Advance care planning for patients with inoperable lung cancer

AIM: To develop and pilot an advance care planning (ACP) intervention for lung cancer nurses to use in discussing end-of-life preferences and choices for care with patients diagnosed with inoperable lung cancer. DESIGN: A prospective qualitative design with semistructured individual patient interviews. A grounded theory approach was used for the analysis. SAMPLE: Fifteen patients took part in ACP discussions with their nurse and nine agreed to be interviewed by a researcher about their perceptions of the intervention. RESULTS: Patients' reactions to the ACP process varied, but they welcomed the recording of their wishes and appreciated the courage of the nurses in bringing up the subject of future care. CONCLUSION: This study explored the role of ACP as a method of enabling patient choice for lung cancer patients in the UK. Further research is needed to determine the components of ACP and the training needs of staff.     

Patient and carer perspectives: a man with inoperable lung cancer

Background: Palliative care professionals have recognized the importance of hope for their patients. However, they sometimes experience hope as a barrier for end-of-life communication, for instance when patients have unrealistic hope. A hope communication tool (HCT) may help them to address hope during clinical encounters but has not been developed yet. The objective of this study was to examine the feasibility of a HCT for palliative care professionals.

Method: Based on synthesis studies of hope, a hope communication tool (HCT) was developed. Palliative care professionals were asked to use and evaluate the tool by making use of a written evaluation scheme, mainly consisting of open-ended questions. Similarities and differences between participants and suggestions for revisions were thematically analyzed and discussed within the research team.

Results: Fourteen healthcare professionals (nine females; mean age 50.9 years) participated in the study: nine nurses, three physicians and two chaplains. The HCT helped participants to reach depth and address end-of-life issues. Most participants used it for other reasons than described in the tool. They used it when they faced difficulties that related to patients’ hope or hope-related themes, such as unrealistic hope or fear. Participants also gave feedback on the open or abstract character of questions, the assumptions of questions, and the distinctions between categories.

Discussion: The HCT is feasible and helps to reach depth and address end-of-life issues. The findings lead to a revised HCT. Future research should examine the impact of the use of this revised tool on patients.     

Being in the situation of a significant other to a person with inoperable lung cancer

Little is known about how significant others experience their own situation when a family member becomes seriously ill. To illuminate the meanings of significant others' experiences of their situation after a family member had been diagnosed with inoperable lung cancer, we analyzed narratives from 12 significant others, using a phenomenological hermeneutic approach. Findings revealed 4 themes: feeling dislocated in life, being in an altered relationship, being in a struggle, and feeling secure. When reflecting on these findings, we considered the transition theories and works of Ricoeur and L?gstrup. The significant others' experiences indicated a transition process because of the changes brought about by the diagnosis of lung cancer and a struggle to endure and overcome difficulties and distress on the way to regaining a smooth functioning life. Furthermore, the diagnosis of lung cancer had altered the relationship toward the next of kin and meant not only feelings of increased closeness but also loss of intimacy and reciprocity. The significant others suffered in this process of transition, and healthcare professionals, who recognize the World Health Organization's definition of palliative care, may consider the findings of this study useful when reflecting on their care of families.     

Unmet needs and distress in people with inoperable lung cancer at the commencement of treatment

Purpose  

People with lung cancer report a higher burden of unmet needs, specifically psychological and daily living unmet needs. They experience more psychological distress and more physical hardship than other tumour sites. This study examined the levels of unmet need and psychological distress in inoperable lung cancer patients at the start of treatment.     

Feasibility of a standardised quality of life questionnaire in a weekly diary format for inoperable lung cancer patients

OBJECTIVE: Previous studies testing quality of life assessment (QoL) in routine oncology clinical practice have been based at single institutions and many have utilised touch-screen computer technology. The objective of this study was to test the feasibility of a low-tech QoL diary that could be held by the patient and shared with professionals across the health care setting. METHODS: The EORTC-QLQ-C30 and LC13 were used and adapted into an A5 diary format. Patients were instructed to complete the questions each week at home and to share the information with any health professional involved in their care. Feasibility of the diary format was examined through assessment of compliance, utilisation and satisfaction using a mixed methods approach. RESULTS: Diary completion rates were good; however, utilisation of the diary was poor, with only 23% (13/57) of patients stating explicitly that they had shared the diary with a health professional. Patients were generally satisfied with the diary format; however, qualitative analysis did identify some negative effects of diary completion. CONCLUSIONS: A patient-held QoL diary is feasible for a proportion of palliative care patients but the importance of training and support for patients and staff cannot be underestimated when implementing a new tool into clinical practice.     

