2 research outputs found
Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice ?
Objective: This survey in preparation of the task force work investigated how the recent advances in pre-operative assessment of lung cancer patients have been put into practice among the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS). Methods: A web-based questionnaire was designed by the ERS/ESTS Task Force on Fitness for Radical Therapy in Lung Cancer Patients and sent to all members of the ESTS and of the ERS thoracic oncology section. Results: Two hundred sixty five physicians responded and 179 completely answered the questionnaire. Most of them (72%) were surgeons and worked in academic hospitals. Forty-two percent answered that the pre-op work-up is planned by a multidisciplinary team and 33% followed published recommendations. Only 30% of respondents use recommended cardiac indexes to stratify cardiac risk before lung resection. One third of participants assess DLCO in all patients although 75% think DLCO is a strong predictor of outcomes. About 80% of respondents think exercise tests have an important role in the decision to operate or not, but an integrated cardio-pulmonary exercise test is performed in only 0-30% of cases by about 80% of respondents. Exercise tests are prescribed by most physicians in patients with low predicted post-operative FEV1 or DLCO. Low-technology tests are of wide interest (only 7% never perform them) but various tests are used with various indications. Regarding patients’care management, 80% of physicians use physiotherapy before or after lung surgery and most of them assign many advantages to pulmonary rehabilitation. Eighty percent of respondents think that patients should be admitted to intensive care units after pneumonectomy. Almost 90% of participants emphasize that the ability to predict impairment of quality of life is an appropriate goal for future studies. Finally, about 70% of respondents stated that lung cancer patients should be treated only in specialized centres. Conclusions: This survey provides a snapshot of the opinion of more than 200 specialists from 38 countries regarding the management of patients with potentially resectable lung cancer. The results identify a lack of consensus in some areas as well as the difficulties of putting some recommendations into practice
ERS-ESTS guidelines on fitness for surgery and radiochemotherapy in lung cancer patients.
The European Respiratory Society (ERS), in collaboration with the European Society of Thoracic Surgery (ESTS), has proposed to bring together multidisciplinary experts on functional evaluation of lung cancer patients to draw up recommendations in order to provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy.The subject was divided in different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted by the entire expert panel. The evidence supporting each recommendation was summarized, and graded as described by the Scottish intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk-stratification of the lung resection candidatesemphasizing cardiologic evaluation, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before radio-chemotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialized settings by multidisciplinary teams