How do patients with lung cancer experience radiation induced oesophagitis?

Abstract

Patients with lung cancer who receive radiotherapy to their chest may experience the specific treatment toxicity of radiation induced oesophagitis (RIO) if the oesophagus is included in the radiotherapy treatment field. RIO causes significant pain and distress to patients. There is a lack of evidence to guide appropriate management. There is also a lack of information on how patients experience this toxicity.

This qualitative, exploratory study examined the experience of RIO described by patients with lung cancer who received RT to the chest, either alone or in combination with chemotherapy.

The aims of this project were to: • identify the properties and characteristics of RIO as experienced by the patient having radiotherapy to the chest for lung cancer, • understand how these properties and characteristics change over time, • understand the patient experience of ongoing symptoms following completion of radiotherapy, • identify aspects of the RIO experience amenable to nursing interventions that will assist in the management of RIO and, • establish research questions to test specific nursing interventions for RIO.

The Theory of Unpleasant Symptoms (TOUS) was chosen as the conceptual framework for the development of the semi-structured interviews and analysis. Two cohorts of patients were recruited to address the research questions used in this study. Cohort 1 consisted of patients who were actively receiving cancer treatment and experiencing RIO. This cohort provided insight into the experience of RIO in the acute setting, including onset and progression. Cohort 2 consisted of patients who completed treatment for primary lung cancer within the last six months and who experienced Grade 3 RIO at some stage during their treatment. Cohort 2 provided insight into the recovery trajectory following RIO, including long term changes.

Semi-structured patient interviews were used to capture the patients experience and recovery of RIO. The interviews sought to identify the properties and characteristics of the pain and swallowing difficulties as described by all patients as well as other relevant features of the experience. Content analysis was used to analyse interview data.

Four patient stories were chosen from the interviews to illustrate the overall experience of RIO and recovery as a means of providing context to the findings of this study. These vignettes illustrate the increasing impact on daily life as the severity of RIO increased. The extracted statements identified from the interviews were organised into the four central predetermined categories to describe the experience of RIO: (1) pain, (2) swallowing, (3) management and (4) the impact or bother of the experience of RIO. TOUS provided a framework to capture the symptom dimensions of quality, intensity, duration and associated distress of RIO for each of these categories as experienced by the patients. The patient statements extracted from the interviews were organised into four categories to describe the experience of recovery from Grade 3 RIO. The four categories were (1) memory of pain and swallowing difficulties, (2) time to recovery, (3) long term effects on swallowing and (4) advice for future patients.

New knowledge of RIO gained from this study shows that experience changes across the trajectory of RIO, that pain and swallowing are inter-related and require combined therapeutic approaches and that while healing occurs, some swallowing difficulty can persist for some patients.