[Approaches to the pre-operative functional assessment of patients with lung cancer and preoperative rehabilitation]. / Bilan fonctionnel préopératoire du cancer bronchique et réhabilitation préopératoire.

Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Guideline algorithms include a cardiological evaluation, a cardiopulmonary assessment to calculate the predicted residual lung function, and identify patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a very high predictive value of complications. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been developed. Implementation of these techniques and programs is associated with a decrease in postoperative mortality and complications. In addition, the current guidelines and the cut-off values they identified are based on early series of patients, and are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. Therefore, after a review of the current guidelines and a brief update on prehabilitation (smoking cessation, exercise training and nutritional aspects), we will discuss the need to redefine functional criteria to select patients who will benefit from lung surgery.

Preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus (PRE-HIIT): protocol for a randomized controlled trial.

BACKGROUND: Patients with cancer of the lung or oesophagus, undergoing curative treatment, usually require a thoracotomy and a complex oncological resection. These surgeries carry a risk of major morbidity and mortality, and risk assessment, preoperative optimisation, and enhanced recovery after surgery (ERAS) pathways are modern approaches to optimise outcomes. Pre-operative fitness is an established predictor of postoperative outcome, accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation is challenging to implement however due to the short opportunity for intervention between diagnosis and surgery. Therefore, individually prescribed, intensive exercise training protocols which convey clinically meaningful improvements in cardiopulmonary fitness over a short period need to be investigated. This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and, through evaluation of health economics, the impact of the programme on hospital costs. METHODS: The PRE-HIIT Randomised Controlled Trial (RCT) will compare a 2-week high intensity interval training (HIIT) programme to standard preoperative care in a cohort of thoracic and oesophageal patients who are > 2-weeks pre-surgery. A total of 78 participants will be recruited (39 per study arm). The primary outcome is cardiorespiratory fitness. Secondary outcomes include, measures of pulmonary and physical and quality of life. Outcomes will be measured at baseline (T0), and post-intervention (T1). Post-operative morbidity will also be captured. The impact of PRE-HIIT on well-being will be examined qualitatively with focus groups/interviews post-intervention (T1). Participant's experience of preparation for surgery on the PRE-HIIT trial will also be explored. The healthcare costs associated with the PRE-HITT programme, in particular acute hospital costs, will also be examined. DISCUSSION: The overall aim of this RCT is to examine the effect of tailored, individually prescribed high intensity interval training aerobic exercise on pre-operative fitness and postoperative recovery for patients undergoing complex surgical resections, and the impact on use of health services. TRIAL REGISTRATION: The study is registered with Clinical Trials.Gov (NCT03978325). Registered on 7th June 2019.

Assessment of gait parameters and physical function in patients with advanced cancer participating in a 12-week exercise and nutrition programme: A controlled clinical trial.

OBJECTIVE: Gait is a sensitive marker for functional declines commonly seen in patients treated for advanced cancer. We tested the effect of a combined exercise and nutrition programme on gait parameters of advanced-stage cancer patients using a novel wearable gait analysis system. METHODS: Eighty patients were allocated to a control group with nutritional support or to an intervention group additionally receiving whole-body electromyostimulation (WB-EMS) training (2×/week). At baseline and after 12 weeks, physical function was assessed by a biosensor-based gait analysis during a six-minute walk test, a 30-s sit-to-stand test, a hand grip strength test, the Karnofsky Index and EORTC QLQ-C30 questionnaire. Body composition was measured by bioelectrical impedance analysis and inflammation by blood analysis. RESULTS: Final analysis included 41 patients (56.1% male; 60.0 ± 13.0 years). After 12 weeks, the WB-EMS group showed higher stride length, gait velocity (p < .05), six-minute walking distance (p < .01), bodyweight and skeletal muscle mass, and emotional functioning (p < .05) compared with controls. Correlations between changes in gait and in body composition, physical function and inflammation were detected. CONCLUSION: Whole-body electromyostimulation combined with nutrition may help to improve gait and functional status of cancer patients. Sensor-based mobile gait analysis objectively reflects patients' physical status and could support treatment decisions.

