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Dianne Zawisza

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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: 9
    • Now Available
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      OA05.01 - A Prospective Study of Swallowing and Voice Outcomes After Treatment for Small-Cell Lung Cancer (Now Available) (ID 2225)

      15:15 - 16:45  |  Presenting Author(s): Jacqui Frowen  |  Author(s): Karla Gough, Jo Phipps-Nelson, Rhys Hughes, Shankar Siva, Allison Drosdowsky, Benjamin J Solomon, Nicole Kiss, Mary Duffy, David Ball

      • Abstract
      • Presentation
      • Slides

      Background

      Dysphagia (difficulty swallowing) and dysphonia (impaired voice) have been identified in patients with lung cancer as being a significant problem. However, research to date has been limited in its measurement and it remains unknown which patients experience dysphagia or dysphonia, and what the impact of these problems are to the patient. The purpose of this study was to identify the prevalence and nature of dysphagia and dysphonia in patients with limited stage SCLC.

      Method

      A prospective cohort pilot study was conducted on 12 patients receiving chemoradiotherapy for limited-stage SCLC. Data collection included: videofluoroscopy swallowing studies (VFSS) to investigate swallowing physiology, aspiration risk and oesophageal motility disorders; limitations to oral intake; patient-reported swallowing problems; and patient-reported voice problems. Data were collected before treatment and again at one, three and six months post-treatment.

      Result

      No patient was observed to aspirate, and the pharyngeal swallow was safe and functional in all cases. Three patients exhibited oesophageal motility disorders before treatment, while three more exhibited these disorders at the post-treatment assessments. Oral intake was most compromised one month post-treatment; at this time one patient was tube dependent, two required a single consistency diet and two had a diet requiring special preparation. At all other time-points patients were managing a normal or near-normal diet. Despite an absence of oropharyngeal dysphagia observed on VFSS, three patients reported moderate or severe swallowing difficulties one month post-treatment; these self-reported difficulties were no more than mild at follow-up assessments. Three additional patients reported the onset of moderate or severe swallowing difficulties at three and six months post-treatment. Patients who reported swallowing difficulties at one month post-treatment had all received a mean radiation dose to the oesophagus of ≥15.7Gy and a maximum dose to the oesophagus of ≥42Gy, however these relationships were no longer apparent at three and six months post-treatment. Patient-reported voice difficulties were variable, with the worst scores being reported at one month post-treatment for a subset of patients, who continued to report problems across voice-related physical, functional and emotional domains at three and six months post-treatment.

      Conclusion

      This is the first time that detailed swallowing and voice outcomes have been reported in patients with SCLC. Although patient numbers are small, this study identified discordance between observed swallowing function and patient-reported problems, which may have significant clinical implications for the management of patients with SCLC, as well as identify important issues for future research.

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      OA05.02 - Patient Experience, Expectations and Knowledge: Lung Cancer in Australia (Now Available) (ID 2323)

      15:15 - 16:45  |  Presenting Author(s): Catherine Holliday

      • Abstract
      • Presentation
      • Slides

      Background

      Lung cancer is the fourth most diagnosed cancer in Australia. In 2015, it was the fourth most common cause of death and the most common cause of cancer death. There were over 11,000 new cases of lung cancer in 2013, with more men (approximately 6,600) than women (approximately 4,500) diagnosed. In 2014, more than 8000 people in Australia died from lung cancer, nearly 5000 of whom were men.

      Patient Experience, Expectations and Knowledge (PEEK) is a research study developed by the International Centre for Community-Driven Research (CCDR). PEEK studies conduct patient experience research using a protocol that will allow for comparisons over time (both quantitative and qualitative components). This study in NSCLC is the largest mixed methodology study in Australia in the past five years.

      Method

      In this study, 80 people with NSCLC stages I to IV throughout Australia participated in a structured (qualitative) interview and an online (quantitative) questionnaire. The interview and questionnaire comprehensively covered all aspects of disease experience from symptoms, diagnosis, treatment, communication, information provision, care and support, quality of life, and future treatment and care expectations. Statistical analysis of quantitative data was conducted using R, and content analysis of qualitative data was conducted using conventional analysis to identify major themes.

