Long-term Lung Cancer Survivors Research Articles

Pathological Pleural Invasion is a Risk Factor for Late Recurrence in Long-Term Survivors of Non-small Cell Lung Cancer after Complete Resection.

Information regarding late recurrence after pulmonary resection for non-small cell lung cancer (NSCLC) is limited. This study aimed to analyze the risk factors for late recurrence after surgery for NSCLC in the current era. We conducted a retrospective study of patients who underwent complete resection for pathological I-III NSCLC between 2006 and 2015. Late recurrence was defined as a recurrence that met the following conditions: (1) the patient underwent chest computed tomography (CT) at or after 54 months after surgery and recurrence was not detected at that time, and (2) recurrence that occurred more than 5 years after surgery. The factors influencing late recurrence, relapse-free survival (RFS), and overall survival (OS) after surgery were analyzed. A total of 1275 with 5-year relapse-free survival after surgery were enrolled in this study. The mean age of the patients was 66.4 years and 54% of the patients were men. The median interval between surgery and the latest follow-up examination was 98 months. In total, 35 patients (2.7%) experienced late recurrence and 138 patients have died thus far. The cumulative recurrence, RFS, and OS rates at 10 years were 3.9%, 84.9%, and 86.3%, respectively. A multivariate analysis revealed that pleural invasion was an independent risk factor for late recurrence. Pleural invasion was a poor prognostic factor for both RFS and OS. Pleural invasion was a predictor of late recurrence. Age>67 years, preoperative serum carcinoembryonic antigen (CEA)>5 ng/ml, non-adenocarcinoma, and pleural invasion were poor prognostic factors for RFS.

Abstract 4792: Nationwide patterns of incidence and surveillance of second primary lung cancer among long-term lung cancer survivors using SEER Medicare data

Abstract Background: With advances in screening and therapy, the number of lung cancer (LC) survivors is rapidly increasing, with over half a million as of 2019. Prior studies demonstrated that the incidence of second primary lung cancer (SPLC) among LC survivors is 4-6 times that of initial primary lung cancer (IPLC) in the general population. However, the incidence of SPLC and surveillance strategies using computed tomography (CT) have not been examined in long-term LC survivors with over 5-year survival. We aim to estimate SPLC incidence among long-term survivors and the effectiveness of annual surveillance CT exams. Methods: We used data from SEER-Medicare with a cohort of 1,232,338 LC patients from the SEER cancer registry followed till death or last follow-up, who were also enrolled in Medicare in 1999-2020. The study cohort included 12,948 patients who were long-term survivors (≥ 5-year survival from IPLC) by age 65, received curative therapy for IPLC, and were continuously enrolled in Medicare 1 year prior to 5 years after IPLC diagnosis. The primary outcome was the 10-year cumulative SPLC incidence accounting for competing risk of death in the full study cohort and by receipt of surveillance CTs post-5-year survival, defined using detailed billing and LC-related ICD codes. To qualify as surveillance CTs, two annual CTs 9-18 months apart is required. Cox regression was used as exploratory analysis to examine the association between LC-specific survival (LC as cause of death) and the receipt of two CTs post-5-year survival as a binary variable, adjusting for SPLC diagnosis, age, sex, marital status, race, IPLC stage, income, education, and poverty. Results: Of 12,948 long-term LC survivors, 46% (n=6,015) were male, 90% (n=11,476) had early-stage disease, 77% (n=9,945) had undergone surgery for initial curative treatment, and 3.8% (n = 486) received two surveillance CTs initiated within 18 months post-5-year survival. The 10-year cumulative incidence of SPLC was 5.06% [95% CI: 5.00-5.12%] in the SEER cohort but was substantially higher among long-term LC survivors at 13.6% [13.0-14.2%]. Those who received two annual surveillance CTs after 5-year survival had a significantly higher 10-year SPLC incidence (23.3% [19.4 - 27.2%]) than those who received one or no CT (13.2% [12.6 - 13.8%]). The adjusted hazard ratio of the association between LC-specific survival and receipt of two CTs was 0.67 [0.59-0.80, p < 0.0001]. Conclusions: The high cumulative risk of SPLC among long-term LC survivors warrants tailored surveillance strategies. Our exploratory analysis showed a high SPLC detection rate among those who received two annual surveillance CTs vs. those who did not, with significantly higher LC-specific survival in the former. Future work will include extensive analysis accounting for time-varying exposure of multiple surveillance CTs using rigorous causal inference methods. Citation Format: Chloe C. Su, Eunji Choi, Julie T. Wu, Allison W. Kurian, Michelle C. Odden, Manisha Desai, Leah M. Backhus, Heather A. Wakelee, Ann N. Leung, Joel W. Neal, Summer S. Han. Nationwide patterns of incidence and surveillance of second primary lung cancer among long-term lung cancer survivors using SEER Medicare data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4792.

