Abstract and Introduction
Abstract
Background: Severe lung cancer is a novel concept that describes a patient with poor performance status (PS; 2–4) but with a high probability of receiving survival benefit and improvement in the PS score. However, there is currently no relevant research or real-world data on those with severe lung cancer, such as incidence, cause, clinical features, and risk factors.
Methods: The data from patients with advanced lung cancer attending multiple centers from January 1, 2022, to June 30, 2022, were collected for a cross-sectional study. In addition, data from fatal cases from January 1, 2019, to June 30, 2022, were retrospectively collected as another cohort. And we developed a questionnaire to assess clinicians' mastery of severe lung cancer.
Results: Three participating institutes enrolled the data set of 1,725 patients, and the dataset of 269 fatal cases were included in another cohort; the incidence of severe lung cancer was 13.10% and 37.55%, respectively. Severe lung cancer patients were mainly stage IV elderly male patients without gene mutation and a history of resection. And the proportion of smoking and comorbidities in severe lung cancer patients is more than in non-severe lung cancer patients (50.4% vs. 40.8%, P=0.006; 46.9% vs. 36.4%, P=0.002). Treatment-related adverse events (AEs) (46.0%) accounted for the largest proportion of the primary causes of severe lung cancer in the cross-sectional study, while cancer-related symptoms (54.5%) accounted for the largest proportion of the primary causes of sever lung cancer in the 101 fatal cases. For the fatal cases, the overall survival of severe lung cancer patients caused by cancer-related symptoms was longer than that caused by treatment-related AEs (8 vs. 3 months; P=0.019). A total of 616 clinicians completed the questionnaire; 90.26% of clinicians agreed with the concept of severe lung cancer.
Conclusions: The incidence of severe lung cancer cannot be ignored based on real-world data. Treatment-related AEs are gradually account for more of the causes of severe lung cancer, surpassing cancer-related symptoms and comorbidities. Furthermore, the prognosis of patients with advanced lung cancer who develop severe lung cancer due to treatment-related AEs is worse than cancer-related symptoms.
Introduction
According to Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2020, lung cancer is currently the second most common cancer and the leading cause of death worldwide.[1] Two-thirds of patients with lung cancer are diagnosed with stage IIIB, IIIC, and IV, and the prognosis of these patients is clinically poor.[2] Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores are evaluated on the basis of the patient's ability of self-care, level of daily activity, and physical ability in terms of walking and working or percentage of time waking hours confined to a bed or chair.[3] The assessment of PS scores in patients with cancer provides prognostic information and guides treatment intervention.[4,5] As PS scores are highly heterogeneous and depend on subjective categorization, the evaluation results of different doctors for the same patient can be different. Besides, the results of the doctor's evaluation and the patient's self-evaluation will also differ.[6] Nevertheless, the evaluation is still a reliable and relevant prognostic variable, being one of the most important independent prognostic factors in lung cancer.[7,8] The recommendation against chemotherapy in patients with poor PS scores dates to the early 1980s, when poor PS score (PS 2–4) was a predictor of poor survival.[9] For a long time, patients with poor PS score were typically ineligible for clinical trials, and existing evidence of limited benefits among patients with poor PS has been derived from only a handful of small trials.[10,11]
The incidence of poor PS is high among patients in all stages of lung cancer. For example, in extensive epidemiological studies, Buccheri and Radzikowska found that 42–50% of patients with lung cancer had a PS score of 2–4 as assessed by their doctors at diagnosis.[12–14] Furthermore, in recent years, the availability of targeted therapies, antiangiogenic agents, and immune checkpoint inhibitors (ICIs) has dramatically prolonged the survival of patients and made poor PS score in these patients less of a concern than that in patients treated with traditional chemotherapy.[15,16] Moreover, an increasing number of clinical studies are enrolling patients with a PS score of 2, and some real-world studies have enrolled patients with PS scores of 3 and 4. In addition to advances in oncology, improved survival in patients with a poor PS score has also been attributed to advances in managing sepsis and associated organ failure.[17,18] Therefore, we found it was necessary to distinguish a certain portion of patients with poor PS scores and end stage lung cancer who could benefit from modern treatment. Based on previous research, our team pioneered the concept of "advanced severe lung cancer" in 2017.[19,20] Moreover, we drafted the first edition of the international consensus on severe lung cancer in 2021.[21]
Severe lung cancer is a novel concept, and there is currently no relevant research or real-world data on those with severe lung cancer, such as incidence, cause, clinical features, and risk factors. Therefore, based on the first edition of the international consensus, we (I) conducted a real-world, multicenter study on patients with severe lung cancer and (II) used questionnaires to assess clinicians' acceptance of the severe lung cancer concept. We present the following article in accordance with the STROBE reporting checklist (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-4/rc).
Transl Lung Cancer Res. 2023;12(3):460-470. © 2023 AME Publishing Company
