OverviewAssessment and Optimisation of Lung Cancer Patients for Treatment with Curative Intent
Section snippets
Statement of Search Strategies Used and Sources of Information
The terms ‘surgical staging’, ‘pulmonary function testing’, ‘mediastinal staging’, ‘performance status’, ‘cardiovascular risk score’, ‘fitness for surgery’, ‘thoracoscore’, ‘smoking cessation’ and ‘pulmonary rehabilitation’ were used to search PubMed and all relevant studies relating to lung cancer were included in the preparation of this overview.
Diagnostic and Staging Investigations – Imaging
Accurate staging is essential for identifying the best treatment for each patient, leading to optimal treatment outcomes. Over the last 15 years there has been a significant change in the approach to lung cancer staging, with improvements in cross-sectional and functional imaging and a move away from surgical staging techniques towards minimally invasive approaches such as endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS).
Diagnostic and Staging Investigations – Pathological Confirmation
Accurate pathological diagnosis is key to determining the optimal treatment for patients with lung cancer. Current national clinical guidelines state that lung cancer should be histologically confirmed whenever practical and make clear recommendations around the sequence of investigations that should be used to diagnose and stage lung cancer [16]. Patients being considered for treatment with curative intent should have computed tomography and PET-CT carried out before biopsies are undertaken.
Age
Although age can be associated with an increased number of significant comorbidities, age alone should not exclude a patient from being considered for surgical treatment [28], [29], [30]. About 30–35% of candidates for surgical resection of lung cancer are aged >70 years [31]. Several guidelines focussing on decision-making in elderly patients with lung cancer agree that assessments of cardiovascular and pulmonary fitness for surgery should be carried out independent of age [16], [30], [31],
Assessment for Curative, Non-surgical Treatments
Although surgery remains the gold standard treatment for patients with early stage lung cancer, those with a good performance status, deemed to have non-operable disease or who decline surgery should still be considered for curative treatments with radiotherapy or chemoradiotherapy. Generally patients with localised disease who are performance status 0-1, without significant comorbidities are suitable. Some performance status 2 patients may also be suitable, but careful selection and
Smoking Cessation
Smoking cessation is always recommended in patients with lung malignancy and most patients presenting with lung cancer will be either current smokers or ex-smokers. Current guidelines recommend that smoking cessation be advocated in patients being considered for surgical resection of lung cancer [16], [31], [32]. There is also increasing evidence that smoking can be detrimental to the efficacy of systemic chemotherapy agents used to treat lung cancer, by inducing enzymes that metabolise these
Conclusion
With an aging population and increasing disease complexity, the work-up, staging and physiological assessments of patients with lung cancer is becoming increasingly challenging. The patient being considered for treatment with curative intent is required to undergo multiple investigations to establish their suitability for treatments. Lung cancer management requires the integration of a well-functioning multidisciplinary team in order to achieve optimal results. Management planning should be
Acknowledgements
Robert Rintoul is part funded by the National Institute for Health Research Cambridge Biomedical Research Centre and the Cambridge Cancer Centre.
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Cited by (4)
Longstanding Challenges in Lung Cancer: Are We Meeting Them?
2016, Clinical OncologyMultidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer
2020, Clinical and Translational OncologyShort-and long-term outcomes in elderly patients with locally advanced non-small-cell lung cancer treated using video-assisted thoracic surgery lobectomy
2018, Therapeutics and Clinical Risk Management
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Authors contributed equally.