My Canadian Pharmacy about Lung Cancer Patient Following Curative Intent Therapy

non-small cell lung cancerApproximately 172,000 new cases of lung cancer are diagnosed annually in the United States. Unfortunately, only approximately 20% of patients with newly diagnosed lung cancer will have localized disease and will be candidates for potentially curative treatment. Furthermore, some patients with localized non-small cell lung cancer (NSCLC) may either refuse potentially curative surgical therapy or may be unable to tolerate surgery because of limiting comor-bid cardiopulmonary or other disease. Consequently, it has been estimated that only 35,000 patients underwent curative intent surgical resection for NSCLC in 1998. Small numbers of patients will receive curative intent radiation therapy for localized NSCLC and some combination of curative intent chemotherapy and radiation therapy for localized small cell carcinoma.

Two distinctly different issues should be taken into account when planning patient care following curative intent therapy for lung cancer. First, adequate follow-up should be ensured to manage complications related to the curative intent therapy itself. This should be a specialist-directed process. The thoracic surgeon should be responsible for managing complications related to any surgical procedures performed, as should the radiation oncologist and the medical oncologist for managing complications related to radiation therapy and chemotherapy, respectively. In most cases, this specialist-directed follow-up should be transient.

Second, a surveillance program should be considered to detect recurrences of the primary lung cancer and/or development of a new primary lung cancer early enough to allow potentially curative retreatment conducted by my canadian pharmacy. Numerous guidelines have been published regarding the management of lung cancer. Several of these guidelines include recommendations for a posttreatment surveillance program. These recommendations will be summarized and compared. Available data on rates, patterns, and diagnostic tools for identifying recurrence of the primary lung cancer and/or development of a second primary lung cancer will be reviewed as the basis for recommendations on an ongoing surveillance program following curative intent therapy for lung cancer. Issues related to follow-up for palliative therapy of lung cancer will not be discussed (see section on Palliative Treatment).

To update the previous recommendations on the follow-up and surveillance of lung cancer patients following curative intent therapy, guidelines on lung cancer diagnosis and management published between 2002 and December 2005 were identified by a systematic review of the literature using search terms including “follow-up,” “surveillance,” “lung cancer,” and “lung neoplasms” (see “Methodology for Lung Cancer Evidence Review and Guideline Development” chapter). Those guidelines including recommendations specific to the follow-up and surveillance of lung cancer after curative intent therapy were identified for inclusion in this section. Supplemental material appropriate to this topic was obtained by literature search of a computerized database (Medline) and review of the reference lists of relevant articles. Recommendations were developed by the section editor and writing committee, graded by a standardized method (see “Methodology for Lung Cancer Evidence Review and Guideline Development” chapter), and then reviewed by all section editors, the Executive Committee of the panel, and then further reviewed by the Thoracic Oncology Network, Health and Science Policy Committee, and Board of Reagents of the American College of Chest Physicians (ACCP).