Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis.

OBJECTIVES: International guidelines recommend that rehabilitation be offered to people with thoracic cancer to improve symptoms, function, and quality of life. When rehabilitation interventions require a change in behaviour, the use of theory and behaviour change techniques (BCTs) enhance participation. Our objective was to systematically identify BCTs and examine their use in relation to the Capability, Opportunity, Motivation-Behaviour model and known enablers and barriers to engagement in this population. METHOD: Bibliographic databases and grey literature were searched for controlled trials of rehabilitation interventions for adults with lung cancer or mesothelioma, with no limits on language or date. Data on the application of behavioural change theory and BCTs were extracted, categorised using the BCT Taxonomy (v1) and described according to the "Capability, Opportunity, Motivation-Behaviour" model. RESULTS: Twenty-seven studies of exercise (n = 15) and symptom self-management (n = 12) interventions were identified. Four studies reported use of behavioural change theory; one study used symptom theory. Across studies, a mean (range) of 7 (1-18) BCTs were used, representing 26 of 93 possible BCTs included in the taxonomy. Most frequent enabling BCTs were "instructions on how to perform behaviours" (74%), "behavioural practice" (74%), and "action planning" (70%). BCTs to address barriers were less frequent and included "information about health consequences" (22%) and "verbal persuasion about capability" (7%) to change perceptions about benefits, burden, and harms. CONCLUSION: The application of behavioural change tools appears sub-optimal in this group of patients. Explicit use of BCTs targeting behavioural components upon which outcomes depend may improve the uptake and effectiveness of rehabilitation interventions.

Analysis of ICU treatment on resection of giant tumors in the mediastinum of the thoracic cavity.

OBJECTIVE: The purpose of this study was to assess prognosis after resection of giant tumors (including lobectomy or pneumonectomy) in the mediastinum. MATERIALS AND METHODS: Patients with resection of a giant tumor in the mediastinum of the thoracic cavity received ICU treatment including dynamic monitoring of vital signs, arterial blood pressure and CVP detection, determination of hemorrhage, pulmonary function and blood gas assay, treatment of relevant complications, examination and treatment with fiber optic bronchoscopy, transfusion and hemostasis as well as postoperative removal of ventilators by invasive and non-invasive sequential mechanical ventilation technologies. RESULTS: Six patients were rehabilitated successfully after ICU treatment with controlled postoperative errhysis and pulmonary infection by examination and treatment with fiber optic bronchoscopy without second application of ventilators and tubes after sequential mechanical ventilation technology. One patient died from multiple organ failure under ICU treatment due to postoperative active hemorrhage after second operative hemostasis. CONCLUSIONS: During peri-operative period of resection of giant tumor (including lobectomy or pneumonectomy) in mediastinum of the thoracic cavity, the ICU plays an important role in dynamic monitoring of vital signs, treatment of postoperative stress state, postoperative hemostasis and successful removal of ventilators after sequential mechanical ventilation.

Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service.

PURPOSE: Guidelines recommend screening patients with cancer to identify their rehabilitation needs. To help quantify this area of need and associated workload from an occupational therapy perspective in patients with thoracic cancer, we report the experiences of a dedicated rehabilitation service. METHODS: Consecutive patients were screened soon after diagnosis using items associated with occupational performance in the Sheffield Profile for Assessment and Referral for Care questionnaire. Those reporting predetermined levels of distress underwent a full occupational therapy evaluation; this generated a problem list from which individualised goals and interventions were instigated. RESULTS: Of 540 patients screened, 273 (51 %) reported levels of distress which warranted a full occupational therapy assessment. Of these, 260 (95%) reported a total of 681 problems (median of 4 [2-5] per patient). Mostly these lay within the domain of self care (553, 78%) in the categories of transfers, functional mobility and bathing/showering. A total of 646 goals (median of 2 [1-3] per patient) were formulated, resulting in 652 individual interventions, most frequently the provision of equipment (79%) or advice (32%) and referral to another professional/agency (23%). Patients considered that most goals were achieved (98%) and that the provision of equipment was useful (97%). CONCLUSIONS: About half of patients with thoracic cancer screened have occupational therapy needs around the time of diagnosis. Problems are mostly in the area of self-care, with equipment provision the most frequent intervention provided. Future work should examine the efficacy of occupational therapy interventions further.

Aspectos técnicos del abordaje anterior transmanubrial en la cirugía de los tumores del estrecho torácico / Technical Aspects of the Anterior Transmanubrial Approach in Thoracic Inlet Tumor Surgery

El tratamiento quirúrgico de los tumores del estrecho torácico superior supone un reto para el cirujano por su localización y por los elementos anatómicos que contiene dicha región. Se han propuesto varias vías de abordaje y cada una de ellas presenta ventajas e inconvenientes. En nuestra opinión, el abordaje anterior transmanubrial descrito en 1997 es uno de los más adecuados. Realizamos la descripción y comentarios sobre algunos detalles técnicos como ayuda al cirujano que pretenda realizar este abordaje, mostramos nuestros resultados sobre 5 pacientes y comentamos asimismo otros diferentes abordajes para esta patología(AU)

Surgical treatment of thoracic inlet tumors represents a challenge to the surgeon due to its location and anatomical elements contained in that region. Several surgical approaches have been proposed, each of them showing some advantages but drawbacks as well. In our opinion, the anterior transmanubrial approach described in 1997 is one of the most convenient. The objective of this paper is to describe and comment on some technical aspects of the procedure in order to aid surgeons who intend to perform this surgical approach. Moreover, we show our results in five patients and also comment on other approaches in this pathology(AU)

Factors influencing exercise performance in thoracic cancer.

