Value of ’Detection of need for care’ in improving outcomes in patients with lung cancer.

Geerse, O. (Olaf) (2014) Value of ’Detection of need for care’ in improving outcomes in patients with lung cancer. thesis, Medicine.

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Abstract

Lung cancer is currently one of the most frequently diagnosed cancers worldwide and is associated with high morbidity and mortality. Detection of need for care (DNC) is the process consisting of completion of a distress screening instrument, discussion of the response pattern, and referral if needed or requested. Structural DNC might be beneficial in patients with lung cancer since a significant proportion of these patients experiences distress during or after treatment. This study investigated whether care and treatment guided by structural DNC leads to a better quality of life than usual care in patients with lung cancer. Furthermore, we investigated the effects of structural DNC on patient satisfaction, healthcare utilization, and survival. Patients were randomly assigned to either receive standard care (standard group) or extra care (CARE group). The Dutch version of the Distress Thermometer and Problem List (DT/PL) was used as screening tool. Patients in the CARE group completed the DT/PL before their scheduled outpatient clinic appointments at one week, 7 weeks, 13 weeks, and 25 weeks after randomization. Patients met individually with the psychosocial nurse at these time points to discuss the response pattern on the DT/PL and were referred if requested. Health-related quality of life at 6 months was the primary outcome parameter, and was assessed by the European Organization of Research and Treatment for Cancer, Quality of Life Questionnaire, C-30 (EORTC-QLQ-C30). Of the 226 patients randomized a total of 130 patients had died at the start of the analysis (67%). No significant difference in the quality of life subscale of the EORTC-QLQ-C30 between the two groups was found at 6 months. Patient satisfaction and healthcare utilization was also not significantly different between the study groups. Finally, no significant differences were found between the two study groups in overall and progression-free survival. Our study shows that structural DNC in patients with lung cancer did not have a significant beneficial effect on quality of life, patient satisfaction, health care utilization, and survival. However, some studies of similar design have shown a positive effect on quality of life; yet, other studies have shown no additional effect of regular distress assessment and psychosocial interventions on patient outcomes, as we did. Therefore, future studies should entail a clear and reproducible intervention, preferably with the use of a validated screening tool. Furthermore, the study size should be large enough to adequately assess potential benefits of structural DNC.

Item Type:	Thesis (Thesis)
Supervisor name:	Hiltermann, Dr. T.J.N. and Hoekstra-Weebers, Dr. JEHM
Supervisor name:	Kerstjens, prof. Dr. H.A.M.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/653

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