1. bookVolume 76 (2022): Edizione 1 (January 2022)
Dettagli della rivista
License
Formato
Rivista
eISSN
1732-2693
Prima pubblicazione
20 Dec 2021
Frequenza di pubblicazione
1 volta all'anno
Lingue
Inglese
Accesso libero

Risk factors of inability to live independently in the course of lung cancer

Pubblicato online: 12 Sep 2022
Volume & Edizione: Volume 76 (2022) - Edizione 1 (January 2022)
Pagine: 402 - 406
Ricevuto: 06 Feb 2022
Accettato: 29 Jun 2022
Dettagli della rivista
License
Formato
Rivista
eISSN
1732-2693
Prima pubblicazione
20 Dec 2021
Frequenza di pubblicazione
1 volta all'anno
Lingue
Inglese
Introduction

Lung cancer is a malignant tumor leading to many deaths around the world. In fact, it is the main cause of cancer-related mortality worldwide [1, 2, 3]. In the literature we can find a variety of works that focus on preventing lung cancer [4, 5, 6, 7] and on implications for early detection [8, 9] but no articles about factors leading to the inability to live independently. It is a cancer that causes significant suffering among patients, both physical [10, 11, 12, 13] and mental [14, 15, 16, 17].

There is a number of articles that focus on functioning with lung cancer, including studies on factors which are responsible for prolonging life [18, 19, 20] and improving quality of life [21, 22, 23, 24]. However, there are no publications on factors leading to inability to live independently in the course of lung cancer. This cancer can cause a damage to the organism's ability to function to a degree that results in patients requiring permanent or long-term care and assistance on the part of another person to satisfy basic life needs [25, 26, 27]. This is a group of patients who are very susceptible and require a holistic approach to care. Therefore, one should become aware of the elements that influence patients' life in such a harmful way and help them by responding to their growing needs, including financial ones, quicker. That is why the first aim of this study is to focus on factors which result in the inability to live independently in the course of lung cancer. Researchers indicate that financially strained patients with lung cancer experience worse emotional and physical quality of life. Other researchers also indicate the importance of interventions to reduce the financial burden of lung cancer [28]. If a patient is found unable to exist independently, he might be entitled to obtain financial help in the form of a nursing supplement or supplementary benefit. Social support should be valued as an important component of sensitive healthcare for the improvement of resilience and life quality among patients with lung cancer [16]. It is worth remembering that all lung cancer survivors are in need of social support. Given these risk factors, attention should be drawn to individuals who may need fast and solid social support because of their fragility. Therefore, the second aim of this study is to make physicians more aware of the problem. They often are the first healthcare professionals who can recognize the problem. They can quickly refer patients and their families to relevant institutions which can eventually help individuals who are unable to live independently.

Patients and methods
Participants and procedures

In this study, all participants had lung cancer. We followed the methods of Tradecki et al [29]. A total of 134 final decisions issued by the Social Insurance Institution in Wrocław, Poland, in 2016 were analyzed (all decisions were made at that time). All patients were interested in obtaining a certificate of the inability to live independently, which is a document for social insurance support signifying that the patients are unable to care for themselves. Patients' medical records were carefully assessed in 2019. Data on age, education, and sex were collected. Moreover, the type of cancer was defined and distant metastases were determined. The functional status of every patient was described based on the Barthel Index for Activities of Daily Living (BI) [30], a validated questionnaire, with a maximum score of 100 points and a minimum of 0. The Body Mass Index (BMI) was calculated based on the available information on weight and height. The study protocol was approved by the Commission of Bioethics at Wrocław Medical University (approval KB-331/2019).

Statistical analysis

The results were subject to a statistical analysis, which was performed using the IBM SPSS Statistics 26 program (Armonk, New York, United States). Variables with a skewed distribution were expressed as medians with interquartile ranges (IQR). Categorical variables were expressed as numbers with percentages. In order to assess the significance of the differences among the groups, the Mann-Whitney test and χ2 test were performed. Statistical significance was set at p value of less than 0.05.

Results

Among the 134 final decisions that were analyzed, 101 patients (75%) obtained a certificate of the inability to live independently (they were included in group A) and 33 individuals (25%) failed to get the certificate (they were included in group B). The groups did not differ statistically in terms of sex (p = 0.161). However, it should be noted that in group A there were slightly more men and in group B women slightly dominated men (Table 1). The groups did not differ statistically in terms of education (p = 0.376). The groups differed statistically in terms of histopathological diagnosis (p = 0.045). All individuals in group B had non-small cell lung cancer (NSCLC), and among those in group A, NSCLC was predominant, but 11.8% of patients had a diagnosis of small cell lung cancer (SCLC, Table 1). We are aware of the fact that 11.8% of patients is not a huge number, but it must be emphasized that there were no SCLC cases in group B. The groups differed statistically in terms of the presence of metastases (p = 0.003). They were much more common among patients in group A (Table 1).