Motivation and preferences of exercise programmes in patients with inoperable metastatic lung cancer: a need assessment.

OBJECTIVES: The aim of this study is to investigate the motivation, ability, preferences, and perceived potential facilitating factors/barriers of patients with inoperable metastatic lung cancer towards exercise programmes. METHODS: This is a cross-sectional study using survey adopting the Theory of Planned Behaviour (TPB) to obtain patients' experience recruited through Odette Cancer Centre, Sunnybrook Health Sciences Complex. Results were expressed in percentages, P value, and Spearman's rho. RESULTS: Sixty patients were recruited from January 2014 to April 2014. Patients generally had a high level across TPB measures, with 63% of them indicating that they have the motivation to exercise. Significant association in relation to motivation was established on attitudes (importance, P = 0.005, rho = 0.326; helpfulness, P = 0.015, rho = 0.348; and easiness, P = 0.001, rho = 0.375) and subjective norm of close members (P = 0.0069, rho = 0.348) and healthcare professionals (P = 0.012, rho = 0.328). Being a non-smoker (P = 0.042, rho = 0.311), having a past exercise history prior to diagnosis (P = 0.000, rho = 0.563), and absence of COPD (P = 0.016, rho = -0.312) were also shown to have a significant association with motivation to exercise. DISCUSSIONS AND CONCLUSIONS: Patients were motivated to participate in an exercise programme despite contrary belief; however, they might have limited ability and preferred light intensity type of exercise such as walking. Their motivation to exercise was driven by different factors when compared to other cancer patient populations. Thus, it is important for healthcare professionals to understand the factors influencing their motivation and increase their awareness (only 26% of patients indicated receiving advice regarding exercise) to better the care towards patients with metastatic lung cancer.

A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease.

BACKGROUND: About 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population. METHODS: This is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis ≥3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours ('worst'), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) 'worst' from baseline to 4 weeks. All analyses were by intention to treat. RESULTS: Between April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the 'worst' score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (-2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference -0.006, 95 % CIs -0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of £20,000 per QALY) was over 80 %. CONCLUSIONS: There was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden. TRIAL REGISTRATION: Registry: ISRCTN; TRIAL REGISTRATION NUMBER: ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307 ; registration date: 25/01/2011.

Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: a review.

INTRODUCTION: Lung cancer is the number one cause of cancer related deaths. It is increasingly recognized that a multidisciplinary approach to the diagnosis and management of patients with lung cancer represents the ideal model for health care delivery. Given the high incidence of comorbid lung disease in lung cancer patients, strategies targeted at improving or optimizing these conditions may improve outcomes. Pulmonary rehabilitation (PR) has proven to be a useful management strategy for patients with chronic lung diseases including chronic obstructive pulmonary disease, interstitial lung disease and pulmonary hypertension. DISCUSSION: PR improves both exercise capacity and dyspnea. The effects of PR have also been studied in patients with lung cancer prior to and following surgical resection. Investigators have demonstrated significant improvements in six minute walk distance and lower extremity strength. In addition, patient recovery time is shorter when inpatient pulmonary rehabilitation is integrated prior to or following surgery. There are also positive reports regarding the benefits of exercise training in lung cancer patients receiving definite chemotherapy and radiotherapy. Pilot studies have demonstrated improvement in dyspnea scores as well as exercise capacity objectively measured by six minute walk distance. PR also offers an educational component in which patients have the opportunity to be educated regarding management of their disease as well as discuss goals of care. CONCLUSION: PR can be included as the standard of care for patients with advanced lung cancer with the goal of optimizing quality of life. Here, we provide a review of the current knowledge regarding PR in the management of patients with lung cancer.

