Supportive Care in Cancer

, Volume 26, Issue 9, pp 3047–3053 | Cite as

Lung cancer and family-centered patient concerns

  • Josephine Feliciano
  • Breanna Becker
  • Manish Shukla
  • Joann Bodurtha
Original Article



The risk factors, diagnosis, management, and outcomes for lung cancer (LC) are a family experience. Genetic and environmental factors interact to predispose certain groups to LC, including family member, and the family or caregiving unit experiences the disease course as an interdependent group. This qualitative study examined the concerns and preferences of LC patients about incorporating family in addressing their lung cancer experiences and cancer risks.


This project aims to identify concerns and preferences for addressing family history documentation, risk assessment, prevention, and follow-up issues for LC patients and their family. We held focus groups (FG) to discuss the format and timing of addressing these preferences and concerns. The qualitative data was analyzed using a grounded theory approach.


7 FG totaling 17 participants were conducted. The mean age was 64. All patients had advanced lung cancer. Participants included five males; nine African-Americans; three current, 11 former and three never smokers. Five participants had parents or grandparents with LC. Two had siblings with LC. Six themes were identified: (1) Varied journeys to LC diagnosis. (2) Mixed patient perceptions of cancer causation. (3) Limited documentation and utilization of family history. (4) Diverse attitudes toward smoking cessation. (5) A range of discussions about cancer risk, prevention, and screening. (6) Implications for implementation of family-centered cancer care and health promotion.


The diagnosis of LC, its management, and outcomes occur in the family context. The diagnosis represents a potential teachable moment with opportunity to reduce the risk of LC development or improve early detection in a population at higher risk of developing lung cancer. Lung cancer patients are interested in discussing risk factors, prevention, and diagnosis of lung cancer for their relatives.


