Non-small Cell Lung Cancer Survivors Research Articles

Long-term safety and survival with gefitinib in select patients with advanced non-small cell lung cancer: Results from the US IRESSA Clinical Access Program (ICAP).

This is the first report of long-term (>10 years) safety, tolerability, and survival data on patients with non-small cell lung cancer (NSCLC) who received treatment with gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor. Patients with advanced NSCLC (N = 191) who entered the IRESSA Clinical Access Program (ICAP) (June 2011 to January 2013) and had previously obtained a clinical benefit from gefitinib therapy (including patients who had received gefitinib since 2001) were analyzed for adverse events (AEs). A subset of patients (n = 79) underwent retrospective chart review to capture demographic, safety, and survival data. Seventy-five of 191 patients (39%) remained on long-term gefitinib therapy as of September 2016. Overall, serious AEs (SAEs) were reported in 64 patients (34%), the majority of which were attributed to underlying disease or comorbidities; only 3 patients (1.6%) had SAEs that were considered as possibly gefitinib-related. In the retrospective chart review cohort, 70% of patients were women; 58% were former smokers, and 30% were never-smokers; 56% were diagnosed with adenocarcinoma, and 13% were diagnosed with squamous carcinoma. Although EGFR mutational status was tested in only 17 patients (22%), it was assumed that most tumors were EGFR-mutation-positive. The median duration of gefitinib therapy was 11.1 years (7.8 years before and 3.5 years during ICAP), with 10-year and 15-year survival rates of 86% and 59%, respectively, from the initiation of therapy. A subset of long-term NSCLC survivors who were receiving gefitinib had an excellent long-term safety profile. Although it is assumed that most of these patients' tumors harbor EGFR mutations, molecular studies of available tumor specimens are planned to uncover the features that predict long-term survival. Cancer 2018;124:2407-14. © 2018 American Cancer Society.

Tai Chi Chuan in postsurgical non-small cell lung cancer patients: study protocol for a randomized controlled trial

BackgroundImpairment of exercise capacity remains a common adverse effect of non-small cell lung cancer (NSCLC) survivors after surgery. Previous research has suggested that Tai Chi Chuan (TCC) offers an exercise capacity benefit in several types of cancers. This is a randomized trial to investigate the efficacy and safety of TCC in postoperative NSCLC patients over an observation period of 3 months and a 9-month follow-up.Methods/designUsing a prospective, one center and randomized design, 120 subjects with histologically confirmed stage I–IIIA NSCLC following complete surgical resection will potentially be eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of two conditions: (1) TCC training, or (2) placebo control. The training sessions for both groups will last 60 min and take place three times a week for 3 months. The sessions will be supervised with target intensity of 60–80% of work capacity, dyspnea, and heart rate management. The primary study endpoint is peak oxygen consumption (VO2peak), and the secondary endpoints include: 6-min walk distance (6MWD), health-related quality of life (HRQoL), lung function, immunity function, and the state of depression and anxiety. All endpoints will be assessed at the baseline and postintervention (3 months). A follow-up period of 9 months will be included. The main time points for the evaluation of clinical efficacy and safety will be months 3, 6, 9, and 12 after enrollment.DiscussionThis study will assess the effect of group TCC in postsurgery NSCLC survivors on VO2peak, lung function, and other aspects. The results of this study will eventually provide clinical proof of the application of TCC as one kind of exercise training for patients across the entire NSCLC continuum, as well as information on the safety and feasibility of exercise.Trial RegistrationChinese Clinical Trial Registry: ChiCTR-IOR-15006548. Registered on 12 June 2015.

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.

Receipt of recommended surveillance with imaging in survivors of early stage non-small cell lung cancer.

