Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Department of Thoracic and Cardiovascular Surgery, Ehime University Medical
School, Toon City/Japan
Background: Recurrent laryngeal nerve (RLN) paralysis can occur following
systematic upper mediastinal nodal dissection by radical surgery for primary
lung cancer. However, there have been very few reports. Methods: We
retrospectively reviewed the clinical data of 365 consecutive patients who
underwent radical surgery for primary lung cancer with an over 6-month
observation period in our institution from July 2010 to August 2015. There
were 22 cases that experienced hoarseness after lung cancer surgery (6.0%).
We could identify the movement of the vocal folds with a laryngoscope in 21
out of 22 cases (95.5%), because one patient refused to have the examination.
Categorical variables were analyzed with Fisher’s exact test and continuous
variables with the student’s-t test. P < 0.05 was considered statistically
significant for all tests. Results: Hoarseness subsequent to radical surgery
for primary lung cancer arose in 16 out of 308 (5.2%) cases of video-assisted
thoracic surgery (VATS) including robotic VATS, in contrast with six out of 88
cases (6.8%) of open thoracotomy. All patients who experienced hoarseness
had received upper mediastinal nodal dissection. Patients who had received
right upper nodal dissection experienced hoarseness in eight out of 150 cases
(5.3%), in contrast to 14 out of 84 cases (16.3%, P = 0.020) for left upper lymph
node dissection. Laryngoscopic examination revealed that five patients
(23.8%) were diagnosed with right RLN paralysis and 15 (71.4%) as left. One
patient who underwent VATS right upper lobectomy with upper mediastinal
and subcarinal nodal dissection had left RLN paralysis. There was a patient
(4.8%) who did not suffer from RLN paralysis, and one patient refused to
undergo the examination. Eleven out of 18 patients (61.1%) were identified to
improve the diagnosis of disorders of the vocal cords with the laryngoscope.
It took one to 24 months (average 6.5 months) to improve the movement of
the vocal cords observed with the laryngoscope. In addition, fourteen out of
19 cases (73.7%) were recognized for the improvement of their hoarseness.
It took one to 28 months (average 10.4 months) to improve the voice disorder
after surgery. Conclusion: In our cohort, 8.4% of patients who underwent
systematic upper mediastinal lymph node dissection had hoarseness as
a subjective symptom. However, 73.7% of patients who suffered from
hoarseness and 62.5% of patients who were identified as having disorders of
the vocal cords improved in more than two years.
Keywords: systematic mediastinal nodal dissection, hoarseness, recurrent
laryngeal nerve paralysis, primary lung cancer
POSTER SESSION 3 – P3.05: PALLIATIVE CARE/ETHICS
Symptoms, Therapeutic Interventions –
WEDNESDAY, DECEMBER 7, 2016
P3.05-001 PSYCHOLOGICAL INTERVENTION TO TREAT DISTRESS
AND SUFFERING EXPERIENCED BY PEOPLE WITH LUNG CANCER
NEARING THE END-OF-LIFE
Maria Ftanou 1 , Mary Duffy 2 , David Ball 3 , Olivia Wong 4 , Joy Forster 4
1 Psychology, Peter MacCallum Cancer Insititue, Melbourne/VIC/Australia, 2 Peter
MacCallum Cancer Centre, Melbourne/VIC/Australia, 3 Radiation Oncology, Peter
MacCallum Cancer Centre, East Melbourne/Australia, 4 Peter MacCallum Cancer
Centre, Melbourne/Australia
Background: Despite advances in medical interventions, lung cancer
continues to be associated with a poor prognosis with approximately 16% of
people with lung cancer living five years post diagnosis. This poor prognosis
can contribute to depression, anxiety, death anxiety and existential concerns
and fears relating to meaning and purpose of life. There is a growing body of
evidence indicating that behavioural and psycho-educational interventions
are efficacious in treating depression and anxiety in lung cancer patients,
however, little is known about how to psychologically treat suffering and
distress nearer to the end-of-life. Methods: A comprehensive search using
PsycINFO and Medline was undertaken to identify existential and meaning
centered psychotherapies that were used towards the end-of-life with people
with cancer. As the research in the area is in its infancy, all quantitative
study designs and qualitative studies were included. Studies that focused
on physical symptom management, dyads and bereavement interventions,
measurement of psychological distress or existential concerns were excluded.
