More people than ever before are now receiving treatment with curative intent for lung cancer.
The most recent figures from the National Lung Cancer Audit (NLCA) show that rates of surgery with curative intent continue to rise in England and Wales: in 2018, 18.4% of patients with NSCLC underwent surgery, up from 17% the previous year.
So, what makes a patient eligible for surgery with curative intent?
One major factor is their overall level of general fitness; a measure of this is called Performance Status, or PS.
“PS is a score that estimates the patient’s ability to perform certain activities of daily living (ADLs) without the help of others. These include basic activities such as getting dressed, eating and bathing, as well as more complex activities such as cleaning the house and working a regular job.
“There are many factors that can predict whether someone is likely to do well or poorly with their disease. Age, the stage of a cancer and other illnesses all affect prognosis, but PS is one of the most important variables. It is more important than a patient’s actual age in predicting how a patient is likely to do.” – NCLA 2018
Some people are already fit enough to be good candidates for treatment, such as our patient advocate Tony Sledmore, who shared his experience of diagnosis and surgery:
“Having retired in 2013 I was fit, healthy and enjoying life. In 2015 I developed a tickly cough. Following a GP visit and same-day X-ray I was asked back to my GPs the following day. I knew it was serious. There was a shadow on my lung, and I was told it could be cancer. As a former smoker, having given up several years previously, I was shocked but not surprised.
“A bronchoscopy confirmed I had non-small-cell adenocarcinoma and it was in a lymph node, which could rule out surgery. My consultant was keen for me to have surgery, so I had a mediastinoscopy confirming nothing else was in the chest area or other lymph nodes. I had an upper lobe resection 6 weeks after my initial X-ray”.
Not all patients are as robust as Tony, however. Increasingly, patients are being encouraged to take positive steps to improve their fitness.
For example, consultant surgeon Ira Goldsmith, based at Morriston Hospital in Swansea, has begun prescribing lung cancer patients with gym sessions ahead of surgery.
In a pilot scheme, he assigned patients two 70-minute sessions in the gym over a three-week period, and he reported that 75% of them became eligible for surgery. The aim is to help patients breathe better.
Mr Goldsmith said, “We found that by improving their breathlessness they are safely able to undergo surgery. Most importantly, it was making inoperable patients operable”.
Many healthcare teams are now advising people with lung cancer to take part in ‘prehab’.
This is a way of preparing for treatment by promoting healthy behaviours and exercise, nutrition and psychological interventions where appropriate.
Better fitness levels can reduce also complications when having a surgery, and improve the chances of making a better and quicker recovery afterwards.
It’s worth remembering that there is another treatment option for early-stage lung cancer when surgery isn’t possible due a patient’s low PS or for people who do not want surgery.
This is SABR (Stereotactic Ablative Body Radiotherapy), sometimes called SBRT (Stereotactic Body RadioTherapy), which is an effective way of giving highly accurate high-dose radiotherapy with fewer treatments over a shorter period of time than standard radiotherapy.
Lung oncology teams will help to support and advise patients about their treatment options.
The National Lung Cancer Audit (NLCA) is an annual overview of healthcare provision for lung cancer patients in England and Wales prepared by the Royal College of Physicians.
It is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh government. It strives to raise standards in order to improve treatment and outcomes for patients with lung cancer. We are proud to take part in helping to review content and help in the preparation of the annual report.