Prevalence and outcome of central airway obstruction in patients with lung cancer.
bronchoscopy
clinical epidemiology
imaging/CT MRI etc
lung cancer
non-small cell lung cancer
palliative care
small cell lung cancer
thoracic surgery
Journal
BMJ open respiratory research
ISSN: 2052-4439
Titre abrégé: BMJ Open Respir Res
Pays: England
ID NLM: 101638061
Informations de publication
Date de publication:
2019
2019
Historique:
received:
14
03
2019
revised:
03
07
2019
accepted:
31
08
2019
entrez:
2
11
2019
pubmed:
2
11
2019
medline:
2
11
2019
Statut:
epublish
Résumé
Central airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to inform our local cancer service. This is a cohort review of all new lung cancer diagnoses between 1 November 2014 and 30 November 2015. CAO was defined by CT appearance. CT scans and routine patient records were followed up to 30 November 2018 to determine the prevalence of CAO at diagnosis; the characteristics of patients with prevalent CAO; mortality (using survival analysis); and incident CAO over follow-up. Of 342 new lung cancer diagnoses, CAO prevalence was 13% (95% CI 10% to 17%; n=45/342). Dedicated CT scan review identified missed CAO in 14/45 (31%) cases. In patients with prevalent CAO, 27/44 (61%) had a performance status of ≤2, 23/45 (51%) were diagnosed during an acute admission and 36/44 (82%) reported symptoms. Treatments were offered to 32/45 (71%); therapeutic bronchoscopy was performed in only 8/31 (26%) eligible patients. Median survival of patients with prevalent CAO was 94 (IQR 33-274) days. Multivariate analysis, adjusting for age, gender and disease stage, found CAO on index CT scan was independently associated with an increased hazard of death (adjusted HR 1.78 (95% CI 1.27 to 2.48); p=0.001). In total, 15/297 (5%) developed CAO during follow-up (median onset 340 (IQR 114-551) days). Over the audit period, 60/342 (18%; 95% CI 14% to 22%) had or developed CAO. This is the first description of CAO prevalence in 40 years. Patients with prevalent CAO had a higher mortality. Our data provide a benchmark for service planning.
Identifiants
pubmed: 31673363
doi: 10.1136/bmjresp-2019-000429
pii: bmjresp-2019-000429
pmc: PMC6797367
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
e000429Subventions
Organisme : Medical Research Council
ID : MR/N020618/1
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Ther Adv Respir Dis. 2016 Apr;10(2):105-12
pubmed: 26644260
Chest. 1988 Jul;94(1):15-21
pubmed: 3383627
Br J Dis Chest. 1971 Oct;65(4):238-42
pubmed: 4944570
Chest. 1977 May;71(5):644-50
pubmed: 852346
J Natl Cancer Inst. 1997 Nov 5;89(21):1580-6
pubmed: 9362155
J Clin Oncol. 1987 Feb;5(2):246-54
pubmed: 3027269
J Am Med Assoc. 1958 Mar 8;166(10):1149-55
pubmed: 13513332
Clin Chest Med. 2015 Jun;36(2):313-34, ix-x
pubmed: 26024607
Acta Oncol. 1999;38(8):993-8
pubmed: 10665751
Chest. 2006 Dec;130(6):1803-7
pubmed: 17167000
Clin Respir J. 2018 Mar;12(3):1093-1099
pubmed: 28371208
Chest. 2015 May;147(5):1282-1298
pubmed: 25358019
ERJ Open Res. 2018 Apr 09;4(2):null
pubmed: 29637076
AJR Am J Roentgenol. 1987 Jan;148(1):1-7
pubmed: 3491497
Clin Transl Oncol. 2016 May;18(5):489-96
pubmed: 26329296
Thorax. 2019 Feb;74(2):141-156
pubmed: 30254139
J Thorac Oncol. 2010 Jan;5(1):23-8
pubmed: 19934774
Am J Respir Crit Care Med. 2004 Jun 15;169(12):1278-97
pubmed: 15187010
Chest. 1996 Dec;110(6):1536-42
pubmed: 8989073