Characteristics and patient-reported outcomes of long-term lung cancer survivors.

Due to advances in screening and treatment of lung cancer, there has been increased interest in long-term lung cancer survivors (LTLCS). The aim of this study was to evaluate the prevalence of LTLCS, their characteristics and patient-reported outcomes (PROs) of LTLCS. Cross-sectional study that included patients diagnosed with primary lung cancer between Jan 2012 and Dec 2016 whose overall survival (OS) was greater than 5 years. A self-administered questionnaire was applied, including European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), Patient Health Questionnaire-4 (PHQ-4) and two open questions regarding quality of life (QoL) and suggestions for improvements. Factors potentially related to QoL were analysed. Of 767 lung cancer patients, 158 (20.6%) were LTLCS and LTLCS' proportion increased yearly. Most patients were male (70.9%) with median age of 65 [interquartile range (IQR), 56-71] years. Fifty-seven percent had adenocarcinoma, 66.2% were diagnosed at early stages but 8.9% were at stage IV. During follow-up, 77.1% quitted smoking, 31.8% had disease progression/relapse and 15.2% developed other tumours. Of all living LTLCS, 100 (85%) patients answered the PROs questionnaire. The median Global Health score was 66.67 (IQR, 50-83), social functioning had the best score and emotional functioning the worst. Pain and fatigue were the symptoms with the worst impact on QoL. PHQ-4 identified mental distress in 36% and patients with a lower QoL were more likely to present anxiety (35.3% vs. 9.4%, P=0.007) or depression (27.9% vs. 3%, P=0.006). In the open questions, patients reported pain (17%), lack of familiar/financial support (16%), dyspnoea (14%), depression (8%), concern for the future (8%) and limitations performing daily activities (8%) as the aspects with most impact in QoL. The most suggested measures were improvement of care provided by health institutions (25%) and better social support (16%). Prevalence of LTLCS is increasing and survivors may experience a high prevalence of anxiety and depression as well as a high disease burden affecting QoL. Therefore, it's important to provide multidisciplinary continuous patient-centred care and a careful follow-up for all lung cancer patients, including LTLCS.

Prevalence of EGFR and PDL1 testing in a population-based lung cancer surgical resection cohort from 2018-2022.

