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
- Professor of Medicine, 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 approximately 223,000 people annually and causes approximately 156,000 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 , attributable to advances in early detection (low-dose computed tomography scanning) and treatment. (See "Screening for lung cancer".)
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".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
- Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49:1374.
- Pozo CL, Morgan MA, Gray JE. Survivorship issues for patients with lung cancer. Cancer Control 2014; 21:40.
- Clark MM, Novotny PJ, Patten CA, et al. Motivational readiness for physical activity and quality of life in long-term lung cancer survivors. Lung Cancer 2008; 61:117.
- Yang P. Epidemiology of lung cancer prognosis: quantity and quality of life. Methods Mol Biol 2009; 471:469.
- Virgo KS, McKirgan LW, Caputo MC, et al. Post-treatment management options for patients with lung cancer. Ann Surg 1995; 222:700.
- Lou F, Sima CS, Rusch VW, et al. Differences in patterns of recurrence in early-stage versus locally advanced non-small cell lung cancer. Ann Thorac Surg 2014; 98:1755.
- Jaklitsch MT, Jacobson FL, Austin JH, et al. 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 2012; 144:33.
- Colt HG, Murgu SD, Korst RJ, et al. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e437S.
- Vansteenkiste J, Crinò L, Dooms C, et al. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol 2014; 25:1462.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Boyle JM, Tandberg DJ, Chino JP, et al. Smoking history predicts for increased risk of second primary lung cancer: a comprehensive analysis. Cancer 2015; 121:598.
- Ripley RT, McMillan RR, Sima CS, et al. Second primary lung cancers: smokers versus nonsmokers after resection of stage I lung adenocarcinoma. Ann Thorac Surg 2014; 98:968.
- Rice D, Kim HW, Sabichi A, et al. The risk of second primary tumors after resection of stage I nonsmall cell lung cancer. Ann Thorac Surg 2003; 76:1001.
- Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995; 109:120.
- Shiels MS, Gibson T, Sampson J, et al. Cigarette smoking prior to first cancer and risk of second smoking-associated cancers among survivors of bladder, kidney, head and neck, and stage I lung cancers. J Clin Oncol 2014; 32:3989.
- Wrixon AD. New ICRP recommendations. J Radiol Prot 2008; 28:161.
- Stiles BM, Mirza F, Towe CW, et al. Cumulative radiation dose from medical imaging procedures in patients undergoing resection for lung cancer. Ann Thorac Surg 2011; 92:1170.
- Lou F, Huang J, Sima CS, et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg 2013; 145:75.
- Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012; 307:2418.
- Gareen IF, Duan F, Greco EM, et al. Impact of lung cancer screening results on participant health-related quality of life and state anxiety in the National Lung Screening Trial. Cancer 2014; 120:3401.
- Younes RN, Gross JL, Deheinzelin D. Follow-up in lung cancer: how often and for what purpose? Chest 1999; 115:1494.
- Calman L, Beaver K, Hind D, et al. Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis. J Thorac Oncol 2011; 6:1993.
- Walsh GL, O'Connor M, Willis KM, et al. Is follow-up of lung cancer patients after resection medically indicated and cost-effective? Ann Thorac Surg 1995; 60:1563.
- Westeel V, Choma D, Clément F, et al. Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg 2000; 70:1185.
- Harpole DH Jr, Herndon JE 2nd, Young WG Jr, et al. Stage I nonsmall cell lung cancer. A multivariate analysis of treatment methods and patterns of recurrence. Cancer 1995; 76:787.
- Hoffman AJ, Given BA, von Eye A, et al. Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer. Oncol Nurs Forum 2007; 34:785.
- Lowe M, Molassiotis A. A longitudinal qualitative analysis of the factors that influence patient distress within the lung cancer population. Lung Cancer 2011; 74:344.
- Lowery AE, Krebs P, Coups EJ, et al. Impact of symptom burden in post-surgical non-small cell lung cancer survivors. Support Care Cancer 2014; 22:173.
