Qualıty of lıfe assessment ın metastatıc (Stage IV) lung cancer patıents

Abstract

Amaç: Yeni tani konmus, platinyum-bazli kemoterapi tedavisi goren metastatik akciger kanserli hastalarin yasam kalitelerinin tedavi oncesi, birinci, ikinci ve ucuncu kemoterapi suresince degerlendirilmesi, yas ve sigara kullanim aliskanliklarinin yasam kalitesine etkisi ve yasam kalitesi ile performans skalalarin (ECOG, KPS) arasindaki iliskinin incelenmesi bu calismanin esas amacidir.Materyal ve Metot: Bu calisma Istanbul Kartal Egitim ve Arastirma Hastanesi Onkoloji Klinik ve Polikliniklerinde yurutulmustur. Yaygin evre kucuk hucreli akciger kanseri ve metastatik (Evre IV) kucuk hucre disi akciger kanserli 17 hasta calismaya dahil edildi. Hastalar EORTC QLQ-C30 anketi ve anketin akciger kanseri QLQ-LC13 modulunu, tedavi oncesi, birinci, ikinci ve ucuncu kemoterapi suresince cevaplandirdi. Demografik, klinik datalar ve performans statuleri kaydedildi.Bulgular: Tedavi oncesinde ucuncu kemoterapi sonrasina suresince hastalarda tedaviye bagli yan etkilerde: agizda agri (p ? 0.05, F= 1.085), disfaji (p ? 0.05, F= 7.040), periferal noropati (p ? 0.05, F= 7.040) ve alopesi (p ? 0.05, F= 0.9904) sonuclarinda anlamli degisiklikler gozlenmistir. Ayni zamanda hastalarin genel saglik durumlarinda ve fiziksel fonksiyonlari (p ? 0.005, F= 1.520), rol fonksiyonlari (p ? 0,05, F= 1.016), duygusal fonksiyonlari (p ? 0.05, F= 3.173), kognitif fonksiyonlari (p ? 0.005, F= 4.152) ve sosyal fonksiyonlarini (p ? 0.05, F=6.14) iceren fiziksel fonksiyonlarinda anlamli degisiklikler saptanmistir. Bulanti-kusma (p ? 0.05, F= 1.301), dispne (p ? 0.023, F= 1.931), insomnia (p ? 0.05, F= 1.523) ve istah kaybi (p ? 0.003, F= 1.668) semptomlarinda artis gozlenmistir. Hastalarin ortalama yasi 59' idi ve yasam kalitesi ile yas arasinda anlamli bir iliski yoktu (p ? 0.05). Sigara kullanim suresi ile yasam kalitesi arasinda anlamli bir iliski yoktu (p ? 0.05). Hastalarin ortalama ECOG performans skoru 2.05 ± 0.15 , KPS 60.00 ± 4.11 olarak hesaplandi. ECOG parformance skoru ile EORTC QLQ-C30 anketinin butun bolumleri arasinda anlamli negatif (r= -0.71, p ? 0.05) bir korelasyon gozledi. KPS ile EORTC QLQ-C30 anketinin butun bolumleri arasinda ise anlamli pozitif bir korelasyon oldugu saptandi (r= 0.74, p ? 0.05)Sonuc: Bu calisma performans durum skalalarinin (ECOG, KPS) metastatik akciger kanserli hastalarda guclu bir prognostik faktor oldugunu onaylamaktadir. Calismamiz ile performans skalasi ECOG= 2 olan yaygin evre kucuk hucreli akciger kanseri ve metastatik (Evre IV) kucuk hucre disi akciger kanserli hastalarinin platinyum bazli tedaviden fayda gormediklerini gostermistir. Bu grup hastalarda yasam kalitesi olcumu rutin olarak yapilarak elde edilen veriler, yan etkileri dusuren, yasam kalitesini yukselten yeni tedavi planlarinin gelistirlmesinde kullanilabilir. Onkoloji hastalarına iyi bir farmasötik bakım verilebilmesi açısından doktorların, klinik eczacıların ve de hemşirelerin bir yoğun bakım ekibi oluşturması çok önemlidir Bu yan etkiler bir klinik eczacı katkısıyla kontrol altına alınabilir. Gelecek araştırmalarda onkoloji ekibinde bir klinik eczacının rolünü ve faydasını belirleyici çalışmalar yapılabilir.Anahtar Kelimler: Yasam Kalitesi, ECOG, KPS, Metastatik kucuk hucre-disi akciger kanseri, Yaygin kucuk hucreli akciger kanseri, Klinik Eczaci

