Pulmonary Rehabilitation and QoL in Lung Cancer Patients

Pulmonary Rehabilitation and QoL in Lung Cancer Patients PULMONARY REHABILITATION AND QUALITY OF LIFE IN LUNG CANCER PATIENTS (Abstract):The quality of life in patients with lung cancer is determined both by factors related to the patient (stage of disease, comorbidities) and the factors related to treatment (surgery, chemotherapy, radiotherapy). Since the impact of treatment on survival of patients with lung canceris quite low, quality of life is a goal increasingly important. Until now, quality oflife was properly assessed in few studies and the results can be influenced by the use of non- validated methods. The most usedtools adapted for measuring the quality of life for lung cancer are the European Organization for Research and Treatment of Cancer (EORTC) LC-13 questionnaire, the Functional Assessment of Cancer Therapy (FACT-L) questionnaire and the Lung Cancer Symptom Scale (LCSS). Keywords:LUNG CANCER, QUALITY OF LIFE, REHABILITATION. Lung cancer is one of the most common types of cancer, with a 5-year survival rate of approximately 15 %. Given the evolution of long asymptomatic lung cancer in contrast to other tumor types, it is often diagnosed at an advanced stage. Symptoms include cough, hemoptysis, dyspnea, chest pain, weakness, loss of appetite.Therefore, treatment goals for these patients are relief of symptoms and increased overall survival [1]. Therapies that improve the survival rate are often accompanied by severe side effects. Due to the increasing number of alternative lines of therapy and treatment, the decrease differences in the clinical effectiveness and drug development costs, the importance of estimating the parameters of quality of life (QOL) increases both health and economic reasons. So little time, the inclusion of these parameters in lung cancer clinical trials was generally neglected [1-3]. During 2001-2011, there were 43 studies conducted to measure health-related quality of life (HRQoL) of patients with lung cancer, 27 of which had as main objective HRQoL. Most publicationsillustrate the results of phase III clinical trials, 38 included patients with locally advanced non-small cell lung cancer (NSCLC), especially in stage III/IV, two studies included patients with small cell lung cancer (SCLC) in all stages and three studies included both patients with NSCLC and SCLC. Most studies have investigated the impact of platinum based drug combinations, 6 studies have investigated the effect of gefitinib and 2 studies concerns of erlotinib. Between the questionnaires used to assess quality of life in patients with lung cancer are mentioned questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30) questionnaire, Functional Assessment of Cancer Therapy-General (FACT G) questionnaire, FACT-L (Lung) questionnaire, Lung Cancer Symptom Scale (LCSS), Anxiety and Depression Scale (HADS), Brief Pain Index (BPI). The most commonly used is the EORTC QLQ-C30 contains 30 criteria, available in 60 languages à ¢Ã¢â€š ¬Ã¢â‚¬ ¹Ãƒ ¢Ã¢â€š ¬Ã¢â‚¬ ¹[4]. FACT-G questionnaire containing 27 physical elements, emotional, social, functional, available in more than 50 languages à ¢Ã¢â€š ¬Ã¢â‚¬ ¹Ãƒ ¢Ã¢â€š ¬Ã¢â‚¬ ¹[5] and the FACT-L is suitable for lung cancer and contains 37 items assessing quality of life [6]. Due to the homogeneity characteristics of the patients and treatment regimens, it is not possible to compare all of the studies on the HRQoL. Most studies include comparing different chemotherapy regimens did not show significant differences in HRQoL between treatment arms [7,8,9,10,11,12,13,14]. Another group of studies report cautious assumptions to improve HRQoL [15,16,17]. Only Belani et al. and Reck et al. indicates HRQoL superiority of paclitaxel or docetaxel compared with vincristine or vinorelbine/cisplatin [18,19]. Regarding EGFR inhibitors, Gelibter et al., Mu et al., And Zhang et al. been shown to improve HRQoL in patients with highly advanced NSCLC treated with gefitinib [20,21,22]. Cella et al. and Natale et al. reported improvements in HRQoL after administration of gefitinib and correlate these improvements with tumor response [23,24]. Regarding erlotinib, Lilenbaum et al. could not demonstrate significant improvement in progression-free survival, median survival and HRQoL compared to standard chemotherapy regimen [25]. Bezjak et al. HRQoL showed significant improvement, where erlotinib is administered in the second line of treatment [26]. LUX- Lung 3 study conducted on a population of patients with