Heidelberg Milestones Communication (HeiMeKOM) - Experiences, Best Practice Examples and Recommendations from the Final Symposium on January 30 and 31 in 2020

Current research suggests that missed nursing care is widespread in preoperative lung cancer patients in China, and preoperative airway management nursing care for lung cancer patients is not standardized. Missed nursing care for preoperative lung cancer patients, on the other hand, is rarely investigated, particularly from the patient's perspective. This study aimed to develop and validate the MISSCARE Survey for pre-operative patients with lung cancer in China. This study generated the preliminary draft of the MISSCARE Survey - Lung Cancer Patient (MS-LCP) and tested its reliability and stability through three rounds of lung cancer resection (494, 50, and 309 cases, respectively). 20 patients and 6 experts determined the face and content validity. EFA and CFA assessed construct and convergent validity. Internal consistency, including Cronbach's alpha, Spearman-Brown reliability, and re-test reliability, was also examined. The scale contained 15 items, including specific care, communicative care, timely care, and basic care. KMO was 0.932 (> 0.6), and Bartlett's Test of Sphericity showed P = 0.000 (<0.05). The attribution factor's item loads ranged from 0.765 to 0.853, accounting for 82.20% of the variation. The scale's Cronbach's alpha, Spearman-Brown, and retest reliability were 0.945, 0.879, and 0.824. CFA showed goodness of fit (RMSEA = 0.021, χ2/df = 1.138, GFI = 0.900, AGFI = 0.945, CFI = 0.996, NFI = 0.967, IFI = 0.996). For each dimension, AVE ranged from 0.555 to 0.717 (>0.50) and CR from 0.861 to 0.904 (>0.70). The MS-LCP was reliable and valid in this study, making it appropriate for the Chinese lung cancer patient population. This tool is more objective in its presentation of missed nursing care, assisting nursing staff in optimizing nursing procedures before surgery, increasing the implementation of higher-quality tumor care, and promoting the recovery of lung cancer surgery patients.

Quantitative Assessment of Lung Function in Stage I and Stage III Lung Radiation Therapy Patients Using 4DCT-based Ventilation Imaging

Lung cancer is the leading cause of cancer death in the US. About 50% of lung cancer patients are current smokers at the time of diagnosis and up to 83% continue to smoke after diagnosis. A recent study suggests that people who continue to smoke after a diagnosis of early-stage lung cancer almost double their risk of dying. Despite a growing body of evidence that continued smoking by patients after a lung cancer diagnosis is linked with less effective treatment and a poorer prognosis, the belief prevails that treating tobacco dependence is useless. With improved cancer treatments and survival rates, smoking cessation among lung cancer patients has become increasingly important. There is a pressing need to clarify the role of smoking cessation in the care of lung cancer patients. Objective: This paper will report on the benefits of smoking cessation for lung cancer patients and the elements of smoking cessation treatment, with consideration of tailoring to the needs of lung cancer patients. Results: Given the significant benefits of smoking cessation and that tobacco dependence remains a challenge for many lung cancer patients, cancer care providers need to offer full support and intensive treatment with a smoking cessation program that is tailored to lung cancer patients’ specific needs. Conclusion: A tobacco dependence treatment plan for lung cancer patients is provided.

Cervical cancer is a malignant disease with high prevalence rate in the world. One of the therapies are often given as a therapy for the cervical cancer patients in advanced stage is chemotherapy. Chemotherapy in cervical cancer patients takes a long time and requires high cost therapy. We report case of the woman who had diagnosted advanced stage of cervical cancer. Patients were given 6 series of chemotherapy, however during chemotherapy until 3 series, the patient was burdened by productivity and non-medical costs. This caused, patient decided not to continue further chemotherapy and choose alternative treatments i.e. drinking medicinal herbs as the treatment of the disease.

