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Respiratory distress symptom intervention for non-pharmacological management of the lung cancer breathlessness-cough-fatigue symptom cluster: randomised controlled trial

Yorke, Janelle; Johnson, Miriam J.; Punnett, Grant; Smith, Jaclyn; Blackhall, Fiona; Lloyd Williams, Mari; MacKereth, Peter; Haines, Jemma; Ryder, David; Krishan, Ashma; Davies, Linda; Khan, Aysha; Molassiotis, Alex

Authors

Janelle Yorke

Grant Punnett

Jaclyn Smith

Fiona Blackhall

Mari Lloyd Williams

Peter MacKereth

Jemma Haines

David Ryder

Ashma Krishan

Linda Davies

Aysha Khan

Alex Molassiotis



Abstract

Objectives: In lung cancer, three prominent symptoms, such as breathlessness, cough and fatigue, are closely related with each other forming a 'respiratory distress symptom cluster'. The aim of this study was to determine the clinical and cost-effectiveness of the respiratory distress symptom intervention (RDSI) for the management of this symptom cluster in people with lung cancer. Methods: A single blind, pragmatic, randomised controlled trial conducted in eight centres in England, UK. A total of 263 patients with lung cancer were randomised, including 132 who received RDSI and 131 who received standard care. To be eligible, participants self-reported adverse impact in daily life from at least two of the three symptoms, in any combination. Outcomes were change at 12 weeks for each symptom within the cluster, including Dyspnoea-12 (D-12), Manchester Cough in Lung Cancer (MCLC) and Functional Assessment of Chronic Illness-Fatigue. Results: At baseline, nearly 60% of participants reported all three symptoms. At trial completion the total trial attrition was 109 (41.4%). Compared with the control group, the RDSI group demonstrated a statistically significant improvement in D-12 (p=0.007) and MCLC (p<0.001). The minimal clinically important difference MCID) was achieved for each outcome: D-12 -4.13 (MCID >3), MCLC -5.49 (MCID >3) and FACIT-F 4.91 (MCID >4). Conclusion: RDSI is a clinically effective, low-risk intervention to support the management of the respiratory distress symptom cluster in lung cancer. However, the study did experience high attrition, which needs to be taken onto consideration when interpreting these results. Trial registration number: NCT03223805.

Citation

Yorke, J., Johnson, M. J., Punnett, G., Smith, J., Blackhall, F., Lloyd Williams, M., …Molassiotis, A. (in press). Respiratory distress symptom intervention for non-pharmacological management of the lung cancer breathlessness-cough-fatigue symptom cluster: randomised controlled trial. BMJ supportive & palliative care, https://doi.org/10.1136/spcare-2022-003924

Journal Article Type Article
Acceptance Date Sep 27, 2022
Online Publication Date Oct 25, 2022
Deposit Date Nov 3, 2022
Publicly Available Date Mar 28, 2024
Journal BMJ Supportive and Palliative Care
Print ISSN 2045-435X
Electronic ISSN 2045-4368
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1136/spcare-2022-003924
Keywords Medical–Surgical Nursing; Oncology (nursing); General Medicine; Medicine (miscellaneous)
Public URL https://hull-repository.worktribe.com/output/4111593

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0

Copyright Statement
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.




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