advanced NSCLC with EGFR mutation positive, showed an unprecedented improvement in cancer-related symptoms and increase quality of life when treated first line with afatinib, an irreversible inhibitor of the ErbB receptor family, compared to chemotherapy with pemetrexed and cisplatin, considered the standard of care in this population of patients with NSCLC [27]. Lung cancer or lung metastases often have symptoms for which palliative radiotherapy is effective [28,29] and improves or maintains quality of life, for about one-third of affected patients [30]. There are forty-three studies that are assessed in at least one arm of the study, use of palliative thoracic radiotherapy that evaluated QOL or symptoms palliation a primary or secondary. Thirty studies have evaluated the treatment of patients with NSCLC. Four studies involved patients who were treated with endobronchial brachytherapy alone or in combination with external radiotherapy. Other nine studies have evaluated the use of palliative radiotherapy in patients with lung cancer other than NSCLC histological type. Clinical trials that compared different regimens of palliative radiotherapy fractionation showed improved quality of life and survival in patients with good performance status who received high doses of radiation (TD = 30Gy/10fractions/3Gy/fraction) compared with lower doses (TD = 20Gy/5fractions/4Gy/fraction, 17Gy/2fractions, 10Gy/1fraction), which are mainly used in patients with reduced performance status and may be interspersed between the series of chemotherapy without causing delay in chemotherapy administration [31,32]. Impact of new radiotherapy techniques (IMRT intensity modulated radiotherapy, IGRT guided radiotherapy imaging) and PET -CT imaging integration in the palliative treatment of patients with pulmonary cancer is not clearly defined. Relative to the palliative role of endobronchial brachytherapy, recent analysis of 13 clinical trials concluded that external radiotherapy is superior endobronchial brachytherapy and brachytherapy added to external radiation has no advantages over external radiotherapy alone [33]. So far, not demonstrated an advantage of concomitant radio chemotherapy to sequential administration for symptoms palliation in patients with lung cancer [34,35,36,37]. First programs of pulmonary rehabilitation have been developed in The United States of America in the 1970’s .Since then, several specialists tried to define better the term of â€Å"pulmonary rehabilitation â€Å": ‘’Pulmonary rehabilitation is a multi-dimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists, with the goal of achieving and maintaining the individuals maximum level of independence and functioning within the community’’(1) Pulmonary rehabilitation may be defined as an art of medical practice wherein an individually tailored, multidisciplinary program is formulated which through accurate diagnosis, therapy, emotional support, and education, stabilizes or reverses both the physio and psychopathology of pulmonary diseases and attempts to return the patients to the highest possible functional capacity allowed by his pulmonary handicap and overall life situation.(2) The definition given by the American College of Chest Physicians (ACCP), the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American Thoracic Society (ATS) and European Respiratory Society (ERS) â€Å" an evidence-based, multi-disciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease.†(3) The most recent definition Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.(4) To understand better the importance of these rehabilitation programs, here are some statements of some patients with pulmonary diseases: -â€Å"It can be extremely upsetting because I can’t find the breath of life that we all need.â€Å" -â€Å"My legs ached, my shoulders ached, my arms ached .I couldn’t continue with my hobbies. I lost hope completely. I literally wanted to die.† -â€Å" This is very depressing ; this makes me very anxious!