ELCC 2021 | Fulfilling unmet supportive care needs of patients with lung cancer

My name is Andreas Charalambous. I’m an Associate Professor at the Cypress University of Technology, and Adjunct Professor at the University of Turku in Finland. I’m also the President-elect of the European Cancer Organization and Executive Board Member of the European Oncology and Nursing Society.

In terms of my presentation, cancer ranks as a leading cause of death and an important barrier to increasing in life expectancy in every country of the world. It is estimated from the healthcare organization that cancer is the first or second leading cause of death before the age of 70 in around 112 countries out of 183 countries and ranks third or fourth in a further 23 countries.

In terms of lung cancer in men, it’s the second most frequently reported cancer in 36 countries around the world. While it is the leading cause of cancer death in men in 93 countries in part, because of its high fatality rate. Just to get an idea, the time of diagnosis, 84% of the patients suffer from locally advanced or metastatic disease or poor prognosis. So, stabilization of the disease and symptom management are therefore the main focus of supportive care.

People with lung cancer have a complex array of supportive care needs that have an impact on various life aspects. Studies show that these needs can be classified into eight broad categories, which include the physical, daily living, emotional, spiritual, informational, communication, social, and cognitive dimensions. Regarding the physical functions, common symptoms reported by let’s say, newly diagnosed patients with lung cancer include fatigue, pain, dyspnoea, cough, and insomnia. The need for information on coping with distress and physical impairment holds also a prominent place in this lung cancer context.

Symptom control remains one of the key areas of unmet needs among patients with thoracic malignancies. Unfortunately, unmet needs have been recorded across the cancer care continuum from diagnosis to survivorship. Let’s say for example from diagnosis to treatment, research shows that these unmet needs can include a supportive care needs, understanding and coping with their disease, emotional and psychological needs.

In the more advanced disease and unmet needs have been reported, for example, on the physical domain, on existential issues and, of course, on the need to have a more personal centre and holistic management by the healthcare team.

In terms of the survivorship phase, the most common domains of unmet needs are in the psychological domain, followed by the physical and the health system, as well as the information domains. The nature of unmet needs includes, let’s say, fears of cancer returning, fatigue, facing an uncertain future, coordination of the healthcare, completing housework and having information on managing health.

In this complex context, digital – I’m sorry – and technological solutions can contribute to the management of these reported unmet needs across the cancer care continuum. Of course, not all health solutions are appropriate or applicable to every group of lung cancer patient in one-size-fits-all approach.

However, even though the identified needs that have been reported within the lung cancer care context are extensive, the utilization of technology presents an opportunity to efficiently and effectively address some of those unmet needs. For example, technological and digital solutions can help in the increased communication between patients and providers, providing education to patients, as well as inform our caregivers, integration of standard clinical assessment with patient-reported outcomes PROs, and help of patients in monitoring their respective conditions and improve patient empowerment and sense of self-management.

Of course, in the literature, there have been numerous successful examples of technological solutions within the context of lung cancer care. However, I’m going to be reporting only a couple just to give an overview or an idea on how these technological solutions can actually help in the management of lung cancer.

Let’s take, for example, a virtual reality or the utilization of virtual environments. The challenge within the treatment of lung cancer care is that undergoing chemotherapy can be a stressful and burdensome period for the patient and one where the mood disturbances, for example, have very higher prevalence. Our research study specifically explores how virtual environment during these burdensome and stressful periods in lung cancer patient can help mitigate or minimize these mood disturbances. The analysis of the results showed that in these randomized double-blind crossover trial with 40 patients in both groups shows statistically significant improvement in six out, four out of six domains of mood disturbances, including tension, anger, vigour, and fatigue.

Another area where technological solutions hold a prominent place in terms of lung cancer treatment is the utilization of mobile applications. Let’s take, for example, the Smart Aftercare app that has been developed by Park and colleagues only recently in 2019, which was specifically designed as a smart phone application to increase pulmonary rehabilitation. This specific mobile application, it was designed to deliver an animated video of 10 minutes stretching exercises, 30 minutes of aerobic exercises, 30 minutes of muscle strengthening exercises followed by five-minute finishing exercises.

The results show a statistically significant improvement in the physical functioning of the patient, as well as improvements in the emotional and social functioning of the patients. These, as I already mentioned, are only a few examples of how technological and digital solutions can be effectively introduced in the management of the unmet needs within the thoracic malignancies context. And of course, the integration of such technological solution creating new way of approaching healthcare where the patient’s rights of autonomy, shared decision-making, getting more access to information and technologies are now considered the new standards of care within this context.