Title: Gotowość chorych na raka płuca do zaakceptowania ograniczeń czynnościowych po leczeniu operacyjnym


Lung cancer is the most prevalent malignant neoplasm in men, the second most common among women. However, as the number of deaths caused by cancer is concerned, it holds the first position among both the genders.It has been assessed that ca. 80% deaths among men and ca. 75% deaths of women caused by lung cancer are related to tobacco smoking. In lung cancer aetiology, factors concerning the exposure to carcinogens caused by an occupation as well as genetic predispositions are less relevant.Lung cancer is very frequently asymptomatic. Its long subclinical development is related to the lack of sensory nerves in lung parenchyma. The most common lung cancer symptoms are cough, haemoptysis, dyspnoea, pain and paraneoplastic syndromes. In case of the cancer suspicion, the basic tests are as follows by turns: chest radiogram, chest CT, bronchoscopy, EBUS/EUS.In Poland, 80% of all the lung cancer cases belong to the non-small cell type. The remaining diagnosed cases are small cell cancers (17%) and other lung cancer types, including sarcoma and carcinoids (3%). An advanced stage of non-small cell lung cancer is diagnosed among 60–85% of the patients. The non-small cell lung cancer treatment is mainly based on combined radio- and chemotherapy. At the early stage of non-small cell lung cancer, the treatment of choice is surgical or combined surgical and systemic treatment. The key elements, which enable the surgical treatment of a patient with lung cancer are: cancer stage and histopathological evaluation. The extent and methodof the treatment is significantly influenced by patient’s general fitness and coexistent diseases.The integral part of the surgical treatment of lung cancer should be rehabilitation. Patients with lung cancer battle with numerous weaknesses, fatigue and emotional and mental problems. They influence the biopsychosocial sphere and concern broadly-understood life quality conditioned by health. Probably, strong defence mechanisms, which activate optimism and hope act here as methods to cope with fear of the hard disease and health perspective. The lung cancer treatment itself, even if oncologically efficient, is related to lasting effects, which may significantly influence further functioning of a patient – family, professional and social. In this respect, this study has been performed in order to answer the questions concerning patients’ readiness to accept limitations that may result from the lung cancer treatment as well as the impact of the lung cancer treatment on general biopsychosocial functioning of the ill. The researches objective was an attempt to find if independent everyday functioning of ill people as well as their dealing with difficult situations, their own evaluation of health condition and treatment acceptance influence the acceptance of cancer. The researches were also aimed at determination of negative consequences of poor health condition in the scope of changes imposed by the disease, lack of self-sufficiency, the feeling of dependence on the others and lower self-confidence. Moreover, the researches have enabled the evaluation of the psychological support degree needed by patients with lung cancer.The study was performed in the period from July 2016 to April 2017, in the Department of Thoracic Surgery, Jagiellonian University Collegium Medicum. The researched group consisted of patients with lung cancer scheduled for curative-intent lung resection. The study was based on surveys (MMSE test, original questionnaire regarding readiness to accept limitations after the lung cancer surgery, AIS, STAI and LOT-R).

Abstract cont.:

In total, 135 patients were enrolled, including 88 men and 47 women. The average age was 63.8 and ranged between 30 and 87. The median age was 65 years. Typical age in the researched group was between 58 and 70. The results indicate that the majority of surveyed patients with lung cancer had propensity for optimism. They also show that the awareness of the treatment results and consequences is high among the patients scheduled for surgery. Despite the concerns related to potential dependence on other people, the vast majority of the surveyed patients with lung cancer perceive themselves as independent.The general level of social conditions connected with the acceptance of the limitations caused by lung cancer was influenced by different factors. The most important one – concerning the conditions related to the biopsychosocial model and the disease awareness – was education of the surveyed. The patients with higher education were significantly more ready to accept the life style change but at the same time, they were significantly less ready to accept the limitations concerning their job as well as shortened time of different activities and limiting social activity.The readiness to accept the changes in life after the surgery depends on disease acceptance degree, life orientation and fear level. The level of disease acceptance of patients with lung cancer depends on the evaluation of own health – both currently (it is higher among the patients who consider their health as good) and compared to the previous year (it is higher among the patients who evaluate it as the same or better than a year ago).The willingness to accept the life changes depends on a gender. Women were less ready than men to accept a chemotherapy or another form of further treatment. Age has significant impact on the readiness to accept the majority of analysed consequences of changes after the surgery, which means all besides the life style change and a chemotherapy or another form of further treatment. The more advanced patients’ age, the higher was the readiness to accept the changes. The results confirm that the higher the age, the lower the fear level. The analysis of the relation between the health condition perception and psychological factors (optimism, fear as a state and a quality as well as acceptance of own disease) enables to draw a conclusion that the perception of own disease depends relevantly on a fear level as a quality.The own health perception also depends largely on own disease acceptance. According to the results, the fear level is high among the majority of patients. The higher level of fear was found as a state and a feature among those patients who perceive themselves as ill. The fear level as a state, influences the readiness to accept pain and death. The fear level as a feature significantly influences the readiness to accept chemotherapy or another form of further treatment. The communication between a patient and the people around him/her is crucial, with the role of doctors and a psychologist being of utmost importance. The results prove that psychological education may contribute to the acceptance of such changes after the surgery like quitting addictions, starting chemotherapy or another forms of treatment. ; A clear advantage of the thesis is that it provides the answer to many crucial questions concerning Polish society from the perspective of psychology, physiotherapy and oncology. It should be underlined that so far, such studies have not been conducted in Poland in a group of patients with lung cancer. Knowledge of the awareness of the results and consequences of surgical treatment among the surveyed patients with lung cancer, their level of the disease acceptance, readiness to accept functional limitations which occur after the treatment, life orientation and fear, should facilitate the understanding of an oncological patient, their behaviour and reaction to the disease, becoming a valuable piece of advice in the contacts with patients and their families as well as indicating the possibilities of coping with the fight against cancer.Regardless of the achievements of the recent years in the lung cancer treatment, it remains the biggest oncologic challenge worldwide. Only multidisciplinary actions including prevention, versatile development of basic tests and early detection and much more efficient diagnosis and treatment may contribute to the change of the situation.

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Level of degree:

2 - studia doktoranckie

Degree discipline:

pulmonologia ; onkologia ; psychologia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Nauk o Zdrowiu.


Jarosław Kużdżał

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Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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May 24, 2021

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Mar 20, 2018

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Edition name Date
ZB-127778 May 24, 2021


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