Aims: This thesis investigated the health and supportive care needs of surgical lung cancer patients to address gaps in the evidence base and inform future service developments. Additionally, the prognostic significance of smoking behaviour was investigated. Methods: Semi-structured interviews were conducted with 29 surgical (VATS and thoracotomy) lung cancer patients to explore health, functioning, smoking, satisfaction with recovery and preferences for a tailored rehabilitation programme. Interviews were analysed using framework approach. Systematic literature searches were conducted to review evidence of the association between smoking history or continued smoking after diagnosis and prognosis. Survival estimates were combined where possible using a random effect inverse variance model. Results: Most participants experienced difficulty during recovery. Breathlessness and pain emerged as dominant health challenges. Participants were open to being offered smoking cessation support. From 78 and 10 studies, preliminary evidence was found that both smoking history and continued smoking are associated with prognosis, respectively. Analyses indicated that smoking-associated increased risk may be mediated through cancer-related pathways. Conclusions: Many surgical lung cancer patients’ supportive care needs are not being met. Well-developed treatments and services for management of breathlessness, pain and smoking cessation may improve quality of life and health outcomes after lung cancer surgery, and require further testing.
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Health and supportive care needs of surgical lung cancer patients, and the prognostic significance of smoking
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