Journal of Cancer Education

, Volume 34, Issue 1, pp 41–49 | Cite as

Effects of a Web-based Health Education Program on Quality of Life and Symptom Distress of Initially Diagnosed Advanced Non-Small Cell Lung Cancer Patients: A Randomized Controlled Trial

  • Chi-Chin Huang
  • Han-Pin Kuo
  • Yueh-E Lin
  • Shu-Ching ChenEmail author


Advanced non-small cell lung cancer (NSCLC) patients treated with chemotherapy experience functional decline and decreased quality of life. The purpose of this study was to evaluate the effects of a web-based health education program on global quality of life, quality of life-related functional dimensions, and symptom distress of initially diagnosed advanced non-small cell lung cancer patients. This study used a randomized, pre- and post-repeated measures design. A total of 55 participants were randomly assigned to an experimental group (n = 27) and a control group (n = 28). The experimental group participated in a web-based health education program, and the control group received usual care. Patients were assessed at 4 time points: baseline assessment (T0), and then 1, 2, and 3 months (T1, T2, and T3) after participating in the web-based health education program or receiving usual care. Patients in the experimental group had significantly greater global quality of life and emotional function, and significantly less top ten significant symptom distresses compared to those in the control group. There were no differences between the groups and within groups with respect to physical function, role function, cognitive function, and social function. The web-based health education can improve global quality of life, emotional function, and top ten significant symptom distresses in patients receiving chemotherapy during the first 3 months after initial diagnosis of advanced NSCLC. Web-based health education can improve quality of life and lessen distress of initially diagnosed NSCLC patients treated with chemotherapy.


Non-small cell lung cancer Web-based health education Symptom distress, quality of life 



This study was supported by grants by the Chang Gung Memorial Hospital (CMRPG3B0732) of Taiwan. The authors gratefully acknowledge the contribution of the patients who participated in the study. The authors also thank Dr. Richard Sandore for the assistance with the English editing.

