Lung Cancer: Lung Cancer I |

Evaluation of Causes of Distress in Patients With Lung Tumors Treated With Sterotactic Body Radiation Therapy FREE TO VIEW

Tasneem Kaleem, MD; Laeticia Hollant, BS; Megan Single, BS; Katherine Gaines, BS; Jacob Habboush; Heather Biers; Atiya Day; Robert Miller, MD
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Mayo Clinic, Jacksonville, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):700A. doi:10.1016/j.chest.2016.08.795
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Psychosocial distress during stereotactic body radiation therapy (SBRT) of lung tumors is poorly assessed. Since 2012, patients receiving SBRT in our clinic have been prospectively surveyed for common causes of distress. SBRT is a high dose per fraction regimen commonly utilized to treat smaller lung tumors either curatively or palliatively. Our patient reported distress (PRD) results expose common concerns of patients undergoing SBRT to the lung and reveal patterns within categories of distresses. Identification of stressors will allow physicians to treat patients with a holistic approach and provide patients with adequate resources during radiation therapy.

METHODS: Patients treated with SBRT at our institution receive a 30 question PRD survey including a linear analog measure of overall distress at the start of and/or during RT. Each of the 30 questions asks patients to rate a different form of distress on a scale of 1 to 5 (5 being the most distressed). The survey also asked patients to rate overall distress according to the National Comprehensive Cancer Network (NCCN) Distress Thermometer on a scale 0 to 10. The reported clinical results of the PRD questionnaire were retrospectively reviewed in patients receiving definitive or palliative SBRT for lung tumors from 04/02/2012 to 08/05/2015.

RESULTS: PRD surveys were completed by 77 patients, 36 (46.7%) male and 41 (53.2%) female. Median age was 73 years (range 35 to 91). The most common tumor histology was adenocarcinoma, 34 (43.4%). 34 patients (44.0%) received chemotherapy and 20 (25.9%) underwent surgery. Treatment intent was curative for 60 patients (78%). Overall, NCCN distress thermometer results ranged from 0 to 10, with a median of 4. The mean distress scores for the top five complaints ranged from 2.35 to 2.87. Top distresses were “Fatigue” (2.87), “How I feel during treatment” (2.67), “Sleep Difficulties” (2.44), “Pain that affects my daily function” (2.41), and “Out of pocket medical costs” (2.35). The least concerning complaints ranged from 1.22 to 1.41. Lower distresses were “My Job” (1.22), “Sexuality” (1.31), “My relationship with my spouse or partner” (1.35),“Power of attorney”(1.40), and “Anger” (1.41).

CONCLUSIONS: Patients’ major apprehensions were consistent with daily quality of life, including fatigue, emotions, pain and insomnia. Moreover, medical expenses were found to be a high point of distress. Highest reported stressors were aligned with the cost of SBRT and side effects associated with treatment. Lower ranked distressors were aligned with relationships, possibly indicating that patients solidified support systems prior to starting intensive therapies such as SBRT.

CLINICAL IMPLICATIONS: By Identifying common stressors, practitioners may more effectively communicate with patients issues regarding daily quality of life and provide appropriate resources to alleviate and ameliorate experience during therapy. This includes addressing quality of life concerns during weekly status checks and providing seamless referrals to financial aid, social work, and psychiatry. An integrated, holistic approach by physicians who are cognizant of distresses will improve doctor-patient relationships and as well as the patient's experience during SBRT.

DISCLOSURE: The following authors have nothing to disclose: Tasneem Kaleem, Laeticia Hollant, Megan Single, Katherine Gaines, Jacob Habboush, Heather Biers, Atiya Day, Robert Miller

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