Cognitive impairment in late-stage cancer is an increasingly seen but underappreciated aspect of terminal care. This review integrates recent findings on the multifactorial etiology and expression of cognitive impairment in terminally ill cancer patients, considering data from neuroimaging, psychopharmacology, theoretical psychology, and palliative medicine. Structural and functional alterations—detected by modalities like CT, MRI, and fMRI—correlate with impairments in executive function, memory, attention, and emotion regulation. These deficits are further influenced by existential distress, cultural background, spiritual thought, and psychological resilience. Therapeutic interventions—ranging from cognitive behavioral therapy and meaning-centered psychotherapy to pharmacologic agents and caregiver-spiritual support—can maintain dignity and foster emotional balance, even in the face of irreversible neurological deterioration. This review article highlights the importance of an integrated, patient-oriented approach to cognitive care in cancer, supporting early identification, interdisciplinary interventions, and culturally sensitive support that respects the patient's mind, identity, and values at the end-of-life.

Lung cancer management challenges amidst COVID-19 pandemic: hope lives here.

Most patients with lung cancer are diagnosed at advanced stages of the disease, where chemotherapy plays an important role. This prospective study was conducted to determine the impact of palliative chemotherapy on quality of life (QOL) in advanced-stage lung cancer patients. QOL in lung cancer out-patients was assessed at diagnosis and end of treatment using the EORTC QLQ-C30 questionnaire. Changes in mean QOL scores were calculated. The correlation between patients' tumor response and change in QOL scores was also studied. Scoring was done according to the EORTC manual and results were analyzed using SPSS statistical package. Out of 52 patients, 46 (88.46%) were men and six (11.54%) were women. After chemotherapy, patients' overall QOL score improved significantly (P = 0.005). Cognitive functioning significantly worsened (P = 0.01). Physical functioning (PF) and emotional functioning (EF) scores improved, while role functioning (RF) and social functioning (SF) scores worsened. Pain, dyspnea, and sleep significantly improved (P = 0.001, P = 0.001, and P = 0.005 respectively). On the other hand, nausea, vomiting (P = 0.000), diarrhea (P = 0.004), and financial difficulties (P = 0.009) worsened. Overall QOL improved in patients with partial tumor response (PR) and stable disease (SD) (P = 0.044 and P = 0.000, respectively), but worsened in progressive disease group (PD) (P = 0.648). Symptom scores improved markedly in PR and SD groups. Chemotherapy toxicity was maximum in PD group (P = 0.028). Global quality of life and symptom control significantly improved in lung cancer patients after chemotherapy. Deterioration of cognitive functioning, increased financial burden, and chemotherapy-related toxicity were noteworthy. Changes in QOL were coherent with patients' tumor response.

Present study investigated the relationships among psychosocial, spiritual well being and death anxiety among advance stage cancer patients in order to improve the prognosis and quality of life as well as reduce their sufferings. By studying various well beings and death anxiety, it would be possible to identify the psychological needs of cancer patients in order to help the treatment of cancer patients and make them mentally strong to cope with their disease. Data was collected from Sample of 80 advance stage cancer patients, from six exclusive cancer hospitals of western and central zones of India. Patients were identified as advance stage patients as per clinical details (treatment history, diagnostic profile & records) and diagnosis was done by treating doctors of the hospital. Results were analyzed to identify the psychological needs of cancer patients. Obtained results were analyzed using SPSS for descriptive and variance analysis followed by multiple correlation. Results revealed negative correlation between psychosocial well being and death anxiety and also same results were found between spiritual well being and death anxiety. It indicates that enhancing the psychosocial and spiritual well being of cancer patients can reduce their death anxiety and promote better quality of life. Palliative care and Cognitive Behaviour therapy can play a very important role in this regard.

PET Imaging-Based Phenotyping as a Predictive Biomarker of Response to Tyrosine Kinase Inhibitor Therapy in Non-small Cell Lung Cancer: Are We There Yet?

