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C. Broderick

Moderator of

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    GR02 - Is There a Role for the Thoracic Oncology Nurse in Ensuring Patients with an Advanced Lung Cancer have Access to Early Phase Clinical Trials? (ID 17)

    • Event: WCLC 2013
    • Type: Grand Round Session
    • Track: Nurses
    • Presentations: 6
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      GR02.0 - N/A - Chair Intro (ID 450)

      M. Culligan

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      GR02.1 - Affirmative (ID 451)

      P. Yates

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      GR02.2 - Affirmative (ID 452)

      J. White

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      GR02.3 - Negative (ID 453)

      M. Culligan, M. Hesdorffer, Y. Lai, P. Yates, J. White, C. Broderick

      • Abstract
      • Presentation
      • Slides

      Abstract
      Cancer is the leading cause of death in the world, accounting for approximately 7.6 million deaths in 2008. Lung cancer accounted for 1.37 million of those deaths.Identification of molecular markers in lung cancer has lead to the development of targeted therapies resulting in improved survival in selected groups of lung cancer patients. Despite the advancements in treatments, the survival for patients with lung cancer, particularly in the metastatic or locally advanced patients (stage IIIb/IV), is generally poor with a 5-year survival of only 6%. The current poor prognosis and latest advances made in the field of lung cancer highlight the importance of clinical trial development, participation and analysis. Participation in clinical trials for the general cancer patient’s is low, between 5-9%. This low percentage is similar to those seen for lung cancer patients. Early stage clinical trials have a smaller number of participants by design and are aimed at establishing a maximum tolerated dose of a drug or treatment, not establishing efficacy.These clinical trials are not designed with curative intent but rather are designed to evaluate drug absorption, distribution, metabolism, excretion and mechanism of action. Only a small number of cancer patients and even a smaller number of advanced stage lung cancer patients enroll into phase I clinical trials. The number of international clinical trials has seen a rapid increase over the past decade. Recently the Office of Inspector General (OIG) reported that as of 2008, 80% of marketing applications for drugs and biologics approved by the US Food and Drug Administration (FDA) contained data from US clinical trials conducted outside of the USA. Despite the importance and availability of clinical trials for lung cancer, participation in early stage clinical trials by advanced stage lung cancer patients remains very low. There are multiple barriers that contribute to these low numbers of participants, some of which include: (1) fear of unknown benefit from the investigational treatment, (2) negative family and family physician influence, (3) logistical and attitudinal constraints – too cumbersome to participate and not willing to be the subject of “experiments”, (4) lack of knowledge, understanding and fear of the complexities of the clinical trial, (5) risk of inability to tolerate related investigational drug / treatment toxicity due to more weaken condition and (7) financial and insurance barriers.Identifying and overcoming the barriers that exist for each patient early in their diagnosis has the potential to improve both the quality and quantity of their lives and potentially help others with the same barriers in the future. Another significant barrier is the real and perceived conflict that exists between the need for palliative and/or Hospice levels of care for advanced stage lung cancer patients. The need for Hospice benefits and palliative care can and does have a significant impact on the decision to participate in early stage clinical trials to the point that participation may not even be an option. Funding and other system related issues act as barriers to participation in early stage clinical trials as well as the philosophical basis of the hospice/palliative care approach to treatment/care. Over the past decade the availability of symptom management and palliative care clinical trials has increased the awareness of this barrier and in many respects further clouded the issue for patients, their families and their healthcare providers. The primary ethical concern is does enrollment into clinical trials interfere with the spirit of hospice care or does it offer hope to a dying patient? Identifying issues that exist globally may help to increase enrollment by advance stage patients while at the same time moving early phase clinical trials forward and onto the phase II/III stage of study. Phase I trials are not designed with curative intent and phase I agents are not likely to prolong life or change the course of a disease. The life expectancy of phase I cancer patients’ averages between 5-6.5 months. Hospice providers and research investigators are in agreement that phase I clinical trials should be open and available to advanced stage lung cancer patients who are concurrently enrolled in hospice care. Overcoming the barriers and obstacles for advanced stage lung cancer patients to participate in early stage clinical trials can only happen in the setting of a committed multidisciplinary research team.Methods to utilize in an effort to move toward that goal include: (1) recognizing the importance of patient and family education, (2) recognizing the importance of healthcare provider education and awareness, (3) careful review and reinforcement of the informed consent process, (4) identifying and recognizing the potential benefit of phase I clinical trial enrollment for advanced stage lung cancer patients – clinical and altruistic, (5) recognizing and assisting patients and families with individual barriers and obstacles to participation and (6) employing effective marketing, recruiting and screening methods that are multidisciplinary in approach. Thoracic Oncology Nurses are well suited to serve as educators, advocates, resources, facilitators, and intermediaries. Nurses traditionally spend a greater amount of time in direct patient care and family interaction. Expanding and clarifying clinical information patients receive from their treating physicians is a vital role nurses play in ensuring patients are well informed and compliant with their plan of care. This is a model that can and has been extended into the realm of clinical trial work.Studies have shown that nurses play an important role in educating and recruiting cancer patients in clinical trials.A randomized clinical trial compared nurses with surgeons recruitment of patients into a clinical trial for prostate cancer and the results indicated that surgeons and nurses were equally as effective in their recruiting and educating abilities and effectiveness. With the proper education about early stage clinical trials, the conduct of clinical research, knowledge of the disease process of advance stage lung cancer and a high degree of self-motivation, thoracic oncology nurses are well suited to improve access and enrollment of advanced stage lung cancer patients into early phase clinical trials.

