Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
of consultations with different healthcare staff providing distinct specialist
services. The topics discussed included diagnostic information about
mesothelioma, treatment options and consequences, trials processes and
logistics, and legal and financial information regarding classification of MPM
as an industrial disease. Despite feeling well informed about their treatment
some participants reported not being prepared for the full extent of the
problems they experienced. Both chemotherapy and surgery were challenging
treatments although they were associated with different physical effects.
Adverse consequences of treatment were described including neutropenic
sepsis and dehydration post chemotherapy, and bleeding, prolonged
pneumothorax and infection post-surgery. For most participants pain and
breathlessness were experienced post-surgery while nausea, anorexia, taste
changes and constipation were associated with chemotherapy. Fatigue that
impacted on daily living was experienced by both groups. Interventions to
manage the consequences of treatment were recounted; some had been
recommended by healthcare staff while others had been developed by
patients from their own initiative. Participants reported struggling to cope
with the effect of treatment whilst trying to deal with the broader context of
coming to terms with their illness. Uncertainty was expressed in relation to
treatment plans (exacerbated by the logistics surrounding participation in a
clinical trial), severity and duration of side effects, rehabilitation and recovery
and treatment outcomes. Participants employed a number of strategies
to help with coping. These included ‘playing things down’, ‘weighing the
balance’, ‘managing expectations’, ‘taking control’ ‘manning up’ and ‘trust in
the doctor and/or treatment’. Many of these strategies facilitated staying
positive, maintaining hope and finding comfort which was important to
participants. Family members played a key role in coping. A diverse range of
healthcare staff provided information, advice and practical interventions
across the care pathway from community, surgical, respiratory and oncology
services. Discussion: Patient’s perspectives on the experience of receiving
radical surgery and/or chemotherapy for mesothelioma were identified by
the study. This provided valuable insights into their impact on patient’s
feelings about their illness and treatment and how they coped with the
challenges they were presented with. Multiple sources of uncertainty were
expressed by participants. The contribution of healthcare staff to supporting
coping and providing information and advice was appraised positively by
participants. However, we identified that fragmentation could occur due to
the diverse services involved in providing care with no single point of contact
or co-ordination. Conclusion: Understanding the patient’s perspective of the
challenges associated with treatment, alongside their strategies for coping,
provides insights for the services that can support patients undergoing
arduous treatments for mesothelioma. The study reveals ways to facilitate
strategies to help patients manage the condition, as well as treatment sideeffects.
Interventions to reduce uncertainty have been identified as a priority
for service improvement.
Keywords: Radical surgery, Mesothelioma, patient experience, Qualitative
research
NU03: SUPPORTING PATIENTS RECEIVING TREATMENT
TUESDAY, DECEMBER 6, 2016 - 11:00-12:30
NU03.03 EHEALTH AND REMOTE PATIENT MONITORING AND
SUPPORTIVE CARE IN THORACIC ONCOLOGY
Roma Maguire
School of Health Sciences, University of Surrey, Glasgow/United Kingdom
Lung cancer is the commonest cancer worldwide with 1.6 million people
diagnosed each year. People with lung cancer experience a high level of
supportive care needs and many of these needs are unmet. Systematic
supportive care is therefore vital in this patient group. Patient Reported
Outcome Measures (PROMs) can be used to identify the supportive care needs
of people with lung cancer and the collection of PROMs data is reported to
have a number of positive effects on patient outcomes. Enhancing the utility
of PROMs within clinical practice is the use of health technologies that have
the ability to collect PROM data remotely from patients in their own homes
and send this information in ‘real time’ immediately to relevant health/social
care professionals for subsequent intervention. The Advanced Symptom
Management System is one of the most evolved remote patient monitoring
systems in cancer care. This presentation will initially focus on remote
patient monitoring within the context of lung cancer before considering the
implications for the future and the ultimate vision of connected health for all.
Keywords: Technology, connected health, lung cancer, supportive care
NU03: SUPPORTING PATIENTS RECEIVING TREATMENT
TUESDAY, DECEMBER 6, 2016 - 11:00-12:30
THERAPY
Tanja Cufer
Medical Oncology Unit, University Clinic Golnik, Golnik/Slovenia
Introduction Systemic therapy (ST) with chemotherapy (Cht), targeted agents
or immunotherapy (IT) represents the mainstay therapy for patients with
advanced lung cancer; while adjuvant systemic therapy is recommended in
a majority of patients with operable and locally advanced disease. The goal
of ST is to prolong life without compromising quality of life (QoL). Despite
the ability of ST to prolong life or even cure patients, QoL and life span might
be compromised due treatment toxicity. In addition, uncontrolled adverse
events (AEs) might lead to treatment interruption or discontinuation.
