Impact of Referral Patterns on the Use of Chemotherapy for Lung Cancer

2002 ◽  
Vol 20 (7) ◽  
pp. 1786-1792 ◽  
Author(s):  
Craig C. Earle ◽  
Peter J. Neumann ◽  
Richard D. Gelber ◽  
Milton C. Weinstein ◽  
Jane C. Weeks
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Treatment Decisions ◽  
Subsequent Treatment ◽  
Advanced Lung Cancer ◽  
Lower Socioeconomic ◽  
Metastatic Lung ◽  
Chemotherapy Patients ◽  
Referring Physicians ◽  
Cancer Specialist

PURPOSE: To determine the extent to which unexplained variation in the use of chemotherapy for advanced lung cancer is due to access to oncologists’ services as opposed to treatment decisions made after seeing an oncologist. METHODS: We performed a retrospective cohort study of 12,015 patients over age 65 diagnosed with metastatic lung cancer between 1991 and 1996 while living in one of 11 regions monitored by a Survival, Epidemiology, and End Results (SEER) tumor registry. Assessment by an oncologist and subsequent treatment with chemotherapy were determined by examining linked Medicare claims. RESULTS: Of patients who did not receive chemotherapy, 36% were never assessed by a physician who provides chemotherapy. Patients living in certain areas, those diagnosed in more recent years, and those who received care in a teaching hospital were all more likely to see a cancer specialist. These factors were unrelated to subsequent treatment decisions, however. Conversely, age and comorbidity did not have a significant effect on whether a patient was seen by an oncologist, but they were associated with the likelihood of subsequently receiving chemotherapy. Black race, probably acting as a proxy for lower socioeconomic status, was associated with both a diminished likelihood of seeing a cancer specialist and subsequently receiving chemotherapy. CONCLUSION: Nonmedical factors are important determinants of whether a lung cancer patient is seen by a physician who provides chemotherapy. After seeing such a physician, treatment decisions seem to be mostly explained by appropriate medical factors. Racial and socioeconomic disparities still exist at both steps, however. As therapeutic options expand, referring physicians must ensure that biases and barriers to care do not deprive patients of the opportunity to consider all of their treatment options.

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

Comorbidity: Usage of, and survival after chemotherapy for advanced lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19157-e19157
Author(s):  
Anders Mellemgaard ◽  
Philomena Bredin ◽  
Maria Iachina ◽  
Anders Green ◽  
Mark Krasnik ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Performance Status ◽  
Advanced Lung Cancer ◽  
Advanced Stage ◽  
Metastatic Lung Cancer ◽  
Cancer Data ◽  
Co Morbidity ◽  
Metastatic Lung ◽  
Advanced Stage Lung Cancer ◽  
Stage Lung Cancer

e19157 Background: Comorbidity may influence prognosis in lung cancer, affect performance status (PS) of patients as well as complicate treatment. The present study examines usage and outcome of chemotherapy (CT) for advanced-stage lung cancer, and focuses on the role of comorbidity. Methods: Patients with advanced-stage lung cancer were identified in the Danish Lung Cancer Registry. A total of 22,999 patients with non-resectable, advanced-stage lung cancer were identified. Data on stage, PS, Charlson comorbidity score (ChS), age, histology and type of first treatment (if any) were avaliable. First treatment was categorized as chemotherapy (n=7,346), chemo-radiotherapy (2,636), radiotherapy (n=4,155) or no therapy (n=8,862). Survival was examined separately for 0-1 year and 1-5 years, and further distinction was made between metastatic and non-metastatic lung cancer. Data are presented for the subgroup of patients receiving chemotherapy as first treatment only. All estimates are derived from logistic regression model adjusting for the effect of performance status, pulmonary function and histological type, except for usage where models included same variables plus stage. Results: Use of chemotherapy was less frequent for more comorbid patients (OR 0.86, 0.64, 0.56 for Charlson score 1, 2, 3+ respectively compared to no comorbidity). Older patients and men were less likely to receive CT. For patients receiving CT as first treatment for non-metastatic lung cancer, survival in the first year was slightly worse for those with co-morbidity (HR 0-1year, non metastatic =0.91, 0.92, 0.87 for ChS 1,2,3+ respectively). For 1-5years and for metastatic lung cancer no correlation between comorbidity and survival was noted. In contrast, PS and sex was strongly associated with survival. Conclusions: With increasing co morbidity, chemotherapy was used less often. Comorbidity is not an important prognostic factor in advanced lung cancer treated with chemotherapy. However, sex and especially performance status remain as strong prognostic factors in this patient group.

