Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Lung


Related Terms

  • Bronchogenic Carcinoma
  • Carcinoma of the Lung
  • Lung Cancer
  • Lung Carcinoma
  • Malignant Neoplasm of Bronchus
  • Malignant Neoplasm of the Trachea
  • Non-small Lung Cell Carcinoma
  • NSLCC
  • SCLC
  • Small-cell Lung Carcinoma

Differential Diagnosis

Specialists

  • General Surgeon
  • Oncologist
  • Pulmonologist
  • Radiology Oncologist
  • Thoracic Surgeon

Comorbid Conditions

  • Chronic lung disease (emphysema)
  • Decreased lung function as a result of surgery or radiation therapy

Factors Influencing Duration

Factors that may influence length of disability include the type and stage of the disease at initial presentation, any concurrent infections, overall health, type of treatment, and any complications that may result from treatment. In general, chemotherapy and radiation therapy treatments extend the length of disability.

Length of disability is also dependent on underlying lung function, which can be assessed by periodic pulmonary function tests.

Medical Codes

ICD-9-CM:
162.0 - Malignant Neoplasm of Trachea, Bronchus, and Lung; Trachea; Cartilage of Trachea; Mucosa of Trachea
162.2 - Malignant Neoplasm of Trachea, Bronchus, and Lung; Trachea; Main Bronchus; Carina; Hilus of Lung
162.3 - Neoplasm, Upper Lobe, Bronchus or Lung, Malignant
162.4 - Neoplasm, Middle Lobe, Bronchus or Lung, Malignant
162.5 - Neoplasm, Lower Lobe, Bronchus or Lung, Malignant
162.8 - Neoplasm, Other Parts of Bronchus or Lung, Malignant
162.9 - Malignant Neoplasm of Trachea, Bronchus, and Lung; Bronchus and Lung, Unspecified
197.0 - Secondary Malignant Neoplasm of Respiratory and Digestive Systems; Lung, Bronchus
231.2 - Carcinoma in Situ of Bronchus and Lung; Carina, Hilus of Lung
239.1 - Neoplasm of Unspecified Nature of Respiratory System

Overview

Lung cancer is the leading cause of cancer death in both men and women. It is also called carcinoma of the lung and refers to an abnormal growth within the lung tissue and the airways of the lungs (trachea and bronchi or tracheobronchial tree). Most lung cancers arise from the bronchial tree and are referred to as bronchogenic carcinomas.

Estimates are the United States had 1,600,000 new cases and 1,380,000 deaths from lung cancer in 2012 (Siegel).

Lung cancer is classified into two major types according to the type of cell present in the tumor. These are small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC). SCLC (oat cell carcinoma, small cell undifferentiated carcinoma) is almost always caused by smoking, and accounts for about 10% to 15% of all new lung cancer cases ("Detailed Guide"). Typically, SCLC metastasizes into the brain, bone, bone marrow, liver, and/or lymph nodes.

NSCLC accounts for the remaining 85% of lung cancers, and can be further divided into three subtypes of cancer: Squamous cell carcinoma, adenocarcinoma, and large-cell undifferentiated carcinoma ("Detailed Guide"). The majority of NSCLC cases are also associated with smoking. NSCLC generally has a better prognosis than SCLC.

Other tumors may occur in the lung in addition to the two main types of lung cancer. Carcinoid tumors of the lung are slow-growing tumors that can be cured surgically, and account for less than 5% of lung tumors ("Detailed Guide"). Rarely, noncancerous (benign) tumors may also occur.

It is important to note that these classifications and subtypes of lung cancer refer to different types of cancer that have key differences in incidence, potential to spread, treatment options, and outcome. Lung cancer is generally characterized by rapid growth, early spread into nearby tissues and organs (metastasis), and rapid recurrence.

