Lung cancer is the leading cause of cancer mortality both in the US and worldwide. 1 Many patients diagnosed with lung cancer present with advanced disease with thoracic symptoms such as cough, hemoptysis, dyspnea, and chest pain. 2-4 Palliative radiotherapy is routinely used in patients with locally advanced and metastatic lung cancer with the goal of relieving these symptoms and improving quality of life. Guidelines published by the American Society for Radiation Oncology (ASTRO) in 2011, and updated in 2018, provide recommendations on palliation of lung cancer with external beam radiotherapy (EBRT) and clarify the roles of concurrent chemotherapy and endobronchial brachytherapy (EBB) for palliation. 5,6
Radiotherapeutic Care of Patients With Stage IV Lung Cancer with Thoracic Symptoms in the Veterans Health Administration
Ruchika Gutt is a Radiation Oncologist at the Washington DC VA Medical Center (VAMC). Sheetal Malhotra is an Endocrinologist at The Southeast Permanente Medical Group in Jonesboro, Georgia. Drew Moghanaki is a Radiation Oncologist at the Atlanta VAMC in Georgia. Alice Cheuk is a Radiation Oncologist at the James J. Peters VAMC in the Bronx, New York, and an Assistant Professor at Mount Sinai School of Medicine. Lori Hoffman-Hogg is National Program Manager for Prevention Policy at Veterans Health Administration National Center for Health Promotion and Disease Prevention in Durham, North Carolina. Maria Kelly and George Dawson are Radiation Oncologists at the New Jersey VA Health Care System in East Orange. Helen Fosmire is Deputy Chief of Staff at the Richard L. Roudebush VAMC in Indianapolis, Indiana.
Correspondence: Ruchika Gutt ([email protected])
The authors report no actual or potential conflicts of interest for this article.
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Background: Radiotherapy plays an important role in the palliation of lung cancer, which is the second most common cancer diagnosed in the Veterans Health Administration (VHA). The American Society for Radiation Oncology (ASTRO) developed evidenced-based treatment guidelines for the management of patients with metastatic lung cancer.
Methods: In May 2016, an electronic survey of 88 VHA radiation oncologists (ROs) was conducted to assess metastatic lung cancer management. Demographic information was obtained and 2 clinical scenarios were presented to glean opinions on dose/fractionation schemes preferred, preferences for/against concurrent chemotherapy, and use of endobronchial brachytherapy (EBB) and/or yttrium aluminum garnet (YAG) laser technology. Survey results were assessed for concordance with published ASTRO guidelines.
Results: The survey response rate was 61%, with 93% of the 40 VHA radiation departments represented. Among respondents, 96% were board certified, and 90% held academic appointments. 88% were familiar with ASTRO guidelines. Preferred fractionation schemes were 20 Gy in 5 fractions (69%) and 30 Gy in 10 fractions (22%). The vast majority (98%) did not recommend concurrent chemotherapy for palliation. In the setting of bronchial obstruction with lung collapse, about half (49%) recommended EBB or YAG lung reexpansion before external beam radiotherapy. A minority of respondents use stereotactic body radiotherapy or EBB for palliation.
Conclusion: Most respondents demonstrated up-to-date knowledge of current evidence-based treatment guidelines. We found no distinction in clinical decisions based on demographic profiles.
CCC19, other registries help define COVID/cancer landscape
Open Clinical Trials for Patients With Lung Cancers (FULL)
Timely Diagnosis of Lung Cancer in a Dedicated VA Referral Unit with Endobronchial Ultrasound Capability (FULL)
Barriers and Facilitators to the Use of Genomic-Based Targeted Therapy in the VA: Qualitative Findings(FULL)
The Use of Immuno-Oncology Treatments in the VA (FULL)
National lung cancer screening guidelines may miss younger African American individuals at high riskPublish date: October 19, 2020
High-dose TRT: A new standard of care for LS-SCLC?Publish date: October 2, 2020
Lorlatinib: Another first-line option for ALK-positive NSCLC?Publish date: September 22, 2020
Survey quantifies COVID-19’s impact on oncologyPublish date: September 20, 2020
COVID-19 prompts ‘democratization’ of cancer trialsPublish date: September 16, 2020
Sintilimab scintillates in first-line nonsquamous NSCLCPublish date: August 11, 2020
Chemo-free management of mesothelioma on horizonPublish date: August 11, 2020
Artificial intelligence matches cancer genotypes to patient phenotypesPublish date: August 10, 2020
Study: Immune checkpoint inhibitors don’t increase risk of death in cancer patients with COVID-19Publish date: August 7, 2020
Higher death rate seen in cancer patients with nosocomial COVID-19Publish date: July 30, 2020
Marginal zone lymphoma