Health Conditions Discover Plan Connect. Medically reviewed by Yamini Ranchod, Ph. Symptoms Causes of death Outlook Untreated lung cancer Takeaway Stage 4 lung cancer means that your cancer has spread from your lung to other parts of your body.
The goal at this stage is to ease your pain and other symptoms to help keep you comfortable. What are the symptoms of the final stages of lung cancer? How do lung cancer patients die? How long does a person have to live with stage 4 lung cancer? How long does it take to die from lung cancer without treatment? The takeaway. Read this next. Lung Cancer Diet. Medically reviewed by Timothy J. Complete a Free Case Evaluation form now. Due to statutes of limitation based on your type of case and the severity of the lung cancer diagnosis, time is of the essence.
Call for a free consultation with a member of our firm. Call or text or complete a Free Case Evaluation form. Scientific studies have historically found no definitive link between occupational asbestos exposure and bladder cancer, even in people with heavy amounts of exposure. Lung cancer is one of the most serious forms of cancer, as it can spread quickly, and patients often do not catch the disease until it has progressed into serious stages.
A complete blood count CBC can check for anemia low red blood cell count , thrombocytopenia low platelet count that can cause bleeding, and neutropenia low white blood cell Often, stage 4 lung cancer is terminal, and it represents the most advanced form of lung cancer. Terminal lung cancer means that the cancer has spread from the lungs into other Instead, it groups cancers into localized, regional, and distant stages: Localized: There is no sign that the cancer has spread outside of the lung.
Regional: The cancer has spread outside the lung to nearby structures or lymph nodes. Distant: The cancer has spread to distant parts of the body, such as the brain, bones, liver, or the other lung. Other important outcomes may include disease progression, health-related quality of life, and treatment-related harms. Reliable prognostication of life expectancy can prevent subjecting patients to costly and unnecessary treatment for an unduly long period before transitioning to hospice care [ 6 ].
Accurate prognostic information can also help physicians decide on choice of curative versus palliative treatments. For instance, if evidence shows no effect of curative treatment on disease progression, significant treatment-related harms can be avoided in favor of palliative treatments [ 7 ].
Accurate disease prognosis thus underpins all management decisions related to the disease, including choice of treatment, planning of supportive care, as well as allocation of resources. We are aware of only one narrative review on the subject [ 4 , 10 ]. Accordingly, this systematic review was undertaken to assess the survival of patients with a confirmed diagnosis of lung cancer without active treatment.
Specifically, our aim was to estimate overall survival in lung cancer when no anticancer therapy is provided. This systematic review was conducted as per the methods elaborated in a protocol that was developed a priori. An ideal study design to assess the natural history of a terminal disease such as lung cancer is a cohort study.
Specifically, an inception cohort, whereby a well-defined group of patients at the same disease stage is assembled at first diagnosis and followed for a defined period of time [ 12 - 14 ]. However, given the availability of treatments for lung cancer in recent years, it would be unethical and logistically challenging to conduct such a study.
An alternative approach is to assess prognosis from retrospective lung cancer registries, case series or from the control arm of individual RCTs that compare active treatment with either no treatment, placebo, or best supportive care [ 5 , 15 ]. In this review, any retrospective or prospective cohort study assessing prognosis in lung cancer without treatment and any RCT assessing the role of treatment versus no treatment, were eligible for inclusion.
A study was eligible for inclusion irrespective of language or publication type. We conducted a systematic search of MEDLINE and Cochrane library electronic databases, proceedings of major scientific meetings, and bibliographies of eligible studies to identify all relevant studies. To retrieve lung cancer prognosis studies in PubMed, we employed search strategies suggested by Wilczynski [ 16 ] that optimizes search sensitivity and specificity. We manually searched abstracts of the American Society of Clinical Oncology and American Society of Hematology meetings and utilized the snowballing procedure to identify other relevant studies.
Studies published until June were included. No restrictions were made regarding the language of the publication. A prospective or retrospective cohort study assessing overall survival as an outcome in lung cancer patients without treatment was eligible for inclusion. A RCT was included if it enrolled patients with confirmed diagnosis of lung cancer, compared treatment versus no treatment for example, supportive care, best supportive care, palliative care, placebo, and so on , and assessed overall survival as an outcome.
