Survivorship Issues for Patients With Lung Cancer

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


Cancer Control. 2014;21(1):40-50. 

In This Article


Most of the focus for patients with lung cancer has been on survival rates. Patients with lung cancer should be included in the survivorship paradigm as progress is made; it is worth noting that 17% and 6% of patients with non–small-cell and small-cell lung cancer, respectively, have survival rates longer than 5 years. Those with lung cancer, in concert with their health care team, should be guided to optimize their quality of life, addressing their needs from physical, psychological, and social perspectives wherever they are in the cancer diagnosis continuum.

As a result of the high mortality of the disease, long-term survivors of lung cancer have been underrepresented in survivorship research.[5] However, cancer survivorship cohort studies have suggested that survivors may experience a heavy burden of disease and have a high frequency of symptoms that persist after active treatment ends. A subset of these patients is also at high risk for tumor recurrence, secondary malignancies, and comorbidities.[1,42,45,69]

Survivorship care plans for patients with lung cancer should be streamlined for factors specifically associated with the disease. In addition to long-term survival rates, comorbidities may affect outcomes. For example, lung cancer can frequently co-occur with cardiovascular disease. In a retrospective study of a large cohort of patients with non–small-cell lung cancer during definitive radiation therapy, beta-blocker use was associated with improved distant metastasisfree survival, disease-free survival, and overall survival rates, but not locoregional progression-free survival rates.[25] Based on preclinical trials, no association with beta-blocker use and locoregional progression-free survival rate was present. Wang et al[25] suggested that these drugs may affect the tumor metastatic cascade rather than the primary tumor, proposing that further exploration of selective and nonselective beta blockers is needed to validate these retrospective findings while also looking at the length and timing of betablocker use.

High levels of physical and psychological distress are common in those with lung cancer, thus leading to diminished quality of life.[14,84] These factors, as they pertain to patients with lung cancer, further solidify the need for future research in order to drive the optimization of lung cancer survivorship care templates. Lung cancer carries a risk of secondary malignancy that continues to remain high for up to 10 years.[24,36] Specific guidance on surveillance with testing and symptoms tailored to individual care will be valuable to clinicians and patients. Lifestyle recommendations, especially smoking cessation addressed at each patient encounter, diet and exercise, the consideration of surgeries and lung capacity for these patients, and the potential impairments or toxicities related to prior treatment(s), as well as late and long-term effects (pain, distress, and dyspnea) that impact quality of life may be improved with better coordination between providers using survivorship care plans. Developing tools to capture outcomes when these tools are in place may lead to improvements in this growing subset of the population.[58] Although much of the research involving quality of life has been conducted in the context of diagnosis and treatment, it is of great importance that the medical community expands its understanding of quality of life and how it can impact patients with lung cancer throughout the continuum of care until end of life.[58]