Lung Cancer Patients' Recovery Studied
CancerWise - November 2007
By Sandi Stromberg
Doctors are studying a more efficient way to help identify symptoms and ultimately improve quality of life after thoracic cancer surgery through a study in which patients self-report symptoms using an interactive voice response system (IVRS).
Goal of the study
Besides providing information to help understand postoperative side effects, symptom data also help doctors know what patients may go through so they can better prepare them before surgery.
Testing the system are M. D. Anderson’s Ara Vaporciyan, M.D., and Wayne Hofstetter, M.D., in the Department of Thoracic and Cardiovascular Surgery, the study’s principal investigator Xin Shelley Wang, M.D., in the Department of Symptom Research, and Charles Cleeland, Ph.D., chair of the Department of Symptom Research.
Significance of study
Obtaining symptom data in real time is a challenge.
“We’ve learned that pain is highest after surgery, then decreases, but after a month increases again only to drift back to baseline after four or five months,” Vaporciyan says.
He speculates that this is due to a combination of factors.
When patients come in for their one-month checkup, they’re told they can begin to resume normal activity. At the same time, their pain medications run out, and they’re transitioned to ibuprofen.
“Simply knowing that the pain will most likely increase and conveying it to the patient helps us alert them to move a little slower and avoid the unnecessary pain,” he says.
Wang adds, “If IVRS is effective in identifying postoperative symptoms, we could extend patients’ use of it to help decrease or manage their side effects.”
Knowing that patients who undergo thoracic surgery for esophageal cancer, lung cancer or lung metastases are at risk for certain symptoms, researchers devised the IVRS, a computer- and telephone-based assessment system that allows patients to report problems resulting from surgery.
These post-surgical side effects include:
- Sleep disturbance
- Shortness of breath
All patients enrolled in this ongoing randomized study receive a weekly phone call from the IVRS. In turn, they use the keypads of their telephones to rate and record symptoms as they occur. Information is reported using a 0-10 scale — with 0 meaning not affected, 10 being as bad as you can imagine.
If any of the targeted symptoms exceeds the threshold value chosen by the investigators, one of two things happens for the control and study groups:
Control group – The information for patients in this group is recorded and archived for study at a later date.
Study group – The symptom data for the patients in this group is forwarded to the health care team to review and potentially act upon.
The study, developed by Wang and Cleeland, is one of three clinical trials targeting a continuum of symptom management for patients with NSCLC from stage I to stage IV.