10017 Background: Lung cancer survivors have a high risk for recurrence and second cancers and a 5-year survival of only 50%. Imaging surveillance for early cancer detection in this group is recommended for life. We measured the rates and determinants of regular surveillance imaging in non-small cell lung cancer (NSCLC) survivors. Methods: Using the Surveillance Epidemiology and End Results (SEER)-Medicare linked database, we identified 10680 patients with stage I and II NSCLC, age ≥ 66 years diagnosed from 2001-2011 and treated with surgery. Patients were censored at the time of recurrence/second cancer, loss of insurance or 3 months before death. Receipt of a CT and/or PET scan during the surveillance periods of 7 to 18, 19 to 30, 31 to 42 and 43 to 60 months from the date of surgery was assessed. Percentage of patients’ receiving regular imaging up to 18, 30 and 60 months of follow-up was determined. Adjusted cox regression was used to measure the effect of receiving recommended imaging on survival. Results: Overall, 79% and 40% survivors had follow-up information till the end of 30-month and 60-month surveillance periods respectively. Forty nine percent survivors were male and 86% were white. With a median follow-up of 7.6 years, 71% of the survivors received imaging in the first 18 months after surgery, but only 56% and 44% of survivors continued to receive regular imaging by 30-month and 60-month of follow-up periods respectively. Survivors were less likely to receive imaging if they were older (≥80 years), black, not married, had rural residence, did not receive adjuvant therapy, had stage I disease (compared to stage II) and were diagnosed in 2006 or earlier. In adjusted analysis, survivors receiving recommended imaging up to 18 months from surgery had improved survival compared to survivors who did not (HR 0.86; 95% CI 0.81-0.92). Survival benefit was also observed in survivors who had regular imaging up to 5 years from surgery (HR 0.68; 95% CI 0.60-0.76). Conclusions: More than half the lung cancer survivors did not receive recommended long-term surveillance imaging especially if older, black or with rural residence. Adherence to regular surveillance even at 5 years from initial surgery is associated with improved survival.

Survivorship in Non-Small Cell Lung Cancer: Challenges Faced and Steps Forward.

Improvements in curative therapies and the advent of screening have led to increased numbers of non-small cell lung cancer (NSCLC) survivors. Most survivors have undergone invasive treatment (surgery, radiation therapy, and/or chemotherapy) and carry a higher comorbidity burden than survivors of other cancers. Overall quality of life (QOL) and health-related quality of life (HRQOL) suffer during the treatment phase, with the potential for long-term decline, and both clinical characteristics and treatment impact these measures. Physical and mental components of HRQOL seem to be most at risk for decline. The issues faced by survivors include physical symptoms such as respiratory issues, fatigue, hearing loss, neuropathy, and postsurgical pain; psychological distress leading to depression, financial issues, and poor compliance with recommended guidelines; and fear or risk of recurrence and secondary malignancies. This article summarizes the major issues faced by NSCLC survivors and suggests appropriate management. Future collaborative efforts are needed to further elucidate the complex issues that affect overall QOL and HRQOL in NSCLC survivors and to develop appropriate interventions in this large and diverse survivor population.

A Pilot Study of the Feasibility and Outcomes of Yoga for Lung Cancer Survivors

To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL). This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy. A community-based cancer support center in the midwestern United States. 7 adults who had completed initial treatment for stages I-IIIa NSCLC. A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis. Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants. Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time. Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship. Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors.

Physical activity preferences of early-stage lung cancer survivors

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors. As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected. The majority of respondents (62%) reported a desire to receive advice regarding physical activity, predominantly before treatment (68%), in face-to-face interactions (95%) with a physician (80%), and within the context of a cancer care center (92%). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73%) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics. The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.

Impact of symptom burden in post-surgical non-small cell lung cancer survivors

Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors. A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden. Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54). Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.

Surveillance With Computed Tomography After Curative Treatment of Early-Stage Lung Cancer

TO THE EDITOR: Furman et al make a persuasive case for limiting intensive follow-up after curative cancer therapy to tumor types for which salvage treatments improve survival. However, their conclusions concerning early-stage non–small-cell lung cancer (NSCLC) disregard the literature that suggests improved outcomes with computed tomography (CT) surveillance may be possible, particularly regarding second primary NSCLC. Using a surveillance program per National Comprehensive Cancer Network recommendations, Lou et al administered postoperative follow-up for 1,294 patients with early-stage NSCLC, using thoracic CT scans every 6 to 12 months for the first 2 years and yearly thereafter. They found a persistent risk of second primary NSCLC of between 3% and 6% per person-years. For patients with early-stage NSCLC treated with stereotactic ablative radiotherapy undergoing the same CT surveillance, second primary NSCLC develops at a similar rate. This reveals that curatively treated survivors of early-stage NSCLC are at a greater risk of lung cancer events than the patients included in the recent National Lung Screening Trial, in which thoracic CT screening improved survival rates by 20% compared with radiographic screenings. Effective surgical salvage for recurrent and second primary NSCLC is possible, with reported 5-year survival rates between 8% and 40% and 25% to 53%, respectively. Although large surgical series have consistently shown that treating recurrences improves survival, this is only feasible in 1% to 4% of patients with isolated local recurrence. This is not the case with CT-detected second primary NSCLC, which are typically small and detected asymptomatically more than 90% of the time. Consequently, such tumors can be resected more than 50% of the time. For patients who are unfit for surgery, stereotactic ablative radiotherapy enables a curative treatment option, achieving 5-year local control rates of approximately 90%, without decreasing patient-reported quality of life. The proponents of intensive surveillance strategies must recognize that the competing risks of death, even in long-term NSCLC survivors, make it difficult to prove improvements in survival. Available literature suggests we should follow surveillance guidelines such as those recommendedbytheAmericanAssociationforThoracicSurgery andsupport ongoing research such as the IFCT-0302 trial in which postsurgical surveillance using radiography is being tested against CT and bronchoscopy, rather than consider NSCLC surveillance futile.

