As the US population ages, more people who are diagnosed with lung cancer will also have an increased number of comorbidities, such as diabetes, heart disease, dementia, and others, say the authors of an article published in the journal Cancer Epidemiology, Biomarkers & Prevention.1
Lung cancer is the leading cause of cancer deaths in the United States, at 27%. The American Cancer Society (ACS) estimates that there will be approximately 115,610 cases of lung cancer in men and 105,590 in women during 2015. The ACS further estimates that 86,380 men will die from lung cancer, and 71,660 women.2
Comorbid conditions shorten the patients’ expected survival, and caring for these patients will involve more than just cancer care for the healthcare providers, so researchers are interested in which comorbidities are the most common, and their individual effect on survival.
Researchers studied 5,683 patients who were newly diagnosed with lung cancer between 2005 and 2009. It was found that 52.5% of the patients also had chronic pulmonary disease when they were diagnosed with lung cancer, 15.7% had diabetes, and 12.9% had congestive heart failure; 26.7% didn’t have any comorbidities of interest.
The mean survival from the point of diagnosis of lung cancer was 9.3 months for all stages; 36.8% of the patients were alive 1 year after diagnosis. Overall survival was found to be negatively associated with congestive heart failure, diabetes with complications, and moderate or severe liver disease. “Patients with regional disease experienced worse [overall survival] when they also had congestive heart failure, dementia, and renal disease,” the authors wrote. “Congestive heart failure and cerebrovascular disease worsened [overall survival] among patients with distant disease.”
This study’s findings were similar to that of a 2014 UK prospective study of 882 patients with lung cancer, where 87.3% of the patients had at least one comorbidity:3
- Weight loss - 53%
- Chronic obstructive pulmonary disease - 43%
- Renal impairment - 28%
- Ischemic heart disease - 27%
Lung cancer screening guidelines have changed, possibly detecting the disease in earlier stages among higher risk patients, thus making it easier to treat. In 2015, the Centers for Medicare and Medicaid Services (CMS), National Comprehensive Cancer Network (NCCN), and US Preventive Service Task Force (USPSTF) issued new recommendations for high risk patients:4
- CMS: Recommends that people aged 55 to 74 years who have a 30-pack per year or longer smoking history or had quit smoking within the previous 15 years, should be screened for lung cancer.
- NCCN: Recommendations include the group mentioned by the CMS, as well as patients who are 50 years or older with at least a 20-pack per year history of smoking, and one additional risk factor, other than secondhand exposure to smoke.
- USPSTF: Recommends that people aged 55 to 80 years old with a 30-pack per year or longer smoking history or had quit smoking within the previous 15 years, should be screened.
The authors of the comorbidity study recommended that there be a prospective study to confirm their results. They would like to develop a lung cancer-specific comorbidity index to help clinicians understand the impact of various comorbid conditions on lung cancer survival.
- Islam KMM, Jiang X, Anggondowati T, et al. (2015). Comorbidity and Survival in Lung Cancer Patients. Cancer Epidemiology, Biomarkers & Prevention, Jul;24(7):1079-85.
- American Cancer Society. (2015). What are the key statistics about lung cancer?.
- Grose D, Morrison DS, Devereux G, et al. (2014). Comorbidities in lung cancer: prevalence, severity and links with socioeconomic status and treatment.Postgraduate Medical Journal.
- Centers for Disease Control and Prevention. (2015). Lung Cancer Screening Guidelines and Recommendations.