[Assessment of the clinical symptoms and treatment tolerance in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy and pulmonary rehabilitation]. / Ocena stanu klinicznego I tolerancji leczenia u chorych na niedrobnokomórkowego raka pluca poddanych chemioterapii pierwszorzutowe i rehabilitacji oddechowej.

UNLABELLED: In Poland lung cancer is the most commonly occurring cancer type, both in men and women. Among the most important concerns related to this disease are clinical symptoms caused by deteriorating physical condition and intolerance to chemotherapy. The aim of this work was the assessment of the clinical symptoms and treatment tolerance in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy and pulmonary rehabilitation. MATERIALS AND METHODS: 90 patients with inoperable NSCLC have undergone the examination. This included 69 men and 21 women aged between 46-75 years (average age 61.5 +/- 8.2 years). These were divided into 3 groups: group 1--30 patients undergoing standard chemotherapy; group II--30 patients undergoing standard chemotherapy and pulmonary rehabilitation; group Ill--30 patients undergoing standard chemotherapy and pulmonary rehabilitation with additional vitamin C supplementation. Clinical symptoms intensification was assessed using the ESAS scale (Edmonton Symptom Assessment System), by comparing the initial score with that after 6 weeks of chemotherapy in each individual. RESULTS: In groups II and III, where pulmonary rehabilitation was carried out, the intensification of the clinical symptoms and lowering of the tolerance for the treatment after 6 weeks of first-line chemotherapy were significantly lower (p < 0.05) than in group I. CONCLUSIONS. Pulmonary rehabilitation significantly limits the side effects of chemotherapy and the deterioration of the state of patients with NSCLC. Simultaneous supplementation with ascorbic acid increases the positive effects of pulmonary rehabilitation in those patients.

Employment status and work-related difficulties in lung cancer survivors compared with the general population.

OBJECTIVE: To investigate the employment status of lung cancer survivors and the work-related problems they face. BACKGROUND: Although the number of lung cancer survivors is increasing, little is known about their employment and work-related issues. METHODS: We enrolled 830 lung cancer survivors 12 months after lung cancer curative surgery (median time after diagnosis, 4.11 years) and 1000 volunteers from the general population. All participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30-item and a questionnaire that included items relating to their jobs. We used logistic regression analysis to identify independent predictors of unemployment. RESULTS: The employment rate of lung cancer survivors decreased from 68.6% at the time of diagnosis to 38.8% after treatment, which was significantly lower than the employment rate of the general population (63.5%; adjusted odds ratio = 2.31, 95% confidence interval: 1.66-3.22). The posttreatment unemployment rate was higher for women than for men. Among survivors, employment was inversely associated with older age, household income, number of comorbidities, and poor social functioning. Fatigue (78.6%) was the most common work-related problem reported by survivors. CONCLUSIONS: Lung cancer survivors experienced more difficulties in employment than did the general population. Age, monthly household income, number of comorbidities, and social functioning appear to be important factors influencing employment status. These findings suggest that lung cancer survivors need support to cope with the financial impact of cancer.

Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery - a randomized controlled trial.