Lung cancer Family Risk Family history Cancer communication Supportive care 



We would like to offer a special thank you to the staff and patients who have helped to make this project possible.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30CrossRefPubMedGoogle Scholar
  2. 2.
    McKay JD et al (2017) Large-scale association analysis identifies new lung cancer susceptibility loci and heterogeneity in genetic susceptibility across histological subtypes. Nat Genet 49:1126–1132CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Samet JM (2017) Is the Incidence of Adenocarcinoma of the Lung Rising in Never Smokers? JNCI. J Natl Cancer Inst 109(7)Google Scholar
  4. 4.
    Kovalchik SA, Tammemagi M, Berg CD, Caporaso NE, Riley TL, Korch M, Silvestri GA, Chaturvedi AK, Katki HA (2013) Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 369(3):245–254CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jaklitsch MT, Jacobson FL, Austin JHM, Field JK, Jett JR, Keshavjee S, MacMahon H, Mulshine JL, Munden RF, Salgia R, Strauss GM, Swanson SJ, Travis WD, Sugarbaker DJ (2012) The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 144(1):33–38CrossRefPubMedGoogle Scholar
  6. 6.
    Sparla A, Flach-Vorgang S, Villalobos M, Krug K, Kamradt M, Coulibaly K, Szecsenyi J, Thomas M, Gusset-Bährer S, Ose D (2016) Individual difficulties and resources–a qualitative analysis in patients with advanced lung cancer and their relatives. Patient Prefer Adherence 10:2021–2029CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kalanithi, P., When breath becomes air. 2017: Random HouseGoogle Scholar
  8. 8.
    Wittenberg E, Borneman T, Koczywas M, del Ferraro C, Ferrell B (2017) Cancer communication and family caregiver quality of life. Behav Sci 7(1):12CrossRefGoogle Scholar
  9. 9.
    Butler, K.M., et al. (2017) Association of Smoking in the home with lung cancer worry, perceived risk, and synergistic risk. in Oncol Nurs ForumGoogle Scholar
  10. 10.
    Butler KM, Rayens MK, Zhang M, Hahn EJ (2011) Motivation to quit smoking among relatives of lung cancer patients. Public Health Nurs 28(1):43–50CrossRefPubMedGoogle Scholar
  11. 11.
    Litzelman K, Kent EE, Mollica M, Rowland JH (2016) How does caregiver well-being relate to perceived quality of care in patients with cancer? Exploring associations and pathways. J Clin Oncol 34(29):3554–3561CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    McBride, C.M., et al. (2015) Patient’s lung cancer diagnosis as a cue for relatives' smoking cessation: evaluating the constructs of the teachable moment. Psycho-OncologyGoogle Scholar
  13. 13.
    Shaffer KM, Jacobs JM, Nipp RD, Carr A, Jackson VA, Park ER, Pirl WF, el-Jawahri A, Gallagher ER, Greer JA, Temel JS (2017) Mental and physical health correlates among family caregivers of patients with newly-diagnosed incurable cancer: a hierarchical linear regression analysis. Support Care Cancer 25(3):965–971CrossRefPubMedGoogle Scholar
  14. 14.
    Siminoff LA, Wilson-Genderson M, Baker S (2010) Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment. Psycho-Oncol 19(12):1285–1293CrossRefGoogle Scholar
  15. 15.
    Weaver, K.E., et al. (2010) Smoking concordance in lung and colorectal cancer patient-caregiver dyads and quality of life. Cancer Epidemiol Prev Biomarkers, 2010: p cebp 0666Google Scholar
  16. 16.
    Grant, M., et al. (2013) Family caregiver burden, skills preparedness, and quality of life in non-small-cell lung cancer. in oncology nursing forum. NIH Public AccessGoogle Scholar
  17. 17.
    Hamann HA, Lee JW, Schiller JH, Horn L, Wagner LI, Chang VTS, Fisch MJ (2013) Clinician perceptions of care difficulty, quality of life, and symptom reports for lung cancer patients: an analysis from the symptom outcomes and practice patterns (SOAPP) study. J Thorac Oncol 8(12):1474–1483CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hamann HA, Ostroff JS, Marks EG, Gerber DE, Schiller JH, Lee SJC (2014) Stigma among patients with lung cancer: a patient-reported measurement model. Psycho-Oncology 23(1):81–92CrossRefPubMedGoogle Scholar
  19. 19.
    Koca D, Oztop I, Yilmaz U (2013) Evaluation of changes in the attitudes and behaviors of relatives of lung cancer patients toward cancer prevention and screening. Indian J Cancer 50(3):233–238CrossRefPubMedGoogle Scholar
  20. 20.
    Prichard I, Lee A, Hutchinson AD, Wilson C (2015) Familial risk for lifestyle-related chronic diseases: can family health history be used as a motivational tool to promote health behaviour in young adults? Health Promot J Austr 26(2):122–128CrossRefPubMedGoogle Scholar
  21. 21.
    Strauss, A. and J. Corbin (1994) Grounded theory methodology. Handbook of Qual Res. 17: p. 273–85Google Scholar
  22. 22.
    Howell, L.A., Brockman T.A., Receptivity and preferences for lifestyle programs to reduce cancer risk among lung cancer family members. Adv Cancer Prev, 2016. 1(3)Google Scholar
  23. 23.
    Devitt B, Hatton A, Baravelli C, Schofield P, Jefford M, Mileshkin L (2010) What should a support program for people with lung cancer look like? Differing attitudes of patients and support group facilitators. J Thorac Oncol 5(8):1227–1232CrossRefPubMedGoogle Scholar
  24. 24.
    Ewing G, Ngwenya N, Benson J, Gilligan D, Bailey S, Seymour J, Farquhar M (2016) Sharing news of a lung cancer diagnosis with adult family members and friends: a qualitative study to inform a supportive intervention. Patient Educ Couns 99(3):378–385CrossRefPubMedGoogle Scholar
  25. 25.
    Bloss CS, Madlensky L, Schork NJ, Topol EJ (2011) Genomic information as a behavioral health intervention: can it work? Pers Med 8(6):659–667CrossRefGoogle Scholar
  26. 26.
    Sanderson S et al (2014) Young Smokers’ interpretations of the estimated lung cancer risk associated with a common genetic variant of low penetrance. Public Health Genomics 17(2):68–75CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Josephine Feliciano
    • 1
  • Breanna Becker
    • 2
  • Manish Shukla
    • 2
  • Joann Bodurtha
    • 3
  1. 1.Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins UniversityBaltimoreUSA
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins School of MedicineBaltimoreUSA

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