Overview of approach to lung cancer survivors
- James Huang, MD
James Huang, MD
- Thoracic Service
- Department of Surgery
- Memorial Sloan-Kettering Cancer Center
- Jamie Ostroff, PhD
Jamie Ostroff, PhD
- Behavioral Sciences Service
- Department of Psychiatry & Behavioral Sciences
- Memorial Sloan-Kettering Cancer Center
- Section Editors
- Larissa Nekhlyudov, MD, MPH
Larissa Nekhlyudov, MD, MPH
- Section Editor — Cancer Survivorship
- Associate Professor
- Department of Medicine
- Brigham & Women’s Hospital
- Harvard Medical School
- David E Midthun, MD
David E Midthun, MD
- Section Editor — Lung Cancer
- Mayo Clinic College of Medicine
Although lung cancer remains the leading cause of cancer mortality in men and women in the United States (US), advances in detection and treatment have increased the likelihood of long-term survival. In the US, lung cancer is estimated to be diagnosed in about 225,000 people annually and causes about 160,000 deaths . Similarly, in the European Union in 2012, there were approximately 310,000 new cases and 265,000 deaths due to lung cancer . Currently, there are an estimated 384,000 survivors of lung cancer in the US, accounting for 4 percent of the adult cancer survivor population, and this number is increasing .
The issues facing cancer survivors and the approach to their management are discussed here. Overviews of lung cancer risk factors and initial evaluation and treatment are presented separately. (See "Overview of the risk factors, pathology, and clinical manifestations of lung cancer" and "Overview of the initial evaluation, treatment and prognosis of lung cancer".)
DEFINITION OF A LUNG CANCER SURVIVOR
The most widely accepted definition of a "cancer survivor" is a person who has been diagnosed with cancer, starting the day of their diagnosis until the end of life . Within this broad definition, a long-term cancer survivor has been defined as a person who is living five years after diagnosis with or without disease [4,5].
For purposes of this discussion, lung cancer survivors are characterized as individuals who have been diagnosed with lung cancer and have completed all of their treatment for lung cancer. This topic will discuss the approach to lung cancer survivors and is focused on patients seen in a coordinated care setting between their primary care and oncology providers as well as those exclusively cared for by their primary care providers following treatment for lung cancer. These patients predominantly have had non-small cell lung cancer (NSCLC), since prolonged disease-free survival of patients with small cell lung cancer is much less common.
EPIDEMIOLOGY AND STAGING
The term "lung cancer" refers to malignancies that originate in the airways or pulmonary parenchyma. Approximately 80 percent of all lung cancers are classified as non-small cell lung cancer (NSCLC), and most of the remainder are small cell lung cancer (SCLC). This distinction is required for proper staging, treatment, and prognosis. Smoking tobacco products is the primary cause of lung cancer; approximately 85 percent of lung cancer cases occur in current or former smokers. (See "Cigarette smoking and other possible risk factors for lung cancer" and "Pathology of lung malignancies".)
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- DEFINITION OF A LUNG CANCER SURVIVOR
- EPIDEMIOLOGY AND STAGING
- ONCOLOGIC MANAGEMENT
- Initial treatment
- SURVEILLANCE AFTER TREATMENT
- Potential harms of surveillance
- COMPLICATIONS OF TREATMENT AND LATE EFFECTS
- Fatigue, dyspnea, pain
- Psychological distress
- Cognitive impairment
- Sexual dysfunction
- LIFESTYLE FACTORS
- Sedentary lifestyle/low physical activity
- Financial/employment implications
- Persistent tobacco use
- COORDINATION OF CARE
- Nurse practitioner model
- SUMMARY AND RECOMMENDATIONS