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      GR02.4 - Negative (ID 454)

      Y. Lai

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      GR02.5 - Discussion (ID 455)

      N. n/a

      • Abstract

      Abstract not provided

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    MO27 - Patient Centred Care (ID 141)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Nurses
    • Presentations: 10
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      MO27.01 - Operable lung cancer patients experiences of rehabilitation and supportive needs at diagnosis. A qualitative study (ID 1664)

      M. Missel, J.H. Pedersen, C. Hendriksen, L. Adamsen

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer patients have complex problems and are considered as disadvantaged when compared with other cancer patients. The needs of lung cancer patients during the treatment trajectory still remain to be identified systematically. The present study is part of a Ph.D. study investigating ’Four critical moments’ in daily life during disease and treatment trajectory in operable lung cancer patients. The Ph.D. study is part of the Centre for Integrated Rehabilitation of Cancer Patients – CIRE. The present study aims to explore lived experiences at diagnosis of operable lung cancer patients in order to identify needs of supportive and rehabilitative care.

      Methods
      A sample of nineteen patients is included in the study. Inclusion criteria are a diagnosis of non small cell lung cancer referred for surgery at department of Thoracic surgery, Rigshospitalet and age above 18. Individual in-depths interviews with a phenomenological approach were conducted approximately seven days following diagnosis. The phenomenological approach is based on the French philosopher Paul Ricoeur. Focus in the interviews is the present and deals with themes of patients’ experiences with the diagnosis and daily life, bodily experiences, smoking and physical activity. Follow-up interviews are performed 14 weeks post surgery focusing on the patients return to daily life.

      Results
      Through the analysis of the narrative interviews, patients' lived experiences are described in themes such as onset of illness with no symptoms; resilience expressed as managing on their own, used to be strong and not complaining; psychological response expressed as feelings of unreality, trying to push it away and experiences of lack of concentration, lack of energy and excessive thoughts; existential thoughts, expressed as a confrontation with death, anxiety, loneliness, afraid of the unknown and an emotional rollercoaster ride; the continued daily life focusing on continuing with usual activities and patterns; disruptions in the social relations expressed as withdrawal from social situations or experiences of family and friends’ withdrawal from the ill person. Will not be a burden or receive compassion from family and friends and will not express their vulnerability to family and friends; physical activity as a daily activity but not used to exercise; smoking as stress reduction; supportive needs from a patient perspective such as conversations with healthcare professionals about the whole situation, early information about surgery and no need of further written information; confidence in the meeting with the health care system; uncertain but hopeful about the future.

      Conclusion
      It is important that health care professionals provide patients with opportunities to talk about their fears, concerns and experiences. Through listening to and understanding operable lung cancer patients, nurses can identify appropriate resources and help patients to access them. Results are expected to contribute to the development and initiation of further interventions for lung cancer patients early in the treatment trajectory.

