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Faye Dickinson



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    IBS07 - Enhancing Recovery in the Treatment of Thoracic Malignancy (Ticketed Session) (ID 38)

    • Event: WCLC 2019
    • Type: Interactive Breakfast Session
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
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      IBS07.02 - The Role of Prehabilitation in the Optimisation of Patients with Thoracic Malignancy (Now Available) (ID 3336)

      07:00 - 08:00  |  Presenting Author(s): Faye Dickinson

      • Abstract
      • Presentation
      • Slides

      Abstract

      Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer. However, it may be responsible of postoperative complication and mortality, especially in patients with impaired pulmonary function. Enhanced recovery after surgery (ERAS) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery. Preoperative exercise-based intervention (Prehabilitation) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion. Impaired lung function with low predicted postoperative forced expiratory volume in first second (ppoFEV1) or/and diffusing capacity for carbon monoxide (ppoDLCO) are considered risk factors for anatomic lung resection. Cardio-pulmonary exercise test (CPET) is the gold standard technique to predict postoperative morbi-mortality. It seems reasonable to think that if we are able to improve FEV1 or CPET we will reduce postoperative risks.The implementation of a preoperative respiratory rehabilitation could optimize patient’s physical capacity before surgery and improve outcomes and enhance recovery. The aim of this presentation is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery and review its impact on patients having lung cancer surgery. Define the type of exercise and its duration, and the group of patients with best benefit. During the presentation we will be able to check that Prehabilitation is a safe intervention without side effects in patients. High-intensity interval training (HIT) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration. Prehabilitation increase exercise capacity and significantly enhances pulmonary function. But the reduction of postoperative complication and mortality has not been clearly demonstrated. Different criteria selection, type of intervention and small sample size, in addition to no randomization, could justify disparate results. It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function. Further randomized clinical trials with enough patients, correct duration of HIT (2 to 6 weeks) and focused in COPD patients are needed to clarify the suitability of prehabilitation. Meanwhile, safety of prehabilitation and good results of some studies support this intervention in high-risk patients. This conclusion is supported by the recent published ERAS society and Eurpoean Society of Thoracic Surgeons (ESTS) guidelines for enhanced recovery after lung surgery, which recommends prehabilitation should be considered for patients with borderline lung function or exercise capacity, despite the low scientific evidence.

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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  |  Author(s): Faye Dickinson

      • 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.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.