â€Å" Over time pulmonary rehabilitation has been an important part in the management of COPD and of other chronic lung diseases. Rehabilitation in lung cancer has not been studied so extensively as the rehabilitation in COPD but the results from various studies indicate clearly the importance of pre and post surgery rehabilitation. Patients who had or have to go through a lung cancer surgery may have breathlessness, pain, fatigue, anxiety, poor physical condition and low quality of life.For oncology patients, pulmonary rehabilitation is not just about how the patient learns to breathe properly and respiratory muscle training, but a multitude of factors that together help the patient to support more easily the surgery or chemo-radiotherapy , to have an early recovery and to increase quality of life. Judging by the motto There are no diseases, but sick people, pulmonary rehabilitation for patients with lung cancer , also has to be personalized . It may be regarded as the tailoring of the rehabilitation programme to the patient’s needs and characteristics and also, to the evolution of his oncological disease. How pulmonary rehabilitation helps people with lung cancer? -helps the patient to carry out his daily activities -increases the quality of life helps to improve general health -decrease the number of postsurgical complications -hastens the postoperative recovery -prevents respiratory tract infections Pulmonary rehabilitation is a complex process and may include the following: Breathing techniques (diaphragmatic breathing, pursed-lip breathing) Energy conservation techniques Aerobic (to increase pulmonary capacity) Respiratory muscle strengthening techniques Nutrition tips Counseling and relaxation techniques Group therapy Before establishing a pulmonary rehabilitation program must be identified that baseline what the patient can do easily, what kind of daily activities is able to do and what kind of activities are done with difficulty. Pulmonary rehabilitation can and pre and / or post surgical. Rehabilitation period is decided by an interdisciplinary team consisting of pneumologist, oncologist and thoracic surgeon. Preoperative rehabilitation can decrease the number of postoperative complications, speed recovery and may also have an economic impact, reducing the number of days of hospitalization, postoperative morbidity. Studies have shown that postoperative rehabilitation is good to be started after about 3 or 4 months after surgery. The minimum duration of a pulmonary rehabilitation exercise program has not yet been widely established. Pulmonary rehabilitation should be taken into consideration for all the patients with lung cancer no matter what stage .Rehabilitation is beneficial for all stages of lung cancer, even for inoperable cases. Moreover, we could say that pulmonary rehabilitation is an essential aspect of the palliative measures in patients with lung cancer. Pulmonary rehabilitation also has it’s riscks, for example, it can cause arrhythmias or cardiac arrest in patients with cardiac pathology, it can cause bone lessions or muscle injuries. Education The patient must learn what he has to do to take care of himself better and to maximize quality of life. The most important thing is that the patient must practice and continue for a lifetime everything he learnt during the medical rehabilitation program conducted at the hospital. Nutrition is an important aspect of the rehabilitation programs because, in most cases, lung cancer patients already have a poor nutritional status which can be caused by the consumptive syndrome, the treatment or because of the depressive syndrome that is often encountered in patients with cancer. The effects of malnutrition in patients with lung cancer: increased fatigue vulnerability to infections -decreases compliance to treatment -delay recovery -affects quality of life Recommendations on nutrition in lung cancer: -eat frequent small portions -eat high-protein and high-calorie foods -avoid fast food and carbonated drinks -do not take vitamins without doctor recommendation use spices to get a better taste of the food -the meat will be cooked at high temperatures -no fried foods -cooking will be done in stringent conditions of cleanliness -adequate hydration, at least 2 liters of fluid per day Counseling Finding the diagnosis of malignancy, the disease and the multitude of investigations and treatments applied to patients with cancer are sources of psycho-emotional stress. Through psychological counseling, the patient finds new ways to adopt a lifestyle as healthy as it can and receives the necessary power to replace negative emotions.. Oncology patients are special patients that require special attention and support from the whole multidisciplinary team and also from their families. In the cases where palliative care is the only solution, the pulmonary rehabilitation team must prepare the patient for a dignified end. Pulmonary rehab is a chance for people with lung cancer to get help, to have a better quality life, to understand better their disease and to feel much confident.