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      MO27.02 - Patient Centered Outcomes in the Management of Malignant Pleural Effusion (ID 1408)

      S.J. Walker, M. Zubrinic, C. Massey, Y. Shargall, E. Bédard, G.E. Darling

      • Abstract
      • Presentation
      • Slides

      Background
      Malignant pleural effusion (MPE) is common in individuals with advanced cancers and has an adverse impact on respiratory function and quality of life (QOL). Research evaluating treatment methods for MPE have focused on medical endpoints such as chest x-ray and there are no studies that have evaluated patient centered outcomes. Taking into consideration the short life expectancy in this patient population at the time of diagnosis, this study aims to determine the effect of any of the currently accepted treatment methods on QOL and hospital length of stay (LOS).

      Methods
      A prospective study of patients with a radiologically confirmed pleural effusion and an underlying malignancy evaluated patient centered outcomes using the London Chest Activity of Daily Living Scale (LCADL), Functional Assessment of Chronic Illness Therapy –Palliative (FACIT-PAL) and Functional Assessment of Chronic Illness Therapy Treatment Satisfaction (FACIT-TS-G). Cytological confirmation of MPE was obtained in the majority of patients. Treatment of MPE was determined by the attending physician. The study was approved by the institutional REB. Patients who were unable to read or speak English were excluded from the study. After providing informed consent, patients completed the questionnaires (LCADL, FACIT-PAL and FACIT-TS-G) prior to treatment, immediately post treatment and 2 and 6 weeks post treatment. Spearman correlation coefficients were calculated with 95% confidence intervals and p-values were utilized to assess linear relationships between QOL measurements. Mixed model regression analysis was used to estimate linear trends in LCADLS, FACIT-PAL, FACIT-TS Recommendation and FACIT-TS Satisfaction scores in the entire cohort and between treatment groups. Mean QOL scores at measurement time points were plotted in order to assess trends over time for both the entire cohort and for treatment groups.

      Results
      There were 105 study participants from 4 hospitals with a median age of 61 years (range 26-89 years). Lung cancer was the most common underlying malignancy, followed by breast and gastrointestinal cancers. MPE was treated by chest tube + pleurodesis (n=39), Tenckhoff catheter alone (n=27), VATS + Tenchkoff (n=20) and VATS + pleurodesis (n=17). In analyzing the entire cohort, there was an overall improvement in shortness of breath (p<0.0001), ability to perform activities of daily living (p=0.03) and quality of life (p<0.0001) for all treatments. There was no statistically significant difference between treatment groups. However, individuals treated with chest tube + pleurodesis had a decrease in treatment satisfaction, while individuals who were treated with VATS + Tenckhoff (p=0.03) or Tenckhoff alone (p=0.04) reported improvement in their treatment satisfaction. LOS was longer for individuals treated with chest tube + pleurodesis (median 10 days) and VATS pleuroscopy (median 6 days) when compared to VATS + Tenckhoff (median 3 days) & Tenckhoff catheter alone (median 2 days).

      Conclusion
      In the management of MPE, patient centered outcomes are most important. All treatment strategies evaluated in this study provided similar improvements in dyspnea, ability to perform activities of daily living and QOL. However, Tenchkoff catheter treatment strategies offer shorter LOS as well as improved treatment satisfaction which is important given the limited life expectancy of patients with MPE.

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      MO27.03 - Rapport between cancer patients and physicians is a critical issue for patients' satisfaction with treatment decision. (ID 1530)

      J. Umihara, K. Kubota, M. Nishikitani

      • Abstract
      • Presentation
      • Slides

      Background
      Cancer patients' satisfaction with their treatment decision has been proven to be associated with improved health outcome, but few studies have been conducted in Japan. Doctor-centered medicine has been prevailing in the area of cancer treatment in Japan. It has been common among Japanese physicians to withhold "bad news" from patients. Several studies have reported that cancer patients were dissatisfied with this situation and desired to participate in the decision -making on their cancer treatments. Such trends led to the enactment of Cancer Control Act in 2006.The purpose of this law was to establish an environment in which cancer patients were informed about their diagnosis ,and allowed to participate in making decision on their treatment. In this study we hypothesized that cancer patients' satisfaction with their treatment can enhance their psychological outcomes. Furthermore, we hypothesized that cancer patients' satisfaction with their treatment was associated with a rapport established by patient-centered communication with their caregivers. We conducted a cross-sectional survey among 576 Japanese cancer patients.

      Methods
      We conducted cross-sectional questionnaire surveys among patients who had received cancer treatment. One source was inpatients of a Cancer Center Hospital, and the other a website of Japan's biggest newspaper. The questionnaire included demographics, and general self-rated life status such as peace of mind, quality of life, daily activities, family relationships, rapport with attending physician, assessment of physician's explanations and feeling of happiness during the previous week.

