Key concepts

O The most important risk factor for the development of lung cancer is smoking, and the most effective way for high-risk patients to reduce their risk is to stop smoking. Additional recommendations should include an increase in dietary intake of fruits and vegetables.

The signs and symptoms of lung cancer can be classified as pulmonary, extrapul-monary, and paraneoplastic. These classifications relate to disease progression.

The treatment goals in lung cancer are cure (early-stage disease), prolongation of survival, and maintenance or improvement of quality of life through alleviation of symptoms.

^^ The performance status (PS) of the patient represents an important aspect of chemotherapy treatment decisions. Patients with a PS of 0 to 1 may be treated with chemotherapy. Patients with a PS of 2 may be treated with less aggressive regimens that have a decreased risk of major toxicities, whereas patients with a PS 3 and 4 should be treated with supportive care only.

^ Surgical resection of the tumor is the mainstay of treatment in early-stage nonsmall cell lung cancer and produces the longest survival rates.

® Doublet chemotherapy regimens offer superior response rates compared to single-agent regimens and should be used when the patient can tolerate the associated toxicity. Platinum-containing doublets are first-line treatment in most cases.

^^ Knowing when and how to treat adverse events from chemotherapy is an important aspect of patient care. Unmanaged events may cause delays in chemotherapy administration and reduced chemotherapy doses, and may contribute to treatment failure.

® While some evidence suggests that the use of a colony-stimulating factor reduces the number of neutropenic fever episodes, hospital stay, and antibiotic administration in certain subsets of lung cancer patients, routine front-line (prophylactic) use of a colony-stimulating factor is not recommended owing to lack of a survival benefit.

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