Incidence and Prevalence: Lung cancer is the leading cause of cancer mortality in both men and women in the US. More individuals die from lung cancer than from breast, prostate, and colon cancers combined. The American Cancer Society predicted 222,520 cases of pulmonary and bronchial cancer in 2010 in the US, which would affect around 116,750 men and 105,770 women, with approximately 157,300 deaths ("Detailed Guide"). Lung cancer is increasing worldwide at a rate of 0.5% per year, possibly due in part to increase of smoking in developing countries and industrial exposure. In all countries, rates are higher in urban than rural areas, and 2 to 6 times higher in males than females. In European countries, lung cancer is the most common type of cancer and the leading cause of cancer mortality, and accounts for about 21% of all cancer cases in men.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The greatest risk factor for lung cancer is tobacco smoke; 80% of lung cancers are thought to be caused by smoking, and more by secondhand smoke ("Detailed Guide"). A non-smoker who lives with a smoker has a 20% to 30% increased risk of developing lung cancer. A diet low in fruits and vegetables can also increase the risk for lung cancer when concurrent in individuals who smoke or who are exposed to tobacco smoke. Those that stop smoking cigarettes, pipes, cigars, or marijuana can reduce their risk of lung cancer by one-third. Individuals who are exposed to tobacco smoke in the workplace have an increased risk for developing lung cancer.

Other risk factors include exposure to certain industrial agents, such as asbestos, arsenic, gasoline, diesel exhaust, ionizing radiation, nickel, aromatic hydrocarbons, and indoor air pollutants such as radon gas. There may also be a genetic predisposition to lung cancer.

Men have a 1 in 13 chance of developing lung cancer, and women a 1 in 18 chance ("Detailed Guide"). Lung cancer is unusual in individuals under 45 years of age; the average age at diagnosis with lung cancer is 70 years ("Detailed Guide").

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report persistent cough, coughing up blood (hemoptysis), shortness of breath (dyspnea), chest pain, loss of appetite and weight loss, hoarseness, and bone pain. The bone pain can manifest anywhere in the body because of the ability of the lung cancer to spread. There may be recent history of a recurrent infection such as bronchitis or pneumonia; sometimes lung cancer goes undiscovered until the individual is treated for one of these conditions. Individuals may have a history of smoking or exposure to industrial carcinogens. In the majority of cases, the cancer will have metastasized into adjacent tissues and organs (advanced stage) by the time it is first diagnosed.

Physical exam: Findings may be variable and depend on the stage of the disease and the extent of local, regional, or distant spread of the cancer. Physical examination of the chest and lungs may be normal. Wheezing or the absence of breath sounds in part of the lungs can indicate partial or total obstruction of the airways. An enlargement of the lymph nodes around the neck and collarbones or localized chest tenderness may indicate spread of the cancer to these areas (metastatic cancer).

If lung cancer tumors affect the upper lung(s), nearby nerves that pass from the neck to the upper chest may become damaged, causing severe shoulder pain (Horner's syndrome, Pancoast tumors). Other signs of Horner's syndrome include drooping of one eyelid (ptosis), reduced/absent perspiration on one side of the face, and a smaller (constricted) pupil of the eye on the same side.

Other lung cancer-related syndromes include tumor-related (paraneoplastic) syndromes, in which hormones or hormone-like substances are released by the cancer cells into the bloodstream, affecting other organs or tissues. Problems with these distant organs or tissues may be the first sign of lung cancer, but can confound even the most astute clinician by mimicking other diseases. Examples of SCLC paraneoplastic syndromes include those that cause low levels of antidiuretic hormone, those that produce blood clots in the legs and internal organs, and those that impair cerebellar function. Examples of NSCLC paraneoplastic syndromes include those that cause hypercalcemia, extra bone growth (hypertrophic osteoarthropathy), blood clot formation, and gynecomastia.

Tests: A chest x-ray is the primary tool for diagnosing lung cancer and is especially helpful if previous chest x-rays are available for comparison. Since many lung cancers have already metastasized by the time they can be detected on chest x-ray, screening programs using low dose spiral CT appear to be replacing chest x-ray when screening smokers. The sputum may be examined microscopically for cancer cells (sputum cytology). If cancer cells are not found, the area of a suspected tumor is directly viewed through a flexible tube (bronchoscopy) and a tissue sample (biopsy) taken for examination under a microscope. A needle biopsy may be performed if the tumor is beyond reach of the bronchoscopy procedure. Bone marrow biopsy is used to sample the bone marrow for metastasis of SCLC. A biopsy may also be taken on occasion through a tube passed by a chest surgeon into a portion of the chest (mediastinum) using a procedure called mediastinoscopy; this procedure is performed under a general anesthesia. Thoracoscopy may also be performed under general anesthesia to visualize the pleural cavity and remove a biopsy sample. If pleural effusion is present, a procedure to drain the pleural fluid and sample it for cancer cells may be useful (thoracentesis).