- Yates P, Schofield P, Zhao I, Currow D. Supportive and palliative care for lung cancer patients. J Thorac Dis 2013; 5 Suppl 5:S623.
- Solberg Nes L, Liu H, Patten CA, et al. Physical activity level and quality of life in long term lung cancer survivors. Lung Cancer 2012; 77:611.
- Brown JK, Cooley ME, Chernecky C, Sarna L. A symptom cluster and sentinel symptom experienced by women with lung cancer. Oncol Nurs Forum 2011; 38:E425.
- Feinstein MB, Krebs P, Coups EJ, et al. Current dyspnea among long-term survivors of early-stage non-small cell lung cancer. J Thorac Oncol 2010; 5:1221.
- Hung R, Krebs P, Coups EJ, et al. Fatigue and functional impairment in early-stage non-small cell lung cancer survivors. J Pain Symptom Manage 2011; 41:426.
- Sarna L, Cooley ME, Brown JK, et al. Symptom severity 1 to 4 months after thoracotomy for lung cancer. Am J Crit Care 2008; 17:455.
- Ilonen IK, Räsänen JV, Knuuttila A, et al. Quality of life following lobectomy or bilobectomy for non-small cell lung cancer, a two-year prospective follow-up study. Lung Cancer 2010; 70:347.
- Mols F, Beijers T, Vreugdenhil G, van de Poll-Franse L. Chemotherapy-induced peripheral neuropathy and its association with quality of life: a systematic review. Support Care Cancer 2014; 22:2261.
- Pisu M, Kenzik KM, Oster RA, et al. Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer? Cancer 2015; 121:1257.
- Philip EJ, Coups EJ, Feinstein MB, et al. Physical activity preferences of early-stage lung cancer survivors. Support Care Cancer 2014; 22:495.
- Shen MJ, Hamann HA, Thomas AJ, Ostroff JS. Association between patient-provider communication and lung cancer stigma. Support Care Cancer 2016; 24:2093.
- Riley KE, Ulrich MR, Hamann HA, Ostroff JS. Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care. AMA J Ethics 2017; 19:475.
- Yun YH, Kim YA, Sim JA, et al. Prognostic value of quality of life score in disease-free survivors of surgically-treated lung cancer. BMC Cancer 2016; 16:505.
- Andrykowski MA, Steffens RF, Bush HM, Tucker TC. Disparities in mental health outcomes among lung cancer survivors associated with ruralness of residence. Psychooncology 2014; 23:428.
- Brown C, Cataldo J. Explorations of lung cancer stigma for female long-term survivors. Nurs Inq 2013; 20:352.
- Chambers SK, Dunn J, Occhipinti S, et al. A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer 2012; 12:184.
- Handy JR Jr. Minimally invasive lung surgery and postoperative quality of life. Thorac Surg Clin 2012; 22:487.
- Whitney KA, Lysaker PH, Steiner AR, et al. Is"chemobrain" a transient state? A prospective pilot study among persons with non-small cell lung cancer. J Support Oncol 2008; 6:313.
- Kanard A, Frytak S, Jatoi A. Cognitive dysfunction in patients with small-cell lung cancer: incidence, causes, and suggestions on management. J Support Oncol 2004; 2:127.
- Wolfson AH, Bae K, Komaki R, et al. Primary analysis of a phase II randomized trial Radiation Therapy Oncology Group (RTOG) 0212: impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer. Int J Radiat Oncol Biol Phys 2011; 81:77.
- Reese JB, Shelby RA, Abernethy AP. Sexual concerns in lung cancer patients: an examination of predictors and moderating effects of age and gender. Support Care Cancer 2011; 19:161.
- Flynn KE, Reese JB, Jeffery DD, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology 2012; 21:594.
- Flynn KE, Jeffery DD, Keefe FJ, et al. Sexual functioning along the cancer continuum: focus group results from the Patient-Reported Outcomes Measurement Information System (PROMIS®). Psychooncology 2011; 20:378.
