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1.  Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent 
Background
Although it is recommended that smokers undergoing surgery for lung cancer quit smoking to reduce post-operative complications, few studies have examined patterns of smoking in the peri-operative period. The goals of this study were to determine: 1) patterns of smoking during post-operative recovery, 2) types of cessation strategies used to quit smoking, and 3) factors related to smoking after lung cancer surgery.
Methods
Data were collected from 94 patients through chart review, tobacco, health-status, and symptom questionnaires at 1, 2, and 4-months after surgery. Smoking status was assessed through self-report and urinary cotinine measurement.
Results
Eighty-four patients (89%) were ever-smokers and 35 (37%) reported smoking at diagnosis. Thirty-nine (46%) ever-smokers remained abstinent, 13 (16%) continued smoking at all time-points, and 32 (38%) relapsed. Ten (46%) of those who relapsed were former-smokers and had not smoked for at least 1-year. Sixteen (46%) of those who were smoking at diagnosis received cessation assistance with pharmacotherapy being the most common strategy. Factors associated with smoking during recovery were younger age and quitting smoking ≤ six-months before the diagnosis of lung cancer. Factors that were marginally significant were lower educational level, male gender, lower number of comorbidities, and the presence of pain
Conclusion
Only half of those who were smoking received assistance to quit prior to surgery. Some patients were unable to quit and relapse rates post-surgery were high even among those who quit more than 1-year prior. Innovative programs incorporating symptom management and relapse prevention may enhance smoking abstinence during post-operative care.
doi:10.1016/j.lungcan.2009.01.021
PMCID: PMC3805262  PMID: 19321223
lung cancer; thoracic surgery; smoking cessation; symptom management
2.  Quality of Life and Symptom Burden among Long Term Lung Cancer Survivors: Changing and Adapting 
Introduction
Information is limited regarding health-related quality of life (QOL) status of long term (greater than five years) lung cancer survivors (LTLCS). Obtaining knowledge about their QOL changes over time is a critical step towards improving poor and maintaining good QOL. The primary aim of this study was to conduct a seven-year longitudinal study in survivors of primary lung cancer that identified factors associated with either decline or improvement in QOL over time.
Methods
Between 1997 and 2003, 447 LTLCS were identified and followed through 2007 using validated questionnaires; data on overall QOL and specific symptoms were at two periods: short-term (less than three years) and long-term post diagnosis. The main analyses were of clinically significant changes (greater than 10%) and factors associated with overall QOL and symptom burden for each period and for changes over time.
Results
Three hundred two (68%) underwent surgical resection only and 122 (27%) received surgical resection and radiation/chemotherapy. Recurrent or new lung malignancies were observed in 84 (19%) survivors. Significant decline or improvement in overall QOL over time were reported in 155 (35%) and 67 (15%) of 447 survivors, respectively. Among the 155 whose QOL declined, significantly worsened symptoms were fatigue (69%), pain (59%), dyspnea (58%), depressed appetite (49%), and coughing (42%). The symptom burden did not lessen among the 67 who reported improvement, suggesting survivors had adapted to their compromised physical condition.
Conclusions
LTLCS suffered substantial symptom burden that significantly impaired their QOL, indicating a need for targeted interventions to alleviate their symptoms.
doi:10.1097/JTO.0b013e3182397b3e
PMCID: PMC3241852  PMID: 22134070
lung cancer; long term survivors; health-related quality of life; symptoms; pain; dyspnea; fatigue
3.  Are quit attempts among U.S. female nurses who smoke different from female smokers in the general population? An analysis of the 2006/2007 tobacco use supplement to the current population survey 
BMC Women's Health  2012;12:4.
Background
Smoking is a significant women's health issue. Examining smoking behaviors among occupational groups with a high prevalence of women may reveal the culture of smoking behavior and quit efforts of female smokers. The purpose of this study was to examine how smoking and quitting characteristics (i.e., ever and recent quit attempts) among females in the occupation of nursing are similar or different to those of women in the general population.
Methods
Cross-sectional data from the Tobacco Use Supplement of the Current Population Survey 2006/2007 were used to compare smoking behaviors of nurses (n = 2, 566) to those of non-healthcare professional women (n = 93, 717). Smoking characteristics included years of smoking, number of cigarettes, and time to first cigarette with smoking within the first 30 minutes as an indicator of nicotine dependence. Logistic regression models using replicate weights were used to determine correlates of ever and previous 12 months quit attempts.
Results
Nurses had a lower smoking prevalence than other women (12.1% vs 16.6%, p < 0.0001); were more likely to have ever made a quit attempt (77% vs 68%, p = 0.0002); but not in the previous 12 months (42% vs 43%, p = 0.77). Among those who ever made a quit attempt, nurses who smoked within 30 minutes of waking, were more likely to have made a quit attempt compared to other women (OR = 3.1, 95% CI: 1.9, 5.1). When considering quit attempts within the last 12 months, nurses whose first cigarette was after 30 minutes of waking were less likely to have made a quit attempt compared to other females (OR = 0.69, 95% CI: 0.49, 0.98). There were no other significant differences in ever/recent quitting.
