Ching-Fei Chang

Playing the odds: lung cancer surveillance after curative surgery

Purpose of review After ‘curative’ resection, many patients are still at risk for further lung cancer, either as a recurrence or a new metachronous primary. In theory, close follow-up should improve survival by catching relapse early – but in reality, many experts feel that surveillance for recurrence is of uncertain value. In this article, we explore the reasons behind the controversy, what the current guidelines recommend, and what future solutions are in development that may ultimately resolve this debate. Recent findings Although postoperative surveillance for a new lung cancer may impart a survival advantage, this benefit does not appear to extend to the phenomenon of recurrence. Nevertheless, close radiographic follow-up after curative resection is still recommended by most professional societies, with more frequent scanning in the first 2 years, and then annual screening thereafter. Given the radiation risk, however, low-dose and minimal-dose computed tomography options are under investigation, as well as timing scans around expected peaks of recurrence rather than a set schedule. Summary Applying the same surveillance algorithm to all lung cancer patients after curative resection may not be cost-effective or reasonable, especially if there is no demonstrable mortality benefit. Therefore, future research should focus on finding safer nonradiographic screening options, such as blood or breath biomarkers, or developing nomograms for predicting which patients will relapse and require closer follow-up. Ultimately, however, better tools for surveillance may be moot until we develop better treatment options for lung cancer recurrence.

Disparities in Lung Cancer Outcomes

Historically, the overall 5-year survival probability from lung cancer is dismal. However, this poor prognosis is not uniformly distributed among those affected—certain subsets of patients appear to fare worse, either due to a more advanced stage at presentation or barriers to appropriate and timely care. Disparities in lung cancer development, diagnosis, treatment, and outcomes are predominantly seen in members of racial, ethnic, and other minority groups, women, HIV patients, and the elderly. The basis for such differences is complex and multifactorial, involving social inequities overlapping with genetic and biologic factors. For this reason, improvement in lung cancer survival can only occur when these disparities are addressed and corrected.

The five commandments of efficient and effective care in the initial evaluation of lung cancer.

Purpose of review Multiple recent studies have found an astounding lack of concordance with national guidelines in the workup of lung cancer in both community and academic settings. The resultant increase in complications and delays may potentially contribute to the overall dismal outcomes, as well as cost. This article aims to increase awareness among clinicians about the scope of this problem, and provides a simplified primer on the core concepts of how to perform an efficient and effective workup that is in-line with national guidelines. Recent findings Although the basic principles underlying lung cancer evaluation have not changed in the last decade, there are new areas of debate which are outlined and discussed in this article. These include: the value of brain and bone imaging in asymptomatic patients, the best initial site to biopsy in the era of genomics, and the use of biomarkers with low-dose chest tomography screening. Summary Given the huge stakes in lung cancer, the current national quality gap in initial evaluation is unacceptable. However, physician re-education can change this. This article provides a quick review of how to properly evaluate a patient with potential lung cancer, as well as an update on new and continuing controversies in the field.

The Importance of Being Adaptable : Developing Guidelines for Lung Nodule Evaluation in Asia

More than 175 million years ago, Pangaea splintered and the continents drifted, carrying with them clusters of living organisms that would eventually develop into our myriad of current species. Like Darwin’s finches, the evolution of today’s human racial groups likely occurred as a result of both genetic inbreeding and local environmental selection pressures, such as differing climates, food resources, and endemic diseases. For this reason, it should come as no surprise that lung cancer can present and respond to therapy differently across diverse populations.