Information on sex, education, histopathology, and metastases in group A and group B

Groups
A (n=101) B (n=33)
SEX N % N % χ2 = 1.960p = 0.161
women 44 43.6 19 57.6
men 57 56.4 14 42.4
EDUCATIONa N % N % χ2 = 3.107p = 0.376
primary 33 37.5 7 21.2
basic vocational 33 37.5 16 48.5
secondary 17 19.3 7 21.2
higher 5 5.7 3 9.1
HISTOPATHOLOGYb N % N % χ2 = 4.024p = 0.045
small cell lung cancer 11 11.8 0 0
non-small cell lung cancer 82 88.2 31 100
METASTASESc N % N % χ2 = 8.933p = 0.003
no 16 16.8 14 42.4
yes 79 83.2 19 57.6

no information on 13 patients from group A

no information on 8 patients from group A and 2 patients from group B

no information on 6 patients from group A

Groups A and B did not differ statistically in terms of age (p = 0.961). However, there was the statistical difference in BMI between the groups (p = 0.011), patients from group A had lower BMI (Table 2). Also, there was the statistical difference in BMI between the groups (p < 0.001), lower overall score on the BI was recorded in group A (Table 2).

Information on age, BMI (body mass index), and BI (The Barthel Index for Activities of Daily Living) in group A and group B (y: years; IQR: interquartile range)

Parameter Group A (n = 101) Group B (n = 33) Statistic p value
Age, y, median (IQR) 66 (63–70) 65 (63–68) Z = −0.049 0.961
BMIa, median (IQR) 23.99 (20.81–26.64) 27.69 (22.31–29.41) Z = −2.527 0.011
BIa, median (IQR) 60 (50–65) 90 (85–95) Z = −8.302 < 0.001

No information on 16 patients from group A

Additionally, group A was analyzed in terms of sex. There was no statistical difference between men and women in this group (Table 3) in terms of age (p = 0.400), BMI (p = 0.645) and BI (p = 0.122).

Information on age, BMI (body mass index) and BI (The Barthel Index for Activities of Daily Living) in group A in terms of sex (y: years; IQR: interquartile range)

Parameter Women (N = 44) Men (N = 57) Statistic p value
Age, y, median (IQR) 66 (64–68) 65 (60–70) Z = −0.841 0.400
BMIa, median (IQR) 24.61 (19.33–26.77) 23.67 (21.45–26.64) Z = −0.461 0.645
BIb, median (IQR) 60 (55–65) 55 (50–65) Z = −1.546 0.122

No information on 11 women and 5 men

No information on 7 women and 9 men

Discussion

As far as we know, this is the first report on risk factors pertaining to the inability to live independently in the course of lung cancer. Our research has shown that patients who were unable to live independently in the course of this cancer had a lower BMI compared to other individuals suffering from lung cancer. The available studies have shown that significant weight loss may impair wound healing and reduce the strength of the immune system, tolerance of treatment, and quality of life [5], which may cause a great impairment of the functional state of the human body and lead to inability to live independently. We have also already known that metastases in the course of lung cancer have been an important factor influencing the survival time [18]. During our study, in patients with the inability to live independently, distant metastases were more frequently diagnosed. Additionally, our study strongly suggests that small cell lung cancer (SCLC) may cause greater functional devastation of patients' bodies than NSCLC and may be a strong indicator of inability to live independently. That's why SCLC is far more aggressive and lethal [31]. All patients diagnosed with this form of lung cancer were considered as unable to live independently in our study. In comparison to other malignant tumours, lung cancer causes greater unmet needs, but these needs have never been fully described [21, 28]. Identifying those needs that affect daily functioning could facilitate interventions to improve the quality of life of patients with lung cancer [12], also in group of individuals with inability to live independently. Our research shows that the BI is a proper tool to assess functional capacity in the context of inability to exist independently. Significantly lower overall score on the BI was recorded in group A. This questionnaire can be filled in quickly and can assess basic activities such as feeding, bathing, grooming, dressing, mobility, and controlling of sphincters. This also confirms that functional performance is an important factor in influencing everyday of life of patients with lung cancer [10]. It should also be remembered that despite the advancement in the detection of lung cancer, the possibility of an accurate histopathological diagnosis, and access to a wide range of treatments for this cancer, many patients still develop advanced, incurable forms that ultimately lead to death [32], and along the way, at some stage of the disease, patients often develop an inability to exist independently.