Effects of Tai Chi Chuan training on cellular immunity in post-surgical non-small cell lung cancer survivors: A randomized pilot trial

BackgroundAlthough emerging evidence points to benefits from Tai Chi Chuan (TCC) in improving immune system function, its effects on cellular immune responses remain under-studied. The objective of this study was to evaluate the effects of TCC training on cellular immunity in non-small cell lung cancer patients. MethodsA 2-group randomized trial design in which post-surgical, non-small cell lung cancer survivors were randomly assigned to a TCC training group (n = 16) or a control group (n = 16). The participants in the TCC group completed a 16-week intervention. The main immune response outcome measures assayed included the ratio of T-helper cells/T-suppressor cells (CD4+:CD8+ ratio) and complement regulatory proteins status (CRPs; CD55 and CD59). Using repeated measures ANOVA, the data were analyzed for the participants who completed the study (n = 27). ResultsAt 16 weeks, the TCC participants showed a significantly lower increment in the expression of CD55 (p < 0.05) as compared to the control group. No significant between-group differences were found in the CD4+:CD8+ ratio or CD59 expression. There were also no significant correlations among the changes in CRPs or T lymphocyte subpopulations, either. ConclusionA 16-week TCC intervention caused no alterations in CD4+:CD8+ ratio, but significantly attenuated CD55 expression among post-surgical non-small cell lung cancer survivors.

Using a standardized Viniyoga protocol for lung cancer survivors: a pilot study examining effects on breathing ease

Although lung cancer is perceived as a dire diagnosis, increases in the 5-year survival rate of individuals with non-small cell lung cancer (NSCLC) have been reported. Survivors, however, continue to be excessively burdened with symptoms such as respiratory distress which interfere with functioning and quality of life. While exercise and physical activity are strongly recommended, NSCLC survivors may be reluctant to participate due to actual or anticipated shortness of breath exacerbated with movement.This quasi-experimental, intervention-only pilot study aimed to determine the effects of an 8-week standardized yoga protocol for Stage I-IIIa NSCLC survivors (n=9). The protocol was developed within the Viniyoga (Hatha) tradition with respiratory experts. Breathing ease, dyspnea, oxygen saturation, and respiratory function were explored in relationship to yoga practice (45-minute sessions once per week and home practice) using repeated-measures analysis. Number of participants reporting dyspnea ranged from 25 to 50% prior to practice with no significant increase during sessions, and moderate decreases noted at times. Oxygen saturation remained high and vital signs stable; forced expiratory volume in 1 second (FEV1) values increased significantly over the 14-week study period (p<0.0001). Yoga, with an emphasis on postures coordinated with breathing and meditation practices, offers a potentially feasible and beneficial option that requires further study in this population.

Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance

At present, there is no consensus on the optimal strategy for follow-up care after curative resection for lung cancer. We sought to understand the patterns of recurrence and second primary lung cancer, and their mode of detection, after resection for early-stage non-small cell lung cancer in patients who were followed by routine surveillance computed tomography scan. We reviewed the outcomes of consecutive patients who underwent resection for early-stage non-small cell lung cancer at Memorial Sloan-Kettering Cancer Center between 2004 and 2009. A total of 1294 consecutive patients with early-stage non-small cell lung cancer underwent resection. The median length of follow-up was 35 months. Recurrence was diagnosed in 257 patients (20%), and second primary lung cancer was diagnosed in 91 patients (7%). The majority of new primary cancers (85 [93%]) were identified by scheduled routine computed tomography scan, as were a smaller majority of recurrences (157 [61%]). During the first 4 years after surgery, the risk of recurrence ranged from 6% to 10% per person-year but decreased thereafter to 2%. Conversely, the risk of second primary lung cancer ranged from 3% to 6% per person-year and did not diminish over time. Additional testing after false-positive surveillance computed tomography scan results was performed for 329 patients (25%), but only 4 of these patients (0.3%) experienced complications as a result of subsequent invasive diagnostic procedures. Almost all second primary cancers and the majority of recurrences were detected by post-therapeutic surveillance computed tomography scan. The risk of recurrence for early-stage non-small cell lung cancer survivors persisted during the first 4 years after resection, and vigilance in surveillance should be maintained.

EComment. Computed tomography surveillance of lung cancer survivors: The jury is still out

Srikantharajah et al.'s review of five single centre studies concludes that the existing evidence for a survival benefit from routine computed tomography (CT) surveillance of non-small cell lung (NSCLC) cancer survivors following an anatomical resection is equivocal and conflicting. Hence they plead for a randomized control trial [1]. In fact this patient subgroup have been largely excluded from prospective analysis by most trial designs.

Clinical factors predictive of long-term survival in advanced non-small cell lung cancer

While the overall prognosis of non-molecularly selected advanced non-small cell lung cancer (NSCLC) patients is poor, a subset of these patients has durable survival. We examined which clinical factors might be predictive for this favourable outcome. Long-term NSCLC survivors (LTS, i.e. >2 years) were retrieved from all our out- and in-patient contacts in a 6 month period (March-August 2009). LTS records were compared with a group of short-term survivors (STS). Both baseline clinical factors (sex, age, smoking status, weight loss, performance status, co-morbidity, histological subtype, place and number of metastasis) and treatment-related features (number and type of therapeutic lines, response, duration of treatment-free interval) were compared. 31 LTS were retrieved (stage IV patients with potentially radical treatment options, e.g. solitary brain or adrenal metastasis, were excluded), and compared with 34 STS. In the LTS group, median survival was 53 months, with 47% of patients alive at 5 years, in the STS patients this was 9.7 months, with 24% alive at 1-year. Baseline factors had little predictive value, but response to 1st line therapy (P = 0.0001), response duration (P = 0.009), and the number of systemic lines (P = 0.0023) were of importance. These data confirm the existence of LTS in patients with advanced NSCLC. There are very little clinical factors at the time of diagnosis that help to distinguish future LTS from STS patients. Factors related to the effect of 1st line treatment are important, and further prospects of patients achieving a 2-year survival are in general quite good.

A study on the long-term non-small cell lung cancer survivors in the Expand Access Program of gefitinib in China

背景与目的中国易瑞沙（吉非替尼、ZD1839）扩大用药（EAP）项目开始于2001年，旨在为标准治疗失败后或不能耐受化疗的晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）患者提供吉非替尼单药治疗。本研究主要评估仍在EAP组长期生存者的生活质量、肿瘤控制情况、服药安全性、临床特点及基因测定。次要目标为探讨长期生存者的临床特征。方法这是一项描述性观察研究，数据收集依据流行病学研究方法。对于仍在EAP组中的患者，数据将采用横断面调查的方法；对于已从EAP组中退出的长期生存者和快速进展者，数据以回顾性方式收集。结果在EAP数据库中共筛选出符合条件的患者934例，其中59例为服用吉非替尼> 3年的长期生存者，包括25例仍在EAP组，34例已退出EAP组，875例为快速进展者。59例长期生存者来自中国的15个临床中心。仍在EAP组的长期生存者，中位肺癌治疗功能评价量表（functional assessment of cancer therapy-lung, FACT-L）、试验结果系数（trial outcome index, TOI）和肺癌量表（lung cancer subscale, LCS）分值分别为64.5、37和12.5，91.6%患者的体力状态（performance status, PS）为0分-1分，客观有效率、疾病控制率和中位有效持续时间分别为37.5%、87.5%和68个月。在59例长期生存者中，没有发现严重或新的不良反应；其中 < 65岁者68.5%，腺癌81.4%，女性55.9%，从不吸烟者71%。与快速进展者比较，长期生存者中女性比例稍高（P=0.02）。本研究收集了3例患者的组织标本，其中1例EGFR突变阳性；2例Ki-67蛋白表达阳性，这2例患者生存期都超过73个月。同时收集了22例血浆标本，1例EGFR突变阳性。结论部分晚期NSCLC应用吉非替尼治疗可获3年以上长期生存，并为长期生存者提供了良好的生活质量、满意的疗效和药物耐受性。

Health behaviors of early-stage non-small cell lung cancer survivors.