      Results
      Of 576 participants who responded, 383 subjects were satisfied and 193 dissatisfied. The dissatisfied group included more females and fewer mandatory retired subjects than did the satisfied group. The patients in the more satisfied group had a more favorable subjective opinion on their recent life. Assessment of physician's role showed significant differences between the two groups; the patients in the satisfied group felt more than those in the dissatisfied group that the doctor's explanations of treatment were sufficient and were satisfied with the rapport with their doctors. Multiple logistic regression analysis revealed that rapport with their doctors showed a significant odds ratio (3.79, 95% CI, 2.25-6.39).

      Conclusion
      Cancer patients' well-being is associated with treatment satisfaction. Rapport between physicians and patients is the most important key factor for patients' satisfaction with their treatment decision.

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      MO27.04 - Delivering Better Supportive Care to People with Lung Cancer: An Exploration of the Use of a Patient-Reported Outcome Measure in Clinical Nursing Practice (ID 994)

      J. McPhelim, R. Maguire, C. Papadopoulou, G. Kotronoulas, M. Simpson, L. Irvine

      • Abstract
      • Presentation
      • Slides

      Background
      Supportive care needs (SCNs) of people with lung cancer (LC) are highly prevalent; yet, are often unrecognised and unmet. Patient Reported Outcome Measures (PROMs) are a way of identifying the SCNs of people with lung cancer in clinical practice. Objectives: To explore the use of PROM's by lung cancer nurse specialists (LCNS) in the delivery of supportive care to people with LC.

      Methods
      A mixed-methods study design was used. Patients (N=20) were recruited from 3 sites in Scotland and took part in the study over 3 time-points: baseline (T1), one month (T2), two months (T3). At each time point, patients completed the Sheffield Profile for Assessment and Referral to Care (SPARC) and used the PROM to direct consultations with their LCNS (N=3). End of study interviews explored patients’/clinicians’ experiences of using the SPARC in the delivery of supportive care.

      Results
      SCNs were highly prevalent at baseline. A significant reduction in overall psychological and spiritual needs from T1-T2, and family/social and treatment concerns from T1- T3 was recorded. The use of the SPARC resulted in patients disclosing needs that they would not have previously raised and promoted them to ask questions about their condition/care. LCNSs perceived that using the SPARC to guide consultations resulted in patients discussing a wider array of SCNs particularly sensitive issues such as death/dying, concerns regarding family/carers, and sexuality.

      Conclusion
      Our findings demonstrate the feasibility and acceptability of the use of PROMs in the delivery of supportive care to people with LC in clinical practice.

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      MO27.05 - DISCUSSANT (ID 4012)

      J. Vardy

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MO27.06 - Feasibility of measurement of function in advanced cancer: Comparison of the 6-minute walk test, 2-minute walk test, isometric arm exercises and reading numbers aloud. (ID 267)

      K. White, M. Agar, D. Currow

      • Abstract
      • Presentation
      • Slides

      Background
      The pattern in which functional decline in people living with advanced cancer occurs has been described as an initial period of reasonably stable function, followed by more rapid functional deterioration with a defined terminal phase. However little is known about the more subtle changes in function in the more advanced stages of cancer, and the role that breathlessness plays in functional changes. The aim of this pilot study is to compare the feasibility of conducting a range of standardised assessments at different levels of performance status in people with advanced cancer.

      Methods
      A consecutive cohort was recruited to a cross sectional study from three large palliative care units in metropolitan Sydney. Participants completed four breathlessness-inducing assessments: Six-minute Walk Test, Two-minute Walk Test, Isometric Upper limb Exercises and Reading Numbers Aloud. Performance status was assessed using the Australian Modified Karnofsky Performance Scale, Eastern Cooperative Oncology Group Performance Scale and Life-Space Assessment. Comorbidity was identified using the Charlson Comorbidity Index. Four scales were used to assess breathlessness in each participant: Medical Research Council Dyspnoea Scale, Intensity and Unpleasantness of Breathlessness Visual Analogue Scales and Numerical Rating Scale for Breathlessness.

      Results
      The results of the pilot study have allowed a comparison of the four methods of breathlessness-inducing assessments by functional status in 37 people with advanced cancer. Median scores for performing breathlessness-inducing assessments by level of function where ≥80% of people could complete the assessments will also be presented.

