Development of a decision tree to assess the severity and prognosis of stable COPD.

The aim of this study was to develop and validate a new method: a classification and regression tree (CART) based on easily accessible measures to predict mortality in patients with stable chronic obstructive pulmonary disease (COPD). This was a prospective study of two independent prospective cohorts: a derivation cohort with 611 recruited patients and a validation cohort with 348 patients, all followed for 5 yrs. CART analysis was used to predict 5-yr mortality risk using the following covariates from the derivation cohort: age, % predicted forced expiratory volume in 1 s (FEV(1)), dyspnoea, physical activity, general health and number of hospital admissions for COPD exacerbations in the previous 2 yrs. Age (≥ 75 or <75 yrs) provided the first branch of the COPD-CART. The highest mortality risk (0.74) was seen in patients >75 yrs of age with higher levels of dyspnoea and FEV(1) <50% pred. Patients with the lowest risk of 5-yr mortality (0.04) were <55 yrs of age with FEV(1) >35% pred and one or no recent hospitalisations for COPD exacerbations. A simple decision tree that uses variables commonly gathered by physicians can provide a quick assessment of the severity of the disease, as measured by the risk of 5-yr mortality.

Impact of changes in physical activity on health-related quality of life among patients with COPD.

The aim of this study was to evaluate whether changes in regular physical activity (PA) affect health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD). 611 patients (mean age 67.2+/-8.4 yrs; forced expiratory volume in 1 s 49.7+/-14.6) completed the St George's Respiratory Questionnaire (SGRQ), the Chronic Respiratory Questionnaire (CRQ) and the Medical Outcomes Short Form (SF-36) questionnaire. PA, defined as patients' self-reported regular walking times, was classified as low, moderate and high. After 5 yrs, 391 survivors completed these instruments again. After adjustment for relevant confounders, patients who reported low PA at baseline and who increased their PA over the study period improved their SGRQ and CRQ scores by 15.9 and 8.7 points, respectively. Patients who moved from moderate to high PA improved their SGRQ scores by 18.4 and their CRQ scores by 14.8. Slightly smaller increases were observed for patients who maintained a high level of PA throughout the study period. Maintaining a low level of PA or decreasing PA over the study period was associated with a significant HRQoL decline. Among COPD patients, a reduction in time spent engaging in PA or maintaining a low level may impair HRQoL, whereas an increase in PA can improve HRQoL parameters.

Classifying the severity of COPD: are the new severity scales better than the old?

BACKGROUND: Forced expiratory volume in 1 second cut-off points establish the severity of chronic obstructive pulmonary disease (COPD). OBJECTIVES: To compare how the American Thoracic Society (ATS), the British Thoracic Society (BTS), the Global Initiative for COPD (GOLD) and the ATS-European Respiratory Society (ATS-ERS) guidelines for rating COPD severity predict several significant outcomes. DESIGN: Five-year prospective cohort study. Spirometry was performed and health-related quality of life (HRQoL) assessed using the Short Form 36 Health Survey and the Saint George's Respiratory Questionnaire. Hospital admissions resulting from COPD exacerbation and mortality during a 5-year follow-up period were recorded. RESULTS: In all guidelines, the number of admissions was directly associated with COPD severity. The sensitivity and specificity for 5-year respiratory mortality were respectively 0.21 and 0.97 for the GOLD/ATS-ERS, 0.51 and 0.79 for the BTS, and 0.37 and 0.89 for the ATS guidelines. A similar pattern was seen for all-cause mortality. For HRQoL, statistically significant differences between guidelines were seen only for the BTS and ATS scales. CONCLUSIONS: These guidelines did not consistently stratify patients with regard to 5-year mortality and HRQoL. Although the BTS system was slightly superior, none of the guidelines were closely related to these outcomes. Other instruments are needed for a better determination of the severity of COPD.

Nuevas técnicas de estadificación del cáncer de pulmón: ecoendoscopia (EBUS) / No disponible

No disponible

El impacto psicológico del cáncer de pulmón en el paciente y su familia / The psychological impact of lung cancer on patients and their families

Escribimos este artículo con el objetivo de describir las necesidades psicológicas detectadas en el trabajo psico-oncológico realizado durante este año con los pacientes diagnosticados de cáncer de pulmón y con sus familias, en el Servicio de Respiratorio del Hospital de Galdakao (Bizkaia). Una psico-oncóloga proporciona atención psicológica a los pacientes y sus familias desde el mismo momento en que el médico neumólogo les comunica el diagnóstico de cáncer de pulmón. Esta intervención se mantiene a lo largo de su proceso de enfermedad y tratamiento. El diagnóstico de cáncer de pulmón va a cambiar la estructura vital del paciente y también de su familia, a los que consideramos cuidadores que necesitan a su vez de cuidados emocionales. Hemos detectado necesidades emocionales relacionadas con la ansiedad, la culpa o el miedo a la muerte entre otras, a las que hemos de evaluar y dar respuesta desde la Psico-oncología

