I'm relieved to report that the enlarged mediastinum nodes (max 9mm) that appeared on my sweetie's 6 month post op scan (7/2014) have all returned to "normal" on yesterday's scan done after a 4 month period. He is back on 6 month scan frequency. As I have said before I could not have gotten through the past few months without cancergrace.
Rhetorical discussion?
I was taken aback when first informed of the 5 year survival stats for my husband's cancer - T2N1M0 and had a right pneumonectomy. So I did some research on the reasons why the rates are not higher. I learned that the most predictive variable for survival after "surgical cure" is the impact of intercurrent disease. Of course I never heard of intercurrent disease but found out it means other health issues affecting the patient. I couldn't believe it but I read it in several retrospective peer reviewed studies. Looking at my husband's continuity of care post-surgery, I have found that there is no medical provider taking charge of optimizing care of his intercurrent disease. I suppose that's the job of the PCP but shouldn't the thoracic surgeon, oncologist or anyone on the cancer team educate the patient that survival is dependent on managing intercurrent disease. In my real world, the oversight of my sweetie's intercurrent disease has fallen on my shoulders. I don't mind but what about others who have been given the gift of a cure but get short circuited by other ailments.
As an example, the 6 month post surgical lung scan noted severe aortic stenosis. I knew my sweetie had aortic stenosis but frankly his cardiologist (now fired) dropped the ball on regular surveillance and when the thoracic surgeon told us about the enlarged lymph nodes we were not advised about the stenosis and importance of getting to a cardiologist ASAP. My research lit a fire under me to locate a new cardio. He is facing the possibility of TAVR to treat it. Surgeon has done 100s but only 1 on 1 lung patient.
Comments?
Reply # - November 12, 2014, 09:18 AM
agent99,
agent99,
I can't speak to the handling of his particular situation, but the median age of a lung cancer diagnosis is about 72, so with half the patients older than that, it is not surprising that they have many comorbidities that can affect their survival.
As many of us are aware, it is always helpful to remain informed and active in your medical care. That's why we're here!
JimC
Forum moderator
Reply # - November 12, 2014, 07:29 PM
I'm glad his follow up scans
I'm glad his follow up scans looked favorable.
Realistically, the best person to manage the other medical issues of a patient depends on the particular medical issues of the patient: sometimes it's cardiac, but it may well be severe emphysema limiting survival and making a pulmonologist the most important person, or it could be a neurologist managing Parkinson's disease. There's no way to categorically presume that an oncologist or thoracic surgeon will be the person to oversee the global medical care needs of a patient. That's part of why it helps in this day and age to have a patient be directly involved in his or her own care to best ensure that everything is being followed as it needs to be.
-Dr. West
Reply # - November 13, 2014, 04:06 PM
Intercurrent disease: a
Intercurrent disease: a disease that intervenes during the course of another disease. So if he acquired pneumonia after his LC diagnosis, that would be considered intercurrent disease. If he had any
pre-existing conditions, they should be followed by that particular doctor. My PCP is familiar with my health history and has copies of all my records from other doctors and makes the referrals as needed. I see my cardio doctor next month. But this had nothing to do with my LC diagnosis. Glad he's seeing his.
Take care, Judy
Reply # - August 8, 2016, 04:16 AM
Hi , would you be able to
Hi , would you be able to shed some light on the information you have found about comorbidity being the number one factor in survival after completed surgery ? I've found some limited information before that mentions it as a risk factor , much the same as being male is a risk factor , but I haven't seen it listed as a major prognosis before
I would be very interested in what information you have
Jase
Reply # - August 8, 2016, 08:47 AM
Hi Jase,
Hi Jase,
In a GRACE podcast on treating elderly patients, Dr. Rogerio Lilenbaum provided some information and statistical evidence on how co-morbidities affect survival, based an evaluation of co-morbidities known as the Charlson score. You can read the transcript here, and the figures (notably figure 8) are here.
Of course, these are statistics, and the specific co-morbidities vary from patient to patient, as well as response to treatment.