scholarly journals Chemotherapy decision-making in advanced lung cancer: a prospective qualitative study

2020 ◽  
pp. bmjspcare-2020-002395
Author(s):  
Annmarie Nelson ◽  
Mirella Longo ◽  
Anthony Byrne ◽  
Stephanie Sivell ◽  
Simon Noble ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Qualitative Study ◽  
Performance Status ◽  
Treatment Decisions ◽  
Treatment Recommendations ◽  
Advanced Lung Cancer ◽  
Additional Stress ◽  
Family Needs ◽  
Treatment Pathways ◽  
Information Giving

ObjectiveTo study how treatment decisions are made alongside the lung cancer clinical pathway.MethodsA prospective, multicentre, multimethods, five-stage, qualitative study. Mediated discourse, thematic, framework and narrative analysis were used to analyse the transcripts.Results51 health professionals, 15 patients with advanced lung cancer, 15 family members and 18 expert stakeholders were recruited from three UK NHS trusts. Multidisciplinary team (MDT) members constructed treatment recommendations around patient performance status, pathology, clinical information and imaging. Information around patients’ social context, needs and preferences were limited. The provisional nature of MDTs treatment recommendations was not always linked to future discussions with the patient along the pathway, that is, patients’ interpretation of their prognosis, treatment discussions occurring prior to seeing the oncologist. This together with the rapid disease trajectory placed additional stress on the oncologist, who had to introduce a different treatment option from that recommended by the MDT or patient’s expectations. Palliative treatment was not referred to explicitly as such, due to its potential for confusion. Patients were unaware of the purpose of each consultation and did not fully understand the non-curative intent of treatment pathways. Patients’ priorities were framed around social and family needs, such as being able to attend a family event.ConclusionMissed opportunities for information giving, affect both clinicians and patients; the pathway for patients with non-small cell lung cancer focuses on clinical management at the expense of patient-centred care. Treatment decisions are a complex process and patients draw conclusions from healthcare interactions prior to the oncology clinic, which prioritises aggressive treatment and influences decisions.

Importance of Faith on Medical Decisions Regarding Cancer Care

2003 ◽  
Vol 21 (7) ◽  
pp. 1379-1382 ◽  
Author(s):  
Gerard A. Silvestri ◽  
Sommer Knittig ◽  
James S. Zoller ◽  
Paul J. Nietert
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Formal Education ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Advanced Lung Cancer ◽  
Medical Decisions ◽  
Future Studies ◽  
Medical Oncologists ◽  
Individual Decisions

Purpose: Decisions regarding cancer treatment choices can be difficult. Several factors may influence the decision to undergo treatment. One poorly understood factor is the influence of a patient’s faith on how they make medical decisions. We compared the importance of faith on treatment decisions among doctors, patients, and patient caregivers. Methods: One hundred patients with advanced lung cancer, their caregivers, and 257 medical oncologists were interviewed. Participants were asked to rank the importance of the following factors that might influence treatment decisions: cancer doctor’s recommendation, faith in God, ability of treatment to cure disease, side effects, family doctor’s recommendation, spouse’s recommendation, and children’s recommendation. Results: All three groups ranked the oncologist’s recommendation as most important. Patients and caregivers ranked faith in God second, whereas physicians placed it last (P < .0001). Patients who placed a high priority on faith in God had less formal education (P < .0001). Conclusion: Patients and caregivers agree on the factors that are important in deciding treatment for advanced lung cancer but differ substantially from doctors. All agree that the oncologist’s recommendation is most important. This is the first study to demonstrate that, for some, faith is an important factor in medical decision making, more so than even the efficacy of treatment. If faith plays an important role in how some patients decide treatment, and physicians do not account for it, the decision-making process may be unsatisfactory to all involved. Future studies should clarify how faith influences individual decisions regarding treatment.

