Survivorship Issues for Patients With Lung Cancer

Christie L. Pratt Pozo, DHSc; Mary Ann A. Morgan, PhD; Jhanelle E. Gray, MD

Disclosures

Cancer Control. 2014;21(1):40-50. 

In This Article

Abstract and Introduction

Abstract

Background: Survivorship concerns for patients with lung and bronchus cancers include quality of life and physical and psychological aspects. Recommendations for follow-up care should incorporate a survivorship paradigm and practices for these patients.

Methods: The authors conducted a literature review on lung cancer survivorship and the late- and long-term effects of treatment, which can impair quality of life in this patient population.

Results: Lung cancer is a diagnosis associated with heavy disease burden, and patients may benefit from survivorship care. High levels of physical and psychological distress leading to diminished quality of life are common in those with lung cancer. Recognition of the potential late- and long-term effects of treatment may help health care professionals intervene early to minimize negative implications.

Conclusions: Survivorship care for patients with cancer requires a multidisciplinary effort and team approach. Addressing the survivorship needs of these patients and their caregivers, along with providing a continuum of cancer care, should improve their quality of life. Further research on evidence-based practices on the long-term effects of lung cancer survivorship care is necessary.

Introduction

In the United States, 50% of men and 33% of women will develop cancer sometime in their lives.[1] Approximately 13.7 million Americans with a history of cancer were alive on January 1, 2012.[1,2] The number of people diagnosed with cancer is likely to increase as the "boomer" population ages and cancer survival rates improve. Therefore, 18 million estimated people will survive cancer by the end of the next decade.[2,3] The mean age of diagnosis for lung and bronchus cancers is 71 years.[4] In 2013, an estimated 228,190 new patients were diagnosed with lung cancer, and approximately 412,230 men and women alive have been diagnosed with lung cancer.[1,4] For those alive with cancer, these numbers represent 3% of all cancers for both men and women compared with women alive with breast cancer (23%) or men alive with prostate cancer (20%).[2,4] Most patients with lung cancer are diagnosed at later stages because early disease is often asymptomatic, with only 15% diagnosed at a local stage. Thus, there are fewer long-term survivors of lung cancer.[5,6] Although both risks and benefits exist for cancer screening tests, low-dose computed tomography (CT) scanning may provide earlier diagnoses for patients at high risk, specifically for current and former smokers, and reduce lung cancer mortality rates for those patients at high risk and between the ages of 55 and 74 years.[2,5,7–10]

For treatment purposes, lung cancer is classified as either non–small-cell lung cancer (NSCLC; 85%) or small-cell lung cancer (SCLC; 14%).[1] Limited-stage SCLC is routinely treated with combined chemotherapy and radiation therapy and, on occasion, with surgical interventions. The standard treatment for extensivestage SCLC chemotherapy with radiation therapy is usually reserved for palliation. For patients diagnosed with early-stage NSCLC, 71% undergo surgery; however, radiation therapy has been curative in rare cases.[2,11] Approximately 18% of these patients may also receive chemotherapy or radiation therapy. Patients with advanced-stage NSCLC may be treated with chemotherapy (20%), radiation (17%), or a combination of both (35%). Patients with advanced-stage NSCLC may also be treated with targeted therapy such as erlotinib.[2] Treatments for all stages of lung cancer may be difficult to tolerate because they have significant toxicity.[12] The 5-year survival rates are 6.1% for SCLC and 17.1% for NSCLC.[2,4] By comparison, the 5-year survival rate for all adult cancers is 66%.[4,13]

Although lung cancer represents a small subset of the survivorship population, it is associated with heavy disease burden that may derive benefit from survivorship care. The purpose of this article is to review survivorship concerns, including quality of life (QOL) and physical and psychological aspects for patients with lung and bronchus cancers. Recommendations for follow-up care that incorporate a survivorship paradigm and practices for these patients are provided. Results from a literature search for lung cancer survivorship and QOL issues, including searches of the Cumulative Index to Nursing and Allied Health, PubMed, Medline, published articles, and Web sites, are also included. Care planning and models for delivering survivorship care are also reviewed.

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