Indiana University-Purdue University Indianapolis (IUPUI) / Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (N = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (n = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n = 23); and (4) those who rated all symptoms as highly important (n = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.

INTRODUÇÃO: Pacientes com câncer de pulmão metastático compreendem uma população bastante heterogênea. A média de sobrevida é de 8-10 meses, porém 25-30% dos pacientes morrem dentro de 6 meses e aproximadamente 20% sobrevivem mais que 18 meses após a disseminação da neoplasia. Por isso, além da Escala de Karnosfky (KPS) e ECOG, outros fatores são necessários para estimar o prognóstico destes pacientes, proporcionando assim uma melhor programação da terapia antitumoral e qualidade de vida, além da possibilidade de estratificar grupos para avaliação de novas drogas. A circunferência muscular do braço (CMB) estima a reserva de proteína corporal, sendo um indicador precoce de depleção nutricional. É uma medida objetiva, rápida, de baixo custo e nãoinvasiva, em comparação com outras investigações bioquímicas. OBJETIVO: Avaliar a CMB como fator prognóstico em pacientes com câncer de pulmão metastático. MÉTODOS: Foi realizada análise de sobrevida em 56 pacientes com câncer de pulmão não pequenas células (CPNPC), em estadio IV, com mais de uma metástase, os quais tiveram suas CMBs mensuradas logo após o diagnóstico. Os resultados da CMB foram classificados de acordo com o Percentual de Adequação, ajustado por sexo e idade. Os pacientes foram caracterizados como eutróficos (CMB > 90%) ou depletados (CMB <90%), e suas sobrevidas foram comparadas. RESULTADOS: A amostra apresentou idade média de 63 anos (47-80). A média do Percentual de Adequação foi de 89% (66-122), apresentando depleção 55% dos pacientes. A sobrevida média foi de 6,2 meses (95% IC:5,1-7,3). Nos pacientes eutróficos, a média de sobrevida foi 10,2 meses (95% IC: 9,2-11,1), e nos depletados foi de 5 meses (95% IC: 4,2-5,8), apresentando diferença estatisticamente significativa entre os dois grupos (P < 0.001). Esta diferença permaneceu significante na análise multivariada (P<0,001, análise de COX) com as co-variáveis KPS, idade, sexo, quimioterapia. CONCLUSÃO: Avaliação da CMB é um forte fator prognóstico em pacientes com CPNPC. Neste estudo, os pacientes depletados, com Percentual de Adequação da CMB < 90% tiveram baixa sobrevida global. / INTRODUCTION: Stage IV patients with lung cancer comprises a very heterogenous population. The median survival is 8-10 months but 25-30% of patients dies within 6 months and about 20% of patients survive longer than 18 months after metastatic spread. Strong prognostic factors other than karnofsky status or ECOG status are still needed to even better estimate the prognosis of these patients and to help in the decision making process of planning standard treatment options or to stratify patients for inclusion in innovative treatment trials. The mid arm muscular circunference (MAMC) is a bedside anthropometric measurement that estimates corporal protein reserve which is an early indicator of nutritional depletion. It has the advantages of being objective, rapid, repeatable, non-invasive and in-expensive in comparison to various biochemical investigations. OBJECTIVE: Our purpose was to evaluate MAMC as a potential prognostic factor in patients with metastatic lung cancer. METHODS: A prospective survival analysis of 56 non-selected, consecutive patients (29 women) with metastatic non small lung cancer who had their MAMC measured in the first nutritional evaluation. The MAMC results were expressed as a percentage of the expected reference values adjusted for sex and age. Patients were categorized as normal (MAMC > 90%) or depleted (AMC < 90%) and their overall survival was compared. RESULTS: The mean age of patients was 63 years (range 47 - 80). The mean MAMC percentage of the expected value was 89 (range 66 – 122), with 55% of our patients (31) classified as depleted by MAMC measurement. Median overall survival of all patients was 6,2 months (95% CI: 5,1 – 7,3). In the group of patients with normal MAMC, median overall survival was 10,2 months (95% CI: 9.2 – 11.1). In patients classified as depleted, the mean overall survival was 5.0 months (95% CI: 4.2 – 5.8). The overall survival differences between these two groups defined by the MAMC (normal x depleted), was highly statistically significant (P < 0.001 by the logrank test, HR=0.21, 95%CI: 0.09 – 0.5 for patients with normal MAMC). These differences remained significant in a multivariated analysis (P<0.001 by the Cox proportional hazards method), with the Karnofsky status, age, chemotherapy and sex as covariates. CONCLUSIONS: One measurement of mid arm muscular circumference in the first nutritional evaluation is a strong prognostic factor in patients with metastatic non small cell lung cancer. In our series, patients with <90% of expected MAMC had poor overall survival.

