Survivorship Challenges and Supportive Care in Lung Cancer

The number of lung cancer survivors-anyone living with and beyond a lung cancer diagnosis-is increasing along with advances in screening, early detection, and treatment. Following diagnosis and treatment, however, many lung cancer survivors experience high symptom burden and functional challenges that culminate in poor health-related quality of life (HRQL). We incorporated the cancer life course endorsed by the United States National Academy of Medicine (formerly Institute of Medicine) and reviewed interventions to improve HRQL, starting from the time of diagnosis, during or following curative intent treatment, noncurative intent treatment, and continued until changes in disease status and/or goals of care. We reviewed clinical guidelines from the American College of Chest Physicians on HRQL following curative intent therapy, symptom management, and supportive care in lung cancer, as well as the role of exercise-based rehabilitation, complementary therapies, and integrative medicine. Moreover, we identified interventions evaluated in 19 randomized controlled trials (RCTs) or pilot RCTs in the past 10 years, involving 2,506 participants, to address HRQL challenges reported by ≥80% of lung cancer survivors as "important" or "very important": dyspnea, fatigue, sleep difficulties, fear/distress, anxiety, depressive symptoms, physical or role function/independence. This narrative review, which incorporates findings from physical exercise and rehabilitation, cognitive-behavioral and psychological therapies, mind-body therapies, mindfulness-based interventions, and other complementary therapies, has significant implications for enhancing the HRQL of the growing population of lung cancer survivors.