Therefore, effective management of adverse events of anti-cancer drugs, the
so-called “supportive care to systemic therapy” is extremely important for a
true benefit, i.e. treatment effectiveness in a routine practice. During the last
decade several improvements in prevention, treatment and amelioration of
ST AEs been achieved. To implement them in everyday clinic practice a good
understanding of adverse events, supportive care measures and professional
skills of all team members are needed. Registered nurses, specialized in the
oncology, the so called “oncology nurses” are key providers of supportive care
in everyday clinical practice. Supportive care for prevention and treatment
of adverse events Chemotherapy-induced nausea and vomiting (CINV)
has been a priority in the supportive care of cancer patients ever since the
first use of Cht (1). The introduction of 5-HT3 and NK1 antagonists into
anti-emetic therapy resulted in much better control of CINV in lung cancer
patients receiving highly emetogenic, platinum-based therapy. With proper
use of available drugs complete control of vomiting could be achieved in
up to 90% of these patients. However, despite the efficacy of new antiemetic
therapies a proper us of anti-emetics and other preventive measures
are vital. Chemotherapy-induced neutropenia with febrile neutropenia
(FN) as its ultimate and most serious complication are often observed in
patients receiving Cht. The risk of FN can be predicted by assessing patient
characteristics and mylotoxicity of the Cht regimen; and granulocyte-colonystimulating
factors (G-CSF) can be used to prevent it (2). Even thought,
most of the regimens for lung cancer do not classify to high, i.e. more than
20% risk of febrile neutropenia, the primary prophylaxis with G-CSF is often
necessary due to high comorbidity index, poor PS or extensive disease often
present in lung cancer patients. In case of FN, a risk-base approach provided
by MASCC helps us to decide which patients need hospitalization and which
can be treated by antimicrobial therapy at home (3). Oral mucositis and
diarrhea related to mucosal damage are frequent complications of Cht as
well as targeted therapy with TKIs that can significantly affect patient’s QoL
and the ability to deliver full doses and complete therapy. Oral care protocols
are essential components in prevention and treatment of stomatitis, while
intensive local therapy protocols with antibiotics, anesthetics and/or
corticosteroids help to ameliorative symptoms (4). Diarrhea is quite common
in lung cancer patients receiving Cht with an even higher occurrence in
patients treated with TKIs (5). It could be life threatening in elderly, fragile
patients and in patients with concurrent neutropenia, thus requiring a rapid
and effective control. When dietary strategy does not work, or when patients
present with severe grade 3/4 diarrhea pharmacologic intervention with
loperamide or even somatostatin analogues should be initiated quickly. Skin
changes (rash, dry skin, paronychia) are the most frequent AEs associated
with targeted therapy for lung cancer next to diarrhea. Even though, they
are usually mild or moderate they hava negative impact on patient’s QoL
and might lead to dose modifications or even discontinuation. Prophylactic
measures with regular use of moisturizing products, sunshine protection and
careful skin hygiene are necessary. In case of severe but still localized changes
topical corticosteroids/antibiotics are indicated while a severe and prolonged
toxicity usually requires TKIs dose interruptions (6). Fatigue is a common
symptom reported in up to 80% of LC patients. In most cases it is impossible
to distinguish to what extend it is the adverse event of ST and to what of
disease. It is increasingly reported in patients receiving targeted therapy or
immunotherapy, and major improvements in recognition and treatment of
fatigue have been achieved recently (7). Immunotherapy with checkpoint
inhibitors (CPIs) represents a novel approach. By breaking of immune
self-tolerance it might lead to autoimmune/inflammatory adverse events,
designated as immune-related adverse events (irAEs), mainly including rash,
diarrhea, hepatitis and endocrinopathies (8). Although most of irAEs are of
low grade, some of them progress rapidly and prompt medical attention with
treatment interruption and the administration of glucocorticoids is critical.
Implications for nursing Oncology nurses should have in-depth knowledge on
adverse events of systemic therapy and must be familiar with the supportive
care protocols. Nursing interventions for prevention and treatment of
particular adverse events are presented in Table 1. Oncology nurses play a
key role in continuous education of patients, their families and caregivers
on adverse events. They are valuable members of the multidisciplinary team
performing ongoing assessment of AEs and monitoring of patients and
actively discussing potential solutions and improvements with other team
members, thus providing a high-quality patient-centered care.
NU03.04 SUPPORTIVE CARE IN PATIENTS RECEIVING SYSTEMIC
S104 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017