6113 Background: Adverse publicity about smoking may lead to feelings of guilt among lung cancer patients or pessimism about their future, potentially compromising health-related quality of life (QoL) and adherence with medical advice. QoL is an important outcome in clinical trials, particularly where survival rates are low. We aim to compare QoL and illness perceptions of lung cancer patients depending on smoking history. Methods: Clinical data, measures of QoL (EORTC-QLQ-C30+LC13) and illness perceptions (Brief IPQ – includes items to assess perceived severity, causality, timeline, understanding, emotional impact, and control over illness) were completed by 190 newly diagnosed lung cancer patients (Non-small cell: 75%; Mean age: 68 years, range: 48-85 years; 58% males). Of these, 24% were current smokers, 69% former smokers, and 7% never smoked. Results: Although overall QoL was similar between the three smoker groups, there was a significant effect of smoking status on QoL subscale emotional function (EF)(F(2,168)=4.08,p=.019). Those who never smoked had significantly higher EF than current smokers (p=.03). There was also a significant effect of smoking history on cough (F(2,166);=5.40 ,p=.005) with smokers reporting significantly greater levels than former smokers (p=.004). Smokers were more likely than former smokers (p=.015) to attribute their lung cancer to smoking (F(2,161)=16.49,p&lt;.000). Furthermore, there was a significant effect of smoking on the perceived timeline of illness (F(2,144)=3.33,p=.039), with smokers being more pessimistic about this than former smokers (p=.043). Conclusions: These findings have implications for planning the care of lung cancer patients. In addition to the different treatment needs of smokers and former smokers, smokers may need greater support to cope with the emotional effects of their illness. Our findings suggest that smokers blame their illness on their own behaviour, and have a more pessimistic view of likely survival time, so they may need more encouragement to accept life-prolonging treatments. These results may also inform tailored smoking-cessation advice.

Adoptive cellular immunotherapy of cancer has been limited to date mostly due to the poor immunogenicity of tumor cells, the immunocompromised status of cancer patients in advanced stages of their disease, and difficulties in raising sufficient numbers of autologous tumor-specific T lymphocytes. On the other hand, the slow tumor penetration and short half-life of exogenously administered tumor-specific monoclonal antibodies have provided major obstacles for an effective destruction of tumor cells by the humoral effector arm of the immune system. Attempts to improve the efficacy of adoptive cellular cancer immunotherapy have led to the development of novel strategies that combine advantages of T cell-based (i.e., efficient tumor penetration, cytokine release and cytotoxicity) and antibody-based (high specificity for tumor-associated antigens) immunotherapy by grafting cytotoxic T lymphocytes (CTLs) with chimeric receptors composed of antibody fragments (which recognize tumor-cell antigens) and a cellular activation motif. Antigen recognition is therefore not restricted by major histocompatibility genes, as the physiological T-cell receptor, but rather is directed to native cell surface structures. Since the requirements of major histocompatibility complex (MHC) restriction in the interaction of effector cells with target cells are bypassed, the tumor cell-binding of CTLs grafted with chimeric receptors is not affected by down-regulation of HLA class I antigens and by defects in the antigen-processing machinery. Ligand binding by the chimeric receptor triggers phosphorylation of immunoglobulin tyrosine activation motifs (ITAMs) in the cytoplasmic region of the molecule and this activates a signaling cascade that is required for the induction of cytotoxicity, cytokine secretion and proliferation. Here, the authors discuss the potential of lymphocytes grafted with chimeric antigen receptors in the immunotherapy of malignant disease.