Compliance with Ethical Standard

Conflicts of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    World Health Organization. Cancer fact sheet Accessed February 2, 2017
  2. 2.
    Ministry of Health Welfare, Taiwan, ROC. 2015 statistics cause of death. Available from: Accessed February 2 25, 2017
  3. 3.
    Dearing KR, Sangal A, Weiss GJ (2014) Maintaining clarity: review of maintenance therapy in non-small cell lung cancer. World J Clin Oncol 5:103–113CrossRefGoogle Scholar
  4. 4.
    Kim ES, Pandya KJ (2013) Advances in personalized therapy for lung cancer. Expert Opin Med Diagn 7:475–485CrossRefGoogle Scholar
  5. 5.
    Choi S, Ryu E (2016) Effects of symptom clusters and depression on the quality of life in patients with advanced lung cancer [published online ahead of print April 26, 2016]. Eur J Cancer Care (Engl) doi:  10.1111/ecc.12508
  6. 6.
    Gupta M, Sahi MS, Bhargava AK, Talwar V (2016) A prospective evaluation of symptom prevalence and overall symptom burden among cohort of critically ill cancer patients. Indian J Palliat Care 22:118–124CrossRefGoogle Scholar
  7. 7.
    Bozcuk H, Dalmis B, Samur M, Ozdogan M, Artac M, Savas B (2006) Quality of life in patients with advanced non-small cell lung cancer. Cancer Nurs 29:104–110CrossRefGoogle Scholar
  8. 8.
    McCorkle R, Young K (1978) Development of symptom distress scale. Cancer Nurs 1:373–378CrossRefGoogle Scholar
  9. 9.
    Iyer S, Roughley A, Rider A, Taylor-Stokes G (2014) The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study. Support Care Cancer 22:181–187CrossRefGoogle Scholar
  10. 10.
    Walling AM, Weeks JC, Kahn KL et al (2015) Symptom prevalence in lung and colorectal cancer patients. J Pain Symptom Manag 49:192–202CrossRefGoogle Scholar
  11. 11.
    Iyer S, Taylor-Stokes G, Roughley A (2013) Symptom burden and quality of life in advanced non-small cell lung cancer patients in France and Germany. Lung Cancer 81:288–293CrossRefGoogle Scholar
  12. 12.
    Rice RW (1984) Work and the quality of life assessment. In: Oskamp S (ed) Applied social psychology annual 5. Applications in organizational settings. Sage, Beverly Hills, pp 155–157Google Scholar
  13. 13.
    Cheng S (1988) Subjective quality of life in the planning and evaluation of programs. Eval Program Plann 11:123–134CrossRefGoogle Scholar
  14. 14.
    Buccheri G, Ferrigno D, Tamburini M et al (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32:1135–1141CrossRefGoogle Scholar
  15. 15.
    Bade BC, Brooks MC, Nietert SB et al (2016) Assessing the correlation between physical activity and quality of life in advanced lung cancer [published online ahead of print December 1, 2016]. Integr Cancer Ther doi:  10.1177/1534735416684016
  16. 16.
    Silvoniemi M, Vasankari T, Löyttyniemi E, Valtonen M, Salminen E (2016) Symptom assessment for patients with non-small cell lung cancer scheduled for chemotherapy. Anticancer Res 36:4123–4128PubMedGoogle Scholar
  17. 17.
    Barak A, Klein B, Proudfoot JG (2009) Defining internet-supported therapeutic interventions. Ann Behav Med 38:4–17CrossRefGoogle Scholar
  18. 18.
    Bray VJ, Dhillon HM, Bell ML et al (2017) Evaluation of a web-based cognitive rehabilitation program in cancer survivors reporting cognitive symptoms after chemotherapy. J Clin Oncol 35:217–225CrossRefGoogle Scholar
  19. 19.
    Bowen DJ, Robbins R, Bush N et al (2017) Effects of a web-based intervention on women's breast health behaviors [published online ahead of print January 17, 2017]. Transl Behav Med doi:  10.1007/s13142-016-0439-z
  20. 20.
    Post KE, Flanagan J (2016) Web based survivorship interventions for women with breast cancer: an integrative review. Eur J Oncol Nurs 25:90–99CrossRefGoogle Scholar
  21. 21.
    Mayer RE (2001) Multimedia learning. Cambridge University Press, New YorkCrossRefGoogle Scholar
  22. 22.
    Moreno R, Mayer R (1999) Cognitive principles of multimedia learning: the role of modality and contiguity. J Educa Psychol 1999;91: 358–368Google Scholar
  23. 23.
    Humphreys J, Lee KA, Carrieri-Kohlman V et al (2008) Theory of symptom management. In: Smith MJ, Liehr PR (eds) Middle range theory for nursing, 2nd edn. Springer, New York, NY, pp 145–158Google Scholar
  24. 24.
    UCSF School of Nursing Symptom Management Faculty Group (1994) A model for symptom management. J Nurs Scholarsh 26:272–276CrossRefGoogle Scholar
  25. 25.
    Kjær TK, Mellemgaard A, Stensøe Oksen M et al (2017) Recruiting newly referred lung cancer patients to a patient navigator intervention (PACO): lessons learnt from a pilot study. Acta Oncol 17:1–7Google Scholar
  26. 26.
    Czerw AI, Religioni U, Deptała A (2016) Adjustment to life with lung cancer. Adv Clin Exp Med 25:733–740CrossRefGoogle Scholar
  27. 27.
    Janssen A, Shaw T, Nagrial A et al (2016) An online learning module to increase self-efficacy and involvement in care for patients with advanced lung cancer: research protocol. JMIR Res Protoc 2016;5:e147Google Scholar
  28. 28.
    Temel JS, Greer JA, El-Jawahri A et al (2016) Effects of early integrated palliative care in patients with lung and GI cancer: a randomized clinical trial. J Clin Oncol 28:JCO2016705046Google Scholar
  29. 29.
    National Comprehensive Cancer Network. 2015 National comprehensive cancer network guidelines. Non-small cell lung cancer V7. Available from: Accessed February 2 25, 2017
  30. 30.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655CrossRefGoogle Scholar
  31. 31.
    Chen SC, Liao CT, Lin CC, Chang JT, Lai YH (2009) Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery. Oral Oncol 45:815–820CrossRefGoogle Scholar
  32. 32.
    Takayama K, Atagi S, Imamura F et al (2016) Quality of life and survival survey of cancer cachexia in advanced non-small cell lung cancer patients—Japan nutrition and QOL survey in patients with advanced non-small cell lung cancer study. Support Care Cancer 24:3473–3480CrossRefGoogle Scholar
  33. 33.
    Chen CL, Liao MN, Chen SC, Chan PL, Chen SC (2012) Body image and its predictors in breast cancer patients receiving surgery. Cancer Nurs 35:E10–E16CrossRefGoogle Scholar
  34. 34.
    Chen SC, Lai YH, Liao CT, Huang BS, Lin CY, Fan KH, Chang JT (2014) Unmet supportive care needs and characteristics of family caregivers of patients with oral cancer after surgery. Psychooncology 23:569–577CrossRefGoogle Scholar
  35. 35.
    Chie WC, Yang CH, Hsu C, Yang PC (2004) Quality of life of lung cancer patients: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13. Qual Life Res 13:257–262CrossRefGoogle Scholar
  36. 36.
    Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organization for Research and Treatment of Cancer, BrusselsGoogle Scholar
  37. 37.
    Liao YC, Shun SC, Liao WY et al (2014) Quality of life and related factors in patients with newly diagnosed advanced lung cancer: a longitudinal study. Oncol Nurs Forum 41:E44–E55CrossRefGoogle Scholar
  38. 38.
    Chan YH (2004) Biostatistics 301A: repeated measurement analysis (mixed models). Singap Med J 45:354–369Google Scholar
  39. 39.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, NJGoogle Scholar
  40. 40.
    Oh PJ, Kim SH (2014) The effects of spiritual interventions in patients with cancer: a meta-analysis. Oncol Nurs Forum 41:290–301CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  • Chi-Chin Huang
    • 1
  • Han-Pin Kuo
    • 2
    • 3
  • Yueh-E Lin
    • 1
    • 4
  • Shu-Ching Chen
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of NursingLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
  2. 2.Department of Chest MedicineLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
  3. 3.Department of Medicine, College of MedicineChang Gung UniversityTaoyuanTaiwan
  4. 4.Department of Nursing, College of NursingChang Gung University of Science and TechnologyTaoyuanTaiwan
  5. 5.Department of Radiation Oncology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Proton and Radiation Therapy CenterTaoyuanTaiwan

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