Interventional Pulmonology Improves Patients' Lung Function

At Cancer Treatment Centers of America®, lung cancer treatments are state-of-the-art.

SUMMARY

Airway obstructions not only cause pneumonia in lung cancer patients, they compromise the patient’s overall quality of life. Removing these obstructions is an important aspect of a new and evolving field of medicine, called interventional pulmonology (IP), which is offered at CTCA.

Consider these facts: Lung cancer is the most common form of cancer. It is the leading cause of cancer death in both women and men worldwide, and it has surpassed breast cancer as the leading cause of cancer death in women.¹ About 49 percent of patients diagnosed at a very early stage survive for five years or longer, while only two percent of people diagnosed with lung cancer that has spread to other areas of their body are living five years after the diagnosis.²

Now consider that of advanced stage non-small cell (NSC) lung cancer patients who were treated at a Cancer Treatment Centers of America® hospital between 2000 and 2005, about 37 percent were living one year after diagnosis compared to only about 21 percent of similar advanced stage NSC lung cancer patients represented in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database.³

During the same time period, about 24 percent of CTCA patients with advanced NSC lung cancer were living 1.5 years after diagnosis as compared to only about 13 percent of similar patients represented in the SEER.

Interventional Pulmonology Improves Patients’ Lung Function

Mark Lund, MD, Director of Interventional Pulmonology and Bronchoscopy at CTCA at Eastern Regional Medical Center in Philadelphia, PA

Airway obstructions not only cause pneumonia in lung cancer patients, they compromise the patient’s overall quality of life. Obstructions make breathing difficult and prevent chemotherapy and other treatments from being as effective as possible. Removing these obstructions is an important aspect of a new and evolving field of medicine, called interventional pulmonology (IP), which is offered at CTCA.

Though IP can be used to treat a number of different lung disorders, Mark Lund,MD, director of interventional pulmonology and bronchoscopy at CTCA at Eastern Regional Medical Center (Eastern) in Philadelphia, uses it to improve lung function in lung cancer patients. Dr. Lund, who is one of a select group of US pulmonologists who have completed a one-year study fellowship in interventional pulmonology, is highly qualified in the discipline.

According to Dr. Lund, about 30 percent of all lung cancer patients develop central airway obstructions, with 80,000 new cases diagnosed each year in the US alone. Such obstructions can significantly reduce the patient’s quality and length of life.

“Imagine fighting for every breath,” he says. “That sensation is tremendously frightening and it keeps patients from getting up and being physically active, and that very lack of activity worsens their condition.”

Dr. Lund’s goal – and the goal of interventional pulmonology – is to improve patients’ lung function by removing the obstruction, which can be a benign or malignant tumor. The procedure may improve their quality of life and better enable them to receive and respond to treatments. “The patient’s functional status needs to be improved before pneumonia can be cured or chemotherapy can be used. In fact, if their functional status is not ideal, chemotherapy can do more damage than good,” he says.

Dr. Lund and his colleague David Visco,MD, also a CTCA pulmonologist, often use a rigid bronchoscope and a laser to remove lung obstructions, and they are among the few pulmonologists in the country who do. “The advantage in using a rigid bronchoscope is that we can ventilate the patient directly through it during the procedure, and because of its large size, we can use it to insert stents to keep airways open, and literally cut tumors out of airways, like coring an apple, or vaporize them with a laser.

The physician needs to be highly experienced in using a rigid scope, though, or the procedure can be very dangerous. That’s why only about ten percent of U.S. pulmonologists use them.”

Using a bronchoscope, Dr. Lund and his team remove airway obstructions in a way that prevents the tumor from growing back quickly. “We will open the airway by cutting the tumor out.We then treat the area with radiation or chemotherapy.”

Helping patients breathe easier is the primary objective of IP. And, says Dr. Lund, the positive effect of IP can be remarkably quick. “Ninety to 97 percent of patients have immediate relief after an interventional bronchoscopy,” he says, “and they experience a significant improvement in their quality of life following the procedure.”⁴

CTCA Lung Cancer Patients Report on Quality of Life

CTCA incorporates quality of life measurements into its routine clinical program.We track each patient’s ability to perform the basic activities of daily living.We ask how satisfied they are with their lives, and we evaluate their overall sense of well-being.The knowledge we gain enables our care teams to monitor and address specific cancer related symptoms such as fatigue, insomnia, and pain. CTCA assesses patient quality of life before and during their treatment. One study conducted at CTCA monitored the quality of life of 474 lung cancer patients who were treated at CTCA between January 2001 and December 2008.The results showed that during their first three months of treatment, these patients maintained their quality of life and experienced close to“normal” levels of physical health and levels of emotional well-being within the “normal” range.

CTCA invites each patient to participate in quality of life assessments both before and during treatment.We use the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30),which is one of the most reliable quality of life questionnaires in cancer research.

¹ http://www.emedicinehealth.com/lung_cancer/article_em.htm
² Ibid.
³ Both the CTCA and SEER patients had been diagnosed with advanced stage non-small cell lung cancer at a similar time. CTCA patient results are based on a sample of 346 advanced-stage NSC lung cancer patients.
⁴ S. Cavaliere,M.D., et al, “Endoscopic Treatment of Malignant