CT of the chest, abdomen, and brain allow further evaluation of general x-ray findings. CT may also help identify the position of the tumor more precisely and determine whether the cancer has metastasized. Positron emission tomography (PET) can be used to detect early stage lung cancer and/or to identify regions of metastasis. MRI may be used to visualize the spread of cancer to the brain or spinal cord. A radioactive substance can be injected and pictures taken (bone scintigraphy) to determine if the cancer has metastasized to the bone. Complete blood count (CBC) and blood tests to measure electrolytes, serum calcium, liver function, and kidney function may be performed to evaluate whether the lung cancer has metastasized.

Source: Medical Disability Advisor



Treatment

Combination chemotherapy is usually the treatment of choice for individuals with SCLC because of rapid growth, tendency to metastasize, and sensitivity to chemotherapeutic drugs. Most individuals with SCLC have cancer that has spread extensively by the time of diagnosis and are not candidates for surgery. Chemotherapy and radiation therapy may also be used to relieve disease symptoms (palliative treatment) in individuals with SCLC.

Individuals with NSCLC that has not metastasized out of the lung are candidates for surgical removal of the diseased lobe (lobectomy) or the entire lung (pneumonectomy) and the surrounding lymph nodes (lymphadenectomy). A smaller segment of the lung may be removed if the individual cannot tolerate a lobectomy; however, complete removal of all tumorous tissue is usually the goal of surgery. High-energy, radioactive particles (radiation therapy) may be used for treatment of NSCLC when surgery is not an option. If the cancer has spread to other organs, treatment with one or more anticancer drugs (combination chemotherapy) may be used in addition to radiation and/or surgical treatment. In general, NSCLC is much less responsive to chemotherapy compared to SCLC.

Other medications for individuals with either NSCLC or SCLC include drugs to reduce airway obstruction (bronchodilators) and antibiotics to treat infection. Pain relief (analgesic) therapy may be necessary following surgery and for advanced lung cancers.

Source: Medical Disability Advisor



Prognosis

The 5-year survival rate is 15% for all stages of lung cancer combined. Individuals who are diagnosed and treated before the cancer has metastasized to the lymph nodes or other organs will have a 5-year survival rate of 49%; however, only 16% of individuals are diagnosed this early ("Detailed Guide").

Source: Medical Disability Advisor



Rehabilitation

Individuals recovering from lung cancer may benefit from several types of rehabilitation. Physical, occupational, and/or respiratory therapy may improve strength, endurance, and self-care. If surgery is performed, breathing exercises after surgery may be useful to prevent postoperative pulmonary complications. Pulmonary rehabilitation, as typically performed for COPD patients, may improve exercise capacity in those who had significant portions of lung tissue removed.

Supportive rehabilitation allows individuals to gain some control over ordinary activities of life and helps them cope emotionally. Individuals who are in the end stages of lung cancer may require palliative therapy, in which the primary focus is pain control. Individuals with the diagnosis of cancer may find it beneficial to undergo psychological counseling either on an individual basis or in a support group setting.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistCancer, Lung
Pulmonary RehabilitationUp to 36 sessions of 1 hour each
http://www.bcbsnc.com/assets/services/public/pdfs/bluemedicare/medicalpolicy/pulm_rehab.pdf

Source: Medical Disability Advisor



Complications

Complications are usually related to the degree of metastasis. Lung cancer often invades surrounding tissue, including the ribs, major blood vessels, and/or major nerves, which can cause additional problems. Lung inflammation or infection (pneumonia) is a common complication and wheezing and shortness of breath may occur as a result of airway obstruction. Confusion, disturbances of gait and balance, headache, and personality changes may occur if the tumor has metastasized into the brain. Spread of the tumor into bone can result in bone pain, fractures, and spinal cord injury (paraplegia or quadriplegia). Bone marrow invasion may result in an abnormally small number of platelets (thrombocytopenia) and red blood cells (anemia) in the bloodstream. Large tumors may cause obstruction of a major vein that returns blood to the heart (vena cava obstruction) and this can result in swelling (edema) of the head and neck, headache, dizziness, vision disturbances, and sudden loss of consciousness (syncope).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who have surgery and do not need chemotherapy may resume their previous duties after an appropriate amount of time to recuperate. Individuals on chemotherapy and/or radiation treatment will have periods of absence from the workplace.

