**7. Conclusion**

Medical operability of lung cancer has been frequently determined based on preoperative FEV1, DLCO, and VO2max. Predicted postoperative FEV1 is still the most helpful indicator for the safe operation as it provides fundamental information about underlying lung function and disease status. As the concept of regional lung function is introduced to anatomic calculation, the prediction accuracy of postoperative lung function is improved. However, substantial gap is still present between ppoFEV1 and apoFEV1, which tends to be greater in COPD and large lung volume resection. This inaccuracy may be critical in the patients with marginal lung function after lung resection. We should consider that the the accuracy can be affected not only by the technique to measure the regional lung function, but also several clinical factors such as the presence of obstructive lung disease, resected lung portion, extent of lung volume resection, preoperative bronchodilator response, adherence to bronchodilator therapy, physical exercise, nutrition, postoperative pain control, patient education and so on.

The moderate to severe COPD should not hinder the curative resection of lung cancer which could increase the chance of cure, if the candidates of surgery would be properly selected, because the surgery could partly work as lung volume reduction, thereby minimizing the loss of pulmonary function in patients with COPD. Proper perioperative management regarding the aforementioned clinical factors is mandatory to improve lung function and reduce postoperative complication despite remarkable advances in anesthesia, surgery.

#### **8. References**

260 Topics in Cancer Survivorship

resection, help us to offer potentially curative treatment to the patients as many as possible. Postoperatively, lung expansion maneuvers and pain control are the two most important methods for reducing the risk of pulmonary complications. Both the incentive spirometry and deep breathing exercise are proved to be effective for lung expansion and reducing pulmonary complications (Thomas & McIntosh 1994). A meta-analysis of randomized controlled trials of postoperative pain control and pulmonary complications demonstrated that epidural local anesthetics significantly reduce the risk of pneumonia and all postoperative pulmonary complications (Ballantyne, et al. 1998). Pulmonary function recovers up to 6 months after a lobectomy, and up to 3 months after a pneumonectomy (Bolliger, et al. 1996; Nezu, et al. 1998). There has been little research on long term postoperative optimized outcome in terms of lung function and quality of life. There is no direct evidence supporting an additional role of bronchodilators in the lung resection candidate beyond what would be standard use for COPD or asthma. A study showed that post-operative respiratory rehabilitation after lung resection for lung cancer was beneficial for the Borg dyspnea scale, exercise capacity represented by 6-minute walk distance, and maintenance of lung function (Cesario, et al. 2007). The inpatient rehabilitation program included supervised incremental exercise and educational sessions covering such topics as pulmonary physiopathology, pharmacology of patients' medications, dietary counseling, relaxation and stress management techniques, energy conservation principles, and breathing retraining. The individuals joining the rehabilitation program had the significantly improved exercise capacity and maintained FEV1, whereas the control group had the significantly decreased exercise capacity and decreased FEV1 compared with baseline values. Although the rehabilitation is not confined to pharmacotherapy, it should be kept in mind that multidimensional efforts to maintain exercise capacity and lung

function should be required because they could be labile after lung resection.

Medical operability of lung cancer has been frequently determined based on preoperative FEV1, DLCO, and VO2max. Predicted postoperative FEV1 is still the most helpful indicator for the safe operation as it provides fundamental information about underlying lung function and disease status. As the concept of regional lung function is introduced to anatomic calculation, the prediction accuracy of postoperative lung function is improved. However, substantial gap is still present between ppoFEV1 and apoFEV1, which tends to be greater in COPD and large lung volume resection. This inaccuracy may be critical in the patients with marginal lung function after lung resection. We should consider that the the accuracy can be affected not only by the technique to measure the regional lung function, but also several clinical factors such as the presence of obstructive lung disease, resected lung portion, extent of lung volume resection, preoperative bronchodilator response, adherence to bronchodilator therapy, physical exercise, nutrition, postoperative pain

The moderate to severe COPD should not hinder the curative resection of lung cancer which could increase the chance of cure, if the candidates of surgery would be properly selected, because the surgery could partly work as lung volume reduction, thereby minimizing the loss of pulmonary function in patients with COPD. Proper perioperative management regarding the aforementioned clinical factors is mandatory to improve lung function and reduce postoperative complication despite remarkable advances in anesthesia, surgery.

**7. Conclusion** 

control, patient education and so on.


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**17** 

*USA* 

**Patients' Survival Expectations** 

**Treatment by Treatment Status** 

*Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia,* 

**Before Localized Prostate Cancer** 

Ravinder Mohan, Hind Beydoun, Myra L. Barnes-Ely,

LaShonda Lee, John W. Davis, Raymond Lance and Paul Schellhammer

Although around 80% of men aged 80 years and older and 15% to 30% of men aged 50 years and older have microscopic undiagnosed prostate cancer found at autopsy, only 3% men die because of prostate cancer.**1** Increasing prostate-specific antigen (PSA) screening at younger ages has increased overdiagnosis2 and overtreatment3 of localized prostate cancer (LPC). More than 90% of US patients currently diagnosed with prostate cancer have LPC and approximately 94% of patients with LPC choose treatment.4 Based on data from leading studies, a model had recently projected only a 0% to 2% 15-year mortality from low-grade (Gleason score <7) screen-detected LPC in men aged 55 to 74 years if they chose observation instead oftreatment.5 By consensus, urologists and radiation oncologists recommend treatment for LPC if a patient has a further 10-year life expectancy 6 (the10-year rule7) regardless of cancer grade, even though no randomized trials have shown that treatment can improve survival in patients in whom the cancer was screen-detected. National guidelines by the American Cancer Society and the National Comprehensive Cancer Network (NCCN) also recommend treatment for most patients.8 However, in the review by Zeliadt et al,9 different studies had found that patients rate the sexual, urinary, and bowel side effects of treatment to be just as important as the potential benefit in survival; that if risks and benefits of treatment were explained with-out bias, 75% of patients chose a lower radiation dose despite a lower predicted survival; that 90% of physicians but fewer than 20% of patients ranked the effect of treatment on survival as one of their top 4 concerns; and that patients who chose treatment believed that treatment was guaranteed to improve survival. At a median of 6 years after treatment, health-related quality of life (HRQOL) of treated patients was worse than that of

To our knowledge, no studies of patient-physician communication have examined patients' anticipated survival benefit of treatment. Without data from randomized trials in screendetected patients, it is difficult to counsel patients regarding their survival with and without treatment. Even with the use of multi-factorial models, accuracy of predicted survival is 75% or lower.12 Physicians are also poor at estimating baseline co-morbidity adjusted life expectancy (CALE), which is critical in making an informed decision.13 Thus, patients may

controlpatients.10 Many patients regretted that they chosetreatment.11

**1. Introduction** 

