Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.

/pdf/venous-thromboembolism-and-lung-cancer-a-review-3fj0zgn5j1.pdf

Venous thromboembolism and lung cancer: a review.

Background: Lung cancer is a common problem seen by pulmonologists. The American Thoracic Society (ATS) and European Respiratory Society (ERS) are professional organizations whose memberships are composed of large numbers of pulmonologists.Purpose: This document describes the key role of pulmonologists in the prevention, early diagnosis, and management of lung cancer.Methods: A committee of ATS and ERS leaders and their oncology groups discussed the activities of pulmonologists in relation to lung cancer in various settings and reviewed available literature on the topic. The content of this statement was approved by the board of directors of both the ATS and ERS.Results: Optimal lung cancer care requires a multidisciplinary team of specialists who care for a significant number of patients on a regular basis. Pulmonologists are responsible for and involved with patients from their initial diagnosis and staging through treatment and restaging. They are often involved with complications, palliative care, and...

/pdf/an-official-american-thoracic-society-european-respiratory-ezalmpij0h.pdf

An official American Thoracic Society/European Respiratory Society statement: the role of the pulmonologist in the diagnosis and management of lung cancer.

Cost-components of lung cancer care within the first three years after initial diagnosis in context of different treatment regimens.

Lung cancer still remains the leading cause of cancer death among males. Several new methodologies are being used in the everyday practise for diagnosis and staging. Novel targeted therapies are being used and others are being investigated. However; early diagnosis still remains the cornerstone for efficient treatment and disease management. Lung cancer patients requires in many situations intensive care unit (ICU) admission, either due to the necessity for supportive care until efficient disease symptom control (respiratory distress due to malignant pleural effusion) or disease adverse effect management (massive pulmonary embolism). In any case guidelines indicating the patient that has to be intubated have not yet been issued. In the current review we will present current data and finally present an algorithm based on the current published information for lung cancer patients that will probably benefit from admission to the ICU.

Intensive care unit and lung cancer: when should we intubate?

The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome. Postoperative preventive and therapeutic management has to be carefully planned in order to reduce postoperative morbidity and mortality.For patients with severe complications, intensive care unit (ICU) mortality rate ranges from 13% to 47%, and hospital mortality ranges from 24% to 65%. Common predictors of in-hospital mortality are severity scores, number of failing organs, general condition, respiratory distress and the need for mechanical ventilation or vasopressors. When considering long-term survival after discharge, cancer-related parameters retain their prognostic value.Thoracic surgeons, anesthesiologists, pneumologists, intensivists and oncologists need to develop close and confident partnerships aimed at implementing evidence-based patient care, securing clinical pathways for patient management while promoting education, research and innovation. The final decision on admitting a patient with lung to the ICU should be taken in close partnership between this medical team and the patient and his or her relatives.

https://erj.ersjournals.com/content/erj/49/5/1602189.full.pdf

Intensive care in thoracic oncology.

BACKGROUND: The care of lung cancer patients in Germany has not been systematically evaluated yet. The aim of this article is to give an overview on the current state of lung cancer care on the basis of existing data. METHODS: In April and May 2010, a literature search was performed in order to collect relevant information concerning epidemiology as well as diagnostic, therapeutic (systemic therapy, radiotherapy, surgery, palliative therapy), and interdisciplinary structures in lung cancer treatment. RESULTS: The published database on lung cancer care in Germany is overall deficient. Treatment of lung cancer patients is mainly located in hospitals, particularly in chest clinics or specialised departments. The access of hospitals for an outpatient treatment as provided per § 116 b SGB V has not yet been realised in all German states. CONCLUSIONS: A systematic and prospective evaluation of lung cancer care is necessary in order to better allocate resources in the future.