e20585 Background: Most long-term survivors of lung cancer had surgery for early stage disease, but long-term survival rates are about 50%. In 2020 and 2021 the ADAURA and IMpower010 trials established adjuvant Osimertinib and Atezolizumab therapy for stage IB-IIIA non-small cell lung cancer. Eligibility for these treatments depends on specific biomarkers. We evaluated biomarker testing patterns and prevalence in a population based surgical resection cohort. Methods: In the prospective observational Mid-South Quality of Surgical Resection cohort, we evaluated EGFR and PDL1 testing from 2018-2022, spanning time before (2018-2020) and after (2021-2022) FDA approval of adjuvant Osimertinib and Atezolizumab therapy. We estimated the prevalence of EGFR mutations and PDL1 expression ( > 0%) using the binomial distribution with exact 95% confidence intervals (CI). We compared demographic characteristics using Wilcoxon and Fishers Exact tests. Results: From 2018-2022, 1687 patients had surgical resection across 12 institutions (1045 from 2018-2020; 642 from 2021-2022). They were 21% black and 77% white, 49% male and 51% female, with a median age of 69 years. From 2018-2020 11% had EGFR testing, compared to 38% in 2021-2022 (p < 0.0001). There were no differences in testing by age (p = 0.79), sex (p = 0.99), race (p = 0.69), or insurance type (p = 0.45). In 132 ADAURA eligible individuals (stage IB-IIIA, non-squamous, R0, > 4cm tumor), EGFR was tested in 13% in 2018-2020 and 56% in 2021-2022 (p < 0.0001) with no differences by demographic factors (all p > 0.20). 15% (53 of 360) of EGFR tests were next-generation sequencing, increasing from 4% in 2018-2020 to 20% in 2021-2022 (p < 0.0001). The prevalence of EGFR mutations was 8.1% (95% CI: 5.5% to 11.4%) overall; 9% in males vs. 7% in females (p = 0.57); 12% in black persons vs. 7% in white persons (p = 0.40). From 2018-2020 8% of patients received PDL1 testing, compared to 20% in 2021-2022 (p < 0.0001). There were no differences in testing by age (p = 0.47), sex (p = 0.41), and race (p = 0.51), but a trend for insurance type (p = 0.07). In 791 Impower010 eligible patients (Stage IB-IIIA, R0), PDL1 was tested in 8% in 2018-2020 and 23% in 2021-2022 (p < 0.0001) with no significant differences by demographic factors (all p > 0.10). Among all 207 PDL1 tests, PDL1 was > 0% in 143, for a prevalence of 69% (95% CI: 62% to 75%). It was 69% in males, 70% in females (p = 0.88); 68% in black persons, 69% in white persons (p = 0.99). Testing differed significantly by institution for both EGFR and PDL1 testing (p < 0.001). When EGFR was not evaluated, PDL1 was evaluated 2% of the time but when EGFR was evaluated, PDL1 was evaluated 51% of the time. Conclusions: With the advent of biomarker-directed adjuvant therapy, EGFR and PDL1 testing are rising but testing levels are sub-optimal. Institutional factors influence testing.

Quality of life in older French long-term lung cancer survivors: VICAN5 national survey

ObjectivesThis study aimed to describe quality of life (QoL) five years after diagnosis, in a representative sample of lung cancer (LC) survivors, to compare the QoL of survivors aged 70 years or older with that of younger ones, and to identify factors associated with poorer long-term QoL in both age groups. Materials and MethodsOur study sample consists of all individuals with a LC diagnosed between January 2010 and December 2011, who participated in the French national survey VICAN 5. ResultsA total of 371 participants had LC. At the time of the survey, 21.3% of the participants were 70 years or older. In this older age group, feeling self-conscious about appearance and suspected neuropathic pain were independently associated with physical QoL impairment and lower Post-Traumatic Growth Inventory score, and suspected neuropathic pain was associated with impaired mental QoL. In younger patients, impaired physical QoL was independently associated with male gender, metastatic cancer, suspected neuropathic pain, report of severe after-effects of LC and difficulty breathing at rest in the past 7 days, and impaired mental QoL was independently associated with male gender, impaired ECOG-PS, and anxiety. ConclusionFactors associated with an impaired QoL in LC survivors, varied according to patient age. In both populations, psychological support and adapted physical activity can be offered to improve mental QoL and physical symptomatology. For older survivors with neuropathic pain, analgesic therapies can be discussed to improve long-term QoL.

M-Health in lung cancer: A literature review.

The internet and digital technology have become an important resource for patients with cancer. Mobile health strategies permit patients and clinicians to interact via different tools to enrich the supplements to routine hospital visits or out-patient attendance. In this work, we have reviewed different mobile health platforms to support lung cancer patients in different areas: pre-surgery; post-surgery and on systemic treatment. We have also reviewed different digital tools used by long-term lung cancer survivors as well as the impact of these tools on the quality of life, and we tried to analyse according to literature the potential efficiency of these platforms in health system administration.

Causes of death and conditional survival estimates of long-term lung cancer survivors.

