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Sarcopenia and Frailty in Lung Cancer

Introduction In 2020, lung cancer was the second most diagnosed cancer and the leading cause of cancer death worldwide causing an estimated 1.8 million deaths. This disease is broadly divided into two histologic subtypes: small cell (SCLC) and nonsmall cell lung cancer (NSCLCs). The clinical presentation of lung cancer is widely varied but often correlates with anatomic location of the tumor within the bronchial tree. Radiation,…

Cancer-Related Fatigue in Lung Cancer

Introduction The American Society of Clinical Oncology (ASCO) reports that the majority of cancer patients will experience some amount of fatigue during their treatment course. Fatigue can be due to the physical and psychological impacts of cancer and a consequence of cancer-associated treatments such as surgery, radiation, and chemotherapy. Prevalence is reported to range from 25% to 99%, with variability in reported numbers due to varying…

Lung Cancer Book—Prehabilitation Chapter

Case Study A 63-year-old woman with a 30-pack-year history of smoking presented with mid-back pain and was found to have 4 cm right upper lobe mass. She was diagnosed with T3N0 nonsmall cell lung carcinoma by CT-guided biopsy. She was offered chemoradiotherapy with curative intent. At her multidisciplinary evaluation, she complained of fatigue. CBC revealed hematocrit of 28, MCV of 71, and iron saturation of 3%.…

Exercise and Lung Cancer

Lung cancer is the leading cause of cancer-related death worldwide. Since the 1980s, multiple studies and organizations have demonstrated the benefit of exercise intervention and physical activity in oncology patients. Although there is limited large-scale research regarding its benefits in lung cancer patients, engaging in exercise or physical activity has been found to be safe and is still strongly recommended. The 2018 Physical Activity Guidelines Advisory…

Lung Cancer Survivorship

Survivorship The number of cancer survivors is estimated to continue to grow given advancements in detection and treatment of cancer. Survivorship begins from the time of diagnosis and lasts throughout one's life, and thus is ideally integrated into the cancer care continuum. Survivorship includes not only the patient, but family members/caregivers as well. Survivorship broadly includes the principles and practices of surveillance for recurrence of disease/primary…

Psychosocial Distress and Anxiety in Lung Cancer

Background In the last decade, there has been a growing awareness of the importance of psychosocial screening and intervention as part of comprehensive cancer care. The negative effects of psychosocial distress and anxiety on health outcomes have been increasingly reported in the literature. Current research shows that survivors of lung cancer are at greater risk for psychosocial distress than other cancers. In order to standardize care…

Lung Cancer in the Palliative Care Setting: Successes, Challenges, and Opportunities for Collaboration

Introduction The World Health Organization (WHO) defines Palliative Care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” Palliative Medicine provides additional support for the relief of pain,…

Assessment, Treatment, and Rehabilitation of Bone and Spinal Metastasis in Lung Cancer

Background Bone is a frequent and early site of metastases for patients with lung cancer. Literature reports that 20%–40% of lung cancer patients will develop bone metastases and that up to 80% of these osseous lesions will be diagnosed during the initial metastatic work up. , The spine is the most common site of bony metastases (40%–50%) followed by the ribs (20%–27%). Osseous metastases produce some…

The Assessment of the Person With Lung Cancer and Implications for the Rehabilitation Clinician

Introduction Lung cancer patients are often diagnosed later in life and at advanced stages of the disease. The treatment of lung cancer often consists of a combination of systemic therapy (chemotherapy, immunotherapy), radiation therapy, and surgery. These treatments as well as age-related changes, comorbid conditions such as emphysema and heart disease can have adverse effects on physical function. Cancer and cancer treatment–related physical impairments can develop…

Systemic Therapy and Radiation Therapy in Lung Cancer

Introduction Lung cancer is the most common cause of cancer-related death in both men and women around the world. Given that lung cancer can remain asymptomatic when it presents with a low disease burden in its early stages, it is usually discovered only after it has progressed to an advanced stage. Nonsmall cell lung cancer (NSCLC) accounts for about 85% of lung cancer cases. Screening with…

An Overview of the Epidemiology, Types of Lung Cancer, Staging, and Rehabilitation Continuum of Care