Pathology Issues in Thoracic Oncology: Histologic Characterization and Tissue/Plasma Genotyping May Resolve Diagnostic Dilemmas

2017 ◽  
pp. 619-629
Author(s):  
Ibiayi Dagogo-Jack ◽  
Andreas Saltos ◽  
Alice T. Shaw ◽  
Jhanelle E. Gray
Keyword(s):  
Lung Cancer ◽  
Diagnostic Algorithm ◽  
Advanced Lung Cancer ◽  
Liquid Biopsies ◽  
Lung Cancers ◽  
Primary Lung Tumors ◽  
Metastatic Lung ◽  
Mixed Histology

Lung cancer is a heterogeneous diagnosis that encompasses a spectrum of histologic and molecular subgroups. A paradigm shift favoring selection of treatment based on histologic and molecular makeup has positively affected prognosis for patients with metastatic lung cancer, with select patients experiencing durable responses to treatment. However, prognosis remains poor for the majority of patients. Furthermore, oncologists are increasingly faced with challenging dilemmas related to histopathologic and molecular characterization of tumors, both at diagnosis and during treatment. In this review, we focus on three particular challenges: (1) management of mixed histology tumors, a particularly aggressive group of lung cancers, (2) distinguishing multiple primary lung tumors from intrapulmonary metastases, and (3) incorporation of liquid biopsies into the diagnostic algorithm and subsequent follow-up of patients with advanced lung cancer. This review will summarize the existing literature and highlight the potential for molecular genotyping to help refine approaches to each of these challenges.

scholarly journals Pneumocystis in metastatic lung cancer, a pragmatic approach in support of prophylaxis

2021 ◽  
Vol 14 (6) ◽  
pp. e232895
Author(s):  
David Luque Paz ◽  
Stephane Jouneau ◽  
Pierre Tattevin ◽  
Charles Ricordel
Keyword(s):  
Lung Cancer ◽  
Primary Prophylaxis ◽  
Cancer Prognosis ◽  
Advanced Lung Cancer ◽  
Current Evidence ◽  
Metastatic Lung Cancer ◽  
Pragmatic Approach ◽  
Small Cell Lung ◽  
Unsuccessful Treatment ◽  
Metastatic Lung

Lung cancer prognosis has improved in the last decade, including in patients with brain metastasis. However, few of these patients who receive corticosteroids have a primary prophylaxis for Pneumocystis jirovecii pneumonia (PJP). We report the case of an 80-year-old man diagnosed with non-small cell lung cancer and concomitant symptomatic brain metastases, treated with 50 mg/day of prednisolone without any prophylaxis, who presented an acute PJP. After 72 hours of unsuccessful treatment of PJP, the patient died. In our review of this case and the existing literature, we emphasise the importance of a wide use of prophylaxis for PJP, especially in advanced lung cancer treated with corticosteroid therapy. We discuss this issue and report current evidence for primary prophylaxis by trimethoprim–sulfamethoxazole.

scholarly journals Outcomes and Prognostic Factors Following High-dose Re-irradiation for Recurrent Lung Cancer

2021 ◽  
Author(s):  
Keisuke Tamari ◽  
Hiroshi Doi ◽  
Hiroya Shiomi ◽  
Ryoongjin Oh ◽  
Kazuhiko Ogawa
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Treatment Options ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Advanced Lung Cancer ◽  
High Dose ◽  
Significant Prognostic Factor ◽  
Locally Advanced Lung Cancer