      Conclusion
      This oral presentation will highlight the pilot study results and the feasibility of using these assessments in research and clinical practice, to improve the assessment of functional capacity and breathlessness in people living with advanced cancer. There is currently limited evidence into how function can be assessed in advanced cancer when breathlessness is present. This study adds to the evidence and knowledge base around the assessment of function in people living with advanced cancer.

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      MO27.07 - Holistic Needs Assessment - What the patient doesn't tell us (ID 2813)

      J. Roberts, J. White

      • Abstract
      • Presentation
      • Slides

      Background
      All cancer survivors should have a personalised assessment and care plan, and support to self manage their condition (UK DoH 2010) The SPARC (Sheffield Profile for Assessment and Referral to Care) is a tool designed to be completed by the patient, with support from carers if needed, and forms the starting point for the holistic needs assessment process. SPARC is a screening questionnaire that explores a variety of issues and may help the patient/carers to reflect on their needs. The SPARC assessment tool was evaluated for its application utilising lung cancer patients who attended the Lung Cancer Clinic in Rotherham from 2011-2012.

      Methods
      100 patients responses utilising the SPARC assessment tool were analysed at various time points of their pathway including diagnosis, post treatment, disease recurrence and 5 years post discharge.

      Results
      The results analysed were in the domains of physical symptoms, communication and information issues, treatment issues, psychological symptoms and distress thermometer outcomes. Key results showed that: - all patients suffered with common symptoms from lung cancer; - were mostly concerned about the effect that their illnes was having on their family or other people; - many required input to help with their personal affairs; - psychological symptoms were evident in a significant proportion of patients; - the distress thermometer was an appropriate tool in this clinic. The results will be shown in detail in the poster.

      Conclusion
      The SPARC assessment tool is an efficient and validated audit tool for assessing patient concerns and to provide feedback to the patients healthcare team. In Rotherhamm the tool will continue to be utilised and evaluated and is offered to all patients at the first post treatment phase and when no further active treatment is planned. The tool is an appropriate audit tool for assessing patient concerns and to provide feedback to clinicians and community health care teams.

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      MO27.08 - Needs assessment of advanced lung cancer patients - evolution over a decade? (ID 2914)

      D. Zawisza, V. Ali, S. Djalalov, M. Patel, S. Lin, R. Tudor, L. Le, N. Leighl

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer patients continue to experience higher symptom distress than others with different cancer types. We assessed changes in the needs and symptoms of advanced lung cancer patients over a 10 year period.

      Methods
      Consecutive outpatients with advanced lung cancer attending thoracic oncology clinics at a major Canadian cancer centre were invited to complete a 25-item self-administered questionnaire assessing physical and psychosocial symptoms, functional impairment, cancer knowledge and information preferences. Patients were surveyed over 6 months in 2002, and a second cohort surveyed over 3 months in 2012. Summary data and relevant changes over time are presented here.

      Results
      108 advanced lung cancer patients were surveyed in 2002, and 100 in 2012. Fatigue, cough, and shortness of breath are the most common physical symptoms, affecting over one-third of patients on a frequent or constant basis. Significant anxiety was reported by 27% in 2002, 20% in 2012, and 15% reported depression, unchanged over time. Lung cancer or treatment-related symptoms impair daily activities in approximately two-thirds of patients. More than a third experience significant financial hardship, and 62% believe their lung cancer imposed significant hardship on their family. More patients in 2012 reported receiving advice on symptom management, information on the goals and benefits of cancer therapy, and an understanding of clinical trials. However a quarter of patients still perceived that they received little to no advice on symptom management, and 19% felt uninformed about treatment goals for their advanced lung cancer. Despite advances in palliative care, less than 20% discussed their end-of-life care wishes with their healthcare team, even though ~40% had specific wishes or plans, with no change over 10 years. In 2002, most advanced lung cancer patients preferred to receive information in print media. In 2012, while most would still be interested in print media, significantly more were interested in a telephone helpline (~60%). Half of patients indicated they would not use internet-based resources even if readily available in 2002, but this number did not change over time (46% in 2012).