Describe the Role of Hr Professionals in Designing

Introduction This question asks to address how bullying policies and procedures are a task of HR to implement in the workplace therefore this answer will define exactly what bullying is, what policies should be in place and any recommendations for the occurrence of bullying in the workplace. Relevant case examples will be used to support the argument along with relevant referenced authors, on this topic. On concluding, how bullying can be prevented will be reflected on after stating what the future may hold for bullying in the workplace.What is bullying? Since the shift from Uni-cultural societies to multi-cultural societies in recent times, there has been a significant decrease in perceived inequalities in the workplace. However, the issue of bullying is still prominent in many organisations, (especially throughout Ireland today). Baillien et al. (2009) defines bullying as persistent negative behaviour at work in which the victim is subject to psychological, physical or sexual acts by the perpetrator and often find themselves in a position where they are unable to defend themselves.The analysis carried out found that bullying, or some form of harassment, was likely to occur out of one of three pathways: interpersonal frustrations, interpersonal conflict and intragroup level. The problem with the latter is that the culture of gossip within organisations has become a norm and hence the certain behaviours by perpetrators may often be overlooked. Although bullying is often associated with actions that people carry out, it also includes actions that individuals fail to do such as providing necessary training to a particular employee. For example, if new technology is introduced into the firm, extra training will be required. Hence, if bullying of a certain employee was occurring, this may lead to their deprivation of sufficient training which in turn will have a negative consequence for the entire firm. ) Within Maslow (1943) hierarchy of needs framework, safety ne eds are crucial to all employees and the victimisation due to bullying will prevent the fulfilment of this need in the workplace. As a result, low productivity and low morale may be present within the workforce.Policies/Procedures As the question states, it is the task of the HR department to ensure the design & implementation of policies and procedures to prevent or deal with the occurrence of workplace bullying. The event hierarchy of the bullying (reference) intervention process has three levels: the prevention zone which involves policy enquiries by the target, the intervention zone which begins with an informal complaint and may lead to a formal complaint, and the failure zone where legal action is taken.In order to prevent an employee reaching the highest level and engaging in legal action, it is the responsibility of HR to assist in dealing with the problem immediate to the first complaint. Bullying/Harassment must be occurring in the workplace as opposed to personal life con flicts between workers in order for HR to manage the situation but studies carried out in this area have shown that senior level management are often weak in dealing with issues of bullying or harassment. (Baillien et al. 009) Consequently, when HR is implementing practices, they need to ensure the co-operation and comprehension of senior level managers in this area. There are three main actions HR can take in order to reduce bullying situations. Firstly the implementation of clear, concise policies needs to be carried out which state unacceptable behaviours classed as bullying or harassment and the procedures an individual may take if found subjected to this behaviour. In addition to this, a Code of Conduct should be established in order to set out training procedures for employees and management as a means of preventing 7workplace bullying.Within management training, conflict resolution and mediation skills need to be provided in order to act effectively. During the recruitment of management in an organisation, it is vital to ensure they have people management skills along with task related competence. Finally, often the most important thing HR and senior managers can do is lead by example. If policies and procedures are implemented but managers are not behaving in a way that complies entirely with these, then this could lead to adverse effects by subordinates. ExampleOne primary example of where HR failed to act on behaviour of a new employee that initially was unacceptable by the firm but resulted in unacceptable behaviour to moral society was in relation to Rob Parsons within Morgan Stanley. (Burton, 1998) Parsons was hired to achieve a growth implementation strategy as Nasr believed he was the man to do it. However, a culture of strict policies and procedures within the organisation meant that Parsons Non-compliance immediately stood out. Initially, he was not involved with bullying but was seen as a ‘lone wolf’ within the firm, significantl y seen through his inability to perform within a team.As time lapsed, HR and Parsons Management failed to confront him on his behaviour and essentially allowed the collapse of their organisational policies for him