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Critical factors for patient management
Lung Cancer (2003) 42, S7 /S8
www.elsevier.com/locate/lungcan
Critical factors for patient management V. Ninanea,*, C. Le Pechouxb, W. Curranc, K. Furused, M. Liptaye, A.P. Meertf, M. Paesmansg, R. Rami-Portah, M. Roelandtsi, J.C. Ruckdeschelj, J.P. Sculierk, S. Senanl, E.F. Smitm a
Department of Pulmonary Diseases, Hoˆpital St-Pierre, Brussels, Belgium Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France c Department of Radiotherapy, Thomas Jefferson University, Philadelphia, PA, USA d Department of Medical Oncology, Osaka Central Hospital, Osaka, Japan e Department of Thoracic Surgery, Evanston Hospital, Evanston, IL, USA f Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium g Department of Statistics, Institut Jules Bordet, Brussels, Belgium h Department of Thoracic Surgery, Barcelona, Spain i Department of Radiotherapy, Institut Jules Bordet, Brussels, Belgium j Department of Medical Oncology, Karmanos Cancer Institute, Detroit, MI, USA k Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium l Department of Radiotherapy, Free University Medical Centre, Amsterdam, Netherlands m Department of Pulmonary Diseases, Free University Medical Centre, Amsterdam, Netherlands b
KEYWORDS Non-small-cell lung; Carcinoma; Consensus; Patient selection; Karnofsky index; Comorbidity; Aged
Summary The main critical factors for lung cancer patient management, apart from TNM staging, include expertise required to offer optimal management and conditions related to the patient, including performance status and weight loss and the presence of lung, cardiac or other comorbidities. Performance status and weight loss must be assessed for all patients. The minimal pulmonary functional evaluation should include spirometry. The minimal cardiac evaluation should consist of a clinical history and evaluation for cardiac risk factors and disease and, at least preoperatively, an ECG. Age per se is not a contraindication for curative treatment. – 2003 Elsevier Ireland Ltd. All rights reserved.
1. Introduction As both tumour staging, the main critical factor for the therapeutic decision, and treatment options have been addressed in other consensus statements during this workshop, only critical
*Corresponding author. E-mail address: [email protected] (V. Ninane).
factors related to NSCLC management will be considered. Biological and genetic characteristics of the tumour are currently not critical factors in determining individual patient management. The prognostic factors influencing individual patient management are TNM, performance status and weight loss although only TNM and performance status are truly reproducible independent factors in large series of patients. We consider the main critical factors for patient management, apart from TNM staging, to be the following:
0169-5002/03/$ - see front matter – 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00297-6
S8
2. Expertise required to offer optimal management The core expertise that should routinely be available without delay should include access to a diagnostic radiologist, general thoracic surgeon, medical oncologist, pathologist, pulmonologist and radiation oncologist. This team should integrate the various critical factors in order to offer the best patient management.
V. Ninane et al.
. Pulmonary reserve should be evaluated in all patients who are candidates for potential curative therapy by an experienced physician and this evaluation should be performed after optimising lung function. . The minimal functional evaluation should include spirometry and a DLCO measurement is also recommended. . When the results of this initial evaluation suggest a high risk for surgery, additional evaluation including split lung function studies and/ or exercise testing should be performed.
3. Condition of the patient 3.1. Performance status and weight loss
3.4. Cardiac function
. Performance status and weight loss must be assessed for all patients. . Poor performance status should be evaluated in order to determine the aetiology and reversibility of such impairment. . Patients with a good performance status (ECOG/ WHO 0 /1 or Karnofsky performance index 80 / 100) should be promptly evaluated for other critical factors.
. Cardiac function is an important factor as the disease itself, comorbidity (e.g. coronary disease) and treatment can all impair the cardiac function. . The cardiac function of all patients who are candidates for potential curative therapy should be evaluated by an experienced physician. . The minimal evaluation should include a clinical history and evaluation for cardiac risk factors and disease, and, at least preoperatively, an ECG. . When the results of this initial evaluation suggest high risk, additional evaluation should be performed.
3.2. Age . Age per se is not a contraindication to curative treatment. . Patient with advanced age should be carefully evaluated for existing and potential comorbidities.
3.5. Other comorbidities 3.3. Pulmonary reserve . Pulmonary reserve is a very important critical factor since the disease itself, frequent comorbid conditions (e.g. COPD), and treatment can all affect the lung.