      Conclusion
      Advanced lung cancer patients continue to experience a significant burden of physical and psychosocial symptoms, with no decrease in this burden over time despite perceived advances in treatment and support. Patients are more informed about symptom management and treatment goals than a decade ago, although a significant number still require more information. Patients with advanced lung cancer also need greater empowerment and support from their oncology team in advanced care planning. Printed information continues to be preferable to internet-based resources for the majority of advanced lung cancer patients, and a growing number are interested in telephone help-line support.

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      MO27.09 - Guideline for Telephone Follow Up for Patients Undergoing<br /> Thoracic Surgery (ID 1592)

      J. White, A. Longe, V. Beattie

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer affects nearly 41, 500 people per year in the United Kingdom (UK) of which 5000 (12%) will undergo major lung resection for primary lung cancer with approximately 15% of all patients having complications post operatively. Once the patient develops a post surgical pulmonary complication mortality increases from 0.5% to 12%, ITU admission rate increases from 1.5% to 26% and the length of stay increases from 5 to 14 days. The UK National Lung Cancer Forum for Nurses have produced a Guideline for Telephone Follow Up for Patients Undergoing Thoracic Surgery . The aim of the Guideline is to help to provide a telephone follow up service to patients to reduce rates of re-admission and to improve patients satisfaction of their care. The guideline was produced following an audit of patients who had undergone thoracic surgery and a consensus of expert opinion within the thoracic surgical speciality.

      Methods
      In 2012 a retrospective audit of patients who had lung surgery was undertaken by UK National Lung Cancer Forum for Nurses Thoracic Surgical Group (TSG) in 2012 to assess the timing of intervention after discharge and what assessments would be important to patients. Following a literature review, opinions gathered from Thoracic Surgeons (who worked with the TSG members) and other Lung Cancer Nurse Specialists an assessment was made on how best to support patients after lung surgery. The guideline was developed through regular meetings of the TSG and was developed following the audit, literature review and consideration of the expert views provided.

      Results
      The audit data was collected from 147 patients from across four Thoracic Surgical Centres in the UK and received 439 comments and focused specifically on post-operative care. The data showed that the consensus opinion from patients was that a preferred interval for post-operative assessment by telephone was between two and seven days after discharge and provided information on the aspects of care that were important to them. The aspects of care that were important to patients included wound management, pain, breathlessness, activity, anxiety, constipation, fatigue and sleep. Following the literature review and expert opinion gathered from Thoracic Surgeons and Clinical Nurse Specialists the decision was made to produce the Guideline for Telephone Follow Up for Patients Undergoing Thoracic Surgery for which can be used by any health professional. The guideline includes assessment tools and interventions utilising best available evidence to assist in the identification of concerns or problems that a patient may face after thoracic surgery. The full guideline can be found at www.nlcfn.org.uk

      Conclusion
      This guideline aims to help support health professionals in the provision of a follow up service to patients after thoracic surgery. The audit of patients who had undergone lung surgery helped to focus on the problems that patients had identified as being important to them and, together, with best available evidence and expert consensus opinion allowed the development of this guideline. The guideline is being utilised in thoracic centres in the UK and could be adapted for use in other countries.

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      MO27.11 - DISCUSSANT (ID 4013)

      M. Hesdorffer

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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Author of

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    GR02 - Is There a Role for the Thoracic Oncology Nurse in Ensuring Patients with an Advanced Lung Cancer have Access to Early Phase Clinical Trials? (ID 17)

    • Event: WCLC 2013
    • Type: Grand Round Session
    • Track: Nurses
    • Presentations: 1
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      GR02.3 - Negative (ID 453)

