Most research regarding lung cancer has been limited to patients with metastatic disease and, therefore, provides little insight into problems experienced by patients who undergo surgery for early stage lung cancer. Interventions targeted to improve post-operative recovery are limited and can be time-intensive in regard to resources and personnel, considerations that tend to limit translation into clinical practice. The purpose of this mixed-methods study is to fully explore the symptom experience of lung cancer patients during the first year after surgery. Guided by the Theory of Unpleasant Symptoms (TOUS), the study will use qualitative and quantitative methods to explore the symptom experience of patients recovering from surgery for lung cancer.
The specific aim i s to apply the TOUS to identify concurrent symptoms, factors that influence symptoms (physiologic, psychologic, and situational) and the impact of symptoms on performance (functional, cognitive, and physical) in patients with and without post-thoracotomy pain syndrome (PTPS). Typically described as aching, burning, or extreme sensitivity to touch at or near the scar or chest tube insertion site, the etiology of PTPS is distinct from the side effects of cancer treatment or cancer progression. Subjects will be 84 patients recruited from University of Pittsburgh Medical Center who are: 1) managed surgically for Stage I, II, or IIIa lung cancer without evidence of metastasis;2) between 2 and 12 months post-surgery;and 3) >40 years of age. Exclusion criteria: 1) any other cancer diagnosis or metastatic disease, 2) inability to speak, read, or understand English, and 3) presence of comorbidities such as dementia, or memory loss. Subjects in the quantitative portion of the study will be recruited as a convenience sample. Representative subjects in the qualitative portion will be selected from participants who complete the quantitative measures. The proposed study will be the first to comprehensively examine the symptom experience following surgical resection for early stage lung cancer including the experience of patients with and without PTPS. The study will provide essential evidence needed to build the science in symptom management for these patients. Guided by the TOUS, the study will use a mixed methods design to permit the researcher to capitalize on patient experiences expressed in both standardized instruments and probing interviews about each patient's unique post-surgical experience. The applicant's long-term research goal is to use study findings, in combination with prior engineering training, to design an interactive health communication application (IHCA) to improve symptom management for lung cancer patients. It is anticipated that the proposed IHCA will provide lung cancer patients with customizable, evidenced-based symptom management strategies.

Public Health Relevance

Lung cancer accounts for more deaths in men and women than any other cancer and all patients, even those with early stage disease, face tremendous challenges dealing with the devastation of a lung cancer diagnosis, including a potentially poor life prognosis and worry regarding disease progression. Comparatively, few studies have addressed problems unique to lung cancer patients and even fewer have addressed issues related to common postoperative symptoms following lung cancer surgery. Consequently, we have limited knowledge of the influencing factors, symptoms and performance limitations experienced by these individuals.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Pittsburgh
Other Health Professions
Schools of Nursing
United States
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