Investigation on Circulating Neonatal Nav1.5 (nNav1.5) and Its Antibodies in the Blood and Serum of 4T1 Orthotopic Mice Model and Breast Cancer Patients from Hospital Universiti Sains Malaysia (HUSM)

BackgroundRadiomics-based image metrics are not used in the clinic despite the rapidly growing literature. We selected eight promising radiomic features and validated their value in decoding lung cancer heterogeneity.MethodsCT images of 236 lung cancer patients were obtained from three different institutes, whereupon radiomic features were extracted according to a standardized procedure. The predictive value for patient long-term prognosis and association with routinely used semantic, genetic (e.g., epidermal growth factor receptor (EGFR)), and histopathological cancer profiles were validated. Feature measurement reproducibility was assessed.ResultsAll eight selected features were robust across repeat scans (intraclass coefficient range: 0.81–0.99), and were associated with at least one of the cancer profiles: prognostic, semantic, genetic, and histopathological. For instance, “kurtosis” had a high predictive value of early death (AUC at first year: 0.70–0.75 in two independent cohorts), negative association with histopathological grade (Spearman’s r: − 0.30), and altered expression levels regarding EGFR mutation and semantic characteristics (solid intensity, spiculated shape, juxtapleural location, and pleura tag; all p < 0.05). Combined as a radiomic score, the features had a higher area under curve for predicting 5-year survival (train: 0.855, test: 0.780, external validation: 0.760) than routine characteristics (0.733, 0.622, 0.613, respectively), and a better capability in patient death risk stratification (hazard ratio: 5.828, 95% confidence interval: 2.915–11.561) than histopathological staging and grading.ConclusionsWe highlighted the clinical value of radiomic features. Following confirmation, these features may change the way in which we approach CT imaging and improve the individualized care of lung cancer patients.

ObjectiveTo investigate the clinical effectiveness of pulmonary rehabilitation health education and respiratory function training based on virtual reality (VR) technology in promoting early postoperative pulmonary function recovery in patients undergoing thoracoscopic surgery for lung cancer.MethodsA single-center, non-concurrent, pre-post controlled study was conducted. Ninety-five patients who underwent thoracoscopic radical resection of lung cancer between June 2023 and February 2024 were assigned to the control group and received routine postoperative respiratory function education. Another 95 patients admitted between March and December 2024 were assigned to the intervention group and received VR-based health education combined with training guidance. The intervention lasted for 3 days. Outcomes compared between groups included pulmonary function recovery, time to extubation, incidence of postoperative pulmonary complications, satisfaction with health education, and safety of the intervention.ResultsThe compliance rate in the intervention group was 94.74%, significantly higher than that in the control group (85.26%) (p < 0.05). On postoperative day 3, FVC%, FEV1%, MVV, and MVV% were significantly better in the intervention group compared to the control group (p < 0.01). The time to extubation was also significantly shorter in the intervention group (p < 0.01). There was no significant difference in the incidence of pulmonary complications within 7 days after surgery between the two groups (p > 0.05). Patient satisfaction in the intervention group was 91.11%, significantly higher than 72.84% in the control group (p < 0.01). Three mild adverse events were reported during the VR intervention, which were resolved after temporary suspension of the session and did not affect the completion of the intervention.ConclusionVR-based health education combined with postoperative respiratory function training effectively improves patient compliance, promotes early pulmonary function recovery, shortens extubation time, and enhances patient satisfaction. It is clinically safe and feasible and holds promise for broader application in postoperative nursing care for lung cancer patients.

Patients with advanced lung cancer and their caregivers are confronted with a complex situation as their disease-related burden comprises physical, psychosocial, and spiritual needs. During the illness trajectory with limited prognosis, they are exposed to different multidisciplinary healthcare settings and providers that challenge the continuity and coordination of care. Additionally, decision-making between active cancer treatment and end-of-life care constitutes a continuous balancing act. Several studies have shown that early integration of palliative care and adequate advance care planning improve quality of life and satisfaction with care. For this strategy, the communication skills of healthcare providers and interprofessional collaboration should be strengthened. A longitudinally structured communication approach along pivotal milestones of the disease can empower patients by facilitating coping and prognostic awareness, and achieve early integration of palliative care and advance care planning. Good interprofessional collaboration and communication lead to better coordination and continuity of care.