Meeting needs of people with inoperable lung cancer through an innovative supportive care intervention: a randomised controlled trial

Background: Lung cancer is associated with high levels of morbidity which can reduce quality-of-life (QoL). Given the poor prognosis for advanced lung cancer patients, there is critical need to develop and test clinically feasible and sustainable interventions targeting distress and QoL. Aim: This study investigated the impact of a supportive care intervention for advanced lung cancer patients. Hypothesis: the intervention would reduce unmet perceived needs; reduce psychological distress; improve QoL. Method: A RCT design with a consecutive sample of PeterMac patients was used. Inclusion criteria: diagnosis of inoperable lung/mesothelioma/pleural cancer; commencing palliative radiotherapy/chemotherapy, or radical chemotherapy and radiotherapy; sufficient English. Exclusion criteria: serious psychiatric/cognitive impairment; ECOG-PS of ≥3; ≤2 months since last treatment. Patients were recruited prior to/at treatment commencement, and randomised to intervention or usual care post-baseline. All measures were reliable and valid (Needs Assessment for Advanced Cancer Patients (NA-ACP), Hospital Anxiety and Depression Scale, Distress Thermometer, EORTCQLQ-C30). Data collection: baseline and 8- and 12-week follow-up. The intervention consisted of two 1-hour sessions with a health professional at treatment commencement and completion. Sessions involved self-assessment of unmet needs, active listening, self-care education and multidisciplinary management of unmet needs. The program was tailored by a) giving the multidisciplinary team information about patients’ needs for management/referral; and b) focusing sessions on participants’ reported needs. Significant others were encouraged to attend. Results: 108 patients consented and were randomised (59%); 75 and 79 completed 8- and 12-week follow-ups respectively. After controlling for baseline levels, significant differences were detected in the NA-ACP Symptom subscale (p < 0.05) and EORTC-QLQ-C30 Appetite Loss subscale (p < 0.05) at 8-week follow-up in the expected direction. No other significant results were found but detailed analysis of effect size statistics revealed several trends in the expected direction. Conclusions: Strengths of this study are: 1) one of the largest of its type; 2) homogeneous sample; 3) adherence to CONSORT criteria; 4) reliable and valid measures. The intervention was effective in reducing unmet symptom needs and improving appetite loss 8-weeks post-baseline. These findings demonstrate the importance of systematic needs assessment and communication of unmet needs to the multidisciplinary team