First Point Scientific

Cough is a common and burdensome symptom in interstitial lung disease (ILD), particularly IPF. It has a profound impact on quality of life and is associated with disease progression and poorer prognosis. This chapter outlines its epidemiology, pathophysiology, assessment and management. Underlying mechanisms include structural distortion, neurogenic inflammation and sensory pathway sensitisation, with comorbidities such as gastro-oesophageal reflux and obstructive sleep apnoea contributing to symptom burden. Evaluation of cough includes both subjective and objective measures. Management focuses on treatable traits, with speech and behavioural therapy showing benefit. Pharmacological options remain limited; however, opioids have demonstrated efficacy and new therapies are emerging. In non-IPF ILD, immunosuppressants may reduce cough, though evidence is mixed. Future research should aim to standardise outcome measures, enrich study populations and clarify whether cough acts as a driver or marker of disease progression. <bold>Cite as:</bold> van Manen MJG, Wu Z, Molyneaux PL, <italic>et al.</italic> Chronic cough and interstitial lung disease. <italic>In:</italic> Song W-J, McGarvey L, Cho PSP, <italic>et al.</italic>, eds. Chronic Cough (ERS Monograph). Sheffield, European Respiratory Society, 2025; pp. 206–224 [<ext-link>https://doi.org/10.1183/2312508X.10027924</ext-link>].

PurposeWhile significant progress in metastatic breast cancer (MBC) treatment has prolonged survival and improved prognosis, there remain substantial gaps in providing patient-centered supportive care. The specific care delivery needs for metastatic cancer differ from that of early-stage cancer due to the incurable nature and lifelong duration of the condition. The objective of this study was to assess how patients living with MBC would re-imagine cancer care delivery.MethodsThis qualitative study was conducted in partnership with patient-led organizations Guiding Researchers and Advocates to Scientific Partnerships (GRASP) and Project Life, a nonprofit, online wellness community founded by patients with MBC for patients living with MBC. Virtual semi-structured interviews (n = 36) were conducted with Project Life members purposively sampled from the groups’ overall membership. The interview guide contained items surrounding patients’ lived experiences of MBC, greatest unmet needs related to care, and perspectives on virtual wellness community involvement. Interviews were coded using two-stage deductive and inductive analysis.ResultsThree major themes for re-imagining cancer care delivery were identified, including holistic care, information needs, and conceptual shifts. Within these several subthemes emerged with patients re-imagining referrals to non-oncological services, caregiver support, acceptance of integrative medicine, streamlined clinical trial enrollment, curated quality patient resources, MBC-specific terminology and approaches, long-term life and goal-of-care planning, and patient-centered voice throughout.ConclusionPeople living with metastatic cancers have specific supportive care needs. These findings highlight patient-driven areas for re-imagination that are most salient for individuals with MBC.

The COVID-19 pandemic substantially impacted the delivery of oncology care, particularly for individuals with metastatic cancers. The objective of this study was to qualitatively evaluate the impacts of COVID-19 on metastatic breast cancer (MBC) care among patients. This study consisted of 36 semi-structured qualitative interviews conducted virtually with people living with MBC, who were members of a patient support organization called Project Life. Project Life is an MBC patient-led, web-based wellness community. Responses were analyzed using Phronetic Iterative Analysis. Interviews were conducted from March 14, 2022, to May 31, 2022. Analysis from 36 individual in-depth qualitative interviews revealed the following themes during COVID-19: (1) variable preferences for telehealth (2) disruptions to care, (3) virtualization of social care. Wide variations existed in preferences surrounding telehealth, centered around ideas of convenience. Disruptions to care included delays to diagnostic care, isolation from caregivers, and interruptions associated with COVID-19 infection. These results call for adaptability in oncology care given wide-ranging preferences on telehealth and the shifting of available support services.