Quality of Life after endobronchial intervention of malignant central airway obstruction
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Master of Science in Lung Cancer, Oncology Unit, 3rd Department of Medicine, National and Kapodistrian University of Athens,“Sotiria” General Hospital Athens, Greece
Pulmonary Department Nicosia General Hospital, Cyprus
1st Respiratory Medicine Department of National and Kapodistrian University of Athens, “Sotiria” General Hospital Athens, Greece
Pulmonology Dept 251 Air Forces General Hospital of Athens, Greece
Corresponding author
Danai Theodoulou   

21 Chalepa street, P.C. 111 41 Athens, Athens, Greece
Pneumon 2018;31(4):212-220
Patients with malignant central airway obstruction (mCAO) may need endobronchial intervention for symptoms relief (dyspnea, hemoptysis, post-obstructive pneumonia), but also to manage atelectasis and consequent respiratory failure that does not allow their treatment to continue. Quality of life (QoL) has been closely linked with symptom intensity in lung cancer patients. It is therefore important to relieve respiratory distress and inform patients, especially those who receive palliative care, about the benefits of an eventual endobronchial intervention.

Over an 18-month period, we enrolled 29 patients with symptomatic malignant central airway obstruction in order to re-establish airway patency. QoL and dyspnea were evaluated by the EORTC -C30 and EORTC -LC13 Questionnaire before the intervention, 1 week after and every following month until first relapse or death.

Overall, 44.8% of patients (n=13) had poor Performance status (PS ≥3) and 51.7% (n=15) of patients were stage IV disease. QoL improved significantly from the first week up to the 6th month (p<0.05). Global Health Questionnaire improved from 29.6 (Standard deviation=19.2) to 70.8 (SD=30.5) (p<0.05) on week 24. Dyspnea accessed with EORTC-LC13 questionnaire decreased from 73.2 (SD=29.2) to 23.6 (SD=26) (p<0.05) on week 24. Patients with PS ≥3 and those at stage IV had greater improvement. Benefits were seen independent of histology of malignancy or history of post-obstructive pneumonia. Mean time until first relapse was 21.2 weeks (SD=20.5) (n=6 patients) and time until death was 15.1 weeks (SD=7.9) (n=16 patents). Patients treated with chemotherapy before the intervention and those with stenosis of trachea and left main bronchus had worse survival.

Interventional management of patients with mCAO results in sustained significant improvement of QoL and shortness of breath and should be considered as essential component of multidisciplinary cancer care approach.

We would like to thank D. Lamprou Athens, Greece, for his valuable assistance in the statistical analysis and the presentation of the data of this study
Guibert N, Mazieres J, Marquette C-H, Rouviere D, Didier A, Hermant C. Integration of interventional bronchoscopy in the management of lung cancer. European Respiratory Review 2015;24:378-91.
Ernst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med 2004;169:1278-97.
Macha HN, Becker KO, Kemmer HP. Pattern of failure and survival in endobronchial laser resection. A matched pair study. Chest 1994;105:1668–72.
Montazeri AM, Gillis CRM, McEwen JM. Quality of life in patients with lung cancer: a review of literature from 1970 to 1995 [Review]. Chest 1998;113:467–81.
Ost DE, Ernst A, Grosu HB, et al. Therapeutic bronchoscopy for malignant central airway obstruction success rates and impact on dyspnea and quality of life. CHEST 2015;147:1282-98.
Stratakos G, Gerovasili V, Dimitropoulos C, et al. Survival and Quality of Life Benefit after Endoscopic Management of Malignant Central Airway Obstruction. J Cancer 2016;7:794-802.
Amjadi K, Voduc N, Cruysberghs Y, et al. Impact of interventional bronchoscopy on quality of life in malignant airway obstruction. Respiration 2008;76:421-8.
Neumann K, Sundset A, Espinoza A, Kongerud J, Fosse E. Changes in quality of life, dyspnea scores, and lung function in lung cancer patients with airway obstruction after a therapeutic bronchoscopy. J Bronchology Interv Pulmonol 2013;20:134-9.
Bergman B, Aaronson NK, Ahmedzai S, et al. The EORTC QLQLC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQC30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life. Eur J Cancer 1994; 30A:635–42.
Mystakidou K, Tsilika E, Parpa E, et al. The EORT Core quality of life questionnaire (QLQ-C30, version 3.0) in terminally ill cancer patients under palliative care: validity and reliability in a Hellenic sample. Int J Cancer 2001;94:135-9.
Guibert N, Mazieres J, Lepage B, et al. Prognostic factors associated with interventional bronchoscopy in lung cancer. Ann Thorac Surg 2014;97:253–9.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use n international clinical trials in oncology. Journal of the National Cancer Institute 1993; 85:365-76.
Cavaliere S, Venuta F, Foccoli P, et al. Endoscopic treatment of malignant airway obstructions in 2008 patients. Chest 1996;110:1536–42.
Oviatt PL, Stather DR, Michaud G, Maceachern P, Tremblay A. Exercise capacity, lung function, and quality of life after interventional bronchoscopy. Journal of Thoracic Oncology: International Association for the Study of Lung Cancer 2011; 6:38-42.
Chhajed PN, Baty F, Pless M, Somandin S, Tamm M, Brutsche MH. Outcome of treated advanced nonsmall cell lung cancer with and without central airway obstruction. Chest 2006; 130:1803–7.
Chen C-H, Wu B-R, Cheng W-C, et al. Interventional pulmonology for patients with central airway obstruction. An 8-year institutional experience. Medicine 2017; 96(2):e5612.
Mahmood K, Wahidi MM, Thomas S, et al. Therapeutic bronchoscopy improves spirometry, quality of life, and survival in central airway obstruction. Respiration 2015;89:404-13.
Sarna LR, Evangelista LR, Tashkin DM, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small ell lung cancer. Chest 2004;125:439–45.
Jeon K, Kim H, Yu CM, et al. Rigid Bronchoscopic intervention in patients with respiratory failure caused by malignant central airway obstruction. J Thorac Oncol 2006;1:319–23.
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