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Morten Quist

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    ES15 - The Management of Cancer Treatment in Thoracic Malignancy (ID 18)

    • Event: WCLC 2019
    • Type: Educational Session
    • Track: Nursing and Allied Professionals
    • Presentations: 7
    • Now Available
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      ES15.01 - Management of Cognitive Changes in Oncology Patients (Now Available) (ID 4063)

      11:00 - 12:45  |  Presenting Author(s): Lauren Urwin

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      ES15.02 - Mary Duffy's Topic (Now Available) (ID 4058)

      11:00 - 12:45  |  Presenting Author(s): Mary Duffy

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      ES15.03 - Toxicities of Radiation and Immunotherapy: What We Know (Now Available) (ID 3237)

      11:00 - 12:45  |  Presenting Author(s): Benjamin Lok

      • Abstract
      • Presentation
      • Slides

      Abstract

      Radiotherapy is one of the longstanding pillars of cancer treatment. Immunotherapy is being established a new cancer treatment pillar and represents a momentous advance in the armamentarium of the cancer care health professional. As such, how these two modalities interact with each other is important to understand to allow the healthcare team to identify and manage the accompanying side effects. The objectives of this session are to cover a brief overview of basic radiotherapy, basic tumor immunology, followed by a more extensive review on the current status of radiotherapy and immunotherapy in clinical practice with a significant focus on reviewing the toxicities of radiotherapy, immunotherapy and their combination. The goal is to equip all members of the healthcare team to delivery optimal care for patients that receive these treatment modalities.

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      ES15.04 - Managing Sleep Difficulties and Cancer (Now Available) (ID 3238)

      11:00 - 12:45  |  Presenting Author(s): Maria Ftanou

      • Abstract
      • Presentation
      • Slides

      Abstract

      This paper discusses evidence-based interventions for managing sleep difficulties in people with cancer.

      Insomnia is a common sleep problem in people with cancer. Insomnia refers to the difficulty of falling asleep, staying asleep and early morning awakenings. It causes distress or impairment in important areas of functioning, such as relationships and employment. It is estimated that between 30-60% of cancer survivors experience significant sleep disturbances that can persist for up to five years post treatment. Aside from greatly impacting on quality of life, poor sleep is associated with anxiety, depression, concentration and memory difficulties, higher rates of pain, increased use of sedatives and poorer work performance [1-3]. People with lung cancer are at an increased risk of experiencing sleep difficulties because of their generally older age, compromised respiratory function, increased disease burden and the impact of treatments [4]. Sleep difficulties also have economic and social impacts on the broader community, due to increased health system costs, productivity losses and wellbeing costs [5].

      Cognitive Behaviour Therapy (CBT) is considered to be the first-line treatment for insomnia [6]. CBT targets dysfunctional attitudes, beliefs and habits that interfere with sleep. CBT for insomnia commences with a comprehensive assessment about the nature and duration of sleep complaints, the impact on daytime functioning, compensatory behaviours, the person's beliefs about sleep and any other biopsychosocial factors that might be impacting on sleep. Common screening tools used to assess the impact of sleep difficulties include the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Insomnia Rating Scale (PIRS). These tools are self-reporting and easy to administer. CBT for insomnia is a multi-component intervention and includes psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, cognitive strategies and relapse prevention strategies. It is usually delivered between four to eight session modules.

      CBT is effective in improving sleep disturbance, fatigue, pain and quality of life. The effects of CBT are durable, with benefits lasting up to three years post-treatment [7, 8]. CBT is suitable for most adults with insomnia, however, it works best with people who are motivated and have the cognitive capacity to learn and adopt CBT strategies. CBT can be effectively provided in group settings, individually, via telephone, video or online methods. Over three quarters of patients achieve remission or significant reduction of sleep disturbance after CBT treatment [9]. CBT has been found to be more effective than mindfulness, massage, exercise and acupuncture intervention. CBT has been found to be as effective as pharmacological intervention in the short-term and more beneficial than medication in the longer term. CBT is also more cost-effective than pharmacological or non-treatment of sleep difficulties [10].