Purpose: The aims of the present study are to investigate the possible changes in QOL between the baseline (pre-treatment), after the first, second and third chemotherapy treatments with newly diagnosed patients with metastatic SCLC (small cell lung cancer) and NSCLC (non-small cell lung cancer) receiving platinum-based chemotherapy, to determine which effects factors such as age and smoking habit have on quality of life, and to observe the correlation between quality of life and performance status scales (ECOG, KPS).Materials and Methods: The study was conducted at the outpatient and inpatient Oncology Clinics of the Lutfi Kirdar Teaching and Research Hospital in Istanbul, Turkey Seventeen patients with advanced small-cell lung cancer and with stage IV non-small cell lung cancer were considered. Patients filled the EORTC core questionnaire QLQ- C30 (version 3.0) and the lung cancer module QLQ-LC13 at four different times (pre-treatment and post-treatment) during the treatment and follow-up. Demographic, clinical data and performance status of the patients were also recorded.Results: From the baseline to the third chemotherapy, there was a significant increase in treatment-related side effects including sore mouth (p ? 0.05, F= 1.085), dysphagia (p ? 0.05, F= 6.559), peripheral neuropathy (p ? 0.05, F= 7.040), and alopecia (p ? 0.05, F= 0.9904). At the same time, there was a significant decrease in GHS (p ? 0.005, F= 1.520) and Functional Scales including physical functioning (p ? 0.05, F= 3.336), role functioning (p ? 0,05, F= 1.016), emotional functioning(p ? 0.05, F= 3.173), cognitive functions (p ? 0.005, F= 4.152), and social functioning (p ? 0.05, F=6.14). There was also an increase in symptom scales including nausea and vomiting (p ? 0.05, F= 1.301), dyspnea (p ? 0.023, F= 1.931), insomnia (p ? 0.05, F= 1.523), and appetite loss (p ? 0.003, F= 1.668). The mean age of the patients was 59 and there was not a correlation between age and quality of life (p ? 0.05). There was not a significant correlation between duration of smoking and QOL scores (p ? 0.05). The mean ECOG performance was 2.05 ± 0.15 and KPS was 60.00 ± 4.11. There was a strong significant negative correlation (r= -0.71, p ? 0.05) between ECOG performance and all domains of the EORTC QLQ-C30. There was a strong significant positive correlation (r= 0.74, p ? 0.05) between KPS and all domains of the EORTC QLQ-C30.Conclusion: This study confirmes that performance status scales (ECOG, KPS) are strong prognostic factors in patients with advance lung cancer. It appears from our data that advanced NSCLC and SCLC PS=2 patients probably do not benefit from platinum-based chemotherapy. The assessments of QOL should also be routine for all patients with advanced NSCLC and SCLC. This information may be useful in developing treatment programs that minimize chemotherapy side effects while maximizing the well being of patients. The formation of a oncology care team consisting of physicians, clinical pharmacists and nurses is very important in order to provide good pharmaceutical care to the lung cancer patients. These problems might be managed with the contribution of a clinical pharmacist. Further studies could focus on defining the role and benefits of the clinical pharmacist within the Oncology team.Key Words: Quality of Life, ECOG, KPS, Metastatic non-small cell lung cancer, Advanced small-cell lung cancer, Clinical Pharmacist