Table 2.

Management of CRF in patients with lung cancer

Screening		Revaluations
When	From the diagnosis	Lung cancer treated with surgery and/or neoadjuvant/adjuvant therapya or with chemoradiotherapy alone	Metastatic LC
How	Use of validated scales for fatigue:18 BFI (widely used in trials in LC), FACT-F, CFS, MFI Performance status evaluation: KPS Use of validated scales for QoL:5 EORTC SF-36 QLQ-C30, SF-36 questionnaire, ESAS, others Use of validated scales for pain:20,21,23 VAS pain, NRS pain Sleep quality:23 sleep duration, trouble falling asleep, wake up feeling exhausted, sleepy during the day Assessment of comorbidities:22,28,29,31 COPD, CVD, endocrine disorders (thyroid disease), anxiety-depressive syndrome, others Daily use of drugs:13–17 Opioids, benzodiazepines, neuroleptic, others Abuse of substances:13–17 Drugs, alcohol Laboratory tests:13–17 Blood count; thyroid, liver, and kidney function Presence of cluster symptoms:20,21,23,52 Anxiety, depression (use HADS), insomnia, somnolence Presence of respiratory cluster symptoms:6 Cough, breathlessness Measuring lung function with PFTs:27 Spirometry to evaluate FEV1/FVC Assessment of physical activity:68–73,74–82 Type of activity before and after the diagnosis. Current limitations Other factors:45,46 ethnicity, socioeconomic and social situation, family relationships	Assessment for fatigue, pain, anxiety, depression, insomnia, somnolence and respiratory cluster symptoms at regular intervals in time (for each symptom it is recommended to always use the same scale) Performance Status (KPS) at regular intervals in time Measuring lung function with PFTs at regular intervals in time Assessment of physical activity Evaluation of symptoms related to adjuvant chemotherapy (sensory neuropathy to the legs)	Assessment for fatigue, pain, anxiety, depression, insomnia, somnolence, and respiratory cluster symptoms at regular intervals in time during treatment (for each symptom, it is recommended to always use the same scale) Performance status (KPS) at each clinic visit Measuring lung function with PFTs at regular intervals in time if stable disease and no obvious clinic progression Assessment of physical activity Evaluation of symptoms related to chemotherapy, target therapy and/or radiotherapy (if in use active therapies)
Proposed treatment			Proposed treatment
Promote pulmonary rehabilitation programs if there is a presence of deficits Promote physical activity based on the KPS and comorbidity Pain control (if present) Psychotherapy (if present distress)b Multidisciplinary approachc Natural remedies, complementary therapiesd EPC			Promote pulmonary rehabilitation programs if there is a presence of deficits (patients with COPD) Promote physical activity based on the KPS and comorbidity Pain control (if present) Psychotherapy (if present distress)b Multidisciplinary approachc Natural remedies, complementary therapiesd Palliative care

Notes:

^aChemotherapy and/or radiotherapy

^bcognitive behavioral therapeutic approaches, psychoeducation, topical counseling, energy conservation and activity management, and methods for the promotion and reinforcement of regeneration

^cif fatigue associated and/or worsened by other comorbidities (such as heart failure, thyroid disease)

^dhypnosis, yoga, and massage therapy.

Abbreviations: LC, lung cancer; BFI, Brief Fatigue Inventory; FACT-F, Functional Assessment of Cancer Therapy-Fatigue; CFS, Cancer Fatigue Scale; MFI, Multidimensional Fatigue Inventory; KPS, Karnofsky Performance Status; QoL, quality of life; EORTC SF-36 QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; ESAS, Edmonton Symptom Assessment System; VAS, Visual Analog Scale; NRS, Numeric Rating Scale; HADS, Hospital Anxiety and Depression Scale; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular diseases; PFTs, pulmonary function tests; FEV₁/FVC, forced vital capacity ratio; EPC, early palliative care.