Risk: According to "Work Ability and Return to Work," "Risk in cancer survivors may be due to chemotherapy. If there is physical exam or electrodiagnostic test evidence of chemotherapy associated peripheral neuropathy, balance may be impaired, and restrictions that would prevent climbing to heights may be indicated. If corticosteroids or chemotherapy have resulted in osteoporosis, restrictions to prevent pathologic fracture may be indicated (including limited climbing to heights and limited heavy lifting). As long as immune system suppression exists after treatment, patients should be restricted from working with sick animals or humans and from fungal exposure (e.g. gardening)" (406).

Capacity: According to "Work Ability and Return to Work," "Patients may have residual myopathy after chemotherapy, and functional testing may be indicated to quantitate residual functional capacity. Some chemotherapy agents have cardiac and pulmonary toxicity, and treadmill testing of exercise ability may be helpful to establish current ability. Similarly, some cancer surgery (eg, pneumonectomy) will decrease cardiopulmonary function (capacity for work or exercise). Similarly, anemia may be significant during and after chemotherapy, and treadmill exercise testing can give both the physician and the patient an idea about exercise or work capacity" (406-407).

Tolerance: The reader is strongly encouraged to read "Work Ability and Return to Work," pages 399-410, as tolerance issues tend to predominate, especially after normal expected surgical healing. Chemotherapy can have effects on functioning which limits tolerance for the work environment. Ideally, reduced work hours may accommodate that limitation while creating a permissive environment of eventual return to work. According to "Work Ability and Return to Work," "Patients undergoing chemotherapy and/or radiation therapy typically have symptoms like nausea, diarrhea, and fatigue that are clearly due to their treatment, and in Western society these symptoms are traditionally judged to be severe enough to justify certification of work absence during the active phase of cancer treatment. Despite these symptoms, many of the self-employed and uninsured return to work" (407).

Source: Medical Disability Advisor



Maximum Medical Improvement

Lung Cancer individuals undergoing chemotherapy are not at MMI until 180 days post-chemo.

Individuals who require surgery only would be at MMI at 90 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was the diagnosis of lung cancer confirmed?
  • What type does individual have, small cell lung carcinoma (SCLC) or non-small cell lung carcinoma (NSCLC)?
  • Is there non-cancer lung disease (e.g. COPD) in the remaining lung tissue?
  • Does the individual have other diseases commonly associated with smoking (coronary artery disease, stroke, peripheral vascular disease, etc.)?
  • If surgical treatment was utilized, was the tumor completely removed?
  • Has the tumor metastasized into other organ systems?

Regarding treatment:

  • If not already being used, would chemotherapy and/or radiation treatments be beneficial?
  • Is treatment goal considered curative or palliative at this point?
  • How effective are current treatments in achieving their goals?
  • What more can be done?
  • Are medications being utilized, as appropriate?
  • Are pain relief efforts effective?
  • What more can be done to make individual comfortable?

Regarding prognosis:

  • Has the cancer metastasized? If "yes" to what organ(s) has the tumor spread and what is the prognosis for short term survival?
  • Has individual experienced any other complications?
  • Does individual have an underlying condition that may impact recovery such as emphysema or decreased lung function as a result of surgery or radiation therapy?
  • Does individual (or individual's family) need assistance in caring for individual? Would individual/family benefit from social services evaluation?
  • Was individual/family introduced to the services hospice provides?

Source: Medical Disability Advisor



References

Cited

American Cancer Society. "Detailed Guide: Non-Small Cell Lung Cancer ." American Cancer Society. 23 Feb. 2012. 11 Mar. 2013 <http://www.cancer.org/cancer/lungcancer-non-smallcell/index>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Tan, Winston W. , and Irfan Maghfoor. "Small Cell Lung Cancer ." eMedicine. Ed. Jules E. Harris. 27 Dec. 2012. Medscape. 11 Mar. 2013 <http://emedicine.medscape.com/article/280104-overview>.

Tan, Winston W. , and Syed Huq. "Non-Small Cell Lung Cancer ." eMedicine. Ed. Jules E. Harris. 16 Jan. 2013. Medscape. 11 Mar. 2013 <http://emedicine.medscape.com/article/279960-overview>.

Source: Medical Disability Advisor






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