OBJECTIVE: Surgical resection enhances long-term survival after lung cancer, but survivors face functional deficits and report on poor quality of life long time after surgery. This study evaluated short and long-term effects of supervised group exercise training on health-related quality of life and physical performance in patients, who were radically operated for lung cancer. METHODS: A randomized, assessor-blinded, controlled trial was performed on 78 patients undergoing lung cancer surgery. The intervention group (IG, n=41) participated in supervised out-patient exercise training sessions, one hour once a week for ten weeks. The sessions were based on aerobic exercises with target intensity of 60-80% of work capacity, resistance training and dyspnoea management. The control group (CG, n=37) received one individual instruction in exercise training. Measurements consisted of: health-related quality of life (SF36), six minute walk test (6MWT) and lung function (spirometry), assessed three weeks after surgery and after four and twelve months. RESULTS: Both groups were comparable at baseline on demographic characteristic and outcome values. We found a statistically significant effect after four months in the bodily pain domain of SF36, with an estimated mean difference (EMD) of 15.3 (95% CI:4 to 26.6, p=0.01) and a trend in favour of the intervention for role physical functioning (EMD 12.04, 95% CI: -1 to 25.1, p=0.07) and physical component summary (EMD 3.76, 95% CI:-0.1 to 7.6, p=0.06). At 12 months, the tendency was reversed, with the CG presenting overall slightly better measures. We found no effect of the intervention on 6MWT or lung volumes at any time-point. CONCLUSION: Supervised compared to unsupervised exercise training resulted in no improvement in health-related quality of life, except for the bodily pain domain, four months after lung cancer surgery. No effects of the intervention were found for any outcome after one year.

A systematic review of supportive care needs of people living with lung cancer.

BACKGROUND AND PURPOSE: Supportive care for people living with a diagnosis of lung cancer is paramount. The purpose of this systematic review was to determine the supportive care needs of people with lung cancer, and explore trends and gaps in the assessment of these needs emerging from this literature. METHODS: Through use of a wide range "free text" terms, a systematic search of five electronic databases (Medline, CINAHL, EMBASE, PsychINFO and BNI) was carried out for the period between January 2000 and September 2012. Two validated scoring systems were used to appraise eligible studies for methodological quality and level of evidence. RESULTS: Based on pre-specified selection criteria, 59 articles (25 of quantitative methodology; 34 of qualitative methodology) reporting on 53 studies were retrieved and considered for further analysis. Overall, studies were of acceptable methodological quality. A wide spectrum of health care needs was evident among people with lung cancer. These needs were classified into nine domains: physical; daily living; psychological/emotional; spiritual/existential; informational; practical; patient-clinician communication; social and family-related; and cognitive. Daily living, practical, and cognitive needs were given less attention in this literature. CONCLUSIONS: People with lung cancer have a complex array of supportive care needs that impact on various life aspects. Yet, our knowledge still remains fragmentary. Embarking on new longitudinal exploratory studies and well-designed clinical trials is therefore strongly encouraged. The use of patient reported outcome measures as a clinical intervention tool may be viewed as a means of identifying and managing unmet needs in this patient population.

Prospective external convergence evaluation of two different quality-of-life instruments in lung resection patients.

OBJECTIVES: The interpretation of studies on quality of life (QoL) after lung surgery is often difficult owing to the use of multiple instruments with inconsistent scales and metrics. Although a more standardized approach would be desirable, the most appropriate instrument to be used in this setting is still largely undefined. The aim of the study was to assess the respective ability of two validated QoL instruments (European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30/L13 and Short Form (36) Health Survey (SF-36)) to detect perioperative changes in QoL of patients submitted to pulmonary resection for non-small-cell lung cancer (NSCLC). METHODS: A prospective study on 33 consecutive patients (May 2009-December 2009) was submitted to pulmonary resection. All patients completed both EORTC QLQ-C30 with lung module 13 and SF-36 pre- and postoperatively (3 months). Preoperative changes of all SF-36 and EORTC scales were assessed by using the Cohen's effect-size method. External convergence between different instruments (SF-36 vs EORTC) was assessed by measuring the correlation of scales evaluating the same concepts (physical, psychosocial, and emotional). The correlation coefficients between standardized perioperative changes (effect sizes) of objective functional parameters (forced expiratory volume in 1s (FEV1) and diffusion lung capacity for carbon monoxide (DLCO)) and SF-36 or EORTC scales were also investigated. RESULTS: A poor correlation (r < 0.5) was detected between most of the scales of the two instruments measuring the same QoL concepts, indicating that they may be complementary in investigating different aspects of QoL. Only the SF-36 and EORTC social functioning scales and the SF-36 mental health and EORTC emotional functioning scales had a correlation coefficient >0.5. In general, EORTC was more sensitive in detecting physical or emotional declines but was more conservative in detecting improvements. Both SF-36 and EORTC showed poor correlations (r < 0.5) between perioperative changes in QoL and FEV1 or DLCO, confirming that objective parameters cannot be surrogates to the subjective perception of QoL. In particular, there was a poor correlation between perceived changes in dyspnea and objective changes in FEV1 or DLCO. CONCLUSIONS: EORTC behaved similarly to SF-36 in assessing perioperative changes in generic QoL scales, but, with the use of its lung module, provided a more detailed evaluation of specific symptoms. For this reason, EORTC should be regarded as the instrument of choice for measuring QoL in the thoracic surgery setting.