IntroductionLung cancer ranks the leading cause of cancer-related death worldwide. This retrospective cohort study was designed to determine time-dependent death hazards of diverse causes and conditional survival of lung cancer.MethodsWe collected 816,436 lung cancer cases during 2000-2015 in the SEER database, after exclusion, 612,100 cases were enrolled for data analyses. Cancer-specific survival, overall survival and dynamic death hazard were assessed in this study. Additionally, based on the FDA approval time of Nivolumab in 2015, we evaluated the effect of immunotherapy on metastatic patients’ survival by comparing cases in 2016-2018 (immunotherapy era, n=7135) and those in 2013-2016 (non-immunotherapy era, n=42061).ResultsOf the 612,100 patients, 285,705 were women, the mean (SD) age was 68.3 (11.0) years old. 252,558 patients were characterized as lung adenocarcinoma, 133,302 cases were lung squamous cell carcinoma, and only 78,700 cases were small cell lung carcinomas. TNM stage was I in 140,518 cases, II in 38,225 cases, III in 159,095 cases, and IV in 274,262 patients. 164,394 cases underwent surgical intervention. The 5-y overall survival and cancer-specific survival were 54.2% and 73.8%, respectively. The 5-y conditional survival rate of cancer-specific survival is improved in a time-dependent pattern, while conditional overall survival tends to be steady after 5-y follow-up. Except from age, hazard disparities of other risk factors (such as stage and surgery) diminished over time according to the conditional survival curves. After 8 years since diagnosis, mortality hazard from other causes became higher than that from lung cancer. This critical time point was earlier in elder patients while was postponed in patients with advanced stages. Moreover, both cancer-specific survival and overall survival of metastatic patients in immunotherapy era were significantly better than those in non-immunotherapy era (P<0.001), indicating that immunotherapeutic intervention indeed bring remarkable benefits to advanced lung cancer patients.ConclusionsOur findings expand on previous studies by demonstrating that non-lung-cancer related death risk becomes more and more predominant over the course of follow-up, and we establish a personalized web-based calculator to determine this critical time point for long-term survivors. We also confirmed the survival benefit of advanced lung cancer patients in immunotherapy era.

Prognostic Nomogram and Therapeutic Option of Cancer-Specific Death in the Patients with Metachronous Second Primary Lung Cancer.

With the increase of long-term primary lung cancer survivors, studies focused on metachronous second primary lung cancer (SPLC) have become very urgent. This study aimed to develop a prognostic nomogram and determine therapeutic options of cancer-specific death for patients with metachronous SPLC with and without the competing risk of other-specific death. Study population came from the SEER-18 database between 2006 and 2016. According to the clinical practice guideline of SPLC, the interval time of IPLC and metachronous SPLC was set to 4 years. We constructed nomograms with Lasso + Cox regression model and competing risk model to predict the prognosis and identify therapeutic options of metachronous SPLC patients with the assessment of model performance by the C-index, calibration plot, and decision curve analysis. In addition, two subgroup analyses stratified by histology and tumor size were used to better select therapeutic options for a certain population. 1300 patients with metachronous SPLC were incorporated in this study with 50.1% of the 5-year cumulative incidence in cancer-specific death. Compared with Lasso + Cox regression analysis, competing risk analysis harbored a higher C-index (0.811 vs. 0.76) and better net benefit in predicting cancer-specific death of metachronous SPLC. Two statistical analyses suggested that surgery alone was a preferentially therapeutic option of metachronous SPLC, whereas the effect of surgery + radiation in treating metachronous SPLC was similar to radiation alone. Subgroup analyses indicated that patients with metachronous SPLC were considered receiving different therapeutic options in different histology and tumor size but preferred to receive surgical treatment as the first choice. For primary lung cancer survivors, aggressive surgical treatment was the first-line selection of metachronous SPLC, followed by radiation alone, surgery + radiation, and no surgery + radiation.

Positive nodal status is still a risk factor for long-term survivors of non-small cell lung cancer 5 years after complete resection.

