Page 177 - Hospital Authority Convention 2017
P. 177

Masterclasses
                                                                                        Masterclasses



                M13.1     Respiratory Medicine                                             13:15  Room 221

               Is Advanced Lung Cancer Becoming a Chronic Disease?
               Ho J
               Department of Medicine, The University of Hong Kong, Hong Kong                                      HOSPITAL AUTHORITY CONVENTION 2017
               Lung cancer, mostly non-small cell lung cancer (NSCLC), has been the top cancer killer in Hong Kong over the past two
               decades. The majority of patients with lung cancer present late with metastatic disease that does not allow curative surgical
               treatment. Recent advances in lung cancer therapeutics (especially for NSCLC) have enabled advanced lung cancer patients
               to survive much longer with preserved quality of life. Traditionally, systemic chemotherapy carries prohibitory side effects
               that do not allow prolonged administration beyond four to five months. At the turn of the millennium, newer generation
               chemotherapy emerged with better efficacy and adverse effects profile, thus allowing continued administration (maintenance
               chemotherapy) even for years. Discovery of targeted therapies is undoubtedly a major breakthrough in treatment of
               advanced NSCLC in the past decade. A growing list of potential targets for specific anticancer treatments is now evident
               that would facilitate personalised choice of the most effective therapeutic options. It is now the standard of care to look
               for potentially actionable targets, e.g. epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase
               (ALK) rearrangement, at diagnosis of advanced NSCLC. There are now three generations of EGFR or ALK targeted therapies
               clinically available, which can help to overcome the hurdles with acquired drug resistance. In recent  two to three years,
               immunotherapy has emerged as a novel anticancer approach especially in lung cancer. The mechanism of reactivating the
               endogenous immune  system  against  lung cancer  cells  carries the advantage  of  sustained  anticancer effects,  resulting  in
               prolonged survival in a selected subgroup of lung cancer patients. With the rapidly expanding armamentaria of lung cancer
               therapeutics and practice of precision medicine, it is now a common scenario to see advanced lung cancer patients coming
               for clinic follow-up for years, similar to patients with many other chronic diseases.















             M13.2     Respiratory Medicine                                             13:15  Room 221

            Health Risks of Obstructive Sleep Apnea
            Ip MSM
            Department of Medicine, The University of Hong Kong, Hong Kong

            What is obstructive sleep apnoea (OSA) and why does it cause health risks:
            Obstructive sleep apnoea refers to the occurrence of recurrent episodes of functional obstruction of the upper airway during
            sleep. These obstructive episodes cause intermittent hypoxaemia (despite normal lungs) and sleep fragmentation. Further
            downstream, systemic sequelae of neurohumeral activation, oxidative stress and inflammation may occur.
            Situation in Hong Kong:
            Data in early 2000s showed that about 8% of men and 4% of women had OSA, while at least half of them were symptomatic.   Wednesday, 17 May
            Ethnic craniofacial morphology may contribute to the occurrence of OSA despite our lower levels of obesity.

            Health risks:
            Neurocognitive impairment
            Excessive daytime sleepiness is a cardinal symptom of OSA, though it does not correlate tightly with the severity of OSA.
            Untreated OSA with daytime sleepiness in drivers may lead to traffic accidents. Neurocognitive impairment, irritability and
            impaired quality of life have been noted.
            Cardiovascular and cerebrovascular diseases
            There is consistent evidence for an adverse effect of moderate/severe OSA on blood pressure, and OSA is now included in
            the list of “secondary” causes of hypertension. Treatment of OSA should always be considered in the armamentarium of anti-
            hypertensive therapy as it carries health benefits beyond lowering of blood pressure.

            Clinically, independent associations have been repeatedly reported between OSA and stroke, congestive heart failure, and
            atrial fibrillation, but a definitive conclusion cannot be drawn due to limitations in the available data .

            Insulin resistance and diabetes mellitus
            Mounting evidence suggests that OSA may have, independent of obesity, adverse effect on insulin resistance and glucose
            metabolism. Nonetheless, such adverse effects may pale beside that conferred by lifestyle habits of diet or physical exercise.
            Several longitudinal cohort studies show that OSA is associated with incident diabetes, but treatment of OSA has not been
            consistently demonstrated to improve glycaemic status.
                                                                                                                  175
   172   173   174   175   176   177   178   179   180   181   182