title: Interdisciplinary palliative care intervention in metastatic non-small-cell lung cancer.
abstract: OBJECTIVE
  Challenges and barriers continue to hinder the integration of palliative care models into comprehensive, ambulatory oncology care. This article aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a National Cancer Institute-supported Program Project informed the development of an interdisciplinary, tailored palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study over a 1-year period. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Research nurses assisted patients in completing the clinical section of the data forms, and patients completed surveys and self-reports at baseline and 6, 12, and 24 weeks.
  
  
  RESULTS
  Patients ranged in age from 40 to 84 years, and 61% were Caucasian non-Hispanic. Sixty-six former (N = 59) and current smokers had an average of 38 pack-year history of smoking. The Karnofsky Performance Status, Instrumental Activities of Daily Living, and Cognitive scores deteriorated significantly (P = .001, .009, and .042, respectively). Social Activity was stable, whereas Social Support increased significantly. Overall symptom distress score and Total symptom score both significantly increased at 24 weeks (P = .003 and .017, respectively). Physical Well-Being decreased significantly (P = .036), whereas the Functional Assessment of Cancer Therapy-Lung, Functional Assessment of Chronic Illness Therapy-Spirituality Subscale, and Distress scores remained statistically stable over time.
  
  
  CONCLUSIONS
  Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving cancer treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.
authors.affiliation: Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA.
authors.forename: Marianna
authors.initials: M
authors.lastname: Koczywas
authors.forename: Mihaela
authors.initials: M
authors.lastname: Cristea
authors.forename: Jay
authors.initials: J
authors.lastname: Thomas
authors.forename: Cassie
authors.initials: C
authors.lastname: McCarty
authors.forename: Tami
authors.initials: T
authors.lastname: Borneman
authors.forename: Catherine
authors.initials: C
authors.lastname: Del Ferraro
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.forename: Gwen
authors.initials: G
authors.lastname: Uman
authors.forename: Betty
authors.initials: B
authors.lastname: Ferrell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D057566:Self Report; D016896:Treatment Outcome
keywords: Cognition; Function; Quality of Life; Social support; Symptoms