BackgroundLung cancer has a poor prognosis; the number of long-term survivors (LTSs) is small compared with that of other cancers. Few studies have focused on late recurrence in LTSs with lung cancer. The purpose of this study was to analyze the risk factors for survival and late recurrence in LTSs after disease-free period of 5 years.MethodsA retrospective analysis of patients with a disease-free survival of at least 5 years after surgical resection for non-small cell lung cancer (NSCLC) between January 1998 and December 2012 was conducted. Patients who underwent neo-adjuvant therapy, had an incomplete resection, or had advanced stage (stages IIIb and IV) cancer were excluded.ResultsA total of 1,254 (53.2%) of 2,357 patients were enrolled. Of these, 759 (60.5%) were men, and the mean patient age was 61.9±10.1 (range, 10–87 years) years. Pathologic N0 (997 patients, 79.5%) and stage I (860 patients, 68.6%) were the dominant stages. Late recurrence occurred in 22 patients (1.8%) 5 years postoperatively. On multivariate analysis, male sex, older age, node-positive status, and late recurrence were found to be independent risk factors for overall survival (OS), while a node-positive status was the only independent risk factor for disease-free survival [hazard ratio (HR) =3.824; P=0.002; 95% confidence interval (CI): 1.658–8.821].ConclusionsThe nodal stage at the time of surgical resection was found to be an independent risk factor for both OS and disease-free survival 5 years after initial treatment in patients with completely resected NSCLC.

Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer.

Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization.Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples.Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0–1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047).Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

Causes of Death and Hospitalization in Long-term Lung Cancer Survivors: A Population-based Appraisal

IntroductionLung cancer survivorship is emerging as an important topic owing to improved survival, but information about health issues among survivors of lung cancer is still lacking. This study used a population dataset to assess causes of death (COD) and hospitalization among long-term (5-year) survivors of lung cancer. Materials and MethodsUsing linked data from the California Cancer Registry and Office of Statewide Health Planning and Development, all patients with lung cancer diagnosed from 2000 to 2012 were identified. COD and principal admission diagnoses were categorized for all survivors beginning 5 years after diagnosis. Annual proportional distribution of diagnoses and COD were calculated over time. ResultsAmong 102,768 patients with lung cancer, 12,048 (11.7%) survived at least 5 years after diagnosis. Lung cancer was the most common reason for admission in the first 5 years after diagnosis. In the sixth year after diagnosis, 3662 (41.8%) of 8755 long-term survivors had at least 1 hospitalization, which declined to 804 (10.4%) of 7718 in year 10. Among long-term survivors, pulmonary disease (18.3%) became the most common reason for admission, followed by cardiovascular and gastrointestinal disease. However, 48.7% of 4728 deaths occurring among long-term survivors were still owing to lung cancer. The next most common COD were cardiovascular disease, pulmonary disease, and secondary neoplasm. ConclusionsHospitalizations among long-term survivors of lung cancer are common and occur most often owing to cardiovascular, pulmonary, and gastrointestinal diseases. Lung cancer remains the dominant COD even after 5-year survival. Active control of chronic cardiopulmonary disease and cancer surveillance should be priorities when providing patient-centered, comprehensive survivorship care.

Long-term survivors of advanced and metastatic lung cancer

The overall prognosis in patients with advanced and metastatic lung cancer is poor, however a subset of these patients has durable survival and they are called long-term survivors (LS). The definition of LS varies in published series from 18 months to 5 years. Few studies have focused on them. We report six cases of LS patients: three cases of non-small- cell lung cancer (stage IIIB and stage IV), two case of small cell lung cancer, and a case of composite carcinoma (small cell carcinoma and squamous carcinoma), all having a survival of five years or more. Our patients show clinical and evolutionary similarities with LS in the literature regarding the prognostic factors associated with prolonged survival namely performance status and good response to first-line chemotherapy.

MS27.01 Staging of Lymph Nodes in Early Stage NSCLC: Therapeutic Implications

MS27.01 Staging of Lymph Nodes in Early Stage NSCLC: Therapeutic Implications

Causes of death in long-term survivors of non-small cell lung cancer: A regional surveillance, epidemiology, and end results study

INTRODUCTION:Survival from lung cancer is improving. There are limited data on the causes of death in 5-year survivors of lung cancer. The aim of this study is to explore the causes of death in long-term survivors of non-small cell lung cancer (NSCLC) and describe the odds of dying from causes other than lung cancer in this patient population.METHODS:An analysis of 5-year survivors of newly diagnosed NSCLC from 1996 to 2007, in Metropolitan Detroit included in Surveillance, Epidemiology, and End Results program, was done.RESULTS:Of 23,059 patients identified, 3789 (16.43%) patients were alive at 5-year period (long-term survivors) and 1897 (50.06%) patients died in the later follow-up period (median 88 months; range 1–219 months). The causes of death besides lung cancer were observed in 55.2% of these patients. The most common causes of death were cardiovascular diseases (CVDs) (16%), chronic obstructive pulmonary diseases (11%), and other malignancies (8%). Patients older than 65 years, males, and those who underwent surgery for treatment of lung cancer faced a greater likelihood of death by other causes as compared to lung cancer (OR: 1.45, 95% confidence interval [CI]: 1.18–1.77; OR: 1.24, 95% CI: 1.02–1.51; and OR: 1.39, 95% CI: 1.06–1.82, respectively)CONCLUSIONS:Five-year survivors of NSCLC more commonly die from causes such as CVDs, lung diseases, and other malignancies. Aggressive preventive and therapeutic measures of these diseases may further improve the outcome in this patient population.