due to the fear he may leave the firm. Eventually, he was fired as a result of a bullying case that occurred at a client meeting. He had been making unacceptable critical remarks to a fellow female employee of the firm, humiliating her in front of the client. Hence, the occurrence of Parson’s psychological bullying was finally evident and may have been prevented if HR followed through with their policies with all employees including Rob Parsons.Future of Workplace Bullying Due to the increase of technology, the working environment now often extends into the realm of personal life. In effect, this may cause the enabling of workplace bullying to stretch further than the perimeter of the four walls of the organisation and in particular, social networking sites are a pr imary target for the extension of this bullying. However, since present policies and procedures focus on ‘workplace bullying’, victims may be limited to the actions they can take.With the growth in the integration of personal and work life, HR may be unable to re-address their policies to include outer work boundaries due to legal constraints. Although, conversely it may be easier to identify and prosecute the perpetrators of bullying or harassment if the behaviour extends to personal life, such as through social networking sites. Conclusion Bullying and harassment is often a topic ignored within the workplace as victims sometimes feel ashamed and managers choose not to deal with the problem. However it is the responsibility of HR to ensure these practices are implemented and abided by all, including management.Failure to do this will undoubtedly lead to extensive consequences such as reputational damage to the firm, direct costs including replacement costs and indirect costs such as low productivity. Although not a continuing case of bullying, the Morgan Stanley case briefly highlights how the failures of HR and senior management to address his unacceptable behaviour from the outset led to undesired effects, including his removal from the firm and legal action by a fellow employee. All in all, the prevention of workplace bullying can be assisted by appropriate practices carried out by HR.

Ns The National Security Agency - 1262 Words

USA Today confirms: the National Security Agency has been secretly collecting the phone call records of tens of millions of Americans, using data provided by ATT, Verizon and BellSouth. With access to records of billions of domestic calls, the NSA has gained a secret window into the communications habits of millions of Americans. (Opsahl 28 Sep. 2013) It’s no secret that the U.S. government agency known as the NSA, National Security Agency, has been monitoring phone calls and Internet usage of United States citizens since the early 2000’s during George W. Bush’s time in office. During his presidency, Bush authorized the motorization of millions of citizen’s phone calls. (Tebbutt 25 Sep. 2013) The NSA created a secret program called â€Å"The Highlander Program† which was designed to monitor satellite phone transmissions on the Inmarsat network in the Middle East. During this secret program, the NSA did not monitor any United States citizens. Bush c laimed the surveillance was limited to the al Qaeda, but that simply was not the case. (Forgang 27 Sep. 2013) Does the United States government have the right to listen in on civilian’s phone calls regardless of the reason? As seen in the media, most citizens don’t want the NSA to be listening in on their calls and other forms of communication. In Samuel Greengard’s magazine article, Spies Among Us, he explains, â€Å"The boundary between protection and privacy has always been fuzzy.† (Greengard 27 Sep. 2013) The point he is offering isShow MoreRelatedThe Ns The National Security Agency1250 Words   |  5 Pages The National Security Agency or otherwise known as the NSA, had sparked a recent debate of the fundamental amendment rights that American citizens have. To provide some historical context, the NSA in 2013 was exposed by Edward Snowden, a former contractor and employer of the NSA. 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What Did The Wwi Made The World War I - 1796 Words

As the outbreak of WWI (World War I), the world was under a huge changing period regarding technologies, ideologies and civilizations. Impacts were inevitable from war, thousands of sacrifices, ruined families, and even the fall of countries. However, it is undisputed that the WWI changed the women s historical process, particularly in European countries. Women s employment scale was largely over prewar level; their status and position in wartime and postwar evoked a dispute. On one hand, the WWI brought the women unprecedented massive scale of employment that used to be unthinkable for them in the wartime; however, on the contrary, the war led to a rare proper sense of citizenship for women. This essay aims to take an analysis on how and what did the WWI made the impact on women in the former European countries. Firstly, it will focus on employments situations for women in wartime, how they react to these changes and the negative dissatisfactory after they urged more rights. 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