INTRODUÇÃO: Pacientes com câncer de pulmão metastático compreendem uma população bastante heterogênea. A média de sobrevida é de 8-10 meses, porém 25-30% dos pacientes morrem dentro de 6 meses e aproximadamente 20% sobrevivem mais que 18 meses após a disseminação da neoplasia. Por isso, além da Escala de Karnosfky (KPS) e ECOG, outros fatores são necessários para estimar o prognóstico destes pacientes, proporcionando assim uma melhor programação da terapia antitumoral e qualidade de vida, além da possibilidade de estratificar grupos para avaliação de novas drogas. A circunferência muscular do braço (CMB) estima a reserva de proteína corporal, sendo um indicador precoce de depleção nutricional. É uma medida objetiva, rápida, de baixo custo e nãoinvasiva, em comparação com outras investigações bioquímicas. OBJETIVO: Avaliar a CMB como fator prognóstico em pacientes com câncer de pulmão metastático. MÉTODOS: Foi realizada análise de sobrevida em 56 pacientes com câncer de pulmão não pequenas células (CPNPC), em estadio IV, com mais de uma metástase, os quais tiveram suas CMBs mensuradas logo após o diagnóstico. Os resultados da CMB foram classificados de acordo com o Percentual de Adequação, ajustado por sexo e idade. Os pacientes foram caracterizados como eutróficos (CMB > 90%) ou depletados (CMB <90%), e suas sobrevidas foram comparadas. RESULTADOS: A amostra apresentou idade média de 63 anos (47-80). A média do Percentual de Adequação foi de 89% (66-122), apresentando depleção 55% dos pacientes. A sobrevida média foi de 6,2 meses (95% IC:5,1-7,3). Nos pacientes eutróficos, a média de sobrevida foi 10,2 meses (95% IC: 9,2-11,1), e nos depletados foi de 5 meses (95% IC: 4,2-5,8), apresentando diferença estatisticamente significativa entre os dois grupos (P < 0.001). Esta diferença permaneceu significante na análise multivariada (P<0,001, análise de COX) com as co-variáveis KPS, idade, sexo, quimioterapia. CONCLUSÃO: Avaliação da CMB é um forte fator prognóstico em pacientes com CPNPC. Neste estudo, os pacientes depletados, com Percentual de Adequação da CMB < 90% tiveram baixa sobrevida global. / INTRODUCTION: Stage IV patients with lung cancer comprises a very heterogenous population. The median survival is 8-10 months but 25-30% of patients dies within 6 months and about 20% of patients survive longer than 18 months after metastatic spread. Strong prognostic factors other than karnofsky status or ECOG status are still needed to even better estimate the prognosis of these patients and to help in the decision making process of planning standard treatment options or to stratify patients for inclusion in innovative treatment trials. The mid arm muscular circunference (MAMC) is a bedside anthropometric measurement that estimates corporal protein reserve which is an early indicator of nutritional depletion. It has the advantages of being objective, rapid, repeatable, non-invasive and in-expensive in comparison to various biochemical investigations. OBJECTIVE: Our purpose was to evaluate MAMC as a potential prognostic factor in patients with metastatic lung cancer. METHODS: A prospective survival analysis of 56 non-selected, consecutive patients (29 women) with metastatic non small lung cancer who had their MAMC measured in the first nutritional evaluation. The MAMC results were expressed as a percentage of the expected reference values adjusted for sex and age. Patients were categorized as normal (MAMC > 90%) or depleted (AMC < 90%) and their overall survival was compared. RESULTS: The mean age of patients was 63 years (range 47 - 80). The mean MAMC percentage of the expected value was 89 (range 66 – 122), with 55% of our patients (31) classified as depleted by MAMC measurement. Median overall survival of all patients was 6,2 months (95% CI: 5,1 – 7,3). In the group of patients with normal MAMC, median overall survival was 10,2 months (95% CI: 9.2 – 11.1). In patients classified as depleted, the mean overall survival was 5.0 months (95% CI: 4.2 – 5.8). The overall survival differences between these two groups defined by the MAMC (normal x depleted), was highly statistically significant (P < 0.001 by the logrank test, HR=0.21, 95%CI: 0.09 – 0.5 for patients with normal MAMC). These differences remained significant in a multivariated analysis (P<0.001 by the Cox proportional hazards method), with the Karnofsky status, age, chemotherapy and sex as covariates. CONCLUSIONS: One measurement of mid arm muscular circumference in the first nutritional evaluation is a strong prognostic factor in patients with metastatic non small cell lung cancer. In our series, patients with <90% of expected MAMC had poor overall survival.