Causes of death in long-term lung cancer survivors: a SEER database analysis

Background: Long-term (>5 years) lung cancer survivors represent a small but distinct subgroup of lung cancer patients and information about the causes of death of this subgroup is scarce.Methods: The Surveillance, Epidemiology and End Results (SEER) database (1988–2008) was utilized to determine the causes of death of long-term survivors of lung cancer. Survival analysis was conducted using Kaplan–Meier analysis and multivariate analysis was conducted using a Cox proportional hazard model. Clinicopathological characteristics and survival outcomes were assessed for the whole cohort.Results: A total of 78,701 lung cancer patients with >5 years survival were identified. This cohort included 54,488 patients surviving 5–10 years and 24,213 patients surviving >10 years. Among patients surviving 5–10 years, 21.8% were dead because of primary lung cancer, 10.2% were dead because of other cancers, 6.8% were dead because of cardiac disease and 5.3% were dead because of non-malignant pulmonary disease. Among patients surviving >10 years, 12% were dead because of primary lung cancer, 6% were dead because of other cancers, 6.9% were dead because of cardiac disease and 5.6% were dead because of non-malignant pulmonary disease. On multivariate analysis, factors associated with longer cardiac-disease-specific survival in multivariate analysis include younger age at diagnosis (p < .0001), white race (vs. African American race) (p = .005), female gender (p < .0001), right-sided disease (p = .003), adenocarcinoma (vs. large cell or small cell carcinoma), histology and receiving local treatment by surgery rather than radiotherapy (p < .0001).Conclusion: The probability of death from primary lung cancer is still significant among other causes of death even 20 years after diagnosis of lung cancer. Moreover, cardiac as well as non-malignant pulmonary causes contribute a considerable proportion of deaths in long-term lung cancer survivors.

Disease Recurrence and Second Tumors in Long-term Survivors of Lung Cancer

Introduction and objectivesAs cancer survival improves, the appearance of multiple tumors in a single patient is becoming more common. The aim of this study was to analyze long-term evolution, focusing particularly on disease recurrence and second primary tumors, in patients with lung cancer (LC) and ≥3 years overall survival. Materials and methodsRetrospective study of 1769 patients with LC. A total of 218 (136 treated with surgery and 82 with other treatments), followed up for between 5 and 23 years were enrolled. LC progress and intercurrent diseases were recorded. ResultsA total of 65 patients presented tumor relapse, of which 60.9% occurred in the first 3 years; 26 patients developed secondary primary tumors (84.6% after 5 years) and 24 developed 2 or more second extrapulmonary tumors (66.6% after 5 years), most of which were smoking-related. The incidence of second primaries was greater than the expected incidence of cancer in the general population matched for age and sex. ConclusionThe multiple carcinogenic effect of smoking persists and manifests in various organs, more than 5 years after the diagnosis of LC, even in patients with long survival. After 5 years, a second tumor is more likely than a relapse of the primary disease, and the lung is the most common site of development of a second tumor.

In their own words: A qualitative study of the psychosocial concerns of posttreatment and long-term lung cancer survivors

ABSTRACTAlthough lung cancer is the deadliest type of cancer, survival rates are improving. To address the dearth of literature about the concerns of lung cancer survivors, the authors conducted 21 in-depth interviews with lung cancer survivors that focused on experiences during diagnosis, treatment, and long-term survivorship. Emergent themes included feeling blamed for having caused their cancer, being stigmatized as throwaways, and long-term survivors' experiencing surprise that they are still alive, given poor overall survival rates. Survivors also desired increased public support. It is imperative for healthcare and public health professionals to learn more about needs of this population.