      Result

      The most common symptom experienced before diagnosis was back and/or shoulder pain (n=35, 43.75%), and the most common symptoms leading to diagnosis was breathing difficulties (n=26, 32.50%). The majority (n=58; 72.50%) of participants knew nothing or very little about lung cancer at diagnosis, and the most commonly reported theme relating to discussion about treatment was that patients were presented with only one treatment plan, with little discussion about treatment options (n=36; 45.00%). There were 76.25% (n=61) of this study population that reported receiving support primarily from family and friends. Quality of life was negatively affected in 85.00% (n=68) of the study population, the most common reason being due to the emotional and physical impact on patients and family (n=44; 55.00%). There were 51.25% (n=41) of the study population that reported relationships being strengthened, despite 75.00% (n=60) of the study population reporting feeling burdensome to their family. In relation to future needs, 53.75% (n=43) of participants called for access to treatments to be more affordable and equitable; for information to address stigma and educate the public in relation to causes of lung cancer (n=16, 20.00%); for clinicians to display more compassion/empathy (n=20, 25.00%); and for support more groups and peer support (n=17, 21.25%).

      Conclusion

      Based on patient experience and feedback, three recommendations are made to improve patient quality of life and/or ability to manage their own health:

      Public health campaigns developed to prevent lung cancer should be developed in a way that protects people currently diagnosed from the impact of negative stigma.

      Information and support services, including support for carers, should be more targeted to specific disease staging and sub-types of disease.

      Research funding should reflect the mortality and prevalence of lung cancer, and the number of clinical trials available should increase to aid timely decisions about new treatments.

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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  |  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.

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      OA05.04 - Discussant - OA05.01, OA05.02, OA05.03 (Now Available) (ID 3753)

      15:15 - 16:45  |  Presenting Author(s): Melissa Jane Culligan

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      OA05.05 - Transforming the Patient Experience in Lung Cancer Through the Use of Clinical Nurse Specialist Virtual Clinics - The Liverpool Experience (Now Available) (ID 2130)

      15:15 - 16:45  |  Presenting Author(s): Andrea Vanessa McIver, Nicola Maddock  |  Author(s): Joanne Dunbar, Sophie Sanders, Martin Ledson, Martin Walshaw, Colin Smyth

      • Abstract
      • Presentation
      • Slides

      Background

      To improve the patient experience in lung cancer, in 2014 we introduced to the UK the concept of “virtual” clinic working, where following secondary care review of suspicious CT scans taken in the community a lung cancer nurse specialist (LCNS) conducts a clerking/holistic assessment via telephone and offers an investigation plan where appropriate.

      In 2017, this model of care was adopted into UK National Lung Cancer Optimal Pathway guidance.

      We were interested to review the effect of our innovative service on patient experience.

      Method

      We looked at patient feedback, staff perceptions and impact on the lung cancer pathway of our virtual clinic 2016-18.

      Result

      Of the 1498 patients with a suspicious CT scan, over 75% were diagnosed with cancer.

      Overall 802 (70%) were diagnosed via the outpatient service and 705 (88%) chose virtual clinic assessment and diagnostic test facilitation.

      Qualitative audit has shown an overwhelmingly positive feedback, where 98% of users felt that the virtual clinic was a better option, and patients felt well informed and supported.

      In addition the LCNSs feel they are utilising their knowledge and skills in a more timely fashion with an appropriate population. The early assessment facilitates the start of that therapeutic relationship that leads to patient needs being addressed, symptom management advice, reducing distress and optimising patient performance status and quality of life.

      Furthermore ‘virtual’ working has seen a dramatic reduction in medical outpatient activity, allowing that resource to be used more efficiently for the benefit of cancer patients.

      Conclusion

      This service review has shown that the data and patient and staff experience all support this new model of care delivery.

      The benefits are multifocal: care is patient-centred , appropriate skill-set use improves staff morale, and the freeing up of infrastructure allows organisational resource reallocation and cost saving.

      We have advocated the role of the LCNS to take the lead in this model of working across the UK, as we feel the LCNS are best placed to do these sensitive and complex assessments.

      We welcome the opportunity to share our experience worldwide.