INTRODUÇÃO: Pacientes com câncer de pulmão metastático compreendem uma população bastante heterogênea. A média de sobrevida é de 8-10 meses, porém 25-30% dos pacientes morrem dentro de 6 meses e aproximadamente 20% sobrevivem mais que 18 meses após a disseminação da neoplasia. Por isso, além da Escala de Karnosfky (KPS) e ECOG, outros fatores são necessários para estimar o prognóstico destes pacientes, proporcionando assim uma melhor programação da terapia antitumoral e qualidade de vida, além da possibilidade de estratificar grupos para avaliação de novas drogas. A circunferência muscular do braço (CMB) estima a reserva de proteína corporal, sendo um indicador precoce de depleção nutricional. É uma medida objetiva, rápida, de baixo custo e nãoinvasiva, em comparação com outras investigações bioquímicas. OBJETIVO: Avaliar a CMB como fator prognóstico em pacientes com câncer de pulmão metastático. MÉTODOS: Foi realizada análise de sobrevida em 56 pacientes com câncer de pulmão não pequenas células (CPNPC), em estadio IV, com mais de uma metástase, os quais tiveram suas CMBs mensuradas logo após o diagnóstico. Os resultados da CMB foram classificados de acordo com o Percentual de Adequação, ajustado por sexo e idade. Os pacientes foram caracterizados como eutróficos (CMB > 90%) ou depletados (CMB <90%), e suas sobrevidas foram comparadas. RESULTADOS: A amostra apresentou idade média de 63 anos (47-80). A média do Percentual de Adequação foi de 89% (66-122), apresentando depleção 55% dos pacientes. A sobrevida média foi de 6,2 meses (95% IC:5,1-7,3). Nos pacientes eutróficos, a média de sobrevida foi 10,2 meses (95% IC: 9,2-11,1), e nos depletados foi de 5 meses (95% IC: 4,2-5,8), apresentando diferença estatisticamente significativa entre os dois grupos (P < 0.001). Esta diferença permaneceu significante na análise multivariada (P<0,001, análise de COX) com as co-variáveis KPS, idade, sexo, quimioterapia. CONCLUSÃO: Avaliação da CMB é um forte fator prognóstico em pacientes com CPNPC. Neste estudo, os pacientes depletados, com Percentual de Adequação da CMB < 90% tiveram baixa sobrevida global. / INTRODUCTION: Stage IV patients with lung cancer comprises a very heterogenous population. The median survival is 8-10 months but 25-30% of patients dies within 6 months and about 20% of patients survive longer than 18 months after metastatic spread. Strong prognostic factors other than karnofsky status or ECOG status are still needed to even better estimate the prognosis of these patients and to help in the decision making process of planning standard treatment options or to stratify patients for inclusion in innovative treatment trials. The mid arm muscular circunference (MAMC) is a bedside anthropometric measurement that estimates corporal protein reserve which is an early indicator of nutritional depletion. It has the advantages of being objective, rapid, repeatable, non-invasive and in-expensive in comparison to various biochemical investigations. OBJECTIVE: Our purpose was to evaluate MAMC as a potential prognostic factor in patients with metastatic lung cancer. METHODS: A prospective survival analysis of 56 non-selected, consecutive patients (29 women) with metastatic non small lung cancer who had their MAMC measured in the first nutritional evaluation. The MAMC results were expressed as a percentage of the expected reference values adjusted for sex and age. Patients were categorized as normal (MAMC > 90%) or depleted (AMC < 90%) and their overall survival was compared. RESULTS: The mean age of patients was 63 years (range 47 - 80). The mean MAMC percentage of the expected value was 89 (range 66 – 122), with 55% of our patients (31) classified as depleted by MAMC measurement. Median overall survival of all patients was 6,2 months (95% CI: 