Abstract Background: Re-irradiation is one of the treatment options for recurrence after initial radiotherapy for locally advanced lung cancer. However, the safety and efficacy of high-dose re-irradiation for recurrent lung cancer has yet to be completely understood. This study investigated the outcomes of high-dose re-irradiation for patients with recurrent lung cancer at our clinic.Methods: Data were collected from 36 patients with lung cancer (median age, 68 years) who received high-dose re-irradiation using intensity-modulated radiotherapy for locoregional recurrence after initial radiotherapy in the locally advanced stage. Histology findings showed that 11 (30.6%), 14 (38.9%), and 11 (30.6%) patients had adenocarcinoma, squamous cell carcinoma, and small cell carcinoma, respectively. The interval from initial radiotherapy to re-irradiation was 23.4 months. Local control (LC), progression-free survival (PFS), and overall survival (OS) were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors, while late toxicities ≥grade3 were evaluated according to the CTCAE ver. 3.0.Results: The median follow-up was 14.6 months. The 1-year LC, PFS, and OS were 74.1%, 45.2%, and 78.7%, respectively. Multivariate analysis showed that histology was a significant prognostic factor for LC (p = 0.02), while histology (p = 0.04) and distant metastasis (p = 0.01) were significant prognostic factors for PFS. Grade 5 late toxicities occurred in 2 patients (5.6%) who exhibited esophageal perforation and bronchial perforation. No other ≥grade3 late toxicities occurred.Conclusion: High-dose re-irradiation for recurrent locally advanced lung cancer was effective and feasible. Lung adenocarcinoma might therefore be a good indication for re-irradiation.

scholarly journals Should Patient-Rated Performance Status Affect Treatment Decisions in Advanced Lung Cancer?

2008 ◽  
Vol 3 (10) ◽  
pp. 1133-1136 ◽  
Author(s):  
Esther Dajczman ◽  
Goulnar Kasymjanova ◽  
Harvey Kreisman ◽  
Nelda Swinton ◽  
Carmela Pepe ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Performance Status ◽  
Treatment Decisions ◽  
Advanced Lung Cancer ◽  
Rated Performance

Clinical Evaluation of Procarbazine and Fluorouracil in Advanced Lung Cancer

1969 ◽  
Vol 55 (5) ◽  
pp. 277-290 ◽  
Author(s):  
Giovanni Bonadonna ◽  
Silvio Monfardini ◽  
Cesare Oldini ◽  
Adalgiso Guzzon ◽  
Sergio Di Pietro
Keyword(s):  
Lung Cancer ◽  
Side Effects ◽  
Combined Treatment ◽  
Advanced Lung Cancer ◽  
Metastatic Lung ◽  
Group A ◽  
Group B ◽  
Histologic Types ◽  
Objective Improvement ◽  
Better Than

Procarbazine and 5-fluorouracil were given to 69 untreated patients with inoperable or metastatic lung cancer. 62 were adequately evaluable. The patients were divided into 3 groups: A) 26 cases received procarbazine (250 mg/day i.v. for 4 weeks); B) 24 cases received procarbazine in association with 5-fluorouracil given by rapid single i.v. injection (10 mg/kg on alternate days for 4 weeks); C) 12 cases received procarbazine in association with 5-fluorouracil which was given by 2 hour i.v. infusion on alternate days for 4 weeks. No maintenance treatment was given. The objective responses were evaluated following the categories of Karnofsky. Considering only the category 1 responses, 15 % of patients of group A showed objective improvement, in comparison to 43 % and 16 % of patients of group B and C respectively. Therefore, it seems that the combination of procarbazine and 5-fluorouracil (rapid i.v. injection) is better than procarbazine alone, and that the combined treatment is more successful when 5-fluorouracil is given by single i.v. injection rather than through slow i.v. infusion. Regressions were observed in all histologic types. However, in the group of cases with adenocarcinoma none (0/5) responded to procarbazine alone but 5/6 to procarbazine plus 5-fluorouracil. It is likely that procarbazine is more effective in the oat-cell type and 5-fluorouracil in adenocarcinomas. Toxicity consisted in nausea and vomiting during the first 7–10 days in the group treated with procarbazine alone (15/26 cases), while only 2/26 patients had transient leukopenia. In group B the side-effects were diarrhea (13 cases) and leukopenia (9 cases), both possibly due to 5-fluorouracil. Only 2/12 patients of group C showed side-effects (1 vomiting and 1 diarrhea). The fact that no patients of this group showed signs of bone marrow depression confirms what is already known, i.e. that when 5-fluorouracil is given by slow i.v. infusion toxicity rarely occurs. The conclusion is that the association of procarbazine with 5-fluorouracil can produce consistent regressions in patients with advanced carcinoma of the lung, although unmaintained remissions are almost always short lived.

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