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Pippa Labuc

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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: 4
    • Now Available
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      ES26.01 - The Impact of Specialist Nursing Intervention in Lung Cancer (Now Available) (ID 3292)

      14:30 - 15:45  |  Presenting Author(s): Alison Leary

      • Abstract
      • Presentation
      • Slides

      Abstract

      The Impact of Specialist Nursing Intervention in Lung Cancer

      Alison Leary on behalf of

      Iain Stewarta, , Aamir Khakwania , Richard B. Hubbarda , Paul Beckettb , Diana Borthwickc , Angela Toddd , Alison Learye , Laila J. Tataa

      A Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK

      B Derby Teaching Hospitals NHS Foundation Trust, DE22 3NE, UK

      c Edinburgh Cancer Centre, Western General Hospital, EH4 2JT, UK

      d School of Nursing and Midwifery, University of Sheffield, S10 2LA, UK

      e School of Primary & Social Care, London South Bank University, SE1 0AA, UK

      Introduction

      In the UK the role of the Clinical Nurse Specialist is well established. Lung Cancer Clinical Nurse Specialists (LCNS) often start a therapeutic relationship with patients and families before formal diagnosis has been made. LCNS often manage the care of people with lung cancer but in an environment of austerity their worth to employers is still questioned.

      This series of studies examined the impact of the LCNS on outcomes for lung cancer patients.

      The focus of this abstract is one of the studies which looks at receipt of treatment for lung cancer.

      Treatment choices for people with lung cancer may be influenced by contact and engagement with lung cancer nurse specialists (LCNSs). We investigated how service factors, LCNS workload, and LCNS working practices may influence the receipt of anticancer treatment.

      Materials and methods

      English National Lung Cancer Audit data and inpatient Hospital Episode Statistics for 109,079 people with lung cancer surviving 30 days from diagnosis were linked along with LCNS workforce census data and a bespoke nationwide LCNS survey. Multinomial logistic regression was used to determine adjusted relative risk ratios (RRRs) for receipt of anticancer therapies associated with LCNS assessment, LCNS workforce composition, caseload, LCNS reported working practices, treatment facilities at the patients’ attending hospitals, and the size of the lung cancer service.

      Results

      Assessment by an LCNS was the strongest independent predictor for receipt of anticancer therapy, with early LCNS assessments being particularly associated with greater receipt of surgery (RRR 1.85, 95%CI 1.63–2.11). For people we considered clinically suitable for surgery, receipt was 55%. Large LCNS caseloads were associated with decreased receipt of surgery among suitable patients (RRR 0.71, 95%CI 0.51–0.97) for caseloads >250 compared to ≤150. Reported LCNS working practices were associated with receipt of surgery, particularly provision of psychological support (RRR 1.60, 95%CI 1.02–2.51) and social support (RRR 1.56, 95%CI 1.07–2.28).

      table1abstract.jpg

      Conclusion

      LCNS assessment, workload, and working practices are associated with the likelihood of patients receiving anticancer therapy. Enabling and supporting LCNSs to undertake key case management interventions offers an opportunity to improve treatment uptake and reduce the apparent gap in receipt of surgery for those suitable

      Early nurse specialist contact is associated with greater receipt of therapy.

      •Receipt of surgery is less likely where nurse specialists have large caseloads.

      •Therapy receipt is more likely if key nursing interventions are routinely provided.

      •Managing nurse specialists’ workload could address disparities in therapy uptake.

      Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy? (2018) Stewart, Iain et al. Lung Cancer, Volume 123, 160 – 165

      https://www.lungcancerjournal.info/article/S0169-5002(18)30482-3/pdf

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      ES26.02 - Rehabilitation After Treatment of Thoracic Malignancies (Now Available) (ID 3293)

      14:30 - 15:45  |  Presenting Author(s): Chris L Wells

      • Abstract
      • Presentation
      • Slides

      Abstract

      In this presentation the speaker will focus the talk on the collaborative model between the Departments of Nursing and Rehabilitation Services in the promotion of functional recovery of hospitalized adults. The speaker will incorporate the current literature regarding early mobilization and rehabilitation and the program's effects on outcomes. The talk will also examine the physical impairments and functional limitations associated with cancer associated frailty. Finally, the speaker will share some priminary data from the efforts at the University of Maryland Medical Center on the implementation of a collaborative mobilization and rehabilitation program to address barriers to recovery and hospital discharge.