An exploration of urban and rural differences in lung cancer survival among medicare beneficiaries.

OBJECTIVES: We tested the relationship between urban or rural residence as defined by rural-urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer. METHODS: We used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073). RESULTS: We found no evidence that lung cancer patients in rural areas have poorer survival than those in urban areas. Rather, individual (Medicaid coverage) and regional (lower census tract-level median income) socioeconomic factors and a smaller supply of subspecialists per 10000 individuals 65 years and older were positively associated with a higher risk of mortality. CONCLUSIONS: Although urban versus rural residence did not directly influence survival, rural residents were more likely to live in poorer areas with a smaller supply of health care providers. Therefore, we still need to be aware of rural beneficiaries' potential disadvantage when it comes to receiving needed care in a timely fashion.

[Lung cancer diagnosis: hospitalization costs]. / Coste hospitalario del diagnóstico del cáncer de pulmón.

OBJECTIVE: To establish the direct costs of the process of diagnosing lung cancer in 2003. As a secondary objective, the cost of admissions defined as inappropriate was evaluated. MATERIAL AND METHODS: A prospective cohort study of lung cancer cases diagnosed in 2003 was performed. Diagnosis was based on cytohistology or clinical and radiological criteria. The total cost was determined according to Decree 222/2003, governing Galician health service rates. A distinction was drawn between hospitalized patients and outpatients, and between small cell and non-small cell carcinomas. Inappropriate admissions were analyzed in accordance with the criteria established by our study team, and the savings that would have been made had these patients been treated as outpatients were calculated. The statistical analyses were performed using SPSS version 10.0. RESULTS: A total of 160 patients were diagnosed with lung cancer; 76 (47.5%) of these were outpatients, and the remaining 84 (52.5%) were hospitalized patients. Admissions were considered inappropriate in 27 cases. Of the total of 160 patients, 108 were diagnosed as having non-small cell carcinomas, and 38 as having small cell carcinomas; the remaining 14 patients were diagnosed on the basis of clinical-radiological criteria. Total cost was 742,847 Euro(mean, 4643 Euro; 95% confidence interval, 4049-5236 Euro), composed of 552,614 Euro(mean, 6579 Euro) for admitted patients, and 190,233 Euro(mean, 2503 Euro) for outpatients. Mean cost was 3692 Euro for the small cell carcinomas, and 5070 Euro for the non-small cell carcinomas. Comparing limited and extensive small cell carcinomas, the mean cost for the former was significantly lower than for the latter (1894 Euro compared to 4098 Euro); there was also a lower mean cost for early compared to advanced stages of non-small cell carcinomas (3660 Euro compared to 5494 Euro). The savings to be made from unnecessary admissions were calculated at 120,258 Euro. CONCLUSIONS: The mean cost for outpatient lung cancer treatment was 62% lower than for hospitalization. Non-small cell carcinomas were more costly on average than small cell carcinomas, and advanced stages of the small cell carcinomas involved a higher average cost than the initial stages of the disease. For our series, the savings to be made from unnecessary admissions were calculated at 120,258 Euro.