Lung cancer survivors are at risk for cancer recurrence and other chronic illnesses related predominantly to prior tobacco use and older age. Optimal quality of post-treatment care requires greater knowledge of survivors' adherence to behavioral health recommendations. This study reports the rates of smoking, physical activity, alcohol use, cancer screenings, and routine primary care visits in non-small cell lung cancer (NSCLC) survivors. Stage IA and IB NSCLC survivors (N = 183, mean age = 69.0years) with no evidence of disease 1-6years post-treatment completed standard survey items regarding health and cancer screening behaviors. Most survivors (83.5%) had a history of smoking, but 64.8% quit prior to diagnosis and only 5.5% continued to smoke. Alcohol intake recommendations were exceeded by 5.4% and 17.3% of men and women, respectively. In a typical week, 23.1% met physical activity guidelines. Regarding cancer screenings, 89.3% were adherent to colorectal cancer screening guidelines. Among women, 72.0% had a mammogram within the previous year and 81.5% had a pap test in the previous 3years; among men, 86.7% had a prostate-specific antigen test in the previous year. Almost all (97.3%) had seen a primary care provider in the past year. The majority of lung cancer survivors were adherent to health promotion recommendations, but few engaged in the recommended level of physical activity. Physical and pulmonary rehabilitation interventions may help lung cancer survivors maintain sufficient levels of physical activity, which can have numerous benefits for older adults.

Fatigue and Functional Impairment in Early-Stage Non-Small Cell Lung Cancer Survivors

Context Fatigue is the most common sequela among non-small cell lung cancer (NSCLC) survivors one to six years post-treatment and is associated with functional limitations. Objectives This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors. Methods Three-hundred fifty individuals diagnosed and surgically treated for Stage IA or IB NSCLC completed a survey that included the Brief Fatigue Inventory (BFI) to assess the prevalence and severity of fatigue. The Karnofsky Self-Reported Performance Rating scale (SR-KPS) was used as a measure of functional status and was compared with the severity of fatigue through Chi-squared analyses. Demographic, psychological, and medical correlates of fatigue were examined using logistic regression. Results The prevalence of fatigue was 57%. Forty-one percent ( n = 142) of participants had mild fatigue and 16.8% ( n = 59) had moderate or severe fatigue (BFI ≥ 4). Among the individuals reporting moderate or severe fatigue, 23.7% ( n = 14) had significant functional impairment (SR-KPS ≤ 70%) compared with 2.8% ( n = 8) with mild or no fatigue (χ 2 = 58.1, P < 0.001). In the multivariate analysis, NSCLC survivors with pulmonary disease (odds ratio [OR] = 2.28), depressive symptoms (OR = 6.99), and anxiety symptoms (OR = 2.31) were more likely to report experiencing clinically significant fatigue, whereas those who met physical activity guidelines (OR = 0.29) reported less fatigue. Conclusion Fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue includes the screening and management of anxious and depressive symptoms, and pulmonary disorders such as chronic obstructive pulmonary disease.

Correlation of 5-year survival and cure in NSCLC: An analysis of delayed cancer deaths in long-term survivors of NSCLC.

6134 Background: Five-year survival following the diagnosis of non small cell lung cancer (NSCLC) has been equated with a cure. Because so few (15%) NSCLC patients survive five years, data on long term survivors is lacking. The Surveillance, Epidemiology, and End Results (SEER) database was employed to investigate the death rate and cause of death in NSCLC patients alive at least 5 years after diagnosis. Methods: A total of 29,002 adult patients alive five years after diagnosis of NSCLC registered in the SEER database from 1988 to 2001 were examined. Variables recorded include age, sex, tumor histology, TNM stage, and surgery performed. Primary endpoints were overall survival (OS), and disease specific survival (DSS) defined as death with NSCLC as the documented cause of death. Survival analysis was performed with Kaplan-Meier estimates and multivariable Cox proportional hazards regression. Results: A total of 13,945 men and 15,057 women (mean ± SD age, 64.4 ± 10.6 years) with NSCLC were analyzed. OS at 10 years was 57.4%, at 15 years was 34.7%, and at 18 years was 25.7%. DSS at 10 years was 78.4%, at 15 years was 67.5%, and at 18 years was 61.7%. Squamous cell (HR 0.881) and large cell (HR 0.806) histologies have a DSS advantage (p < 0.0005) compared to adenocarcinoma. Pneumonectomy (HR 0.453), lobectomy (HR 0.495), and sublobar resection (HR 0.746) were all statistically superior in DSS than no surgery (p < 0.0001). Compared to stage IA, DSS of stage IB (HR 1.172), IIA (1.796), IIB (1.547), IIIA (1.972), IIIB (1.788), and IV (2.204) were all inferior (p < 0.0001). Conclusions: Five-year survivors from NSCLC have a persistent risk of death from lung cancer up to 18 years from diagnosis. Surgical resection and nonadenocarcinoma histology are associated with better disease specific survival. Although the rate of death from NSCLC decreases with time, significant numbers of patients die from lung cancer as long as 18 years after initial diagnosis. No significant financial relationships to disclose.

The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design

BackgroundThe Lung Cancer Exercise Training Study (LUNGEVITY) is a randomized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness (VO2peak), patient-reported outcomes, and the organ components that govern VO2peak in post-operative non-small cell lung cancer (NSCLC) patients.Methods/DesignUsing a single-center, randomized design, 160 subjects (40 patients/study arm) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center (DUMC) will be potentially eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of four conditions: (1) aerobic training alone, (2) resistance training alone, (3) the combination of aerobic and resistance training, or (4) attention-control (progressive stretching). The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70% of the individually determined VO2peak for aerobic training and an intensity between 60 and 80% of one-repetition maximum for resistance training, for 30-45 minutes/session. Progressive stretching will be matched to the exercise groups in terms of program length (i.e., 16 weeks), social interaction (participants will receive one-on-one instruction), and duration (30-45 mins/session). The primary study endpoint is VO2peak. Secondary endpoints include: patient-reported outcomes (PROs) (e.g., quality of life, fatigue, depression, etc.) and organ components of the oxygen cascade (i.e., pulmonary function, cardiac function, skeletal muscle function). All endpoints will be assessed at baseline and postintervention (16 weeks). Substudies will include genetic studies regarding individual responses to an exercise stimulus, theoretical determinants of exercise adherence, examination of the psychological mediators of the exercise - PRO relationship, and exercise-induced changes in gene expression.DiscussionVO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC. LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect. Overall, this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum.Trial RegistrationNCT00018255

Women With Lung Cancer: Quality of Life After Thoracotomy

Data about health-related quality of life (QOL) after surgical treatment for lung cancer are limited. Such information can be valuable in developing appropriate nursing interventions for follow-up care for survivors. The purposes of this study were to describe physical and emotional QOL of disease-free female non-small cell lung cancer (NSCLC) survivors and to determine characteristics associated with greater risk for disruptions. One-hundred-nineteen women surgically treated for NSCLC completed the Short-Form 36 (as a measure of physical and mental QOL) along with health status assessments (including comorbidity, depression, Center for Epidemiologic Studies-Depression Scale, smoking status, and body mass index), dyspnea (Dyspnea Index), meaning of illness, and demographic and clinical information at baseline and 3 and 6 months. On average, the women were 68 years of age, diagnosed 2 years previously, had adenocarcinoma, and were treated surgically with lobectomy. The majority (66%) had comorbid disease, 29% had depressed mood (Center for Epidemiologic Studies-Depression Scale score > or =16), 8% were current smokers, 62% were overweight, 22% had dyspnea (scores > or =2), and 24% had a negative meaning of illness. Physical and emotional QOL scores were comparable to Short-Form 36 norms for older adults and exhibited little change over time. Controlling for time since diagnosis, dyspnea, and depressed mood were strongly related to disruptions in physical and emotional QOL, respectively, across the 6-month study period, with comorbid disease contributing to both models. Depressed mood, comorbidities, and dyspnea were factors related to poorer physical and emotional QOL. Survivors with these characteristics might benefit from greater supportive care. Screening for dyspnea, depressed mood, and comorbid illness can identify female survivors at-risk for poorer QOL after surgery.