Potential limitations of this study include lack of information on treatment of lung cancer in both groups. Our study is also based on the data from only one centre (Wrocław, Poland) and from patients who applied for the certificate of the inability to live independently. During the stage of data collection, we found it difficult to obtain information regarding all patients (for instance, we had no information on metastases of six patients in group A). The reasons are as follows: certification in absentia, patients' reluctance to provide information, as well as undisputed inability to lead an independent life with no necessity to gain additional information.

Conclusions

The presence of metastases and BMI are crucial in assessing the risk of inability to live independently among patients with lung cancer. Histopathological diagnosis may be a strong predictor of inability to live independently in the course of this cancer. Age, education, and sex are not proper predictors of this inability. The BI proves to be helpful in assessing the inability to live independently. However, further research including larger samples and information on treatment is still required.

Information on sex, education, histopathology, and metastases in group A and group B

Groups
A (n=101) B (n=33)
SEX N % N % χ2 = 1.960p = 0.161
women 44 43.6 19 57.6
men 57 56.4 14 42.4
EDUCATIONa N % N % χ2 = 3.107p = 0.376
primary 33 37.5 7 21.2
basic vocational 33 37.5 16 48.5
secondary 17 19.3 7 21.2
higher 5 5.7 3 9.1
HISTOPATHOLOGYb N % N % χ2 = 4.024p = 0.045
small cell lung cancer 11 11.8 0 0
non-small cell lung cancer 82 88.2 31 100
METASTASESc N % N % χ2 = 8.933p = 0.003
no 16 16.8 14 42.4
yes 79 83.2 19 57.6

Information on age, BMI (body mass index), and BI (The Barthel Index for Activities of Daily Living) in group A and group B (y: years; IQR: interquartile range)

Parameter Group A (n = 101) Group B (n = 33) Statistic p value
Age, y, median (IQR) 66 (63–70) 65 (63–68) Z = −0.049 0.961
BMIa, median (IQR) 23.99 (20.81–26.64) 27.69 (22.31–29.41) Z = −2.527 0.011
BIa, median (IQR) 60 (50–65) 90 (85–95) Z = −8.302 < 0.001

Information on age, BMI (body mass index) and BI (The Barthel Index for Activities of Daily Living) in group A in terms of sex (y: years; IQR: interquartile range)

Parameter Women (N = 44) Men (N = 57) Statistic p value
Age, y, median (IQR) 66 (64–68) 65 (60–70) Z = −0.841 0.400
BMIa, median (IQR) 24.61 (19.33–26.77) 23.67 (21.45–26.64) Z = −0.461 0.645
BIb, median (IQR) 60 (55–65) 55 (50–65) Z = −1.546 0.122

Cho YJ, Cho YM, Kim SH, Shin KH, Jung ST, Kim HS. Clinical analysis of patients with skeletal metastasis of lung cancer. BMC Cancer. 2019; 19: 303. ChoYJ ChoYM KimSH ShinKH JungST KimHS Clinical analysis of patients with skeletal metastasis of lung cancer BMC Cancer. 2019 19 303 10.1186/s12885-019-5534-3644627830943924 Search in Google Scholar

Lee SH. Chemotherapy for lung cancer in the era of personalized medicine. Tuberc Respir Dis. 2019; 82: 179–189. LeeSH Chemotherapy for lung cancer in the era of personalized medicine Tuberc Respir Dis. 2019 82 179 189 10.4046/trd.2018.0068660952330841023 Search in Google Scholar

Shahedah KK, How SH, Jamalludin AR, Mohd Faiz MT, Kuan YC, Ong CK. Depressive symptoms in newly diagnosed lung carcinoma: Prevalence and associated risk factors. Tuberc Respir Dis. 2019; 82: 217–226. ShahedahKK HowSH JamalludinAR Mohd FaizMT KuanYC OngCK Depressive symptoms in newly diagnosed lung carcinoma: Prevalence and associated risk factors Tuberc Respir Dis. 2019 82 217 226 10.4046/trd.2018.0048660952430841021 Search in Google Scholar