区域靶向联合优选化疗用于不能手术的Ⅲ、Ⅳ期非小细胞肺癌

近年来肺癌的发病率和死亡率均位于恶性肿瘤首位，就诊患者中，中晚期肺癌约占80％。目前，在选择治疗上多集中于化疗或放疗，药物靶向治疗也显示了较好的疗效，但其有效率徘徊在40％左右，生存率、区域肿瘤的控制等方面还不尽人意。区域靶向治疗对局部肿瘤的控制具有显著的优势，联合个性化化疗能有效提高生活质量和延长无肿瘤进展生存时间。     

Major concerns and needs of breast cancer patients

Between 1989 and 1991, 102 breast cancer patients completed a questionnaire survey on concerns and needs at their first visit to the University Clinic after they were diagnosed or treated for breast cancer at other clinics. Their major concerns and needs were health, family, finances, work, the future, self-esteem, counseling and support for themselves and their family. Married women and those younger than 50 years were more likely to have concerns about their family. Nonwhites had more concerns about finances and work than white women, with an odds ratio (OR) of 6.58. Older women and those married, however, had less concerns about finances and work than younger women and those not married, with ORs of 0.96 and 0.34, respectively. Fewer nonwhite than white patients expressed concerns about their future (OR = 0.31). Young women were more concerned about self-esteem than older women. More nonwhites than whites and more married than unmarried women expressed needs for family counseling and support (OR = 3.58 and 3.68, respectively). Help for interpreting information was required more frequently by nonwhites than whites (OR = 7.25, 95% confidence interval [CI] = 2.19-24.00). Nonwhite women also tended to require more referrals than whites. In summary, major concerns and needs varied among patients of different demographic characteristics, especially those of age, race, and marital status.     

Exploring concerns of children with cancer

Background

Aggressive treatment protocols in pediatric oncology have major effects on the lives of children with cancer. The effects of lifestyle changes such as hospitalization and home schooling on quality of life have not been investigated. This study explores lifestyle effects of cancer therapy on the quality of life of children with cancer. The goals of this study were to identify important quality-of-life issues from the perspectives of children with cancer and to identify how they think their experience with cancer treatment could be improved.

Materials and methods

Pediatric oncology patients age 5–21 were interviewed individually. Sample questions included, “Ever since you got sick, what has bothered you the most?” and “How has having this illness affected your life?” Responses were analyzed using standard qualitative techniques.

Results

Thirty-one patients were interviewed in depth. Four major themes emerged including (1) loneliness and isolation: the loss of a normal childhood, (2) decreased pleasure from food, (3) physical discomfort and disability, and (4) emotional responses to cancer, specifically anger and fear. Their suggestions for improvement included better-tasting food, more comfortable hospital décor, and social activities with children their own age.

Conclusions

Children cited concerns regarding pleasures taken away as well as pain inflicted due to cancer treatment. In addition to traditionally mentioned side effects, children complained of difficulty enjoying food and restricted social activity. To improve the quality of life of children with cancer, healthcare providers should focus on potentially modifiable variables including food-related pleasure, hospital aesthetics, and social activity.     

Sexual concerns of adolescents with cancer

The sexually related concerns of adolescents with cancer were compared with those of healthy adolescents. Forty-one adolescents age 12 to 19 years participated. A sexual concerns questionnaire was used. The study had three primary objectives: (1) to identify concerns related to physical, emotional, and behavioral aspects of sexuality present among all adolescents in the study; (2) to determine if there were differences between sexual concerns of adolescents with cancer and those of healthy adolescents; and (3) to determine whether a relationship existed between age and the concerns adolescents had about sexuality. Results of the study indicate that although no age-linked trends in sexually related concerns existed for the adolescents studied, adolescents had concerns regarding sexuality. Adolescents with cancer did not seem to be any more concerned about common developmental aspects of sexuality than healthy adolescents. However, adolescents with cancer had numerous sexually related concerns not identified by healthy adolescents. These concerns seem to relate to being treated for cancer. They included worries about hair loss, feeling isolated, ability to have children, and children having genetic or congenital defects. Nurses who care for adolescents with cancer can provide education and support regarding sexual concerns to help adolescents cope with and resolve some of these treatment-related anxieties. Further research that includes in-depth, narrative interviews could give better insight into the concerns that both adolescents with cancer and healthy adolescents have about sexual issues.     