      C. Broderick

      • Abstract
      • Presentation
      • Slides

      Abstract
      Cancer is the leading cause of death in the world, accounting for approximately 7.6 million deaths in 2008. Lung cancer accounted for 1.37 million of those deaths.Identification of molecular markers in lung cancer has lead to the development of targeted therapies resulting in improved survival in selected groups of lung cancer patients. Despite the advancements in treatments, the survival for patients with lung cancer, particularly in the metastatic or locally advanced patients (stage IIIb/IV), is generally poor with a 5-year survival of only 6%. The current poor prognosis and latest advances made in the field of lung cancer highlight the importance of clinical trial development, participation and analysis. Participation in clinical trials for the general cancer patient’s is low, between 5-9%. This low percentage is similar to those seen for lung cancer patients. Early stage clinical trials have a smaller number of participants by design and are aimed at establishing a maximum tolerated dose of a drug or treatment, not establishing efficacy.These clinical trials are not designed with curative intent but rather are designed to evaluate drug absorption, distribution, metabolism, excretion and mechanism of action. Only a small number of cancer patients and even a smaller number of advanced stage lung cancer patients enroll into phase I clinical trials. The number of international clinical trials has seen a rapid increase over the past decade. Recently the Office of Inspector General (OIG) reported that as of 2008, 80% of marketing applications for drugs and biologics approved by the US Food and Drug Administration (FDA) contained data from US clinical trials conducted outside of the USA. Despite the importance and availability of clinical trials for lung cancer, participation in early stage clinical trials by advanced stage lung cancer patients remains very low. There are multiple barriers that contribute to these low numbers of participants, some of which include: (1) fear of unknown benefit from the investigational treatment, (2) negative family and family physician influence, (3) logistical and attitudinal constraints – too cumbersome to participate and not willing to be the subject of “experiments”, (4) lack of knowledge, understanding and fear of the complexities of the clinical trial, (5) risk of inability to tolerate related investigational drug / treatment toxicity due to more weaken condition and (7) financial and insurance barriers.Identifying and overcoming the barriers that exist for each patient early in their diagnosis has the potential to improve both the quality and quantity of their lives and potentially help others with the same barriers in the future. Another significant barrier is the real and perceived conflict that exists between the need for palliative and/or Hospice levels of care for advanced stage lung cancer patients. The need for Hospice benefits and palliative care can and does have a significant impact on the decision to participate in early stage clinical trials to the point that participation may not even be an option. Funding and other system related issues act as barriers to participation in early stage clinical trials as well as the philosophical basis of the hospice/palliative care approach to treatment/care. Over the past decade the availability of symptom management and palliative care clinical trials has increased the awareness of this barrier and in many respects further clouded the issue for patients, their families and their healthcare providers. The primary ethical concern is does enrollment into clinical trials interfere with the spirit of hospice care or does it offer hope to a dying patient? Identifying issues that exist globally may help to increase enrollment by advance stage patients while at the same time moving early phase clinical trials forward and onto the phase II/III stage of study. Phase I trials are not designed with curative intent and phase I agents are not likely to prolong life or change the course of a disease. The life expectancy of phase I cancer patients’ averages between 5-6.5 months. Hospice providers and research investigators are in agreement that phase I clinical trials should be open and available to advanced stage lung cancer patients who are concurrently enrolled in hospice care. Overcoming the barriers and obstacles for advanced stage lung cancer patients to participate in early stage clinical trials can only happen in the setting of a committed multidisciplinary research team.Methods to utilize in an effort to move toward that goal include: (1) recognizing the importance of patient and family education, (2) recognizing the importance of healthcare provider education and awareness, (3) careful review and reinforcement of the informed consent process, (4) identifying and recognizing the potential benefit of phase I clinical trial enrollment for advanced stage lung cancer patients – clinical and altruistic, (5) recognizing and assisting patients and families with individual barriers and obstacles to participation and (6) employing effective marketing, recruiting and screening methods that are multidisciplinary in approach. Thoracic Oncology Nurses are well suited to serve as educators, advocates, resources, facilitators, and intermediaries. Nurses traditionally spend a greater amount of time in direct patient care and family interaction. Expanding and clarifying clinical information patients receive from their treating physicians is a vital role nurses play in ensuring patients are well informed and compliant with their plan of care. This is a model that can and has been extended into the realm of clinical trial work.Studies have shown that nurses play an important role in educating and recruiting cancer patients in clinical trials.A randomized clinical trial compared nurses with surgeons recruitment of patients into a clinical trial for prostate cancer and the results indicated that surgeons and nurses were equally as effective in their recruiting and educating abilities and effectiveness. With the proper education about early stage clinical trials, the conduct of clinical research, knowledge of the disease process of advance stage lung cancer and a high degree of self-motivation, thoracic oncology nurses are well suited to improve access and enrollment of advanced stage lung cancer patients into early phase clinical trials.

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    ITONF - International Thoracic Oncology Nursing Forum (ITONF) Workshop (ID 220)

    • Event: WCLC 2013
    • Type: Other Sessions
    • Track: Nurses
    • Presentations: 1
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      ITONF.04 - Survivorship - How Do We Define in Lung Cancer (ID 4035)

      C. Broderick

      • Abstract
      • Presentation

      Abstract not provided

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