. Other significant comorbidities (e.g. renal impairment or prior radiation/chemotherapy) should be evaluated in all candidates for potential curative and aggressive therapy by an experienced team of physicians.
www.elsevier.com/locate/lungcan
Critical factors for patient management V. Ninanea,*, C. Le Pechouxb, W. Curranc, K. Furused, M. Liptaye, A.P. Meertf, M. Paesmansg, R. Rami-Portah, M. Roelandtsi, J.C. Ruckdeschelj, J.P. Sculierk, S. Senanl, E.F. Smitm a
Department of Pulmonary Diseases, Hoˆpital St-Pierre, Brussels, Belgium Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France c Department of Radiotherapy, Thomas Jefferson University, Philadelphia, PA, USA d Department of Medical Oncology, Osaka Central Hospital, Osaka, Japan e Department of Thoracic Surgery, Evanston Hospital, Evanston, IL, USA f Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium g Department of Statistics, Institut Jules Bordet, Brussels, Belgium h Department of Thoracic Surgery, Barcelona, Spain i Department of Radiotherapy, Institut Jules Bordet, Brussels, Belgium j Department of Medical Oncology, Karmanos Cancer Institute, Detroit, MI, USA k Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium l Department of Radiotherapy, Free University Medical Centre, Amsterdam, Netherlands m Department of Pulmonary Diseases, Free University Medical Centre, Amsterdam, Netherlands b
KEYWORDS Non-small-cell lung; Carcinoma; Consensus; Patient selection; Karnofsky index; Comorbidity; Aged
Summary The main critical factors for lung cancer patient management, apart from TNM staging, include expertise required to offer optimal management and conditions related to the patient, including performance status and weight loss and the presence of lung, cardiac or other comorbidities. Performance status and weight loss must be assessed for all patients. The minimal pulmonary functional evaluation should include spirometry. The minimal cardiac evaluation should consist of a clinical history and evaluation for cardiac risk factors and disease and, at least preoperatively, an ECG. Age per se is not a contraindication for curative treatment. – 2003 Elsevier Ireland Ltd. All rights reserved.
1. Introduction As both tumour staging, the main critical factor for the therapeutic decision, and treatment options have been addressed in other consensus statements during this workshop, only critical
*Corresponding author. E-mail address: [email protected] (V. Ninane).
factors related to NSCLC management will be considered. Biological and genetic characteristics of the tumour are currently not critical factors in determining individual patient management. The prognostic factors influencing individual patient management are TNM, performance status and weight loss although only TNM and performance status are truly reproducible independent factors in large series of patients. We consider the main critical factors for patient management, apart from TNM staging, to be the following:
0169-5002/03/$ - see front matter – 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00297-6
S8
2. Expertise required to offer optimal management The core expertise that should routinely be available without delay should include access to a diagnostic radiologist, general thoracic surgeon, medical oncologist, pathologist, pulmonologist and radiation oncologist. This team should integrate the various critical factors in order to offer the best patient management.
V. Ninane et al.
. Pulmonary reserve should be evaluated in all patients who are candidates for potential curative therapy by an experienced physician and this evaluation should be performed after optimising lung function. . The minimal functional evaluation should include spirometry and a DLCO measurement is also recommended. . When the results of this initial evaluation suggest a high risk for surgery, additional evaluation including split lung function studies and/ or exercise testing should be performed.
3. Condition of the patient 3.1. Performance status and weight loss
3.4. Cardiac function
. Performance status and weight loss must be assessed for all patients. . Poor performance status should be evaluated in order to determine the aetiology and reversibility of such impairment. . Patients with a good performance status (ECOG/ WHO 0 /1 or Karnofsky performance index 80 / 100) should be promptly evaluated for other critical factors.
. Cardiac function is an important factor as the disease itself, comorbidity (e.g. coronary disease) and treatment can all impair the cardiac function. . The cardiac function of all patients who are candidates for potential curative therapy should be evaluated by an experienced physician. . The minimal evaluation should include a clinical history and evaluation for cardiac risk factors and disease, and, at least preoperatively, an ECG. . When the results of this initial evaluation suggest high risk, additional evaluation should be performed.
3.2. Age . Age per se is not a contraindication to curative treatment. . Patient with advanced age should be carefully evaluated for existing and potential comorbidities.
3.5. Other comorbidities 3.3. Pulmonary reserve . Pulmonary reserve is a very important critical factor since the disease itself, frequent comorbid conditions (e.g. COPD), and treatment can all affect the lung.
. Other significant comorbidities (e.g. renal impairment or prior radiation/chemotherapy) should be evaluated in all candidates for potential curative and aggressive therapy by an experienced team of physicians.