Prevalence and outcome of central airway obstruction in patients with lung cancer

Abstract

IntroductionCentral airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to inform our local cancer service.MethodsThis is a cohort review of all new lung cancer diagnoses between 1 November 2014 and 30 November 2015. CAO was defined by CT appearance. CT scans and routine patient records were followed up to 30 November 2018 to determine the prevalence of CAO at diagnosis; the characteristics of patients with prevalent CAO; mortality (using survival analysis); and incident CAO over follow-up.ResultsOf 342 new lung cancer diagnoses, CAO prevalence was 13% (95% CI 10% to 17%; n=45/342). Dedicated CT scan review identified missed CAO in 14/45 (31%) cases. In patients with prevalent CAO, 27/44 (61%) had a performance status of ≤2, 23/45 (51%) were diagnosed during an acute admission and 36/44 (82%) reported symptoms. Treatments were offered to 32/45 (71%); therapeutic bronchoscopy was performed in only 8/31 (26%) eligible patients. Median survival of patients with prevalent CAO was 94 (IQR 33–274) days. Multivariate analysis, adjusting for age, gender and disease stage, found CAO on index CT scan was independently associated with an increased hazard of death (adjusted HR 1.78 (95% CI 1.27 to 2.48); p=0.001). In total, 15/297 (5%) developed CAO during follow-up (median onset 340 (IQR 114–551) days). Over the audit period, 60/342 (18%; 95% CI 14% to 22%) had or developed CAO.DiscussionsThis is the first description of CAO prevalence in 40 years. Patients with prevalent CAO had a higher mortality. Our data provide a benchmark for service planning.

Outcomes of Airway Stents in the Palliative Care of Patients With Cancer

“…Central airway obstruction (CAO) is defined as any disease process affecting the trachea, right and left main bronchus, or bronchus intermedius on imaging or by direct visualization at bronchoscopy. 1 Malignant airway obstruction (MAO) may develop due to a primary intraluminal malignancy, extension of an adjacent tumour with airway invasion, metastatic endoluminal disease, or extrinsic compression from a contiguous malignant process. 2 It is estimated that 20% to 30% of patients with lung cancer have MAO, and 40% of deaths are attributed to progressive locoregional disease.…”

Feasibility and safety of a novel electrosurgery device as part of multi-modal bronchoscopic therapy for malignant central airway lesions

“…We believe the study adds to the body of literature that thermal ablative interventions relieve airway obstruction and symptoms, thus allowing initiation or continuation of systemic anti-cancer therapy. This is relevant as the prevalence of CAO in lung cancer patients is 13% (13). Many patients have diagnostic delays and often present when are very symptomatic and require hospitalization (2).…”

Therapeutic bronchoscopy facilitates liberation from mechanical ventilation and improves quality of life for critically ill patients with central airway obstruction

“…A recent single center cohort analysis of 342 newly diagnosed lung cancer patients identified CAO in 45 (13%) patients at the time of diagnosis with an additional 15 patients (5%) developing CAO over a median follow up of approximately one year (4). Of the 45 CAO patients, 23 received a diagnosis during or after a hospital admission for cough or breathlessness (4). A careful review of these 45 CAO patients also found that 14 (31%) did not have CAO reported on index CT imaging (4).…”