Arrieta O, Lopez-Meija M, Macedo-Perez EO, Corona-Cruz JF. Proposals for the prevention of lung Cancer in the Health system of Mexico. Salud Publica de Mexico. 2016; 58: 274–278. ArrietaO Lopez-MeijaM Macedo-PerezEO Corona-CruzJF Proposals for the prevention of lung Cancer in the Health system of Mexico Salud Publica de Mexico. 2016 58 274 278 10.21149/spm.v58i2.779627557385 Search in Google Scholar

Ge T, Lin T, Yang J, Wang M. Nutritional status and related factors of patients with advanced lung cancer in northern China: A retrospective study. Cancer Management and Research. 2019; 11: 2225–2231. GeT LinT YangJ WangM Nutritional status and related factors of patients with advanced lung cancer in northern China: A retrospective study Cancer Management and Research. 2019 11 2225 2231 10.2147/CMAR.S193567643310930962711 Search in Google Scholar

Luo Q, Steinberg J, O'Connel DL, Yu XQ, Caruana M, Wade S, Pesola F, Grogan PB, Dessaix A, Freeman B, et al. Lung cancer mortality in Australia in the twenty-first century: How many lives can be saved with effective tobacco control? Lung Cancer. 2019; 130: 208–215. LuoQ SteinbergJ O'ConnelDL YuXQ CaruanaM WadeS PesolaF GroganPB DessaixA FreemanB Lung cancer mortality in Australia in the twenty-first century: How many lives can be saved with effective tobacco control? Lung Cancer. 2019 130 208 215 10.1016/j.lungcan.2019.02.02830885346 Search in Google Scholar

Rafiemanesh H, Mehtarpour M, Khani F, Hesami SM, Shamlou R, Towhidi F, Salehiniya H, Makhsosi BR, Moini A. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis. 2016; 8: 1094–1102. RafiemaneshH MehtarpourM KhaniF HesamiSM ShamlouR TowhidiF SalehiniyaH MakhsosiBR MoiniA Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world J Thorac Dis. 2016 8 1094 1102 10.21037/jtd.2016.03.91488602027293825 Search in Google Scholar

Dement JM, Ringen K, Hines S, Cranford K, Quinn PS. Lung cancer mortality among construction workers: Implications for early detection. Occup Environ Med. 2020; 77: 207–213. DementJM RingenK HinesS CranfordK QuinnPS Lung cancer mortality among construction workers: Implications for early detection Occup Environ Med. 2020 77 207 213 10.1136/oemed-2019-10619631996473 Search in Google Scholar

Welch LS, Dement JM, Cranford K, Shorter J, Quinn PS, Madtes DK, Ringen K. Early detection of lung cancer in a population at high risk due to occupation and smoking. Occup Environ Med. 2019; 76: 137–142. WelchLS DementJM CranfordK ShorterJ QuinnPS MadtesDK RingenK Early detection of lung cancer in a population at high risk due to occupation and smoking Occup Environ Med. 2019 76 137 142 10.1136/oemed-2018-10543130415231 Search in Google Scholar

Lehto RH. Symptom burden in lung cancer: Management updates. Lung Cancer Manag. 2016; 5: 61–78. LehtoRH Symptom burden in lung cancer: Management updates Lung Cancer Manag. 2016 5 61 78 10.2217/lmt-2016-0001631030030643551 Search in Google Scholar

Leppert W, Zajaczkowska R, Wordliczek J, Dobrogowski J, Woron J, Krzakowski M. Pathophysiology and clinical characteristics of pain in most common locations in Cancer patients. J Physiol Pharmacol. 2016; 67: 787–799. LeppertW ZajaczkowskaR WordliczekJ DobrogowskiJ WoronJ KrzakowskiM Pathophysiology and clinical characteristics of pain in most common locations in Cancer patients J Physiol Pharmacol. 2016 67 787 799 Search in Google Scholar

Steffen LE, Vowles KE, Smith BW, Gan GN, Edelman MJ. Daily diary study of hope, stigma and functioning in lung cancer patients. Health Psychol. 2018; 37: 218–227. SteffenLE VowlesKE SmithBW GanGN EdelmanMJ Daily diary study of hope, stigma and functioning in lung cancer patients Health Psychol. 2018 37 218 227 10.1037/hea0000570583791829172604 Search in Google Scholar

Zahir ST, Mirtalebi M. Survival of patients with lung cancer, Yazd, Iran. Asian Pacific J Cancer Prev. 2012; 13: 4387–4391. ZahirST MirtalebiM Survival of patients with lung cancer, Yazd, Iran Asian Pacific J Cancer Prev. 2012 13 4387 4391 10.7314/APJCP.2012.13.9.4387 Search in Google Scholar

