COPD is commonly underdiagnosed in patients with lung cancer: results from the RECOIL study (retrospective study of COPD infradiagnosis in lung cancer)

Abstract

IntroductionMany patients with COPD are underdiagnosed, including patients with coexisting lung cancer.MethodsWe conducted a retrospective study of COPD prevalence and outcomes among all patients diagnosed with lung cancer at our institution during a 2-year period. Patients with known COPD (group A) were compared with those who received a diagnosis of COPD at the time of their oncologic workup (group B).ResultsA total of 306 patients were diagnosed with lung cancer during the study period, including 87 with COPD (28.6%). Sixty percent of patients with coexisting lung cancer and COPD were unaware of their obstructive airways disease prior to the lung cancer diagnosis. Patients in group A were older (74+9 vs 69+9 years; P=0.03), had more severe obstruction (% of predicted forced expiratory volume in one second [FEV1%] 55+17 vs 71+13; P=0.04), more emphysema (91% vs 65%; P=0.02), and worse diffusing capacity of the lungs for carbon monoxide 59+19% vs 72+22%; P=0.01) than patients in group B, but the latter had more advanced lung cancer (27.3% vs 13.8% stage IV disease; P=0.01) and consumed more outpatient resources (P=0.03). Overall mortality was similar (56% vs 58%). However, stage-adjusted mortality showed a trend toward greater mortality in group B patients (1.87 [0.91–3.85]; P=0.087).ConclusionCOPD infradiagnosis is common in patients with coexisting lung cancer and is associated with more advanced cancer stage, greater outpatient resource consumption, and may be associated with greater stage-adjusted mortality.

Sleep Disordered Breathing Is Highly Prevalent in Patients with Lung Cancer: Results of the Sleep Apnea in Lung Cancer Study

“…Interestingly, patients with advanced stage III-IV lung cancer had a tendency to achieve better FEV1 and DLCO values than those with stage I-II lung cancer. This finding is consistent with a prior publication of our group reporting that patients with coexisting COPD and lung cancer show an inverse correlation between cancer stage and the severity of airflow obstruction [28]. We attributed this finding to the fact that patients with lung cancer and known, generally more severe, COPD are often under medical surveillance as opposed to patients with less severe COPD who present with more advanced stage lung cancer as a consequence of lack of surveillance.…”

Management and outcomes of patients with chronic obstructive lung disease and lung cancer in a public healthcare system

“…The primary concern in this regard would be the contribution of small cell lung cancer (SCLC), as localized SCLC rarely involves surgery. Interestingly, two prior studies suggest SCLC is an under-represented histology in populations having COPD and lung cancer, at 6.5 and 7.8%, as compared with more commonly reported rates of 15% or higher for the overall lung cancer population [ 29 – 31 ]. If anything, the SCLC population would decrease the apparent surgical rate in our non-COPD population.…”

A population-based analysis of spirometry use and the prevalence of chronic obstructive pulmonary disease in lung cancer

“…In our study, individuals with COPD were younger at the time of lung cancer diagnosis and were more likely to be diagnosed with early stage disease, although the differences were modest. While a small ( n = 80) retrospective study also found that patients diagnosed with COPD prior to a diagnosis of cancer were more likely to have earlier stage disease, they found these individuals tended to be older [ 18 ]. The works of Mourante-Roibas and Zhang did not appreciate age or stage differences by COPD diagnosis on multivariate analysis [ 6 , 7 ].…”