Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Clin Oncol. 2024 Oct 20;42(30):3570-3580. doi: 10.1200/JCO.24.00048. Epub 2024 Aug 1.
In patients with lung cancer, dyspnea is one of the most prevalent and disabling symptoms, for which effective treatments are lacking. We examined the efficacy of a nurse-led brief behavioral intervention to improve dyspnea in patients with advanced lung cancer.
Patients with advanced lung cancer reporting at least moderate breathlessness (n = 247) were enrolled in a randomized trial of a nurse-led two-session intervention (focused on breathing techniques, postural positions, and fan therapy) versus usual care. At baseline and weeks 8 (primary end point), 16, and 24, participants completed measures of dyspnea (Modified Medical Research Council Dyspnea Scale [mMRCDS]; Cancer Dyspnoea Scale [CDS]), quality of life (Functional Assessment of Cancer Therapy-Lung [FACT-L]), psychological symptoms (Hospital Anxiety and Depression Scale), and activity level (Godin-Shephard Leisure Time Physical Activity Questionnaire). To examine intervention effects, we conducted analysis of covariance and longitudinal mixed effects models.
The sample (Age = 66.15 years; 55.9% female) primarily included patients with advanced non-small cell lung cancer (85.4%). Compared with usual care, the intervention improved the primary outcome of patient-reported dyspnea on the mMRCDS (difference = -0.33 [95% CI, -0.61 to -0.05]) but not the CDS total score at 8 weeks. Intervention patients also reported less dyspnea on the CDS sense of discomfort subscale (difference = -0.59 [95% CI, -1.16 to -0.01]) and better functional well-being per the FACT-L (difference = 1.39 [95% CI, 0.18 to 2.59]) versus the control group. Study groups did not differ in overall quality of life, psychological symptoms, or activity level at 8 weeks or longitudinally over 24 weeks.
For patients with advanced lung cancer, a scalable behavioral intervention alleviated the intractable symptom of dyspnea. Further research is needed on ways to enhance intervention effects over the long-term and across additional outcomes.
在肺癌患者中，呼吸困难是最常见和最致残的症状之一，但缺乏有效的治疗方法。我们研究了一种由护士主导的简短行为干预措施，以改善晚期肺癌患者的呼吸困难。
至少有中度呼吸困难的晚期肺癌患者（n=247）参加了一项护士主导的两阶段干预（侧重于呼吸技术、姿势和风扇疗法）与常规护理的随机试验。在基线和第 8 周（主要终点）、第 16 周和第 24 周，参与者完成了呼吸困难（改良医学研究委员会呼吸困难量表[mMRCDS]；癌症呼吸困难量表[CDS]）、生活质量（癌症治疗肺功能评估[FACT-L]）、心理症状（医院焦虑和抑郁量表）和活动水平（Godin-Shephard 休闲时间体力活动问卷）的评估。为了检验干预效果，我们进行了协方差分析和纵向混合效应模型分析。
该样本（年龄=66.15 岁；55.9%为女性）主要包括晚期非小细胞肺癌患者（85.4%）。与常规护理相比，干预措施改善了患者报告的 mMRCDS 呼吸困难的主要结果（差异=-0.33[95%置信区间，-0.61 至-0.05]），但在第 8 周时 CDS 总分没有改善。干预组患者还报告 CDS 不适感子量表的呼吸困难程度较低（差异=-0.59[95%置信区间，-1.16 至-0.01]），且根据 FACT-L，功能健康状况较好（差异=1.39[95%置信区间，0.18 至 2.59]），而对照组则没有差异。在第 8 周或 24 周的纵向研究中，两组患者的整体生活质量、心理症状或活动水平均无差异。
对于晚期肺癌患者，一种可扩展的行为干预措施缓解了难以控制的呼吸困难症状。需要进一步研究如何在长期内提高干预效果，并扩大到其他结果。
