Malignant airway obstruction accounts for significant morbidity and mortality in patients with lung and metastatic cancer. We prospectively assessed the effects of bronchoscopic interventions for treatment of malignant airways obstruction, with specific attention to exercise capacity and quality of life (QoL).
Prospective cohort study. Patients presenting with high grade, symptomatic central malignant airways obstruction were assessed at baseline then at day 30 post bronchoscopic intervention with spirometry, 6-minute walk test, QoL score (European Organization for Research and Treatment of Cancer Quality of Life [QoL C30] and Lung Cancer Questionnaire modules and [LC-13]) and self rating of dyspnea via the MRC and BORG scales.
Forty patients were enrolled, with 3 excluded for failing to meet entry criteria, leaving 37 patients included in the statistical analysis. Increases in FEV1 by 432ml (95%CI 248–615ml, p<0.001), FVC by 424ml (95%CI 348ml-609ml, p=0.001), and 6-MWT distance by 118.6m (95%CI 49.3–188.0m, p=0.002) were seen at day 30 compared to baseline. Improvement in resting MRC Dyspnea Score of 0.7 (95%CI 0.05–1.35, p=0.035), resting BORG Dyspnea Score of 1.42 (95% CI 0.06–2.77, p=0.041), and post 6-MWT Borg Dyspnea score of 1.13 (95% CI −0.56–2.81, p=0.169) were also seen at day 30. Clinically and statistically significant improvements were noted in composite dyspnea score at day 30 by both QoL C30 questionnaire (decrease of 28.4, 95%CI 15.3–41.6, p<0.001) and LC-13 questionnaire (mean decrease of 20.6, 95%CI 10.1–31.1, p<0.001). Global Health QoL at day 30 improved by 6.3 points, though this failed to meet statistical significance (95%CI -16.1–34.3, p=0.196). Post intervention airways patency of 50% or more was obtained in 34 of 37 patients (92%), and maintained in 16 of 19 (84%) of patients re-assessed at day 30 flexible bronchoscopy.
Bronchoscopic interventions for malignant airways obstruction are successful strategies for re-establishing airways patency, and are associated with improvements in spirometry, dyspnea and 6 minute walk test at 30 days.
Interventional bronchoscopic techniques should be considered in the management of patients with malignant airway obstruction.
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