In this independent project final paper, two peer-viewed journal articles that examine the hypothesis of smoking tobacco and its effects on lung cancer patients using different study designs are selected. Both articles are then analyzed in terms of their objectives, study design, results, conclusions, and their strengths and limitations. Finally, the two articles are then compared to determine if they have similar findings, which article has the superior methodology and which article is more believable. The chosen two articles are ‘ Relationship Between Quality of Life of Lung Cancer Patients and Smoking’ and ‘Tobacco Cessation May Improve Lung Cancer Patient Survival.’
Article I
The article title is ‘ Relationship Between Quality of Life of Lung Cancer Patients and Smoking.’ The objective of this research article was to determine the effects of smoking tobacco products on the quality of life of patients who had lung cancer. The research designed used to collect data was a cross-sectional, non-experimental design. The target population chosen were patients with lung cancer, who were not in their terminal stage of the disease, who were in all clinical facilities and had not undergone any surgical treatment or oncological treatment. The research sample were 198 patients who were diagnosed with lung cancer where 60% of these patients were men (118), and 40% were women (80) (Dimunova, Veselka, Rakova, & Bednarek, 2018). After gaining approval to perform the study, the research was done in the pulmonary ward of the six health-care institutions in Slovakia.
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EORTC QLQ-C30 questionnaire, together with its module EORTC QLQ-LC13, were the methods used to collect data. The EORTC QLQC30 was used to analyze five functioning scales (physical, role, emotional, cognitive, and social performance), global health status, three symptom scales (fatigue, pain, nausea or vomiting), and six single items such as constipation, dyspnoea, appetite loss, insomnia, diarrhoea, and financial difficulties (Dimunova et al. 2018). On the other hand, the EORTC QLQ-LC13 used was a supplementary questionnaire module which included items assessing lung cancer-associated symptoms such as hemoptysis, cough, dyspnoea, and site-specific pain.
The result obtained was categorized into non-smokers, current or former. From the chosen sample, the results showed that 40% of the patients were smokers, 42% were non-smokers, and 39% were former smokers. The obtained results also showed that the patients who were smokers smoked an average of 18.14 cigarettes a day (SD ± 0.28) for 35.42 years (SD ± 0.98) (Dimunova et al. 2018). The variable includes appetite loss, dyspnoea, insomnia, constipation, diarrhea, financial difficulties, global health status, three symptom scales (fatigue, pain, nausea or vomiting), and five functioning scales (physical, role, emotional, cognitive, and social performance) (Prucha, 2018).
The variables were measured using a Kruskal-Wallis test that was used to explore possible differences in both EORTC QLQ-C30 and QLQ-LC13 subscales. The results collected showed that there was a comparison in the EORTC QLQC30 concerning the smoking status, as explained through the Kruskal-Wallis test. Significant differences were found in physical functioning, global health status, dyspnoea, pain, and financial difficulties. In non-smokers, physical functioning and health status were better than those of the former and current smokers (Moyer, 2014) . Financial difficulties, dyspnoea, and pain were more for the former and current smokers than the non-smokers. Also, the results obtained showed that there was a comparison in the EORTC QLQLC13 concerning the smoking status as indicated by the Kruskal-Wallis test. There was a significant difference in coughing, dyspnoea, hemoptysis, pain in chest dysphagia, and pain in other parts. The problems were more significant for former smokers and current smokers in comparison with non-smokers.
The article concludes, indicating that the findings they obtained from the study have shown that smoking has undesirable effects on the quality of life of patients with lung cancer. The limitation of this study is that the results can be affected by the cancer stage and the medication method of the patient. On the other hand, the author of the study claimed that the study has no conflict of interest, and it was conducted following the principles of ethical research. The study conclusion generalizes the overall population of lung cancer patients. This is because the results show that tobacco use has undesirable effects on the quality of life of lung cancer patients.
