Impact of molecular alterations on quality of life and prognostic understanding over time in patients with incurable lung cancer: a multicenter, longitudinal, prospective cohort study.

PURPOSE: The purpose of this study is to investigate changes over time in quality of life (QoL) in incurable lung cancer patients and the impact of determinants like molecular alterations (MA). METHODS: In a prospective, longitudinal, multicentric study, we assessed QoL, symptom burden, psychological distress, unmet needs, and prognostic understanding of patients diagnosed with incurable lung cancer at the time of the diagnosis (T0) and after 3 (T1), 6 (T2) and 12 months (T3) using validated questionnaires like FACT-L, National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), PHQ-4, SCNS-SF-34, and SEIQoL. RESULTS: Two hundred seventeen patients were enrolled, 22 (10%) with reported MA. QoL scores improved over time, with a significant trend for DT, PHQ-4, and SCNS-SF-34. Significant determinants for stable or improving scores over time were survival > 6 months, performance status at the time of diagnosis, and presence of MA. Patients with MA showed better QoL scores (FACT-L at T1 104.4 vs 86.3; at T2 107.5 vs 90.0; at T3 100.9 vs 92.8) and lower psychological distress (NCCN DT at T1 3.3 vs 5; at T2 2.7 vs 4.5; at T3 3.7 vs 4.5; PHQ-4 at T1 2.3 vs 4.1; at T2 1.7 vs 3.6; at T3 2.2 vs 3.6), but also a worsening of the scores at 1 year and a higher percentage of inaccurate prognostic understanding (27 vs 17%) compared to patients without MA. CONCLUSION: Patients with tumors harboring MA are at risk of QoL deterioration during the course of the disease. Physicians should adapt their communication strategies in order to maintain or improve QoL.

[Medical training in palliative care at the Hannover Medical School: development of the interdisciplinary and cross-sectoral education in the cross-sectional subject Q13 (WEISE-Q13)]. / Ärztliche Ausbildung im Fach Palliativmedizin an der Medizinischen Hochschule Hannover ­ Weiterentwicklung der interdisziplinären und sektorenübergreifenden Lehre im Querschnittsbereich Q13 (WEISE-Q13).

BACKGROUND: The implementation of the cross-sectional subject of palliative care (Q13) at medical faculties in Germany is heterogeneous. In faculties without a chair for palliative medicine, other solutions are needed. OBJECTIVES: This study describes the development and implementation process of the new educational concept in Q13 at the Hannover Medical School and its evaluation by medical students and lecturers. MATERIALS AND METHODS: The new educational concept was developed in 2017/18 following the six-step approach of curriculum development by Kern, and was implemented and tested in the academic year 2018/19. Evaluation was assessed in two steps, both in qualitative and quantitative terms (mixed methods): an anonymous written evaluation by students with the option of free text answers and feedback discussions with lecturers. RESULTS: Students and lecturers welcomed the new educational concept in equal measures. Students thought that education in Q13 stimulates reflection on the individual attitude towards the issues of death and dying and prepares them for encounters with terminally ill and dying people. The case-based learning units in particular led to a consolidation of theoretical knowledge (i.e. pain management) with adequate patient orientation. Teachers positively highlighted the organization and the educational material. Content structuring was considered to be particularly helpful. CONCLUSIONS: With the new teaching concept, medical students feel well prepared for the treatment of terminally ill and dying patients. The combination of different learning formats with an interdisciplinary and cross-sectoral focus promotes education with a practical orientation.

Symptoms and Needs of Patients with Advanced Lung Cancer: Early Prevalence Assessment.

BACKGROUND: Little is known on symptom burden, psychosocial needs, and perception of prognosis in advanced lung cancer patients at the time of diagnosis, although early assessment is strongly recommended within the setting of daily routine care. METHODS: Twelve study sites cross-sectionally assessed symptoms and psychosocial needs of patients suffering from newly diagnosed incurable lung cancer. Assessment comprised NCCN distress thermometer, FACT-L, SEIQoL-Q, PHQ-4, and shortened and modified SCNS-SF-34 questionnaires. Additional prognostic information from both patients and physicians were collected. RESULTS: A total of 208 patients were evaluated. Mean age was 63.6 years, 58% were male, 84% suffered from stage IV lung cancer, and 71% had an ECOG performance status of 0-1. Mean distress level was 5.4 (SD 2.5), FACT-L total score was 86 (21.5), and TOI 50.5 (14.9). PHQ-4 was 4.6 (3.3), and shortened and modified SCNS-SF-34 showed 9 (8.7) unmet needs per patient. According to their physicians' perspective, 98.1% of patients were reflecting on and 85.2% were accepting incurability, while 26.5% of patients considered the treatment to be of curative intent. CONCLUSION: Our findings emphasize substantial domains of symptom burden seen in newly diagnosed, incurable lung cancer patients. Oncologists should be aware of these features and address prognostic issues early in the disease trajectory to facilitate opportunities to improve coping, advance care planning, and appropriate integration of palliative care, thus improving quality of life.