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      ES26.03 - The Impact of Early Nursing Intervention on Outcomes for Thoracic Oncology Patients (Now Available) (ID 3295)

      14:30 - 15:45  |  Presenting Author(s): Iveta Nohavova

      • Abstract
      • Presentation
      • Slides

      Abstract

      Introduction: The roles of nurses vary from cancer screening, detection, and prevention, to active clinical assessment, treatment administration or symptom management. These various aspects play part when raising public awareness of important role of prevention. One of the very effective examples of an early health intervention is prevention of no tobacco use uptake or quitting using tobacco products in order to enhance health outcomes. The latest WHO/Europe report1 “European tobacco use – trends report 2019” shows tobacco use continues to be a paramount public health issue. At the same time, it is estimated 90% of lung cancers (incl. tracheal or bronchal) could be avoided if tobacco use is eliminated. Sadly, the WHO European Region has the highest proportion of tobacco use in the world, with an estimated 29% of population using tobacco. Nurses can help.

      Methods: A review of guidelines and recommendations for nurses to use in daily practice will be presented.

      Results: Not applicable

      Conclusions: With prevention must be the key priority action, such focused early nurses interventions can contribute to timely diagnosis of the cancer positively impacting outcomes of thoracic oncology patients, including quality of life and care experience. Nurses are ideally positioned to assume this role. This presentation will explore current evidence related to the role of cancer nurse in early interventions to thoracic cancer patients‘ outcomes. The session will include discussion and recommendations to increase role of nurses in prevention of tobacco use.

      References:

      1. WHO (2019). European Tobacco Use: Trends Report 2019. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0009/402777/Tobacco-Trends-Report-ENG-WEB.pdf

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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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Author of

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    OA05 - Increasing the Impact of Nursing and Allied Health Professional Interventions in Lung Cancer Care (ID 130)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
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      OA05.03 - Development of a Fatigue and Breathlessness Group for Thoracic Oncology Patients (Now Available) (ID 2612)

      15:15 - 16:45  |  Presenting Author(s): Pippa Labuc

      • Abstract
      • Presentation
      • Slides

      Background

      Cancer related fatigue and breathlessness are well-established common symptoms of lung cancer, with 57%-100% of all lung cancer patients experiencing cancer related fatigue and 19%-51% experiencing dyspnoea. Both symptoms can be highly subjective and distressing for the individual, impacting on all domains of their life: physical, social and emotional.

      Due to this fatigue, dyspnoea and anxiety are a symptom cluster effecting up to 96% lung cancer patients, and is associated with poor performance status and reduced patient reported quality of life (QoL).

      In order to address this the symptoms of fatigue, breathlessness and anxiety need to be addressed concurrently in order to ensure the best results for the individual and improve QoL.

      Method

      A literature review was completed using online journal libraries to determine the incidence and impact of fatigue and breathlessness on lung cancer patients, as well as the most effective symptoms management interventions.

      Following this, patients attending the thoracic oncology outpatient clinics at Guy’s Cancer Centre completed a questionnaire to determine:

      1. The incidence fatigue, breathlessness and mood changes

      2, Their individual experience of the symptoms

      3. If the symptoms are impacting on QoL

      4. Would they want to attend a group to address these symptoms

      5. The preferred location, time and frequency of the group

      Outcome measures to address the symptoms were reviewed to ensure that those with the highest validity were selected for use.

      Result

      A six session group was developed, using the Breathing, Thinking Functioning model at its core, to ensure that the sessions address all domains of the patients life, as well as the mechanisms of dyspnoea. Sessions also addressed fatigue and sleep hygiene, once again addressing the issues holistically.

      Each session consists of both an educational element, to address the subject of the week, followed by a practical session to allow for practice of the techniques provided and assist the individuals to gain mastery of these.

      In order to gain both qualitative and quantitative data, patients complete the FACIT-Fatigue, EORTC QLQ-C30, Dyspnoea 12 and individual goal setting prior to commencing the programme. The individual goals are discussed with the clinician when attending the initial session to ensure that these are addressed during the group. On completion of the session these assessment are repeated in order to determine the impact that the group has had on all symptoms as well as the individuals QoL.

      Conclusion

      Fatigue and breathlessness are debilitating side effects of a lung cancer diagnosis, which result in both physical and emotional changes for the patient.

      In order to address these symptoms holistically they need to be address concurrently, as well as addressing the impact they have on anxiety and depression.

      By providing a structured group programme to address these symptoms and the impact they have on the individual, it allows patients to master skills to reduce the impact of these symptoms, as well as promote self-management and improve QoL.

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