Epidemiology Lung cancer incidence and prevalence trends have evolved due to changes in screening and primary prevention, while early detection and improved treatments increase survivorship. Data from 2012 report that providers are annually diagnosing approximately 1.8 million new cases of lung cancer with 1.6 million related deaths. In developed countries, the age standardized risk (ASR) of incidence and mortality was 1.4–1.5-fold higher and 1.5–1.8 fold higher,…

Cardiovascular Toxicities of Radiation Therapy

Introduction ■ Cardiovascular disease and cancer are the top two causes of global mortality, accounting for 46% of deaths worldwide. To complicate matters further, cancer treatment has led to a significant increase in the global incidence of cardiovascular disease. A mainstay of cancer treatment is radiation therapy (RT). Its success with and without systemic therapy as an effective modality in Hodgkin’s and non-Hodgkin’s lymphomas, breast cancer,…

Pulmonary Toxicities of Radiation Therapy

Introduction ■ Radiation is an integral component of many patients’ treatment regimens. The goal of radiation therapy is to deliver a dose to the target while sparing the normal tissue so that the treatment can be well tolerated. Treatment toxicity is caused by dose to the normal organs that receive radiation as bystanders. All lung and mediastinal tumors have an adjacent boundary with the normal lung…

Dermatologic Toxicities of Radiation Therapy

Introduction ■ Radiation dermatitis is one of the earliest known side effects of radiation. Almost all patients receiving radiation therapy have some changes in the skin. Acute and/or chronic skin changes may occur, which may have implications for quality of life during and after completion of radiation. These dermatological reactions may lead to delay in treatment or diminished cosmesis and functional deficits. ■ Radiation is used…

Mucosal and Esophageal Toxicites of Radiation Therapy

Introduction ■ Oral and esophageal mucosal injuries are inevitable postradiation changes, encountered with daily radiation therapy. Mucositis has remained a morbid side effect of radiation therapy since its first clinical use as an agent effective against cancer. Mucosal injury is generally the first change that is observed as the radiation beam enters human tissues. Alimentary mucositis (AM) is the recommended term to describe cancer therapy–associated mucosal…

Mechanisms of Radiation-Related Toxicities

Introduction Radiotherapy comprises the delivery of ionizing radiation, most commonly in the form of X-rays, for the treatment of malignant or benign neoplasms. Radiotherapy induces DNA damage either through direct ionization or through the generation of intermediary reactive oxygen species. Left unrepaired, this damage can lead to normal and tumor cell death via apoptosis, mitotic catastrophe, autophagy, or terminal growth arrest Deficiencies in DNA repair, a…

Rheumatological Toxicities of Immunotherapy

Introduction ■ The introduction of immune checkpoint inhibitor (ICI) therapy to treat cancer has changed the treatment paradigm for many malignancies. These agents exploit suppressor and regulatory pathways to boost integrated immunity against tumors but are associated with a unique spectrum of immune-related adverse events (irAEs) related to their untoward autoinflammatory and off-target effects. The field of irAEs from checkpoint inhibitor therapy is growing at a…

Cardivascular Toxicities of Immunotherapy

Introduction Recent advances in the field of immunotherapy have revolutionized the treatment of cancer and have given hope to patients with cancers that were associated with a poor prognosis. Immune therapies have now been US Food and Drug Administration (FDA)–approved in the frontline setting for metastatic melanoma, non–small-cell lung cancer (NSCLC), renal cell carcinoma, and as second-line therapy for renal cell carcinomas, bladder cancer, Merkel cell…

Dermatologic Toxicities of Immunotherapy

Introduction ■ Cancer immunoediting is the process by which malignant cells evade the immune system—first by incomplete elimination of tumor cells during immunosurveillance, followed by an equilibrium phase, and finally by an immune escape phase. The immune escape phenomenon is mediated by a variety of interactions within the tumor microenvironment, among which immune checkpoint pathways play a prominent role. Immune checkpoint axes such as cytotoxic T-lymphocyte–associated…

Pulmonary Toxicities of Immunotherapy

Introduction ■Cancer immunotherapy has come a long way since its inception centuries ago when, in 1777, the surgeon to the Duke of Kent injected himself with malignant cells in an effort to develop a cancer vaccine. The ability to harness one’s own immune system to combat malignancy has gained widespread clinical utility in the management of a broad spectrum of malignancies such as melanoma, non–small-cell lung…