Results: The search yielded a total of 62 articles, of which only 34 examined
the use of psychotherapies towards the end-of-life care of people with
cancer. The majority of these studies were focused on women with breast
cancer, used different outcome measures and included very few, if any,
participants with lung cancer. These studies identified and described at
least 14 novel psychotherapeutic interventions that could be used towards
the end-of-life. These interventions included: Legacy Activities, Life Review
Therapy, Meaning-Centred Group Psychotherapy, Individual Meaning-Centred
Psychotherapy, Dignity Therapy, Forgiveness Therapy, Meaning-Making
Psychotherapy, Outlook Psychotherapy, Supportive Group Interventions,
The Healing Journey Intervention, Cognitive Existential Interventions, Recreating
Your Life Therapy, Mindfulness Interventions and Managing Cancer
and Living Meaningfully. These interventions varied in the number of sessions
and the level of training required to administer the interventions. Some of
these interventions were manualized and others were less structured in their
approach. Some of these interventions show potential in alleviating distress
and suffering, improving life satisfaction, self-esteem and mood. Conclusion:
There are only a small number of studies that evaluate the efficacy of
psychotherapeutic interventions to be used with people with advanced
cancer towards the end-of-life. Although results are promising it is difficult
to conclude that one intervention is better than another. Further research is
required to trial and adapts these interventions for use with people with lung
cancer towards the end-of-life.
Keywords: Psychological Interventions, Existential distress, Therapies
POSTER SESSION 3 – P3.05: PALLIATIVE CARE/ETHICS
SYMPTOMS, THERAPEUTIC INTERVENTIONS –
WEDNESDAY, DECEMBER 7, 2016
P3.05-002 MALNUTRITION IS AN INDEPENDENT RISK FACTOR ON
SURVIVAL ON EGFR MUTATED PATIENTS DIAGNOSED WITH NON-
SMALL CELL LUNG CANCER
Martha De La Torre-Vallejo, Julissa Luvian-Morales, Ana Gonzalez-Ling, Jenny
Turcott, Oscar Arrieta
Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto
Nacional de Cancerología, Mexico City/Mexico
Background: Lung cancer continues to be the leading cause of cancer-related
death worldwide. In Mexico, EGFR mutation is around 31%. Malnutrition is
a common problem among patients with cancer, affecting up to 85% of endstage
cancer patients, and 50-56% advanced NSCLC patients. Malnutrition
poses an unfavorable prognosis and has also been associated with higher
incidence of treatment related toxicity. No evidence about malnutrition in
EGFR mutated patients has been described. The objective of the study is
to asses the relation between malnutrition and survival of patients with
NSCLC and EGFR mutation. Methods: One hundred-five patients diagnosed
with NSCLC haring EGFR mutation undergoing any line of treatment were
assessed from January 2015 to June 2016. Malnutrition was measured using
the Subjective Global Assessment tool (SGA), patients were classified as
without malnourishment (SGA=A) or malnourished (SGA=B+C). Overall
survival was compared with the Kaplan-Meier method. Results: Baseline
characteristics are shown in Table 1, 51.9% of patients were malnourished by
the time of evaluation. Overall survival (OS) was 13.6 months (95% CI:12.7-14.4
months). Patients without malnutrition at the time of treatment initiation
had a better OS than malnourished patients 14.2 vs 10.5 months (p=0.003)
(Figure 1). Malnutrition is a risk factor for death independently of age, sex
and treatment with TKIs versus chemotherapy (OR=8.7, 95% CI: 1.01-75.4,
p=0.049). Conclusion: Patients harbouring EGFR mutations benefit from more
effective treatments, and usually have better prognosis. Malnutrition is an
independent risk factor for mortality in this population, thus assessment of
nutritional status and a timely referral to a nutrition expert could result a
better prognosis and health related quality of life.
POSTER SESSION 3 – P3.05: PALLIATIVE CARE/ETHICS
SYMPTOMS, THERAPEUTIC INTERVENTIONS –
WEDNESDAY, DECEMBER 7, 2016
P3.05-003 ANXIETY AND DEPRESSION IN PATIENTS WITH EGFR+
NSCLC RECEIVING TREATMENT WITH TKIS
Ana Gonzalez-Ling, Martha De La Torre-Vallejo, Julissa Luvian-Morales, Oscar
Arrieta
Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto
Nacional de Cancerología, Mexico City/Mexico
Background: Patients with lung cancer (LC) report higher levels of anxiety
and depression than cancer patients in general. Targeted therapies, such
as tyrosine kinase inhibitors (TKIs) offer patients with EGFR mutations
improved survival outcomes with less associated toxicity. This type of
treatment has been associated with improvement on quality of life and
lower symptomatic burden, which influence emotional status. The aim
of this study is to report anxiety and depression prevalence and severity
on patients with EGFR mutation on the course of the first four months of
treatment with TKIs. Methods: A cohort of 76 LC patients receiving TKIs was
evaluated. Hospital Anxiety and Depression Scale (HADS) and Quality of Life
(QLQ-30) scores were registered at baseline (T0), and after treatment (two
cycles [T2] and four cycles [T4]). For each subscale of HADS, scores were rated: