Optimization of radiotherapy in lung cancer treatment : balance between survival and quality of life

Abstract Background:Interstitial pneumonia (IP) is a disease with a poor prognosis. In addition, IP patients are more likely to develop lung cancer. Since IP patients frequently develop toxicities during cancer treatment, minimally invasive cancer treatment is warranted for such patients to maintain their quality of life. This study retrospectively investigated the efficacy and safety of proton therapy (PT) for non-small cell lung cancer (NSCLC) in patients with IP.Methods:Twenty-nine NSCLC patients with IP were treated with PT between September 2013 and December 2019. The patients had stage IA to IIIB primary NSCLC. Ten of the 29 patients exhibited the usual interstitial pneumonia pattern. The prescribed dose was 66-74 Grays (relative biological effectiveness) in 10-37 fractions.Results:The median follow-up period was 17.4 months (interquartile range (IQR), 9.5–32.7). The median patient age was 77 years (IQR, 71–81). The median planning target volume was 112.0 ml (IQR, 56.1–246.3). The 2-year local control, progression-free survival, and overall survival rates were 77% (95% confidence interval: 34 to 94), 31% (13–50), and 50% (26–70), respectively. According to the Common Terminology Criteria for Adverse Events (version 4.0), grade 3 acute radiation pneumonitis (RP) was observed in 1 patient. Two patients developed grade 3 late RP, but no other patients experienced serious toxicities. The patients’ quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-LC13 and SF-36) scores had not changed after 3 months.Conclusions:PT may safely control NSCLC without adversely affecting the daily lives of IP patients.

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Impact of race on early-stage lung cancer treatment and survival.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.232 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 232-232 ◽

Cited By ~ 1

Author(s):

Christina D. Williams ◽

Dawn T. Provenzale ◽

Karen M. Stechuchak ◽

Michael J. Kelley

Keyword(s):

Lung Cancer ◽

Survival Rate ◽

Cancer Treatment ◽

Palliative Treatment ◽

Early Stage ◽

Early Stage Lung Cancer ◽

Similar Treatment ◽

Lung Cancer Treatment ◽

Stage Lung Cancer

232 Background: Studies have documented racial differences along the lung cancer continuum and equity in care is essential to quality improvement. The purpose of this study was to investigate the influence of race on lung cancer treatment and survival among early-stage non-small cell lung cancer patients in an equal access healthcare system. We hypothesize that patients receiving similar treatment will have similar survival. Methods: Data were from the External Peer Review Program (EPRP) Lung Cancer Special Study, which was a cross-sectional study conducted to assess the quality of care among patients diagnosed with lung cancer and receiving care at a VA facility. All patients were diagnosed between October 1, 2006 and December 31, 2007. Analyses were restricted to patients with Stage I/II NSCLC (n=1,426; 1,229 whites, 197 blacks). Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). Results: The proportion of blacks who had surgery was significantly less than that among whites (OR: 0.56, 95% CI 0.39-0.79). There was no racial difference in receipt of adjuvant therapy (chemotherapy and/or radiation therapy) among patients who had surgery (p=0.08). Among patients who did not undergo surgery, blacks were more likely to refuse surgery (OR: 2.30, 95% CI 1.29-4.13); however, the proportion of patients with contraindications to surgery and those receiving palliative treatment were similar in both race groups. The 2-year survival rate was 69% and race was not a predictor of survival when controlling for receipt of surgery along with other covariates (p=0.76). The 2-year survival rate was 82% among patients who had surgery, and 48% among patients who did not have surgery. Specifically among patients who did not have surgery due to refusal, the survival rate was 55%. Conclusions: We observed a racial disparity in surgery, partially due to the greater rate of refusal among blacks, but not adjuvant or palliative treatment. Race did not have a major impact on 2-year survival for patients with early-stage lung cancer. These findings stress the need to better understand patient preferences regarding surgery and identify ways to reduce this variation in surgery to improve quality of lung cancer care.

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Cancer treatment impact on cognitive functioning and quality of life in lung cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.9112 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 9112-9112 ◽

Cited By ~ 2

Author(s):

S. Kohli ◽

P. J. Novotny ◽

J. A. Sloan ◽

J. C. Buckner ◽

P. D. Brown ◽

...

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Cancer Survivors ◽

Cancer Treatment ◽

Cognitive Functioning

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Feasibility and acceptability of yoga to improve psychosocial and physical function among patients with lung cancer: A pilot study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24068 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24068-e24068

Author(s):

Mary E Medysky ◽

Donald Richard Sullivan ◽

Anna Tyzik ◽

Charles R. Thomas ◽

Kerri M. Winters-Stone

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Depressive Symptoms ◽

Cancer Treatment ◽

Physical Function ◽

Grip Strength ◽

Chair Stand ◽

Hand Grip ◽

After Cancer

e24068 Background: Patients with lung cancer suffer from depression symptoms, reduced quality of life (QOL), and declines in physical function during and after cancer treatment. Since yoga is a low energy demand form of exercise, we hypothesized that yoga is a feasible, safe, and efficacious strategy to mitigate these problems in lung cancer patients. Purpose: 1) Determine the feasibility, acceptability, and safety of a yoga program in patients (pts) with lung cancer during or soon after cancer treatment; 2) Determine the preliminary efficacy of yoga to improve depressive symptoms, quality of life, and physical function among pts with lung cancer. Methods: This study was a single group 12-week (wk) pilot trial of low-moderate intensity yoga among pts with stages I-IV lung cancer (n = 20) during (n = 14) or after (n = 6) cancer treatment. Assessments conducted at baseline, 6- and 12-wks included the Patient Health Questionnaire-8, Functional Assessment of Chronic Illness Therapy-Lung (FACT-L), 6-minute walk distance (6MWD), hand grip strength, chair stand time, and flexibility (back scratch and sit-reach) tests. Results: At baseline, 20 pts, including those with metastatic disease (n = 8), enrolled and 7 pts (35%) withdrew by 6-wks due to poor/worsening health. No further withdrawals occurred at 12-wks. Among pts (n = 13) who completed the study, adherence to the intervention was 75% and 78% at 6 and 12-wks, respectively. No moderate or serious adverse events were reported. Over 12 wks, depressive symptoms (average = -1.8 ±1.23, 43.9% change) decreased, improvements in QOL improved (average = +4 ±2.9, 6.5% change),6MWD (average = +22.6m ±15.9, 6.5% change), hand grip strength (average = +1.6kg ±1.2, 5.7% change), chair stand time (average = -3sec ±2.1, 5.8% change), and upper (average = -10.8cm ±7.5, 49.4% change) and lower (average = -11.9cm ±8.4, 74.6% change) body flexibility occurred. Conclusions: In this sample of lung cancer pts, a 12-week yoga program was modestly feasible, was shown to be safe and potentially beneficial for psychosocial and physical function. Though retention was lower than expected due to early pt withdrawal for poor health, adherence to supervised practice among those pts who were able to complete the intervention exceeded the target goal. Among pts with stage I-IV lung cancer yoga may be a useful strategy to improve psychosocial outcomes and physical functioning, though alternate delivery approaches for pts with advanced disease deserves further exploration. Clinical trial information: NCT03649737 .

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