The impact of comorbidity upon determinants of outcome in patients with lung cancer

Grose, Derek; Morrison, David S.; Devereux, Graham; Jones, Richard D.; Sharma, Dave; Selby, C.; Docherty, Kirsty; McIntosh, David E.; Nicolson, Marianne; McMillan, Donald C.; Milroy, Robert

doi:10.1016/j.lungcan.2014.11.012

Cited by 41 publications

(39 citation statements)

References 47 publications

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“…Cancer stage at the time of diagnosis is the most important predictor for treatment options, response to treatment and survival. Only 14% of patients are diagnosed in stage I, since lung cancer in early stages is often asymptomatic [4]. The majority of lung tumours is diagnosed at the advanced stage IV (men: 72.4%, women: 69.1%) with a poor prognosis compared to other cancer diseases [3], which is often associated with high psychological, physical and social stress for patients and family caregivers [5].…”

Section: Introductionmentioning

confidence: 99%

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

et al. 2020

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Background: Despite improvements in diagnostics and therapy, the majority of lung tumours are diagnosed at advanced stage IV with a poor prognosis. Due to the nature of an incurable disease, patients need to engage in shared decision making on advance care planning. To implement this in clinical practice, effective communication between patients, caregivers and healthcare professionals is essential. The Heidelberg Milestones Communication Approach (MCA) is delivered by a specifically trained interprofessional tandem and consists of four milestone conversations (MCs) at pivotal times in the disease trajectory. MC 1 (Diagnosis): i.e. prognosis; MC 2 (Stable disease): i.e. prognostic awareness; MC 3 (Progression): i.e. reassessment; MC 4 (Best supportive care): i.e. end of treatment. In between MCs, follow-up calls are carried out to sustain communication. This study aimed to assess to what extent the MCA was implemented as planned and consolidated in specialized oncology practice. Methods: A prospective observational process evaluation study was conducted, which focused on the implementation fidelity of the MCA. All MCs during two assessment periods were included. We analysed all written records of the conversations, which are part of the routine documentation during MCs and follow-up calls. Adherence to key aspects of the manual was documented on structured checklists at the beginning of the implementation of the MCA and after 6 months. The analysis was descriptive. Differences between the two assessment periods are analysed with chi-square tests. Results: A total of 133 MCs and 54 follow-up-calls (t1) and of 172 MCs and 92 follow-up calls (t2) were analysed. MC 2 were the most frequently completed conversations (n = 51 and n = 47). Advance care planning was discussed in 26 and 13% of MC 2 in the respective assessment periods; in 31 and 47% of MC 2, prognostic awareness was recorded. The most frequently documented topic in the follow-up calls was the physical condition in patients (82 and 83%). Conclusion: The implementation of a trajectory-specific communication concept was largely successful. Additional studies are needed to understand how fidelity could be further improved. Trial registration: DRKS00013469 / Date of registration: 22.12.2017.

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Section: Introductionmentioning

confidence: 99%

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

et al. 2020

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“…Common comorbid conditions were COPD and cardiovascular diseases (e.g., atrial fibrillation, stroke, and heart failure). Although comorbidity seems to be a predisposing factor for UHAs, there remains debate in the scarce literature concerning the effect of comorbidity on healthcare utilization and prognosis in cancer patients [8,16,17]. To our knowledge, no unequivocal relationship between comorbidities and healthcare utilization in lung cancer patients could be established.…”

Section: Causes and Outcome Of Unplanned Admissionsmentioning

confidence: 94%

Characteristics and outcome of unplanned hospital admissions in patients with lung cancer: a longitudinal tertiary center study. Towards a strategy to reduce the burden

Cuppens

Oyen

Derweduwen

et al. 2016

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UHAs in lung cancer were more cancer- than therapy-related. Majority of patients (2/3) were not seen by their general practitioner. A significant number of same day returns were noted. UHAs in patients with poor PS, uncontrolled cancer and cancer-related events had the worst outcome. This work is a first step in identifying specific characteristics of UHAs in lung cancer patients, which may lead to strategies to reduce the burden of UHAs.

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“…The majority of European countries do not collect many of these items, and it would take significant investment and political support to achieve this. Assessing comorbidities is a fundamental part of patient evaluation prior to making a treatment plan, and there is good evidence for the influence of comorbidity on outcome [51][52][53][54]. The Charlson index was developed in the late 1970s and validated on a cohort of patients with breast cancer [55].…”

Section: Extended Patient Featuresmentioning

confidence: 99%

ERS statement on harmonised standards for lung cancer registration and lung cancer services in Europe

Rich

Baldwin

Beckett³

et al. 2018

Eur Respir J

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The European Respiratory Society (ERS) task force for harmonised standards for lung cancer registration and lung cancer services in Europe recognised the need to create a single dataset for use in pan-European data collection and a manual of standards for European lung cancer services.The multidisciplinary task force considered evidence from two different sources, reviewing existing national and international datasets alongside the results of a survey of clinical data collection on lung cancer in 35 European countries. A similar process was followed for the manual of lung cancer services, with the task force using existing guidelines and national or international recommendations for lung cancer services to develop a manual of standards for services in Europe.The task force developed essential and minimum datasets for lung cancer registration to enable all countries to collect the same essential data and some to collect data with greater detail. The task force also developed a manual specifying standards for lung cancer services in Europe.Despite the wide variation in the sociopolitical landscape across Europe, the ERS is determined to encourage the delivery of high-quality lung cancer care. Both the manual of lung cancer services and the minimum dataset for lung cancer registration will support this aspiration.

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The impact of comorbidity upon determinants of outcome in patients with lung cancer

Cited by 41 publications

References 47 publications

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

Characteristics and outcome of unplanned hospital admissions in patients with lung cancer: a longitudinal tertiary center study. Towards a strategy to reduce the burden

ERS statement on harmonised standards for lung cancer registration and lung cancer services in Europe

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