerns predicted QoL, while the dimension Bodily distress was a significant predictor of QoL after one month. The Life situation with LC dimension was a significant predictor of QoL three months after diagnosis. Conclusions: Symptom clusters are important to LC patients' QoL and need to be acknowledged by healthcare professionals. The present study shows the importance of patients' descriptions of key concerns, which vary from diagnosis onwards, and urges healthcare professionals to be vigilant to such changes.
European Journal of Cancer, 2001
➤ Fatigue, pain, dyspnea, and dry mouth are symptoms reported frequently by people with cancer who were newly admitted to hospice home care. ➤ Pain, dyspnea, and constipation intensity are related negatively to quality of life. ➤ Symptom distress is the strongest predictor of overall quality of life in people with advanced cancer. Purpose/Objectives: To evaluate the relationships between quality of life (QOL) and symptom distress, pain intensity, dyspnea intensity, and constipation intensity in people with advanced cancer who were newly admitted to hospice home care. Design: Descriptive and correlational. Setting: A large hospice that provides primarily home care. Sample: 178 adult hospice homecare patients with cancer who were accrued to a clinical trial funded by the National Institutes of Health focusing on symptom management and QOL. Patients were excluded if they received a score lower than seven on the Short Portable Mental Status Questionnaire. Method: The patients were invited to participate in the clinical trial within 48 hours of admission to hospice home care. Among the questionnaires they completed were a QOL index and a distress scale. Scales measuring present intensity of pain, dyspnea, and constipation also were administered. Main Research Variables: QOL, symptom distress, pain intensity, dyspnea intensity, and constipation intensity. Findings: The most frequently reported symptoms among the sample were lack of energy, pain, dry mouth, and shortness of breath. Lack of energy caused the greatest distress, followed closely by dry mouth and pain. The results of the regression analysis indicated that total distress score, pain intensity, dyspnea intensity, and constipation intensity were related to QOL at the univariate level. When all predictors were considered simultaneously, only the total distress score remained a significant predictor of QOL (p < 0.001), accounting for about 35% of variance. Conclusions: QOL was affected by symptom distress in people with advanced cancer near the end of life. Implications for Nursing: The symptoms most commonly reported and those that cause the greatest patient distress should be addressed first by hospice nurses. Continued effort is needed in the important area of symptom management.
Palliative care Questionnaires Health status Self-assessment Treatment outcome A B S T R A C T This study aimed at developing a shortened version of the EORTC QLQ-C30, one of the most widely used health-related quality of life questionnaires in oncology, for palliative care research. The study included interviews with 41 patients and 66 health care professionals in palliative care to determine the appropriateness, relevance and importance of the various domains of the QLQ-C30. Item response theory methods were used to shorten scales.
Contemporary oncology (Poznań, Poland), 2016
To evaluate the intensity of dejection and self-assessment of quality of life in patients with lung cancer from the start of palliative care until death. The study included 63 patients with lung cancer from the start of care until death in palliative medicine centers in Bydgoszcz in 2012-2013. The visual-analogue scale constituting part of the ESAS scale was used to assess dejection, while question number 30 of the EORTC QLQ-C30 was used for self-assessment of quality of life. "Moderate" and "very" intense dejection initially occurred in 19 (30%) and 24 (38%), and in the 2(nd) assessment in as many as 23 (36%) and 30 (48%) patients. Average quality of life deteriorated in this respect by 0.09 in the two-step scale (p = 0.005). Increase in the intensity of "moderate" dejection occurred between the 1(st) and 3(rd) assessment. Initially it occurred in 2 (9%) patients and in 14 (66%) during the 3(rd) assessment. In contrast, the levels of "very" s...
Annals of Oncology, 2006
Background: The aim of this prognostic factor analysis was to investigate if a patient's self-reported health-related quality of life (HRQOL) provided independent prognostic information for survival in non-small cell lung cancer (NSCLC) patients. Patients and methods: Pretreatment HRQOL was measured in 391 advanced NSCLC patients using the EORTC QLQ-C30 and the EORTC Lung Cancer module (QLQ-LC13). The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap validation technique was used to assess the stability of the outcomes. Results: The final multivariate Cox regression model retained four parameters as independent prognostic factors for survival: male gender with a hazard ratio (HR) = 1.32 (95% CI 1.03-1.69; P = 0.03); performance status (0 to 1 versus 2) with HR = 1.63 (95% CI 1.04-2.54; P = 0.032); patient's self-reported score of pain with HR= 1.11 (95% CI 1.07-1.16; P < 0.001) and dysphagia with HR = 1.12 (95% CI 1.04-1.21; P = 0.003). A 10-point shift worse in the scale measuring pain and dysphagia translated into an 11% and 12% increased in the likelihood of death respectively. A risk group categorization was also developed. Conclusion: The results suggest that patients' self-reported HRQOL provide independent prognostic information for survival. This finding supports the collection of such data in routine clinical practice.
Journal of Hospice & Palliative Nursing, 2016
Lung cancer patients' unrelieved symptoms are associated with poor quality of life. Understanding their symptoms can direct interventions to enhance quality of life. This longitudinal study explored the symptoms of patients with advanced lung cancer by examining changes in symptom frequency, severity, and distress and their relationship with quality of life and functional status. Eighty patients with advanced lung cancer were interviewed within 1 month of diagnosis and at 2-and 4-month follow-up periods. Fifty percent of patients died within 5 months of diagnosis. Patients reported less symptom frequency and severity over time but no significant changes in symptom distress. Lack of energy, pain, shortness of breath, cough, and difficulty sleeping were the most common symptoms. The patients reported increased pain frequency, decreased severity in sleeping difficulties, and decreased distress related to shortness of breath. The 11 most commonly occurring symptoms were inversely related to quality of life. Five of these symptoms were negatively associated with functional status. Although symptom prevalence and severity decreased over time, symptom distress did not. Frequent and ongoing symptom assessment that includes perceived distress is paramount to direct interventions to enhance quality of life and functional status of patients with advanced lung cancer.
Annals of Surgical Oncology, 2012
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 earlystage 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. An evolving body of evidence supports the value of integrating palliative care into diseased focused care in patients with serious illness, such as lung cancer. 1-3 Data strongly support that patients with non-small cell lung cancer (NSCLC) experience high symptom burdens, many comorbidities, and psychosocial-spiritual concerns related to the diagnosis. 4-10 The
Clinical lung cancer, 2017
Palliative systemic therapy is frequently underutilized in patients with advanced non-small-cell lung cancer (NSCLC), for many reasons. The aim of this study was to identify patient-reported factors that may predict for treatment decisions and survival in advanced NSCLC, using the Edmonton Symptom Assessment Scale (ESAS), which is a self-reported questionnaire that quantifies symptom burden by asking patients to rate the severity of 9 common symptoms. With ethics approval, we analyzed ESAS scores at initial oncology consultation for 461 patients with advanced NSCLC seen at The Ottawa Hospital Cancer Centre from 2009 to 2012. Subgroup analysis was performed to determine if treatment strategies or overall survival (OS) were related to the total symptom burden, as defined by the sum of the individual ESAS symptom scores. The severity of the ESAS total symptom burden score was positively correlated with Eastern Cooperative Oncology Group performance status (R = 0.48; P < .0001). Furt...