      Despite the benefits of CBT, access for people with cancer is limited due to lack specialist availability, cost and awareness of the benefit of CBT. To improve access to evidence-based interventions for people with cancer, stepped-care approaches (where face-to-face CBT is reserved for the most complex cases while less burdensome and less costly self-managed interventions are available for less complex cases) could help translate evidence into clinical practice.

      Conclusion

      Sleep difficulties are highly prevalent in people with cancer, however, access to evidenced-based interventions are limited. Embedding evidence based-screening and CBT into routine care is essential to improving quality of life and care for people with cancer.

      Savard, J., Simard, S., Blanchet, J., Ivers, H. & Morin, C.M. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24, 583-590 (2001).

      Davidson, J.R., MacLean, A.W., Brundage, M.D. & Schulze, K. Sleep disturbance in cancer patients. Social science & medicine (1982) 54, 1309-1321 (2002).

      Howell, Doris, et al. "A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer." Supportive Care in Cancer21.10 (2013): 2695-2706.

      Halle, Ingrid Helene, et al. "Trajectory of sleep disturbances in patients undergoing lung cancer surgery: a prospective study." Interactive cardiovascular and thoracic surgery 25.2 (2017): 285-291.

      Deloitte Access Economics. Re-awakening Australia: the economic cost of sleep disorders in Australia C, Australia: Deloitte Access Economics, 2011. . Re-awakening Australia: the economic cost of sleep disorders in Australia, 2010.Canberra, Australia; 2011.

      Morin CM, Benca R. Chronic insomnia. Lancet (London, England). 2012;379(9821):1129-41

      Arico D, Raggi A, Ferri R. Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature. Frontiers in psychology. 2016;7:1162.

      Blom, K., Jernelöv, S., Rück, C., Lindefors, N., & Kaldo, V. (2016). Three-Year follow-up of insomnia and hypnotics after controlled internet treatment for insomnia. Sleep, 39(6), 1, 1267-1274. doi: 10.5665/sleep.5850

      Fiorentino L, McQuaid JR, Liu L, Natarajan L, He F, Cornejo M, et al. Individual cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover pilot study. Nature and science of sleep. 2009;2010:1-8.

      Reynolds S, R. M. The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based Treatment. Sleep Medicine Clinics,. 2017;12(1):39-46.

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      ES15.05 - Nursing Role in Managing Toxicity and Expectations of Treatment (Now Available) (ID 3239)

      11:00 - 12:45  |  Presenting Author(s): John McPhelim

      • Abstract
      • Presentation
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      Abstract

      This presentation will discuss the clinical patient care and management of patients receiving immunotherapies. A team approach to patient management including patient education, pre asessment, toxicity management and follow up will be presented. This team consists of Oncologists, specialist nurses and cancer care pharmacists, who work together in a dedicated clinic. The benefits to patients will be presented as well as demonstrating efficient use of clinical time.

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      ES15.06 - The Role of Microbiome Restoration in Chemotherapy and Immunotherapy (Now Available) (ID 3240)

      11:00 - 12:45  |  Presenting Author(s): Alexandre Chan

      • Abstract
      • Presentation
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      Abstract

      Microbiomes are composed of bacteria, viruses, fungi, protozoa and archaea that reside on the surface of our body’s epithelial barrier. There is increasing evidence to suggest microbiomes’ role in carcinogenesis as well as cancer treatment efficacy and toxicity. In this presentation, we will focus on the impact of gut microbiome on efficacy of chemotherapy and immunotherapy. We will also discuss strategies to restore gut microbiome, with the potential on improving the delivery of chemotherapy and immunotherapy.