A study in which patients had anticancer treatment prior to enrollment and subgroup analyses were excluded. Additionally, RCTs comparing two active treatments were excluded. Two reviewers read the titles and abstracts of identified citations to identify potentially eligible studies. Full text of potentially relevant reports were retrieved and examined for eligibility. Disagreements about study inclusion or exclusion were resolved via discussion until a consensus was reached.
Data extraction was performed using a standardized data extraction form. Two reviewers independently extracted the following information from each included study: number of patients enrolled, number of deaths, median survival, funding source industry versus public, and so on , type of centers involved single versus multicenter, and so on. For cohort studies, we extracted data on the number of deaths and total number of patients diagnosed with lung cancer. For RCTs, we extracted data on the number of deaths all-cause mortality and number of participants randomized to the control arm.
To evaluate the methodological quality of included studies, a modified checklist of predefined criteria was developed on four methodological domains pertinent to minimization of bias. This modified checklist uses applicable elements from existing tools Quality in Prognosis Studies tool [ 18 ], Evidence-Based Medicine Group criteria for prognostic studies [ 19 ], Newcastle-Ottawa Quality Assessment Scale [ 20 ], Cochrane Collaboration risk of bias criteria [ 21 ] and related studies Hudak et al.
The modified checklist contains 11 items for cohort studies and 14 items for RCTs. Data synthesis was conducted according to the study design separately as well as combined in the final stage that is, retrospective cohort and RCT. For the purpose of meta-analysis, we used methods by Stuarts et al. The pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions, using the random-effects model.
To perform meta-analysis of median survival, we used published methods [ 25 ] to pool the estimates as mean survival and standard error under the random effects model. That is, using median survival and range reported in Kaplan-Meier curve, we converted these estimates into mean survival and standard error.
We explored the potential causes of heterogeneity by assessing the differences between subgroups using the test of interaction. We assessed robustness of the results by conducting sensitivity analysis with respect to methodological quality criteria of reporting, study location, and funding source. RevMan Version 5. Initial search identified 1, potentially relevant citations excluding 71 duplicates. Further assessment of full texts of remaining 73 studies led to exclusion of 51 studies.
Altogether, 22 studies met the pre-defined inclusion criteria: 7 were retrospective cohort studies [ 20 , 28 - 33 ] and 15 were RCTs [ 34 - 48 ]. We did not find any inception cohort study or prospective cohort study assessing prognosis of patients with lung cancer without treatment. The seven retrospective cohort studies included 4, patients and the fifteen RCTs enrolled 1, patients. Altogether, the 22 studies included 5, patients. The median sample size in the cohort studies was patients range: 39 to 2, patients with a median study period of 8 years range: 5 to 13 years.
The median number of patients enrolled in the RCTs was 61 patients range: 17 to patients with a median study period of 3 years range: 1 to 7 years. That is, adequate description of the population of interest for key characteristics, adequate description of withdrawal incomplete outcome data , a priori and objective definition of outcomes, and frequencies of most important data were reported in all RCTs.
Data on mortality was extractable from all seven cohort studies enrolling 4, patients. Pooled proportion of mortality in lung cancer studies.
The size of each square is proportional to the weight of the study inverse variance. Data on mortality was extractable from the control arm of all 15 RCTs 1, patients. Pooled proportion of mortality across the 22 studies was 0. Because these two designs are inherently different from each other, we conducted separate analyses. Data on median overall survival was extractable from six cohort studies 4, patients. Pooled mean survival and heterogeneity between subgroups.
Data on median overall survival was extractable from all 15 RCTs 1, patients. The pooled mean survival for patients in the control arm was 5. Pooled proportion of mean survival across the 21 studies was 7. To assess the robustness of overall results according to the study design cohort versus RCT as well as explore the reasons for observed heterogeneity in the pooled proportion of mortality and mean survival, we conducted additional sensitivity analyses.
For both cohort studies and RCTs, we conducted sensitivity analyses according to methodological quality criteria, funding source, and study location. For RCTs only, we conducted additional sensitivity analyses according to type of control.
Overall, the results remained unchanged in the sensitivity analyses.
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