Long-Term Effect of an Interdisciplinary Supportive Care Intervention for Lung Cancer Survivors After Surgical Procedures

Abstract

Background: Surgical procedures provide the best chance for cure and long-term survival in non-small cell cancer (NSCLC). Persistent symptoms after surgical procedures are common, and they can negatively affect health-related quality of life (HRQOL). The purpose of this study was to examine the long-term effect of an interdisciplinary supportive care intervention to improve HRQOL, psychological distress, and symptoms in lung cancer survivors who were treated surgically.

Methods: Patients undergoing curative intent resection for NSCLC were enrolled in a prospective sequential design whereby the control group was accrued first, followed by the intervention group. Patients in the intervention group were assessed and presented by nurses at weekly interdisciplinary care meetings before surgical procedures, and received four educational sessions (physical, psychological, social, and spiritual well-being) after surgical procedures. Appropriate symptom management, social work, rehabilitation, and spiritual support interventions were coordinated by the study nurse. In both groups, HRQOL, psychological distress, and symptom severity were assessed at baseline and at 6, 12, 24, 36, and 52 weeks with the use of surveys that included the validated Functional Assessment of Cancer Therapy-Lung (FACT-L), Lung Cancer Subscale (LCS), and Distress Thermometer. Mean survey scores were analyzed with factorial analysis of covariance at 12 months.

Results: A total of 71 survivors (control = 33; intervention = 38) were accrued. No difference was found in age, baseline performance status, or stage of disease between groups. Patients in the intervention group had significantly less distress (mean, 1.0 versus 4.0; range, 0 to 10; p < 0.001) and more favorable mean FACT-L scores (126.1 versus 98.7; range, 0 to 140; p < 0.001) and LCS scores (29.4 versus 23.6; range, 0 to 32; p < 0.001) at 12 months. The mean scores of all categories of questions in FACT-L (physical, social/family, emotional, and functional well-being) were considerably more favorable in the intervention group at 12 months.

Conclusions: An interdisciplinary supportive care intervention improves psychological distress and HRQOL at 12 months after lung cancer surgical procedures. This study has important implications in improving HRQOL of lung cancer survivors after surgical procedures. Further study is warranted on incorporating the interdisciplinary personalized interventions used in this study into clinical practice for lung cancer survivors.

Figure 1

This is a graphical representation of 12 month scores for the psychological distress thermometer, FACT LCS, FACIT-Sp12, and FACT-L for the usual care and intervention groups. Error bars represent standard deviation.

Figure 2

This is a graphical representation of the trajectory of individual symptom scores for fatigue (figure 2a), sleep (figure 2b), dyspnea (figure 2c), cough (figure 2d), and pain (figure 2e) from the FACT-L across the 12 month study period for the usual care and intervention groups.

Figure 2

This is a graphical representation of the trajectory of individual symptom scores for fatigue (figure 2a), sleep (figure 2b), dyspnea (figure 2c), cough (figure 2d), and pain (figure 2e) from the FACT-L across the 12 month study period for the usual care and intervention groups.

Figure 2

This is a graphical representation of the trajectory of individual symptom scores for fatigue (figure 2a), sleep (figure 2b), dyspnea (figure 2c), cough (figure 2d), and pain (figure 2e) from the FACT-L across the 12 month study period for the usual care and intervention groups.

Figure 2

This is a graphical representation of the trajectory of individual symptom scores for fatigue (figure 2a), sleep (figure 2b), dyspnea (figure 2c), cough (figure 2d), and pain (figure 2e) from the FACT-L across the 12 month study period for the usual care and intervention groups.

Figure 2

This is a graphical representation of the trajectory of individual symptom scores for fatigue (figure 2a), sleep (figure 2b), dyspnea (figure 2c), cough (figure 2d), and pain (figure 2e) from the FACT-L across the 12 month study period for the usual care and intervention groups.