title: Treatment of Lung Cancer in Medically Compromised Patients.
abstract: Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.
authors.affiliation: Department of Medicine and Solid Tumor Therapeutics Program, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; University of Maryland Greenebaum Cancer Center, Baltimore, MD.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.affiliation: Department of Medicine and Solid Tumor Therapeutics Program, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; University of Maryland Greenebaum Cancer Center, Baltimore, MD.
authors.forename: Paul
authors.initials: P
authors.lastname: Wheatley-Price
authors.affiliation: Department of Medicine and Solid Tumor Therapeutics Program, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; University of Maryland Greenebaum Cancer Center, Baltimore, MD.
authors.forename: Josephine Louella
authors.initials: JL
authors.lastname: Feliciano
mesh_terms: D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy*; D009367:Neoplasm Staging; D010361:Patients / Q000331:legislation & jurisprudence*