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      OA05.06 - Nursing Intervention on Immuno-Related Adverse Events in Lung Cancer Patients (Now Available) (ID 2135)

      15:15 - 16:45  |  Presenting Author(s): Monica Arellano  |  Author(s): Isabel Brao, M. Paz Fernández

      • Abstract
      • Presentation
      • Slides

      Background

      New treatment of immunotherapy permits to stimulate the patient’s immune responses against cancer. That it supposes a new strategy for melanoma, renal and lung cancers. Although, is different than Chemotherapy’s toxicity, the effect on tissues and organs are systemic and can be dealing to unpredictable side-effects that should be detected and treated as soon as possible. Nurses are vital to manage toxicity related to immunotherapy & educate and to provide patient’s with best education.

      Our objetive is to describe lung cancer clinical nurses specialists’ role on the management of toxicities related to immunotherapy in lung cancer patients. How is the control and follow–up for those patients

      Method

      In 2018, a cross-sectional study was conducted with lung cancer patients receiving immunotherapy at the Lung Functional Unit of Catalan Institute of Oncology, hospital Duran I Reynals in Barcelona-Spain. The variables included were socio-demographic profile, the clinical were; tumour histological, toxicities prevalence and severity and finally variables from the roles and references made by nurses. A descriptive analysis of prevalence was performed with type of toxicities and patient characteristics.

      Result

      New patients receiving immunotherapy were 69 and the most common toxicities were; asthenia (82.5%), skin toxicity (35.5%), Pneumonitis (22.5%), colitis (20%), arthralgia (12.5%), endocrine toxicity (12.5%), emesis (10%), vascular (7.5%), gastritis (5%), hepatic (5%), renal (5%) & neurologic (5%). Attending grading severity, it was GI-GII, both were controlled by nurses, GIII and GIV required specialists, hospitalization and other professionals. Nurses visited 95% of the patients previously to initiate their treatments, attended 128 phone calls and in 111 patients they realised the follow-up and control. From total a 50% need emergency services and finally got hospitalization in 30% of them.

      Conclusion

      Grades I and II are the most common toxicity. Nurses were in charge for patient education, providing careful information to patients, family members and caregivers, along the whole process. This role is vital to get better and earlier control on the side-effects, higher satisfaction and to facilitate the multidisciplinary team-working dynamic.

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      OA05.07 - Co-Operation Between the Cities of Glasgow and Bethlehem and the Development of a Cancer Nursing Diploma at Bethlehem University Palestine (Now Available) (ID 206)

      15:15 - 16:45  |  Presenting Author(s): Gerry O Hare

      • Abstract
      • Presentation
      • Slides

      Background

      Cancer is a serious public health issue in Palestine. The impact of the conflict between Palestine and Israel has a negative impact on the diagnosis and treatment of cancer patients. In addition, the political situation has hindered the development of effective cancer nursing reflective practice and education for Palestinian nurses. A meeting between Gerry O Hare (oncology CNS Glasgow and Clyde Health Board) and Mariam Awad (Dean of Nursing Bethlehem University) in 2011 led to an exploration of opportunities for cancer nursing educational initiatives between Glasgow, Scotland and Bethlehem Palestine.

      Support for cancer nurses education was secured from Glasgow Health Board, the office of Lord Provost of Glasgow, Bethlehem University, Medical Aid for Palestine, European Oncology Nursing Society, Palestinian Dept of Health, and supportive UK and Bethlehem nurse academics. This multi-agency commitment and support resulted in the launch of the first Post-Graduate High Diploma in Cancer/Palliative nursing in Palestine by the Nursing Department at Bethlehem University Palestine in 2016.

      This is an example of motivated nurses from geographical distant countries positively influencing agencies to develop a pioneering cancer/palliative care nurse educational high diploma programme at Bethlehem University, Palestine. This initiative sends a message to cancer nurses globally to encourage them to cross cultural, political and geographical barriers to achieving positive outcomes for cancer nurse education.

      Method

      Section not applicable

      Result

      Section not applicaple

      Conclusion

      Section not applicable

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      OA05.08 - Discussant - OA05.05, OA05.06, OA05.07 (Now Available) (ID 3754)

      15:15 - 16:45  |  Presenting Author(s): Mary Duffy

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      OA05.09 - IASLC Lectureship Award for Nursing and Allied Health (Now Available) (ID 3755)

      15:15 - 16:45  |  Presenting Author(s): Kahren White

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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