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      ES15.07 - Achieving Holistic Care in Hard to Reach Patient Cohorts (Now Available) (ID 4087)

      11:00 - 12:45  |  Presenting Author(s): Phemelo Martha Magabanyane

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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Author of

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    ES26 - The Impact of Specialist Nursing and Allied Health Professionals in the Care of Thoracic Oncology Patients (ID 28)

    • Event: WCLC 2019
    • Type: Educational Session
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
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      ES26.04 - Early Intervention and Rehabilitation for Patients Newly Diagnosed with Thoracic Malignancies (Now Available) (ID 3296)

      14:30 - 15:45  |  Presenting Author(s): Morten Quist

      • Abstract
      • Presentation
      • Slides

      Abstract

      This presentation will outline the rationale, role and evidence supporting early Intervention and rehabilitation for patients newly diagnosed with thoracic malignancies. Thoracic malignancies are associated with high disease burden and increased inactivity. Newly diagnosed Individuals with thoracic malignancies experience complex symptoms, which can include dyspnoea, fatigue and pain. These frequently lead to a cycle of inactivity and functional decline. Individuals with thoracic malignancies are less physically active than similar aged healthy peers at time of diagnosis, with less than 40% meeting the physical activity guidelines (1). Following diagnosis, physical activity levels are lowest whilst patients undergo treatment and do not recover back to pretreatment levels within six months. Progressive functional decline occurs over time, with reduction in exercise capacity and muscle strength (1). In thoracic malignancies, reduced exercise performance is associated with poorer functional independence, worse cancer treatment tolerability and higher all-cause mortality (2). People with thoracic malignancies, who are less physically active, have worse symptoms, and poorer exercise capacity and health-related quality of life (HRQoL) compared to those who are more active (1). This is supported and linked with the research by Gralla et al in 2014 (3) who identified key issues that patients with thoracic malignancies mainly fear. Gralla el al described the five rated issues which were: maintaining independence, ability to perform normal daily activities, ability to sleep, not being a burden for caregivers and not being fatigued, in a survey among 660 patients with lung cancer. Moreover, up to 44% of patients with thoracic malignancies experience depression and anxiety symptoms, which is consistently higher than other cancers types, and psychological distress has also been proven to affect anti-cancer treatment and mortality (4).

      Supervised high-intensity exercise training is associated with improved exercise capacity and QOL in most cancer patients (5). Systematic reviews have reported that both pre- and postoperative exercise interventions are safe and feasible for patients with operable thoracic malignancies, and suggest benefits on exercise capacity, symptoms as fatigue and some domains of QOL (6). However, this evidence does not include patients with advanced inoperable thoracic malignancies. Although research groups have previously shown that exercise in these patients is safe, feasible, and beneficial (7), conclusive randomized controlled trials (RCT) still remain to be carried out to determine the effect of exercise for patients with advanced inoperable thoracic malignancies. But larger RCT within this group of patients is currently finished and ongoing and within the next few years the evidence will increase. Next step though is to implement evidence into daily practice.

      1. Granger CL, McDonald CF, Irving L, Clark RA, Gough K, Murnane A, et al. Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer. 2014;83(2):292-9.

      2. Jones LW, Hornsby WE, Goetzinger A, Forbes LM, Sherrard EL, Quist M, et al. Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer. Lung Cancer. 2012;76(2):248-52.

      3. Gralla RJ, Hollen PJ, Msaouel P, Davis BV, Petersen J. An evidence-based determination of issues affecting quality of life and patient-reported outcomes in lung cancer: results of a survey of 660 patients. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2014;9(9):1243-8.

      4. Sullivan DR, Ganzini L, Duckart JP, Lopez-Chavez A, Deffebach ME, Thielke SM, et al. Treatment receipt and outcomes among lung cancer patients with depression. Clinical oncology (Royal College of Radiologists (Great Britain)). 2014;26(1):25-31.

      5. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer treatment reviews. 2017;52:91-104.

      6. Ni HJ, Pudasaini B, Yuan XT, Li HF, Shi L, Yuan P. Exercise Training for Patients Pre- and Postsurgically Treated for Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther. 2016.

      7. Quist M, Adamsen L, Rorth M, Laursen JH, Christensen KB, Langer SW. The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy. Integr Cancer Ther. 2015;14(4):341-9.

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