Clinical Characteristics of Acute Respiratory Deterioration in Pulmonary Fibrosis Associated with Lung Cancer Following Anti-cancer Therapy

Background And Objective: To clarify the clinical characteristics and risk factors for acute respiratory deterioration following anti-cancer therapy in patients with pulmonary fibrosis (PF) and lung cancer.

Methods: Patients with primary lung cancer and PF were identified by review of medical records. Of the 865 consecutive patients with primary lung cancer who had been treated between June 1999 and September 2007, 53 were diagnosed as having PF. This retrospective study analysed the prevalence of and risk factors for acute respiratory deterioration after treatment of lung cancer in these patients.

Results: Acute respiratory deterioration was found in 10 (24%) of the 41 patients who received anti-cancer therapy, and six (60%) of these patients died of respiratory failure. The incidence of acute respiratory deterioration was 28% (8/29) after chemotherapy and 16% (2/12) after surgery. Mortality after acute respiratory deterioration was 50% (4/8) among patients with idiopathic PF and 100% (2/2) among the patients with PF associated with rheumatoid arthritis. Logistic regression analysis revealed that a higher smoking index (cigarettes smoked per day x years of smoking) was a significant risk factor for acute respiratory deterioration (odds ratio: 1.002, P = 0.025).

Conclusions: Patients with lung cancer who have pre-existing PF should be carefully managed because of their high risk for developing acute respiratory deterioration after anti-cancer therapy.