Article II
The title of the article is Tobacco Cessation May Improve Lung Cancer Patient Survival . This research study aims to determine if tobacco cessation among lung cancer patients may increase their overall survival after diagnosis. The study design used in the study was the descriptive statistics and Cox proportional hazards models. The target population in this study were the lung cancer patients who were at Roswell Park Cancer Institute: an NCI Designated Comprehensive Cancer Center (Amato et al., 2015) The authors collected their data demographics, clinical information and self-reported tobacco used at last through the electronic medical records. The sample of the patients who were involved in the study were 388. The lung cancer patients were included in the study analysis by participating in at least one telephone call with the RPCI TACS. A patient had to show that he or she had been tobacco-free for at least 24 hours before the last contact to be considered that he or she had quit.
The results showed that 313 of 388 lung cancer patients had referred to the cessation service. 80% were contacted successfully, and they participated in at least one telephone call concerning cessation, and 40.8% of the individuals who were contacted claimed that they had quit the last contact. The study controlled for pack-year history, group performance status, sex, age, Eastern Cooperative Oncology, tumor histology, the time between diagnosis and last contact and clinical assistance (Amato et al., 2015). After controlling for this factor, the results showed a statistically significant increase in the survival was associated with quitting than the continued tobacco use at last contact (HR = 1.79; 95% confidence interval: 1.14–2.82) with a median nine months increase in the overall survival.
The variables included in this study were pack-years, age at diagnosis, sex, tumor histology (NSCLC vs. other), clinical stage, ECOG status, days between diagnosis and last contact, and tobacco use status at the time of referral. For categorical tests, frequencies and χ2 tests were used, for continuous variables and quit rates ANOVA was used, and Kaplan–Meier with log-rank test for survival quit rates (Heale & Twycross, 2015). From the study, the results persisted even with control for performance status, age at diagnosis, tumor histology pack-year history, clinical stage, days between last contact, sex, and having quit at referral.
The study concluded stating that the results show that lung cancer patients who reported quitting smoking at or following their diagnosis showed better survival than that of the patients who continued to smoke tobacco even after diagnosis. The authors claim that the study faced limitations. The limitations included the limited sample size of the participants, loss to follow-ups, having tobacco use status considering self-report, and the inaccuracy of the patient self-report. On the other hand, the results were not changed when some successful counseling support call mode was added. Also, the restriction of the final model to patients who participated in at least two calls contributed similar results. The study conclusion generalizes the overall population of lung cancer patients. It shows the importance of tobacco cessation to improve their survival after diagnosis.
Comparison
The two articles conclude by stating that tobacco use is not suitable for lung cancer patients. The first article states that tobacco affects the quality of life for the lung cancer patient, and the second article says that tobacco quitting is vital in improving lung cancer patient survival. The conclusions are similar since they both show that tobacco use has undesirable effects on lung cancer patients. The first article, ‘ Relationship Between Quality of Life of Lung Cancer Patients and Smoking,’ has a superior methodology compared to the second article. This is because, in the first articles, they faced fewer limitations in collecting their data compared to the second article (Merriam & Tisdell, 2015). I would more likely believe the first article since the data collection was accurate, and the results were well explained (Lewis, 2015). I would design the ideal study to examine the hypothesis by ensuring the participants involved in the study have the exposure, that is, they use tobacco, and they are also lung cancer patients to collect accurate data.
Conclusion
In conclusion, although the two articles had different research study designs, they both concluded that tobacco use has a direct effect in the development of lung cancer and the quality of life of patients with lung cancer.
References
Amato, K. A. D., Hyland, A., Reed, R., Mahoney, M. C., Marshall, J., Giovino, G., ... & Nwogu, C. (2015). Tobacco cessation may improve lung cancer patient survival. Journal of Thoracic Oncology, 10(7), 1014-1019.
Dimunová, L., Veselská, Z. D., Raková, J., & Bednarek, A. (2018). Relationship between quality of life of lung cancer patients and smoking. Central European Journal of Nursing and Midwifery, 9(2), 812-817.
Heale, R., & Twycross, A., (2015). Validity and reliability in quantitative studies. Evidence- based nursing, 18(3), 66-67.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.
Merriam, S. B., & Tisdell, E. J. (2015). Qualitative research: A guide to design and implementation. John Wiley & Sons.
Moyer, V. A. (2014). Screening for lung cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine , 160 (5), 330-338.
Prucha, I. R. (2018). Instrumental variables/method of moments estimation. Handbook of regional science, 1-21.
