Chronic obstructive pulmonary disease in patients with lung cancer: prevalence, impact and management challenges

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the ONA take:

Chronic obstructive pulmonary disease (COPD) is a common disease, especially among current/former smokers and the elderly. Lung cancer is the most prevalent cancer in the United States. Because these diseases share a common cause — smoking — they usually coexist in everyday clinical practice. COPD is an independent risk factor for lung cancer.

In addition, the common etiologic factor and possible interrelated pathogenetic pathways also contribute to a high incidence of COPD among patients with lung cancer. In this review, the authors conducted a meta-analysis of studies on the prevalence of COPD among patients with lung cancer and vice versa, and the impact of COPD on survival, screening, and treatment approaches.

Simultaneous diagnoses of lung cancer and COPD has been found in multiple studies to result in significantly lower survival rates. Taking into account the high incidence of lung cancer among patients with COPD, this review suggests that patients in this group should be targeted for more frequent lung cancer screening with low-dose computed tomography and at a younger age.

Patients with COPD are more likely to develop radiation pneumonitis as a result of undergoing radiation therapy for lung cancer. Conventional radical radiotherapy should be avoided; however, SBRT has proven more effective. But studies comparing the 2 modalities head to head are lacking. Presence of COPD is a contraindication or, at the least, severely limits surgical options in the treatment of lung cancer.

This review concludes that COPD as a comorbidity with lung cancer is common. Patients with these diagnoses simultaneously have poor prognosis. Treatment plans for lung cancer may be affected by presence of COPD.

Chronic obstructive pulmonary disease and lung cancer share a common etiological factor and usually coexist in everyday clinical practice.
Chronic obstructive pulmonary disease and lung cancer share a common etiological factor and usually coexist in everyday clinical practice.

Abstract: Chronic obstructive pulmonary disease (COPD) and lung cancer share a common etiological factor (cigarette smoking) and usually coexist in everyday clinical practice. The prevalence of COPD among newly diagnosed patients with lung cancer sometimes exceeds 50%. COPD is an independent risk factor (2–4 times higher than non-COPD subjects) for lung cancer development.

The presence of emphysema in addition to other factors (e.g., smoking history, age) could be incorporated into risk scores in order to define the most appropriate target group for lung cancer screening using low-dose computed tomography. Clinical management of patients with coexistence of COPD and lung cancer requires a multidisciplinary oncology board that includes a pulmonologist. Detailed evaluation (lung function tests, cardiopulmonary exercise test) and management (inhaled drugs, smoking cessation, pulmonary rehabilitation) of COPD should be taken into account for lung cancer treatment (surgical approach, radiotherapy).

Keywords: lung cancer, COPD, coexistence, risk factor, therapy decisions

Introduction

Chronic obstructive pulmonary disease (COPD) and lung cancer are among the most common causes of death worldwide,1 and as they have the same etiological factor (cigarette smoking) they usually coexist in everyday clinical practice.2

Lung cancer is the leading cause of cancer in the USA, even though it is the second in prevalence for both sexes. Recently published worldwide statistics showed that it is also the leading cause of cancer death among men and the second cause of cancer death among women.3 The 5-year survival rates are quite disappointing (17.9% for the USA), even though there is a statistically significant improvement during the last years (−2.3% in mortality between 2004 and 2013).4

On the other hand, COPD is a common disease – especially among current/former smokers and the elderly – as it was estimated that 10% of adults >40 years old suffered from clinically important disease (spirometric stage II or higher).5 According to World Health Organization, COPD is the third leading cause of death worldwide accounting for 3.2 million of deaths in 2015.6 The aim the present review article is to point out the treatment challenges of patients who suffer from lung cancer and COPD simultaneously.

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