Epidemiology of lung cancer prognosis: quantity and quality of life

Abstract

Primary lung cancer is very heterogeneous in its clinical presentation, histopathology, and treatment response; and like other diseases, the prognosis consists of two essential facets: survival and quality of life (QOL). Lung cancer survival is mostly determined by disease stage and treatment modality, and the 5-Year survival rate has been in a plateau of 15% for three decades. QOL is focused on life aspects that are affected by health conditions and medical interventions; the balance of physical functioning and suffering from treatment side effects has long been a concern of care providers as well as patients. Obviously needed are easily measurable biologic markers to stratify patients before treatment for optimal results in survival and QOL and to monitor treatment responses and toxicities. Targeted therapies toward the mechanisms of tumor development, growth, and metastasis are promising and actively translated into clinical practice. Long-term lung cancer (LTLC) survivors are people who are alive 5 Years after the diagnosis. Knowledge about the health and QOL in LTLC survivors is limited because outcome research in lung cancer has been focused mainly on short-term survival. The independent or combined effects of lung cancer treatment, aging, smoking and drinking, comorbid conditions, and psychosocial factors likely cause late effects, including organ malfunction, chronic fatigue, pain, or premature death among lung cancer survivors. New knowledge to be gained should help lung cancer survivors, their healthcare providers, and their caregivers by providing evidence for establishing clinical recommendations to enhance their long-term survival and health-related QOL.

Figure 1. Five-year Survival Rates and 99% Confidence Intervals of Mayo Clinic NSCLC Patients Compared to MD Anderson Cancer Center’s Patients ^a

^a Open bars are average survival rates for each disease stage based on Mountain’s series of MD Anderson Cancer Center; circles with lines are estimated survival rates and 99% confidence intervals of Mayo Clinic’s series.

Figure 2. ^a Survival Curve Predicted by Gene Risk Index (50 genes) and Conventional Variables (stage, age, gender, cell type and grade)

a. Adapted from Sun and Yang, 2006, CEPB

Figure 3. An integrated View: Lung Cancer Outcome Research ^a

^a Adapted from Sugimura & Yang, 2005, CHEST