[Thoracic surgery for non-small cell lung cancer. Cost-benefit of its management in specialized intermediate care]. / Chirurgie thoracique pour cancer du poumon non à petites cellules. Coût-bénéfice d'une prise en charge en soins intermédiaires spécialisés.

In 1989, we reorganized acute and rehabilitation cares for patients operated for non small cell lung cancer (NSCLC) in order to decrease costs by setting up a specialised intermediate care unit (SICU). This report deals with the postoperative complications and the total cost of these cares (SICU, acute and rehabilitation cares) as well as their cost/benefit. From 1990 to 1994, we performed 95 thoracotomies, 7 exploratory and 88 with lung resection (24 pneumonectomies, 8 bilobectomies, 48 lobectomies and 8 segmentectomies or wedge resections). The postoperative staging was I in 52, II in 17, III a in 15, S III b in 2, IV in 2. Patients 30-days postoperative mortality was 2/95 (2.1%). We had in 11 patients respiratory complications (12%; 3 bronchopleural fistulas, 3 pneumonias, 3 pneumothorax > 7 days, 1 empyema, 1 chronic hypoxemia), in 15 patients cardiac arrhythmias which were easily controlled by medication and in 2 general complications (1 hemiplegia, 1 transitory stupor state). The total duration of hospital stay, including SICU, acute and rehabilitative cares, was 32 +/- 10 (3-70) days with a mean total cost of 14,722 Sfr. per case. In conclusion, surgery for NSCLC can be safely performed in intermediate cares without intensive care unit at low costs and with a low morbidity and mortality provided they are staffed by a specialised and well trained team.

Quality-of-life and cost-effectiveness assessment in lung cancer.

This paper reviews recent advances in the methods for assessing the quality of life of patients with lung cancer and recent applications of quality-of-life measures in lung cancer clinical trials. In terms of methodology, there exist today a number of self-report quality-of-life questionnaires that are valid, reliable, and sufficiently brief to be of practical use in clinical research settings. Application of these measures in lung cancer clinical trials has contributed to the evaluation of: 1) long-versus short-duration chemotherapy, four- versus two-drug combinations, intensive versus standard chemotherapy, and continuous versus bolus injection chemotherapy in the treatment of small cell lung cancer; 2) high versus low radiation doses in the treatment of non-small cell lung cancer; 3) megestrol acetate and hydrazine sulfate as supportive treatment for small cell lung cancer and non-small cell lung cancer patients receiving chemotherapy; 4) granulocyte colony-stimulating factor in small cell lung cancer patients receiving dose-intensified chemotherapy; and 5) the rehabilitation needs of lung cancer survivors. Future efforts should be directed toward achieving higher levels of compliance with clinical trial-based quality-of-life studies, and the development of techniques for integrating quality of life and clinical outcomes for purposes of cost-effectiveness evaluations.

[Assessment of cost effectiveness of radical treatment of patients with pulmonary cancer]. / Otsenka ékonomicheskoi éffektivnosti radikal'nogo lecheniia bol'nykh rakom legkogo.

Cost-effectiveness of diagnostic and treatment procedures was assessed in 101 able-bodied patients with lung cancer who had undergone radical surgery. Those procedures proved cost-effective in cases of early stage tumor only since pulmonologic commissions assured shorter period of examination and good results were obtained by occupational rehabilitation.

[Relevant aspects of medical opinion in lung cancer]. / Gutachterlich relevante Gesichtspunkte des Lungenkarzinoms.

From 1984 to 1988 in the industrial area Most (70,000 workers) an analysis was performed in 138 patients with lung cancer (ICD-Nr. 162). From the results of analysis conclusions with relevance for medical opinion were derived. There are opportunities to incorporate a part of patients in the working process without difficulties, if the patient is free of signs of recidivation. The aim of our procedure is to improve the psychological situation of the patient, to reach a complete resocialization, to ensure the economic standard and to optimize the grant of sick-pay.