Conclusions
Smoking prevalence among female nurses was lower than among women who were not in healthcare occupations, as expected. The lack of difference in recent quit efforts among female nurses as compared to other female smokers has not been previously reported. The link between lower level of nicotine dependence, as reflected by the longer time to first cigarette, and lower quit attempts among nurses needs further exploration.
doi:10.1186/1472-6874-12-4
PMCID: PMC3328253  PMID: 22429917
4.  National Cancer Institute Conference on Treating Tobacco Dependence at Cancer Centers 
Journal of Oncology Practice  2011;7(3):178-182.
The National Cancer Institute cancer centers possess the credibility to help smokers quit. With the greater life expectancies forecast for patients with cancer, addressing smoking at cancer centers has taken on greater importance.
doi:10.1200/JOP.2010.000175
PMCID: PMC3092659  PMID: 21886500
5.  Quality of Life Supersedes the Classic Prognosticators for Long-Term Survival in Locally Advanced Non–Small-Cell Lung Cancer: An Analysis of RTOG 9801 
Journal of Clinical Oncology  2009;27(34):5816-5822.
Purpose
To determine the added value of quality of life (QOL) as a prognostic factor for overall survival (OS) in patients with locally advanced non–small-cell lung cancer (NSCLC) treated on Radiation Therapy Oncology Group RTOG-9801.
Patients and Methods
Two hundred forty-three patients with stage II/IIIAB NSCLC received induction paclitaxel and carboplatin (PC) and then concurrent weekly PC and hyperfractionated radiation (to 69.6 Gy). Patients were randomly assigned to amifostine (AM) or no AM during chemoradiotherapy. The following pretreatment factors were analyzed as prognostic factors for OS: Karnofsky performance status, stage, sex, age, race, marital status, histology, tumor location, hemoglobin, tobacco use, treatment arm (AM v no AM) and QOL scores (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 [QLQ-C30] and Lung Cancer 13 [LC-13]). A multivariate (MVA) Cox proportional hazards model was performed using a backwards selection process.
Results
Of the 239 analyzable patients, 91% had a baseline global QOL score. Median follow-up time was 59 months for patients still alive and 17 months for all patients. Median baseline QLQ-C30 global QOL score was 66.7 on both treatment arms. Whether the global QOL score was treated as a dichotomized variable (based on the median score) or a continuous variable, all other variables fell out of the MVA for OS. Patients with a global QOL score less than 66.7 had an approximately 70% higher rate of death than patients with scores ≥ 66.7 (P = .004). A 10-point higher baseline global QOL score corresponded to a decrease in the hazard of death by approximately 10% (P = .004). The other independent QOL predictors for OS were the QLQ-C30 physical functioning (P = .011) and LC-13 dyspnea scores (P = .012).
Conclusion
In this analysis, baseline global QOL score replaced known prognostic factors as the sole predictor of long-term OS for patients with locally advanced NSCLC.
doi:10.1200/JCO.2009.23.7420
PMCID: PMC2793002  PMID: 19858383
6.  Symptom Management in Hepatocellular Carcinoma 
Worldwide, hepatocellular carcinoma (HCC) causes approximately one million deaths every year. Due to advanced stage at diagnosis, HCC carries a five-year survival rate of <5%, if diagnosed with unresectable disease. Incidence for HCC is higher in males and individuals of Asian descent, where viral hepatitis is endemic and a leading cause of HCC. The purpose of this article is to provide an overview of the complexity in symptom management of patients with HCC. The occurrence of multiple symptoms in HCC patients is common, and may include pain, fatigue, weight loss, and obstructive syndromes such as ascites and jaundice. Because of the limitations in the efficacy of current treatment options for HCC, aggressive symptom management is key to preserving physical functioning and QOL in this cancer population. Oncology nurses can play an integral role in symptom management of HCC patients. A multidisciplinary team approach to symptom management of HCC patients is critical due to the multidimensionality of common symptoms in this cancer population.
doi:10.1188/08.CJON.759-766
PMCID: PMC2881685  PMID: 18842532
7.  Smoking Cessation and Lung Cancer: Oncology Nurses Can Make a Difference 
Seminars in oncology nursing  2008;24(1):16-26.
OBJECTIVES
Provide an overview of the impact of smoking after a diagnosis of lung cancer, discuss the relationship between smoking cessation and improved outcomes during the lung cancer trajectory, present information about tobacco dependence evidence-based treatments, reimbursement for these treatments, and tobacco-related resources available for patients and health care professionals, and emphasize the important role of nurses.
DATA SOURCES
Published articles, reports, websites, and research studies.
CONCLUSION
Tobacco use is associated with 30% of cancer deaths. Prevention of tobacco use and cessation are primary ways to prevent lung cancer. However, even after a diagnosis of lung cancer, smoking cessation is important in improving survival and quality of life. Although effective tobacco dependence treatments are available to help smokers quit smoking, persistent efforts over repeated contacts may be necessary to achieve long-term cessation.
IMPLICATION FOR NURSING PRACTICE
Oncology nursing action is essential in the identification of and intervention with patients who struggle with tobacco dependence after diagnosis.
doi:10.1016/j.soncn.2007.11.008
PMCID: PMC2249620  PMID: 18222148
smoking cessation interventions; tobacco dependence treatment and lung cancer

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