Causes and outcomes of spontaneous pneumothoraces in solid tumor cancer patients: An update for the medical oncologist

PURPOSE: Defined as lung collapse in the absence of a recent invasive thoracic procedure, a spontaneous pneumothorax can be a catastrophic event, leading to abrupt shortness of breath, chest pain, hypotension, and occasionally death. A dearth of present day information on this entity in solid tumor cancer patients prompted this single-institution retrospective study on current causes and outcomes. METHODS: All patients with diagnoses of "spontaneous pneumothorax" and "cancer" between 1990 and 2004 had their records retrieved and reviewed. Among 546 patients with a diagnosis of spontaneous pneumothorax, only 25 (5%) met predefined inclusion criteria that included an antecedent diagnosis of an invasive solid tumor malignancy. Lung (n = 5) and bladder cancer (n = 4) were the most common malignancies; eight patients had received radiation and one had received carmustine. Of note, 78% were smokers, 13 had chronic obstructive pulmonary disease, and 12 had no known active cancer at the time of the pneumothorax. RESULTS: Pneumothorax management was associated with great morbidity, including hospitalization in 24 patients and chest tube placement and/or surgery in most patients. Median survival for the group as a whole was 31 months, but patients with known active cancer tended to do poorly, with only a 3-month median survival. CONCLUSION: A spontaneous pneumothorax is rare, and patients with known active cancer tend to do poorly. However, even patients with no known active cancer are at risk, perhaps in part from smoking. The fact that patients with no known active cancer can live for years after this event suggests that the pneumothorax should not be assumed to be related to cancer recurrence, that cancer restaging is not always mandatory, and that there is justification for managing the pneumothorax in this subgroup aggressively.