5,1 – 7,3). In the group of patients with normal MAMC, median overall survival was 10,2 months (95% CI: 9.2 – 11.1). In patients classified as depleted, the mean overall survival was 5.0 months (95% CI: 4.2 – 5.8). The overall survival differences between these two groups defined by the MAMC (normal x depleted), was highly statistically significant (P < 0.001 by the logrank test, HR=0.21, 95%CI: 0.09 – 0.5 for patients with normal MAMC). These differences remained significant in a multivariated analysis (P<0.001 by the Cox proportional hazards method), with the Karnofsky status, age, chemotherapy and sex as covariates. CONCLUSIONS: One measurement of mid arm muscular circumference in the first nutritional evaluation is a strong prognostic factor in patients with metastatic non small cell lung cancer. In our series, patients with <90% of expected MAMC had poor overall survival.

Bakgrund: Lungcancer är en av de dödligaste cancersjukdomarna. Fysisk aktivitet är en viktig del hos patienter med avancerad lungcancer eftersom fysisk aktivitet kan lindra symtom som uppstår efter en lungcancerbehandling. Syfte: Var att belysa faktorer som påverkar fysisk aktivitet hos patienter med avancerad lungcancer efter genomgången lungcancerbehandling. Metod: Studien är genomförd som en allmän systematisk litteraturstudie och baseras på sju resultatartiklar som har genomgått en granskning för att kunna fastställa ett resultat. Artiklarna var refereegranskade och publicerade mellan 2011–2021. Resultat: Brist på motivation är en bidragande faktor till varför fysisk aktivitet minskar hos patienter med avancerad lungcancer. Motivationen saknas på grund av de olika symtom och biverkningar som uppkommer efter en lungcancerbehandling. För att stärka motivationen krävs det stöd från sjuksköterskan eller utföra fysisk aktivitet tillsammans med vänner och familj. Gruppträning med andra människor som är i en liknande situation har visat sig vara hjälpsamt. Patienter som har avancerad lungcancer och som kan vara fysiskt aktiva i sin vardag upplever mer hopp inför framtiden. Trots att patienterna lider av avancerad lungcancer så känner de ändå hopp inför framtiden. Konklusion: Det som framkom i denna litteraturstudie var att fysisk aktivitet kan hjälpa till öka välbefinnandet och lindra lidande. Stöd från sjuksköterskan har visat sig vara hjälpsamt för patienter med en lungcancerdiagnos. / Background: Lung cancer is a cancer disease known to have a high mortality rate. Physical activity have a vital part in decreasing the symptoms of advanced lung cancer that occurs in connection with lung cancer treatment. Aim: To illustrate factors that effect physical activity in patients with advanced lung cancer after treatment. Method: This is a general literature review covering seven peer-reviewed journal articles published between 2011-2021. The articles chosen have been reviewed in order to establish a result. Result: Lack of motivation is a contributing factor to why physical activity decreases in patients with advanced lung cancer. The absence of motivation is caused by symptoms and reactions that occurs in connection with the lung cancer treatment. The nurse can help increase motivation by empowering the patient to improve the level of exercise. Friends and family can encourage and offer support. Group training with other people who are in a similar situation has proven to be helpful. Patients who have advanced lung cancer and who can be physically active in their everyday lives experience more hope for the future. Conclusion: What emerged in this literature study was that physical activity can increase comfort and ease suffering. Support from the nurse has proven to be helpful for patients with a lung cancer diagnosis.

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