Staged versus conventional nursing for patients receiving chemotherapy for advanced non-small cell lung cancer: a before and after study

Background: Advanced non-small cell lung cancer (NSCLC) patients receiving chemotherapy usually experience adverse events, especially chemotherapy-induced nausea and vomiting (CINV), which reduces their quality of life (QoL). The present before and after study was performed to investigate the influence of graded nursing on adverse events and QoL of advanced NSCLC patients. Methods: Patients with stage III or IV NSCLC who received conventional nursing from January 2017 to December 2017 were selected as the control group. Patients with stage III or IV NSCLC who received staged nursing from January 2018 to December 2018 were selected as the study group. Adverse events, especially CINV, were recorded as a primary outcome of this study. The QoL of patients was assessed using the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 scale. All patients were followed up for at least 1 year. Results: Patients showed no significant difference in baseline clinical characteristics between the control and study groups. Adverse events, including vomiting, nausea, constipation, fever, cough, mucositis, and epigastric pain, occurred, of which CINV was the most common. However, no difference in these adverse events was found between the 2 groups. The EORTC QLQ-C30 scale, which assesses the physical, role, emotional, cognitive, and social functions and global health status, indicated no significant difference between the 2 groups prior to receiving chemotherapy. Expectedly, patients in the study group had improved emotional, cognitive, and social function and global health status compared with the control group (P=0.004, P=0.017, P=0.008, and P=0.003, respectively). Additionally, the Kaplan-Meier survival curve indicated that patients in the study group had a statistically better survival rate than patients in the control group (P=0.032). Graded nursing was found to be a protective factor of overall survival of advanced NSCLC patients according to the Cox proportional hazards model (P=0.024). Conclusions: Graded nursing could significantly improve QoL and prolong the survival of advanced NSCLC patients receiving chemotherapy, and may be a feasible measurement to improve their prognosis.