Management of long-term lung cancer survivors in Korea

폐암은 2013년 갑상선암, 위암, 대장암에 이어 네 번째로 발생률이 높았으며, 특히 65세 이상 남성에서 가장 호발한 암 종으로, 폐에만 국한된 병기의 경우 5년 생존율이 58.2%에 달 한다[1]. 폐암의 연령 표준화 사망률은 인구 10만 명당 20명 으로 암 사망률 1위를 차지하다 보니 일차의료인이 장기적 추 적관찰을 하는 경우는 많지 않다고 생각할 수 있다[2]. 그럼에 도 불구하고, 일차의료인으로서 폐암 경험자의 건강문제에 주 목해야 하는 이유는, 다른 암종에 비해 통증, 호흡곤란 등으로 삶의 질 저하가 심각하고 치료 당시부터 동반질환이 많거나 치료 이후에도 심뇌혈관 위험이 증가하는 등 적지 않은 건강 문제를 가지고 있기 때문이다. 또한 45세 미만의 젊은 폐암 환 자의 비율이 미국(1.7%)이나 영국(1.1%)보다 한국이 2.8%로 상대적으로 높고, 65세 미만 환자의 경우도 한국이 39.2%로 미국(30.7%), 영국(22.9%)보다 높아 이 또한, 한국 폐암 경험 자의 장기적 건강관리가 필요한 이유이기도 하다[3].

Survivorship care planning and its influence on long-term patient-reported outcomes among colorectal and lung cancer survivors: the CanCORS disease-free survivor follow-up study.

This study aims to evaluate the relationship between survivorship care planning (SCP) and survivorship care and health outcomes reported by long-term lung and colorectal cancer survivors. Participants (n = 832) were diagnosed and enrolled during 2003-2005. In 2012, patient-reported outcomes (survivorship care and health outcomes) and two patient-reported SCP measures (receipt of written summary of cancer treatment and receipt of instructions on who to see for routine cancer follow-up) were collected. Analyses controlled for SCP predictors collected from medical records and an interview 1 year after diagnosis. One in four survivors reported receiving both SCP elements. Those receiving both were more certain which doctor was in charge (odds ratio (OR) 7.0; 95 % confidence intervals (95 % CI) 3.9-12.5), more likely to report follow-up checkup (OR 5.1; 95 % CI 3.3-8.0), and had an MRI/PET/CT scan in the past 2 years (OR 2.8; 95 % CI 1.7-4.7) compared to those receiving neither. Physician communication experiences were significantly more positive and having physical exams (OR 2.0; 95 % CI 1.2-3.4) and meeting exercise guidelines (OR 1.6; 95 % CI 1.004-2.4) more likely. Physical health (p = 0.012) and good-to-excellent self-perceived health status (OR 2.2; 95 % CI 1.3-3.9) were better for those receiving both elements. SCP may lead to better cancer follow-up care, long-term physical health, and physician-patient communication experiences. The positive association between outcomes and SCP suggests that efforts to implement SCP should be fruitful.

Long-Term Lung Cancer Survivors Have Permanently Decreased Quality of Life After Surgery

BackgroundRetrospective evaluation of the long-term health-related quality of life (HRQoL) among survivors after non–small-cell lung cancer (NSCLC) surgery. Patients and MethodsA total of 586 patients underwent surgery for NSCLC in Helsinki University Central Hospital between January 2000 and June 2009. Two validated quality-of-life questionnaires, the 15D and the EORTC QLQ-C30 with its lung cancer–specific module, QLQ-LC13, were sent to the 276 patients alive in June 2011. Response rate was 83.3%. Results of the 15D were compared with those of an age- and gender-standardized general population. ResultsMedian follow-up was 5 years. Compared with a general population, our patients had a significantly lower 15D total score, representing their total HRQoL and scores for dimensions of mobility, breathing, usual activities, depression, distress, and vitality. The patients, however, scored significantly higher on vision, hearing, and mental function. ConclusionsNSCLC survivors may suffer postoperatively from permanently reduced long-term HRQoL compared to an age- and gender-matched general population. This is essential patient information as more patients are surviving longer.