The aim of this article is to describe the psychological needs detected during the pyscho-oncological work carried out during the year with patients diagnosed with lung cancer and their families in the Respiratory Services Department of Galdakao Hospital (Bizkaia). A psycho-oncologist provides psychological support to patients and their families from the moment the lung specialist diagnoses them as suffering from lung cancer. This involvement is maintained over the duration of the illness and treatment. The diagnosis of lung cancer will completely change a patient’s life and that of their family, whom we consider to be carers who are also in need of emotional reassurance. We have detected emotional needs relating to, inter alia, anxiety, guilt or fear of death, which we must assess and address from the field of psycho-oncology

[Assessment of quality of life in lung cancer patients]. / Evaluación de la calidad de vida en pacientes con cáncer de pulmón.

OBJETIVES: The aim of this study was to describe lung cancer patients' quality of life, measuring physical, psychological and social parameters, and general and specific symptoms of the disease using different questionnaires. METHODS: 103 primary lung cancer patients who were between 20 and 80 years old and recruited during one year were included. All patients fulfilled the generic health related quality of life (HRQoL) questionnaire SF-36 and the specific EORTC-C30. Also sociodemographic and clinical important data were collected. Differences in aspects of perceived quality of life by diagnostic group and stage were analysed. RESULTS: The results indicate that the patients with a higher disease stage had worse perception of their quality of life in comparison with patients in a lower stage of the disease. Likewise, small cell lung cancer patients, overall, showed a worse perception of their quality of life than non-small cell lung cancer patients. These differences were shown either by generic and the specific questionnaire scores. CONCLUSIONS: The results obtained in the study show that the SF-36 and EORTC capture the differences in the perceived quality of life in patients by diagnosis and evolution stage of the disease. All quality of life areas were already affected at the moment of the diagnosis of the disease. The scores of both questionnaires are coherent with clinical evaluation, based on the clinical stage, which support the discriminative validity of those instruments.

Evaluación de la calidad de vida en pacientes con cáncer de pulmón / Assessment of quality of life in lung cancer patients)

Objetivo: El objetivo de este estudio ha sido describir la calidad de vida de los pacientes afectados de cáncer de pulmón, midiendo parámetros físicos, psíquicos, sociales, y síntomas generales y específicos de la enfermedad, por medio de cuestionarios, e investigar si existen diferencias en aspectos de la percepción de su calidad de vida según diagnóstico. Métodos: Se incluyeron 103 pacientes con cáncer de pulmón primario con diagnóstico citohistológico de seguridad, con edades comprendidas entre 20 y 80 años, que fueron diagnosticados a lo largo de un año. Todos los pacientes rellenaron el cuestionario de calidad de vida genérico SF-36 y el cuestionario específico EORTC-C30, y se recogió información sobrevariables sociodemográficas y clínicas relevantes. Se analizan los resultados según grupo diagnóstico y estadificación. Resultados: Los resultados obtenidos indican que los pacientes con un estadio de la enfermedad más elevado muestran una peor calidad de vida en comparación con los pacientes que se encuentran en estadios más bajos de la enfermedad. Así mismo, los pacientes con células pequeñas en su conjunto muestran peor calidad de vida que los pacientes con diagnóstico de células no pequeñas. Estas diferencias pueden observarse tanto en las puntuaciones del cuestionario genérico como en las del cuestionario específico. Conclusiones: En conclusión, los resultados obtenidos en el estudio muestran que el SF-36 y el EORTC captan las diferencias existentes en la percepción de la calidad de vida de los pacientes según el diagnóstico y el estadio de evolución de la enfermedad. Todas las áreas de la calidad de vida están afectadas ya en el momento del diagnóstico. Las puntuaciones resultantes de estos 2 cuestionarios son coherentes con la valoración clínica según la estadificación, lo que apoya su validez discriminativa (AU)

Objetives: The aim of this study was to describe lung cancer patients’ quality of life, measuring physical, psychological and social parameters, and general and specific symptoms of the disease using different questionnaires.Methods: 103 primary lung cancer patients who were between 20 and 80 years old and recruited during one year were included. All patients fulfilled the generic health related qualityof life (HRQoL) questionnaire SF-36 and the specificEORTC-C30. Also sociodemographic and clinical important data were collected. Differences in aspects of perceived quality of life by diagnostic group and stage were analysed. Results: The results indicate that the patients with a higher disease stage had worse perception of their quality of life incomparison with patients in a lower stage of the disease. Likewise, small cell lung cancer patients, overall, showed a worse perception of their quality of life than non-small cell lung cancer patients. These differences were shown either by generic and the specific questionnaire scores. Conclusions: The results obtained in the study show that theSF-36 and EORTC capture the differences in the perceived quality of life in patients by diagnosis and evolution stage of the disease. All quality of life areas were already affected at the moment of the diagnosis of the disease. The scores of both questionnaires are coherent with clinical evaluation, based on the clinical stage, which support the discriminative validity of those instruments (AU)