/pdf/lungenkrebs-in-deutschland-zur-versorgungslage-der-nation-h2axisozq2.pdf

Lungenkrebs in Deutschland – zur Versorgungslage der Nation

Hintergrund: Thromboembolische Komplikationen bei Lungenkrebspatienten gelten als haufig, jedoch liegen nur wenige Daten uber deren Inzidenz vor. Zur Klarung der Haufigkeit thromboembolischer Ereignisse im arteriellen und venosen System wurden die in unserem Hause mit einem Lungenkarzinom diagnostizierten Patienten retrospektiv bezuglich des Auftretens thromboembolischer Ereignisse ausgewertet. Patienten/Methode: Alle Patienten mit Erstdiagnose eines Lungenkarzinoms wurden seit 1/2008 prospektiv erfasst und hier bis 12/2010 retrospektiv bezuglich thromboembolischer Komplikationen im venosen und arteriellen System ausgewertet unter Berucksichtigung von Tumorstadium, Histologie und platinhaltiger Chemotherapie. Bei den venosen thromboembolischen Komplikationen wurden Lungenarterienembolien und tiefe Venenthrombosen berucksichtigt, bei den arteriellen thromboembolischen Komplikationen Myokardinfarkt, mesenteriale Ischamie, peripher-arterielle Ischamie, Nierenarterienischamie und ischamischer Apoplex. Ergebnisse: In den 36 Monaten wurde in unserem Zentrum bei 1940 Patienten (1209 Manner, 731 Frauen) die Erstdiagnose eines Lungenkarzinoms gestellt, 156 kleinzellige Lungenkarzinome (SCLC; 8 %) und 1784 nichtkleinzellige Lungenkarzinome (NSCLC; 92 %). Insgesamt traten bisher bei 190/1940 Patienten (9,8 %) thromboembolische Komplikationen auf; bei 148/190 (78 %) venose und bei 51/190 (27 %) arterielle thromboembolische Komplikationen. Wir dokumentierten 82/148 (55 %) tiefe Venenthrombosen, 98/148 (66 %) Lungenarterienembolien sowie arterielle thromboembolische Ereignisse: ischamischer Apoplex 23/51 (45 %), Koronararterien 14/51 (28 %), Extremitatenarterien 12/51 (24 %), Mesenterialarterien 4/51 (7,8 %), extrakranielle hirnversorgende Arterien 3/51 (5,9 %). Diskussion/Schlussfolgerungen: Thromboembolische Ereignisse sind eine haufige Komplikation bei Patienten mit Lungenkarzinom. Auf dem Boden dieser Ergebnisse sollte der Stellenwert einer entsprechenden Primarprophylaxe erneut diskutiert werden.

/pdf/haufigkeit-thromboembolischer-komplikationen-bei-patienten-1xwbyjf5a6.pdf

Häufigkeit thromboembolischer Komplikationen bei Patienten mit Lungenkarzinom

BACKGROUND: The care of lung cancer patients in Germany has not been systematically evaluated yet. The aim of this article is to give an overview on the current state of lung cancer care on the basis of existing data. METHODS: In April and May 2010, a literature search was performed in order to collect relevant information concerning epidemiology as well as diagnostic, therapeutic (systemic therapy, radiotherapy, surgery, palliative therapy), and interdisciplinary structures in lung cancer treatment. RESULTS: The published database on lung cancer care in Germany is overall deficient. Treatment of lung cancer patients is mainly located in hospitals, particularly in chest clinics or specialised departments. The access of hospitals for an outpatient treatment as provided per § 116b SGB V has not yet been realised in all German states. CONCLUSIONS: A systematic and prospective evaluation of lung cancer care is necessary in order to better allocate resources in the future.

Hintergrund: Mit der Entwicklung flexibler Kryosonden steht ein wichtiges Instrument fur die endobronchiale interventionelle Therapie, aber auch fur die histologische Diagnostik zur Verfugung. Verschiedene Studien vergleichen die diagnostische Effektivitat und/oder die Komplikationen der Kryotechnik mit der flexiblen Zange als Standard. Die Realitat der endoskopischen Routine setzt immer eine kombinierte Anwendung verschiedener Methoden voraus. Diese Vorgehensweise verspricht nach wie vor die hochste diagnostische Ausbeute. Wir haben die Bedeutung der Kryotechnik bei kombinierter Anwendung in der Routine fur die Diagnostik maligner Tumoren in unserem Lungenkrebszentrum untersucht. Patienten und Methode: Uber 30 Monate wurde die Anwendung der Kryotechnik, die Komplikationen und ihr diagnostischer Wert prospektiv erfasst. Dabei wurden bei jedem Patienten konventionelle Techniken je nach Indikation angewandt und die Diagnostik durch die Kryotechnik erganzt (n = 469). Ergebnisse: Ein histologischer Tumornachweis war durch die Kryotechnik deutlich haufiger moglich als durch die alleinige Zangenbiopsie (81,4 vs. 59,9 % zentral bzw. 66,2 vs 37,7 % peripher). Allerdings wird dieser Vorteil bei der Kombination anderer Nicht-Kryobiopsieverfahren geringer. Bei zentralen Befunden schatzen wir den Informationsgewinn auf 7,4 % (p = 0,02), bei peripheren Befunden ist er 19,3 % (p  Schlussfolgerung: Die Kryotechnik hat neben ihrem interventionellen Wert ein hohes diagnostisches Potenzial. Das veranderte Komplikationsprofil der Technik verandert den Bedarf an Aufklarung und Masnahmen zur Sicherheit wahrend der Untersuchung.

/pdf/diagnostic-yield-and-safety-of-bronchoscopic-cryotechnique-oy13ih6zap.pdf

Diagnostic yield and safety of bronchoscopic cryotechnique in routine diagnostics for suspected lung cancer

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Lungenkrebs in Deutschland – zur Versorgungslage der Nation

Häufigkeit thromboembolischer Komplikationen bei Patienten mit Lungenkarzinom

Lungenkrebs in Deutschland – zur Versorgungslage der Nation

Häufigkeit thromboembolischer Komplikationen bei Patienten mit Lungenkarzinom

Diagnostic yield and safety of bronchoscopic cryotechnique in routine diagnostics for suspected lung cancer