Running head: LUNG CANCER EVIDENCE BASED PRACTICE

Lung Cancer Evidence Based Practice vs. Hospital Based Practice

Narjess Yazback
BMC-BSN
University Of South Florida

LUNG CANCER EVIDENCE BASED PRACTICE

Lung Cancer
This paper will cover the pathophysiology of Lung cancer and its prevalence in the
United States. Current medication guidelines along with interventions for diagnosis will be
discussed below using peer reviewed articles. These interventions will be compared with those
actually seen and applied in hospitals using a recent patient case scenario.
Pathophysiology of Lung Cancer
One should know that 90 % of lung cancer cases are caused by active smoking because of
the high content of carcinogens in tobacco. Other causes and risk factors of lung cancer include
environmental factors such as exposure to asbestos, radon, and non-malignant lung diseases
including COPD (coronary obstructive pulmonary disease), tuberculosis and idiopathic
pulmonary fibrosis. Biological factors also play a role; recent studies have shown that gene
susceptibility is also a risk and is related with abnormalities in the ras family of oncogenes and
inactivation of tumor suppressor genes (Tan, 2013). As Tan supports in his article, there are
usually two main categories of lung cancer. These include small cell lung cancer (SCLC), and
non- small cell lung cancer (NSCLC). Adrenocarcinoma, a NSCLC is the type of cancer most
commonly seen in non-smokers.
Symptoms & Diagnosis
Early recognition of symptoms and checkups are important because lung cancer
progresses subtly and may produce little to no symptoms until it is in advanced stages. Common
symptoms to monitor include: coughing, chest pain, hemoptysis, wheezing, shortness of breath,
weight loss and loss of appetite, fatigue, and recurring pulmonary infections. Bone pain, spinal
cord impingement and neurological issues may indicate metastasis of the cancer (Tan, 2013). A

LUNG CANCER EVIDENCE BASED PRACTICE

change in the nature of an existing cough or a cough lasting three weeks or longer are also
possible symptoms of lung cancer (Bennet, 2013). In general, patients with lung cancer have
increased levels of depression and anxiety, poor quality of life and decreased physical
capabilities (Quist, M., Langer, S. W., Roth, M., Christensen, K., & Adamsen, L. , 2013). In his
research, Doctor Tan (2013) states that chest x-rays are usually the preferred method and first
step of diagnosis. Other methods such as bronchoscopy, Sputum Cytology and Thoracoscopy are
used to confirm diagnosis after a chest x-ray has been performed. Furthermore, in order to
determine the stage of the cancer, a computed tomography (CT) scan is necessary. A chest x-ray
of someone with the disease might display pleural effusion, atelectasis, pulmonary module or
mass and hilar enlargement.
Prognosis
Research data compiled by the American Cancer Society and featured in Doctor Tans
article shows that lung cancer is the most common fatal type of cancer with statistics of 31% in
men and 26% in women. The 5 year survival rate for lung cancer is currently 15.7% in the
United States which shows a progression since the 1970s 12.5 % survival rate. Studies show
that quitting smoking after early diagnosis of lung cancer might have a lengthening effect on the
prognosis (Tan, 2013). For patients with advanced stages of lung cancer, the expected survival
time after diagnosis is between 10-13 months (Quist, M. et al, 2013).
Medical/nursing interventions and care guidelines
One of the most important interventions with lung cancer is smoking cessation by the patient
(Tan, 2013). Physical exercise is another intervention that can reduce the levels of depression
and anxiety in a lung cancer patient and increase their functional and physical capacity (Quist,

LUNG CANCER EVIDENCE BASED PRACTICE

M. et al, 2013). Pharmacological management of breathlessness with opioids, oxygen therapy,

nebulized drugs and bronchodilators is a medical/nursing intervention that can greatly increase
the quality of life of a patient. Non-pharmacological interventions are also used and provide the
patient with the ability to actively participate in their own care. These interventions include
breathing exercises, proper positioning, complementary therapies and activity planning (Claims,
L. 2012). Other important interventions that are commonly used based on the staging of the
cancer include palliative care, surgery of the lung, radical radiation treatment and chemotherapy
(Bennet, 2013).
Patient scenario/ Interventions implemented
Upon comparing the possible interventions and care guidelines demonstrated above with the
ones implemented in one specific hospital, it is clear that there is a gap between research findings
and hospital practices. Interventions such as radiation and chemotherapy were implemented at
the hospital, but there was a lack of beneficial non-pharmacological interventions including
breathing exercises and activity planning. The patient at hand had an advanced stage of lung
cancer and was placed in hospice. This patient was undergoing one last day of radiation therapy
before starting chemotherapy a few weeks down the road. Although the patient already had a
long list of current medications, a few more were added for depression, anxiety and dyspnea. The
patient had no assigned physical therapist, and there was a lack of exercise interventions and
non-pharmacological measures to ensure an increased quality of life.
Conclusion
Overall, a gap between research findings on lung cancer interventions/treatments and actual
hospital practices is present. Although the discrepancies are small, they are still present; this

LUNG CANCER EVIDENCE BASED PRACTICE

should be addressed because every possible measure should be taken to ensure the utmost care is
provided to the patient. Research findings are meant to contribute to the improvement and
advancement of the care provided to lung cancer patients, therefore if an intervention is proven
to help through research and studies, it should be implemented in the hospitals by nurses and
physicians. With time and studies, the low rate of survival of lung cancer patients can possibly be
further increased as it has from 12.5% in the 1970s to 15.7 % in 2013 (Tan, 2013).

LUNG CANCER EVIDENCE BASED PRACTICE

References
Bennet, Alison, and John White. 2013. Improving care and quality of life for patient with lung
cancer. Nursing Standard 28, n.9: 50-58. Academic Search Premier.

Claims, L. (2012). Managing breathlessness in patients with lung cancer. Nursing Standard, 27
(13), 44-49.
Quist, M., Langer, S. W., Roth, M., Christensen, K., & Adamsen, L. (2013). Exhale. Exercise
as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized trial
comparing the effects of 12 weeks supervised exercise intervention versus usual care for
advanced stage lung cancer patients. BMC Cancer. Doi: 10.1186/1471-2407-13-477
Tan, w.w. (2013). Non- Small Cell Lung Cancer. Medscape. Retrieved from
http://emedicine.medscape.com/article/279960-overview#aw2aab6b2b3