Descriptors and predictors of symptom experience, information needs and caregiver burden in Thai patients with advanced lung cancer and their family caregivers during palliative radiotherapy

Thanthong, Saengrawee (2025) Descriptors and predictors of symptom experience, information needs and caregiver burden in Thai patients with advanced lung cancer and their family caregivers during palliative radiotherapy. PhD thesis, University of Glasgow.

Abstract

Introduction: Patients with advanced lung cancer undergoing palliative radiotherapy often face significant both symptoms from lung cancer and side effects from radiotherapy, which affect their quality of life and require effective self-management strategies. Family caregivers play a crucial role in supporting patients throughout their cancer journey, necessitating a comprehensive assessment of their information needs and understanding of symptom management. Research on symptom experiences, information needs, and caregiver burden among patients receiving palliative radiotherapy is limited, particularly within the context of Thai populations. This thesis aimed to explore and quantify the extent of the symptoms experienced by Thai patients with advanced lung cancer, the information needs of these patients and their family caregivers during palliative radiotherapy, and the caregivers’ burden, and also to identify predictors that influence symptom self-management, meeting information needs and affecting caregivers’ burden.

Methods: The thesis employed an observational, correlational, repeated measures design, which used the Memorial Symptom Assessment Scale (MSAS); the information needs subscale from the Supportive Care Need Survey (SCNS) for patients and caregivers, and the Zarit burden interview to gather information about symptom prevalence, frequency, and severity and the distress caused by these symptoms, information needs, and the level of caregivers’ burden. Participants included Thai patients diagnosed with advanced lung cancer and their family caregivers at four time points: before palliative radiotherapy (visit 1), weekly during palliative radiotherapy (visits 2 and 3), and a month post-palliative radiotherapy (visit 4). Quantitative data collection utilises standardised symptom assessment tools to quantify symptom burden, and demographic and clinical factors are examined as potential predictors.

Findings: Patients with advanced lung cancer (n=56) undergoing palliative radiotherapy and (n=56) of their caregivers were included. The most prevalent symptoms that patients reported were lack of energy, pain, cough, weight loss, and “I don’t look like myself”. Symptom prevalence peaked during the last week of treatment (Visit 3). The most frequent symptom across all four visits was fatigue. Symptom scores exhibited a consistent reduction from baseline at all visits. Most caregivers reported either no burden or little burden. The most frequent concern of caregivers was related to the apprehension about their relative’s future. Burden scores indicated a trend of a decrease from baseline. Both patients and caregivers sought information primarily from healthcare providers, with discussions being the preferred information format. For both patients and caregivers, wanting information about managing fatigue was the most frequently identified information needed across all visits. Patients’ information needs regarding self-help methods for recovery decreased from baseline across the visits. Caregivers' information needs concerning complementary and alternative therapies decreased from baseline in all categories. Symptom experience scores were associated with smoking history, gender, and radiotherapy type. Psychological symptom scores were higher in married patients with a smoking history. Symptom experience scores were associated with smoking history (p=0.027), gender (p=0.011), and radiotherapy type (p=0.037). Moreover, a smoking history was indicative of higher Global Distress Index scores. Gender and relationship status influenced increased caregivers’ burden. Smoking history, age, treatment area, education level, and radiotherapy dose were predictors of heightened information needs. Gender and relationship status influenced caregivers’ information needs. Male caregivers had a bigger reduction in information needs than females (p=0.041), and spouses/partners had a bigger information need than those with a different relationship to the patient (p=0.021). These findings provide valuable insights into the symptom experiences and information needs of patients during palliative radiotherapy for lung cancer and caregivers’ burden and caregivers’ information needs during taking care of these patients offering potential directions for tailored interventions and care strategies. Caregivers also experience their own challenges while supporting patients, highlighting the need for tailored information and support strategies for caregivers.

Conclusion: The results relate to Thailand but cannot be generalised to all patients and caregivers in Thailand due to the specific characteristics of the study sample and healthcare settings. This study highlights the importance of systematic symptom-monitoring to identify which symptoms may persist that may require more intense supportive care intervention. The caregivers report a low burden level, but fostering open communication channels between caregivers and healthcare providers can help address any concerns to ensure that they feel supported throughout the patient’s treatment journey. The findings have implications for the development of patient-centred interventions that aim to enhance symptom self-management e.g. x and provide targeted information to both patients and their family caregivers. By addressing the identified predictors, healthcare professionals can better support the unique needs of patients and caregivers, ultimately improving the quality of care and patients’ quality of life. Tailored interventions, if implemented, have the potential to address these complex needs and enhance the well-being of patients with advanced lung cancer who are receiving palliative radiotherapy.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Supervisor's Name: Johnston, Professor Bridget and Kotronoulas, Dr. Greg
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85258
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 27 Jun 2025 12:29
• Last Modified: 27 Jun 2025 12:29
• Thesis DOI: 10.5525/gla.thesis.85258
• URI: https://theses.gla.ac.uk/id/eprint/85258

Related URLs

• Article DOI
• Article DOI