氩氦刀联合放化疗治疗局部晚期非小细胞肺癌

目的 讨论氩氯刀联合放化疗治疗局部晚期非小细胞肺癌的疗效。方法 2003年10月至2006年2月采用氩氯刀联合放化疗治疗局部晚期非小细胞肺癌42例（综合组），选择同期奈件相同采用常规放化疗局部晚期非小细胞肺癌38例作对照（常规组）；比较两组病人的KPS、局部复发率、中位生存期、生存率。结果 综合组和常规组的KPS改善率分别为28．57％和10．52％，稳定率分别为42．86％和36．84％，恶化率分别为2857％和52．63％：综合组KPS评分高于常规组（X^2=6．32，P〈005）。原发灶局部复发率综合组显著低于常规组（28．57％〈50.00％；X^2=3．86，P〈0．05）；中位生存期综合组16个月，常规组14个月；1、2、3年生存率综合组稍高于常规组（63．53％〉5350％，31．99％〉29．13％，21．33％〉16．18％）。但两组间生存曲线比较无统计学意义（X^2=0．33，P〈0．05）。结论 氩氯刀联合放化疗可有效地降低不可切除非小细胞肺癌的局部复发率．改善病人功能状态。     

An exploration of health concerns & health-promotion behaviors in pregnant women over age 35

PURPOSE: To explore the specific health concerns and health-promotion behaviors of childbearing women 35 years of age or older. STUDY DESIGN AND METHODS: Semistructured interviews with women ( = 50) ages > or =35 in their third trimester of pregnancy. Interviews lasted approximately 1 hour, were conducted by two nursing faculty, and were scheduled to accommodate participant needs. Process recording was used to document participant responses. Verbatim statements were recorded, and subjects were redirected to clarify responses when necessary. Content analysis and coding were completed by an independent researcher, based upon techniques derived from Miles and Huberman (1994). Data reduction was accomplished by the identification of categories of responses that described the participants' meaning. RESULTS: Study participants reported concerns reflecting both fetal well-being and maternal health-related issues. The majority of childbearing women (86%) reported engaging in multiple health-promotion behaviors focusing on daily nutritional intake, lifestyle activities, and rest patterns. Participants reported conscientious decisions to eliminate substances recognized as harmful, and to alter exercise, employment, or daily responsibilities to accommodate physical changes during pregnancy. Participants were "proactive healthcare seekers," accessing information from a variety of sources and seeking services to meet their individualized needs. CLINICAL IMPLICATIONS: The multitude and frequency of health-promotion behaviors adopted by those > or =35 years of age during pregnancy is indicative of this group's ability to independently initiate change, and exceeds the percentages previously reported. The nurse can be influential in supporting lifestyle modifications adopted during the childbearing period as permanent health-promotion behaviors.     

不同化疗方案联合放疗治疗Ⅲ期非小细胞肺癌

目的：评价不同化疗方案加放射治疗不能手术的期非小细胞肺癌的疗效。方法：57例不能手术的期非小细胞肺癌患者随机分为两组。治疗组29例接受紫杉醇210 mg,第1 d;顺铂20 mg,第1-5 d联合化疗（PP方案）两周期,同时给予放疗。对照组28例患者采用足叶乙甙100 mg,第1-5 d;顺铂20 mg,第1-5 d化疗两周期（EP方案）,同时予以放疗。两组放疗方式和剂量相同,常规分割照射,每次2 Gy,每周5次,原发灶和淋巴结受累部位的总剂量为60-70 Gy,淋巴引流区40 Gy。结果：治疗组总有效率82.8%,完全缓解率10.4%;对照组总有效率53.6%,完全缓解率17.9%。两组总有效率差异有统计学意义（P〈0.05）。化疗的不良反应主要是胃肠道反应和骨髓抑制。结论：PP方案加放疗治疗无法手术的期非小细胞肺癌,不良反应可耐受,疗效明显优于EP方案加放疗。