BACKGROUND: Patients with incurable thoracic cancer often complain of a reduced ability to exercise, but the cause of this has been little studied. Thus, we have explored how various physiological and psychological factors relate to exercise performance in this group. METHODS: Inspiratory muscle strength, peripheral muscle power, lung function and mastery over breathlessness were assessed using sniff nasal inspiratory pressure, leg extensor power, simple spirometry and the mastery domain of the Chronic Respiratory Disease Questionnaire respectively. Exercise performance was assessed using the Incremental Shuttle Walking Test (ISWT) during which patients wore a K4 b(2) system permitting measurement of resting and breakpoint heart rate, minute ventilation (VE) and oxygen uptake (VO(2)). Relationships between ISWT distance and the four factors were determined using correlation and ß regression coefficients. RESULTS: Forty-one patients (21 male, mean (SD) age 64 (8) years) walked a median [IQR] of 320 [250-430] metres and reached a mean (SD) of 76 (10), 77 (25), and 48 (14) of their percent predicted maximum heart rate, VO(2), and VE respectively. Exercise performance was significantly associated only with inspiratory muscle strength (r = 0.42, P < 0.01) and peripheral muscle power (r = 0.39, P = 0.01). These factors were also significant determinants of exercise performance (ß coefficients [95%CI] 1.77 [0.53, 3.01] and 1.22 [0.31, 2.14] respectively). CONCLUSION: Of the factors examined, only inspiratory and peripheral muscle performance were significantly related to and predictive of exercise performance. Rehabilitation interventions which include inspiratory and peripheral muscle training are worth exploring further in this group of patients with thoracic cancer.

Subjective and objective assessment of quality of life after chest wall resection.

OBJECTIVE: To date, quality of life (QoL) after extensive chest wall resection is not known. This study analyses QoL in long-term survivors after extensive resection. METHODS: Retrospective analysis of 51 patients operated for non-small-cell lung cancer (NSCLC)/mediastinal tumour invading the chest wall, primary/secondary chest wall tumours. QoL and functional status of long-term survivors (>36 months) were studied using Borg scale, Mahler dyspnoea index, Functional Autonomy Measuring System (SMAF) and 36-item Short Form Health Survey (SF-36) questionnaire. Out of the 51 patients, pulmonary function tests were available before and after resection in 24 patients and were subjected to analysis. RESULTS: Five-year survival was 50%, 26 patients survived>36 months. At follow-up, 22/28 deaths were cancer related. Compared to baseline, the reduction of flow expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were 18% and 15%, respectively (p<0.001). The QoL study included 23 long-term survivors. A moderate/severe dyspnoea was present in 5/23 patients (21%). The SF-36 questionnaire revealed that, compared to controls, patients with chest wall resection experienced impaired QoL in physical functioning, in role physical, in body pain, in social functioning and in mental health. Objective measurements of pulmonary function correlated poorly with QoL, whereas subjective assessment of dyspnoea was significantly associated with QoL. CONCLUSIONS: This study shows that long-term survivors after extensive chest wall resection experienced moderate impairments in several QoL subscales. As previously reported in patients after pulmonary resection, subjective assessment such as dyspnoea correlated well with patient-perceived QoL.

[The application of combined antibacterial preparation Unazin for the prophylaxis of purulent postop complications at the clinic of thoracic oncology]. / Primenenie kombinirovannogo antibakterial'nogo preparata unazin dlia profilaktiki gnoinykh posleoperatsionnykh oslozhnenii v onkotorakal'noi klinike.

Antimicrobal preparation Unazin, combining sodium sulbactam and sodium ampicillin, characterized by broad antibacterial spectrum and potency to overcome the microorganisms stability, was applied in 15 patients in the early postoperative period after operations for pulmonary, esophageal, cardial cancers and mediastinal tumor. In these patients purulent-septic complications were not noted. According to the retrospective analysis data, of 846 patients, operated earlier, the complications have occurred in 131 (13.2%).

A method for reconstruction of large full-thickness defects of the bony thorax.

Wide resection in 12 cases of malignant or potentially malignant lesions of the chest wall resulted in full-thickness loss of skeleton and frequently of overlying soft tissues (defect greater than or equal to 15 cm in its smallest diameter or at least 90% of the sternum resected). In reconstruction of the defect, steel bars were used to replace lost ribs and a double layer of Marlex mesh for intercostal spaces. Soft-tissue coverage and primary closure were accomplished with current plastic surgical procedures and good stability of the chest wall was achieved. Protracted respiratory support was required in only one case. Postoperative pain was managed with epidural anesthesia and routine analgesics. Functionally and cosmetically satisfactory long-term results were obtained, with no infection and no need for removal of prosthetic material. The overall 5-year and 10-year actuarial survival rates were 60% and 37.5%. If lesions are radically resectable, the extent of thoracic wall resection need not be restricted because of inability to close the defects.