Research Update: A Prospective Outcomes Pilot Evaluation of Inspire Now: A Program for People with Lung Cancer

Research Update articles are produced in order to keep practitioners up to date on impactful research that is relevant to the field of integrative medicine. These articles may contain summaries of recent studies, events, or other industry news that advances current knowledge and standards of care. The following article summarizes the research conducted by Conte et al. titled, “A prospective outcomes pilot evaluation of Inspire Now: A program for people with lung cancer,” which was published in Integrative Cancer Therapies in 2020. (4)

Background

While lung cancer is the leading cause of cancer death in both Canada and the United States, there is a lack of support for people with lung cancer. (1)(3)(7) Less research funding (2)(5) and charitable donations (9) go to lung cancer compared to other cancers. A lung cancer diagnosis can be extremely difficult for patients, as it is often an aggressive cancer with a poor prognosis. Supportive care needs for people with lung cancer include:

• Cognitive (8)
• Communication
• Daily living needs
• Informational (e.g., how to improve health and manage side effects) (6)
• Physical (e.g., fatigue, SOB, pain)
• Psychological and emotional
• Social and family-related
• Spiritual and existential

The Ottawa Integrative Cancer Center (OICC) developed a supportive care program called Inspire Now, which was designed to address the unmet supportive care needs of patients with lung cancer. The program was collaboratively developed by a yoga therapist and a clinic director at the OICC, with the help of two survivor advocates from Lung Cancer Canada and The Ottawa Hospital. Facilitated by a yoga therapist, the six-week program involves weekly sessions that include group and social support, discussions exploring fear, stigma, and grief, mind-body therapies, and informational presentations. This pilot research study set out to evaluate the program, including its feasibility and outcomes.

Method

Registration for the program required patients to have a primary diagnosis of lung cancer. The primary outcome of the study was feasibility, which was assessed by measuring program recruitment rates, attendance, willingness to participate in research, and questionnaire completion. Secondary outcomes included patient-reported outcomes, program satisfaction, and qualitative experiences of all participants including the facilitator and survivor advocates. Patient-reported outcomes were assessed at baseline and program completion using two validated questionnaires: the Functional Assessment of Cancer Therapy – Lung (FACT-L) Version 4 and the Measure Yourself Concerns and Well-being (MYCaW). FACT-L evaluated quality of life, whereas MYCaW evaluated patients’ concerns. The other secondary outcomes (i.e., program satisfaction and qualitative experiences) were obtained through internally developed surveys. The researchers also employed structured interviews to obtain supplemental data from the two survivor advocates and the program facilitator.

Results

Feasibility of the program and its evaluation

This study demonstrated that the program and its evaluation were feasible. Nine people registered for the program, eight of whom consented to participate in the research study. There was high attendance, with the median number of sessions attended being six out of six (100%), and five of the eight participants attended all of the sessions (62.5%). Questionnaire completion was also high, with 100% at baseline and 75% (6/8) at the end of the study.

Patient-reported outcomes

The FACT-L questionnaire assessed various domains, including physical, emotional, social, and functional. Pre- and post-program results demonstrated improvement across most domains (with the exception of emotional), indicating that the program may provide some benefit to quality of life. The greatest improvement was reported in the social domain. On the MYCaW, participants were asked to self-identify up to two concerns at baseline and also assess their well-being. Most of the concerns reported were psychological and emotional in nature. At program completion, there was an improvement in the scores for their first concern and well-being and a decline in the mean for their other concern.

Program satisfaction and qualitative experiences

Patients’ program satisfaction and qualitative experiences were assessed through the two internally developed surveys. The surveys shed light on participants’ aspirations, aspects of the program they enjoyed, and areas for improvement. In the beginning, participants looked forward to learning new information and connecting with others who also have lung cancer. A common goal among participants was to learn how to cope with the disease. In the end-of-program survey, participants had a very positive reaction to the program. On a scale of one (strongly disagree) to five (strongly agree), participants were asked to rate how much they agreed with seven statements about the program. Average scores ranged from 4.5 to 5. All participants strongly agreed with the statements “I feel support and acceptance” and “Others would benefit from this program.” Participants enjoyed the social and group support aspects of the program, interactive physical activities, and breathing exercises. Some participants expressed that the 3.5-hour sessions were too long, whereas others desired more speakers from the broader medical community.

Semi-structured interviews

Interviews of the facilitator and two survivor advocates yielded supplemental information about the program. Some additional strengths identified by the interviews included the openness of the group in discussing grief and death, increases in participant-reported body awareness, and reductions in anxiety and breathlessness. On the other hand, the interviews revealed some areas of improvement, including the need for consistent presentation structure from guest speakers and presentations that focused on activities that could be practiced at home.

Supportive care programs like Inspire Now may help improve the quality of life of patients with lung cancer.

Critical analysis

This pilot study was valuable in helping integrative practitioners understand patient experiences and outcomes and how supportive care programs can be improved for patients with lung cancer. A strength of this study was its use of various tools to evaluate the program. The methods allowed the researchers to gather insights into the quality of the program via multiple dimensions. The incorporation of validated questionnaires (i.e., FACT-L and MYCaW) helped to increase validity of assessing quality of life and patient concerns. Additionally, the MYCaW survey allowed participants to express their individualized concerns, facilitating a wider range of feedback. Semi-structured interviews were beneficial because they captured feedback from the individuals running the program, which provided a different perspective than what would have been only provided from patients. On the contrary, this study also has some methodological limitations. Being an uncontrolled study with a small sample size, the impact of the program on quality of life cannot be established with certainty. The sample was also potentially biased, as all participants were female, were already engaged in another support group for people with lung cancer (they may be biased towards engaging in supportive care programs), and had been diagnosed with lung cancer for a median time of approximately three years, which may not be representative of patients with various stages of lung cancer

The bottom line

This pilot research study is an important step to helping address the supportive care needs of people with lung cancer. The study demonstrated the potential benefits that supportive care programs like Inspire Now can have on quality of life and areas of improvement. This study can be used to help evaluate and modify other programs to improve patient outcomes.