Huang X, Yan A, Liu Q, Liu Q, Wu L. Effects of magnanimous therapy on coping, adjustment and living function in advanced lung cancer. Curr Oncol. 2019; 26: e48–e56. HuangX YanA LiuQ LiuQ WuL Effects of magnanimous therapy on coping, adjustment and living function in advanced lung cancer Curr Oncol. 2019 26 e48 e56 10.3747/co.26.4126638063730853809 Search in Google Scholar

Jazinizade M, Malakoutikhah A, Madadimahani A, Iranmanesh MH, Oghabian S, Mohammadshahi F, Janfaza F, Zakeri MA. Stress and quality of life of patients with cancer: the mediating role of mindfulness. J Oncol. 2020; 2020: 3289521. JazinizadeM MalakoutikhahA MadadimahaniA IranmaneshMH OghabianS MohammadshahiF JanfazaF ZakeriMA Stress and quality of life of patients with cancer: the mediating role of mindfulness J Oncol. 2020 2020 3289521 10.1155/2020/3289521774889533381176 Search in Google Scholar

Lehto RH. Psychosocial challenges for patients with advanced lung cancer: Interventions to improve well-being. Lung Cancer Targets and Therapy. 2017; 8: 79–90. LehtoRH Psychosocial challenges for patients with advanced lung cancer: Interventions to improve well-being Lung Cancer Targets and Therapy. 2017 8 79 90 10.2147/LCTT.S120215554682728814906 Search in Google Scholar

Oancea C, Suciu C, Timar B, Papava I, Raica M, Burlacu O. The reciprocal relationship between coping mechanisms and lung cancer diagnosis: Findings of a prospective study. Cancer Management and Research. 2018; 10: 33–40. OanceaC SuciuC TimarB PapavaI RaicaM BurlacuO The reciprocal relationship between coping mechanisms and lung cancer diagnosis: Findings of a prospective study Cancer Management and Research. 2018 10 33 40 10.2147/CMAR.S148341575748929379318 Search in Google Scholar

Abazari M, Gholamnejad M, Roshanaei G, Abazari R, Roosta Y, Mahjub M. Estimation of survival rates in patients with lung cancer in West Azerbaijan, the Northwest of Iran. Asian Pacific J Cancer Prev. 2015; 16: 3923–3926. AbazariM GholamnejadM RoshanaeiG AbazariR RoostaY MahjubM Estimation of survival rates in patients with lung cancer in West Azerbaijan, the Northwest of Iran Asian Pacific J Cancer Prev. 2015 16 3923 3926 10.7314/APJCP.2015.16.9.3923 Search in Google Scholar

Abedi S, Janbabaei G, Afshari M, Moosazadeh M, Rashidi Alashti M, Hedayatizadeh-Omran A, Alizadeh-Navaei R, Abedini E. Estimating the survival of patients with lung cancer: what is the best statistical model? J Prev Med Public Health. 2019; 52: 140–144. AbediS JanbabaeiG AfshariM MoosazadehM Rashidi AlashtiM Hedayatizadeh-OmranA Alizadeh-NavaeiR AbediniE Estimating the survival of patients with lung cancer: what is the best statistical model? J Prev Med Public Health. 2019 52 140 144 10.3961/jpmph.17.090645976030971081 Search in Google Scholar

Hellmann MD, Li BT, Chaft JE, Kris MG. Chemotherapy remains an essential element of personalized care for persons with lung cancers. Ann Oncol. 2016; 27: 1829–1835. HellmannMD LiBT ChaftJE KrisMG Chemotherapy remains an essential element of personalized care for persons with lung cancers Ann Oncol. 2016 27 1829 1835 10.1093/annonc/mdw271503578627456296 Search in Google Scholar

Chabowski M, Polanski J, Jankowska-Polanska B, Lomper K, Janczak D, Rosinczuk J. The acceptance of illness, the intensity of pain and the quality of life in patients with lung cancer. J Thorac Dis. 2017; 9: 2952–2958. ChabowskiM PolanskiJ Jankowska-PolanskaB LomperK JanczakD RosinczukJ The acceptance of illness, the intensity of pain and the quality of life in patients with lung cancer J Thorac Dis. 2017 9 2952 2958 10.21037/jtd.2017.08.70570845329221267 Search in Google Scholar