- Shell JA, Carolan M, Zhang Y, Meneses KD. The longitudinal effects of cancer treatment on sexuality in individuals with lung cancer. Oncol Nurs Forum 2008; 35:73.
- Coups EJ, Park BJ, Feinstein MB, et al. Physical activity among lung cancer survivors: changes across the cancer trajectory and associations with quality of life. Cancer Epidemiol Biomarkers Prev 2009; 18:664.
- Krebs P, Coups EJ, Feinstein MB, et al. Health behaviors of early-stage non-small cell lung cancer survivors. J Cancer Surviv 2012; 6:37.
- Granger CL, McDonald CF, Berney S, et al. Exercise intervention to improve exercise capacity and health related quality of life for patients with Non-small cell lung cancer: a systematic review. Lung Cancer 2011; 72:139.
- World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR, 2007. http://www.aicr.org/assets/docs/pdf/reports/Second_Expert_Report.pdf (Accessed on August 17, 2015).
- Roelen CA, Koopmans PC, Groothoff JW, et al. Sickness absence and full return to work after cancer: 2-year follow-up of register data for different cancer sites. Psychooncology 2011; 20:1001.
- Mosher CE, Given BA, Ostroff JS. Barriers to mental health service use among distressed family caregivers of lung cancer patients. Eur J Cancer Care (Engl) 2015; 24:50.
- Mosher CE, Ott MA, Hanna N, et al. Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers. Support Care Cancer 2015; 23:2053.
- Mosher CE, Champion VL, Hanna N, et al. Support service use and interest in support services among distressed family caregivers of lung cancer patients. Psychooncology 2013; 22:1549.
- Toll BA, Brandon TH, Gritz ER, et al. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. Clin Cancer Res 2013; 19:1941.
- Andreas S, Rittmeyer A, Hinterthaner M, Huber RM. Smoking cessation in lung cancer-achievable and effective. Dtsch Arztebl Int 2013; 110:719.
- Cooley ME, Sipples RL, Murphy M, Sarna L. Smoking cessation and lung cancer: oncology nurses can make a difference. Semin Oncol Nurs 2008; 24:16.
- Guo NL, Tosun K, Horn K. Impact and interactions between smoking and traditional prognostic factors in lung cancer progression. Lung Cancer 2009; 66:386.
- Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ 2010; 340:b5569.
- Warren GW, Sobus S, Gritz ER. The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support. Lancet Oncol 2014; 15:e568.
- Park ER, Japuntich SJ, Rigotti NA, et al. A snapshot of smokers after lung and colorectal cancer diagnosis. Cancer 2012; 118:3153.
- Cooley ME, Sarna L, Kotlerman J, et al. Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent. Lung Cancer 2009; 66:218.
- Warren GW, Marshall JR, Cummings KM, et al. Practice patterns and perceptions of thoracic oncology providers on tobacco use and cessation in cancer patients. J Thorac Oncol 2013; 8:543.
- Moore S, Corner J, Haviland J, et al. Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial. BMJ 2002; 325:1145.
- Huang J, Logue AE, Ostroff JS, et al. Comprehensive long-term care of patients with lung cancer: development of a novel thoracic survivorship program. Ann Thorac Surg 2014; 98:955.
- Korst RJ, Kansler AL, Port JL, et al. Accuracy of surveillance computed tomography in detecting recurrent or new primary lung cancer in patients with completely resected lung cancer. Ann Thorac Surg 2006; 82:1009.
- Rosales AR, Byrne D, Burnham C, et al. Comprehensive survivorship care with cost and revenue analysis. J Oncol Pract 2014; 10:e81.
- Nekhlyudov L, Aziz NM, Lerro C, Virgo KS. Oncologists' and primary care physicians' awareness of late and long-term effects of chemotherapy: implications for care of the growing population of survivors. J Oncol Pract 2014; 10:e29.
- 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