Interdisciplinary Palliative Care Intervention in Metastatic Non–Small-Cell Lung Cancer

Abstract

Introduction/Background Challenges and barriers continue to hinder the integration of palliative care models into comprehensive, ambulatory oncology care. This paper aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a NCI-supported Program Project informed the development of an interdisciplinary, tailored palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). Patient and Methods Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study over a one-year period of time. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Research nurses assisted patients in completing the clinical section of the data forms, and patients completed surveys and self-reports at baseline, 6, 12, and 24 weeks. Results Patients ranged in age from 40–84 years, 61% were Caucasian non-Hispanic, Sixty-six former (N=59) and current smokers had an average of 38 pack-year history of smoking. KPS, IADL, and Cognitive scores deteriorated significantly (p=.001, .009, and .042, respectively). Social Activity was stable, while Social Support increased significantly. Overall symptom distress score and Total symptom score both significantly increased at 24 weeks (p=.003 and .017, respectively). Physical Well-Being decreased significantly (p=.036), while the FACT-L, Facit-SP12, and Distress scores remained statistically stable over time. Conclusion Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving cancer treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.

The lung cancer patient, the pneumologist and palliative care: a developing alliance

“…In addition to the generally poor prognosis, the majority of lung cancer patients undergoes a progressive deterioration in terms of symptom burden or well-being during the course of their disease, as depicted most recently by KOCZYWAS and co-workers [140,141] in their observational studies involving NSCLC stage I-III (n=103) as well as NSCLC stage IV patients (n=114) over a period of up to 1 year. Thus, outcome analyses for lung cancer patients have already been extended far beyond sole survival or relapse data acquisition [142][143][144][145][146][147][148].…”

Improving Palliative Cancer Care

“…Since the release of the reports by the IOM and published advocacy statements, it is encouraging to state that progress has been made in the integration of PC NCP, 2013;Koczywas et al, 2013). Major hospice and key organizations are working together to integrate PC when caring for patients with cancer, which is recommended by the IOM Temel et al, 2010;Koczywas et al, 2013;NCP, 2013).…”

“…As in other cancer settings, challenges and barriers exist in the integration of models of PC into routine oncologic care in lung cancer (Koczywas et al, 2013).…”

“…The report urged the entire health-care industry (including all stakeholders) to reevaluate their roles and responsibilities in cancer care and work together to develop a higher-quality cancer care delivery system nationally (IOM, 2013). The report underscored the importance of developing, testing, and disseminating disease-specific models of PC (IOM, 2013), which can be successfully integrated into organizational systems to address the escalating challenges of delivering high-quality care (IOM, 2013;Koczywas et al, 2013). Development of disease-specific PC models may provide patients and families with support mechanisms more relevant to their needs (Gaertner, Wolf, Hallek, Glossman, & Voltz, 2011;IOM, 2013).…”

“…Major hospice and key organizations are working together to integrate PC when caring for patients with cancer, which is recommended by the IOM Temel et al, 2010;Koczywas et al, 2013;NCP, 2013).…”