Gu W, Xu YM, Zhu JH, Zhong BL. Depression and its impact on health-related quality of life among Chinese inpatients with lung cancer. Oncotarget. 2017; 8: 104806–12. GuW XuYM ZhuJH ZhongBL Depression and its impact on health-related quality of life among Chinese inpatients with lung cancer Oncotarget. 2017 8 104806 12 10.18632/oncotarget.21001573960229285215 Search in Google Scholar

Udupa K, Rajendranath R, Sagar TG. Comparison study of quality of life in advanced lung cancer patients on tyrosine kinase inhibitor and platinum doublet chemotherapy. Indian J Cancer. 2017; 54: 161–163. UdupaK RajendranathR SagarTG Comparison study of quality of life in advanced lung cancer patients on tyrosine kinase inhibitor and platinum doublet chemotherapy Indian J Cancer. 2017 54 161 163 10.4103/0019-509X.21955829199681 Search in Google Scholar

Yun YH, Kim YA, Sim JA, Shin AS, Chang YJ, Lee J, Kim MS, Shim YM, Zo JL. Prognostic value of quality of life score in disease-free survivors of surgically treated lung cancer. BMC Cancer. 2016; 16: 505. YunYH KimYA SimJA ShinAS ChangYJ LeeJ KimMS ShimYM ZoJL Prognostic value of quality of life score in disease-free survivors of surgically treated lung cancer BMC Cancer. 2016 16 505 10.1186/s12885-016-2504-x495205827439430 Search in Google Scholar

Wilmowska-Pietruszyńska A. Health, financial and social situation of the disabled and the dependent in Poland. Orzecznictwo Lekarskie. 2009; 6: 1–12. Wilmowska-PietruszyńskaA Health, financial and social situation of the disabled and the dependent in Poland Orzecznictwo Lekarskie. 2009 6 1 12 Search in Google Scholar

Wilmowska-Pietruszyńska A. Social security for the disabled and the dependent in Poland. Orzecznictwo Lekarskie. 2007; 4: 13–25. Wilmowska-PietruszyńskaA Social security for the disabled and the dependent in Poland Orzecznictwo Lekarskie. 2007 4 13 25 Search in Google Scholar

Wilmowska-Pietruszyńska A. The risk of incapacity for independent living-necessity of social protection. Polityka Zdrowotna. 2012; 10: 41–55. Wilmowska-PietruszyńskaA The risk of incapacity for independent living-necessity of social protection Polityka Zdrowotna. 2012 10 41 55 Search in Google Scholar

Giuliani ME, Milne RA, Puts M, Sampson LR, Kwan JYY, Le LW, Alibhai SMH, Howell D, Abdelmutti N, Liu G, et al. The prevalence and nature of supportive care needs in lung cancer patients. Curr Oncol. 2016; 23: 258–265. GiulianiME MilneRA PutsM SampsonLR KwanJYY LeLW AlibhaiSMH HowellD AbdelmuttiN LiuG The prevalence and nature of supportive care needs in lung cancer patients Curr Oncol. 2016 23 258 265 10.3747/co.23.3012497403327536176 Search in Google Scholar

Tradecki M, Ziółkowska J, Roemer-Ślimak R, Mazur G, Butrym A. Inability to live independently in the course of breast cancer: Main risk factors. Pol Arch Intern Med. 2021; 131: 16118. TradeckiM ZiółkowskaJ Roemer-ŚlimakR MazurG ButrymA Inability to live independently in the course of breast cancer: Main risk factors Pol Arch Intern Med. 2021 131 16118 Search in Google Scholar

Mahoney FI, Barthel DQ. Functional evaluation: The Barthel Index. Md State Med. J. 1965; 14: 61–65. MahoneyFI BarthelDQ Functional evaluation: The Barthel Index Md State Med. J. 1965 14 61 65 Search in Google Scholar

Lundin A, Driscoll B. Lung cancer stem cells: progress and prospects. Cancer Lett. 2013; 338: 89–93. LundinA DriscollB Lung cancer stem cells: progress and prospects Cancer Lett. 2013 338 89 93 10.1016/j.canlet.2012.08.014368699622906416 Search in Google Scholar

Lim RBL. End-of-life care in patients with advanced lung cancer. Adv Respir Dis. 2016; 10: 455–467. LimRBL End-of-life care in patients with advanced lung cancer Adv Respir Dis. 2016 10 455 467 10.1177/1753465816660925593361927585597 Search in Google Scholar

Articoli consigliati da Trend MD

Pianifica la tua conferenza remota con Sciendo