JimC
Forum moderator
Reply # - August 8, 2016, 07:56 PM
This is the first time in
This is the first time in almost 6 months that I have checked cancergrace. My sweetie passed away in January '16 due to complications of a neurological disorder that was diagnosed a year before lung cancer. He had just graduated to yearly scans (2 years post surgery). In my heart, he survived lung cancer.
I will try to locate the study and post the link.
Reply # - August 9, 2016, 06:03 PM
HI Jase,
HI Jase,
Unfortunately I cannot find the studies I mentioned above but I did find this article. It's been a couple of years and I didn't save hard copies. My XP laptop is not booting so I can't locate shortcuts I might have created. I did find the article below and will continue to search for the particular journal article(s) that prompted my question.
Please try not to be so "male" and maintain regular health checkups with your other providers to monitor any existing illnesses and detect any others early that may develop. ALso, get every scan, report, test result, etc. and read them and/or empower a health advocate to that for or with you. I was amazed by the number of non-nuisance issues my sweetie had that we were not told about that I had to pursue.
http://annonc.oxfordjournals.org/content/26/5/902.full.pdf
All my best
Lisa
Reply # - August 10, 2016, 03:27 AM
Thanks for the reply , it's a
Thanks for the reply , it's a little confusing , on one hand it seems that most deaths are still lung cancer , but the comorbidity seems like a fairly high risk factor .. So maybe the comorbidity is effecting the effectiveness of the treatments ?
Reply # - August 10, 2016, 07:04 PM
Hi Jase,
Hi Jase,
As the second chart on page 7 of the figures shows, co-morbidities often affect a patient's ability to complete the full course of treatment, which can shorten survival. So even though the cause of death may be the cancer, co-morbidities may be a significant contributing factor.
As a result, it can be helpful to choose therapies for these patients which are easier to tolerate. Dr. Weiss presented an informative GRACEcast presentation in which he reviewed a number of treatment regimens with tolerability in mind. Although it's presented as a guide for treating elderly patients, the same considerations apply to patients with significant co-morbidities.
JimC
Forum moderator
Reply # - August 10, 2016, 07:46 PM
Thanks Jim for that
Thanks Jim for that explanation for Jase. My sweetie's treatment was completed. He had a pneumonectomy and a course of adjuvant chemo (carbo/alimta) within 6 months of diagnosis in 2014 (age 67). The chemo was hard on him.
After that he had 2 brain surgeries for normal pressure hydrocephalus, one that resulted in a brain infection. One of the antibiotics (vancomycin) caused acute kidney failure. Somewhere between lung cancer treatment and acute kidney failure he develop anemia of chronic disease which is essentially untreatable if the causative chronic disease isn't figured out which it wasn't. Then he had transcatheter aortic valve replacement (TAVR) through his femoral artery because he was too high risk to have open heart surgery (one lung). Several months later he started having swallowing difficulties and did not want to see any more doctors/providers. After 3.5 years of being excused from university teaching duties, he taught a class on the first day of the spring semester in Jan. 2016. That night he collapsed at home. A week later he was at peace.
I suppose his case could fall into both categories of intercurrent disease and comorbidities.
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Reply # - August 10, 2016, 07:50 PM
Thanks Jim for that
Thanks Jim for that explanation for Jase. My sweetie's treatment was completed. He had a pneumonectomy and a course of adjuvant chemo (carbo/alimta) within 6 months of diagnosis in 2014 (age 67). The chemo was hard on him.
After that he had 2 brain surgeries for normal pressure hydrocephalus, one that resulted in a brain infection. One of the antibiotics (vancomycin) caused acute kidney failure. Somewhere between lung cancer treatment and acute kidney failure he develop anemia of chronic disease which is essentially untreatable if the causative chronic disease isn't figured out which it wasn't. Then he had transcatheter aortic valve replacement (TAVR) for repair severely stenotic bicuspid valve through his femoral artery because he was too high risk to have open heart surgery (one lung). Several months later he started having swallowing difficulties and did not want to see any more doctors/providers. After 3.5 years of being excused from university teaching duties, he taught a class on the first day of the spring semester in Jan. 2016. That night he collapsed at home. A week later he was at peace.
I suppose his case could fall into both categories of intercurrent disease and comorbidities.
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