Screening for Cancer
SCREENING LEMS PATIENTS FOR SCLC
DELTA-P (Dutch-English LEMS Tumor Association Prediction) Score
The DELTA-P score is a clinical tool developed in 2011 by Titulaer and colleagues—and validated in a 2020
prospective cohort study—that helps predict the risk of small cell lung cancer (SCLC) in patients with Lambert-
Eaton myasthenic syndrome (LEMS).49,50
The abbreviation is also a mnemonic that highlights the signs associated with SCLC-associated LEMS.
Each item is
scored equally50
Total score ranges from 0-6, with higher scores linked to greater likelihood of small cell lung cancer (SCLC)50
DELTA-P predicts SCLC with
reliability early in the course of LEMS50
*Karnofsky Performance Score is an attempt to quantify cancer patients’ general well-being and their quality of life. The score runs from 100 to 0, where 100 = perfect health and 0 = death. A cutoff value of 70 was chosen; those with values below 70 need at least occasional assistance for activities of daily living.50
Cancer Screening Steps
A thorough patient history can help uncover key clues
Review timing of symptom onset in relation to symptom spread or exacerbation
SCLC-associated has a more rapid and aggressive onset than SCLC not associated with LEMS; this can help reveal the signs of an occult tumor51,52
Verify current or past tobacco use
The majority of cancer-related LEMS cases occur in people with a history of smoking4,11,12,41
If you suspect cancer
An X-ray, PET scan, or CT scan can reveal tumor presence4,41
Rich’s Patient History
His pursuit of a neuromuscular diagnosis yielded another discovery
Listen as Rich, a 53-year-old with LEMS, recalls the onset of symptoms that led to his eventual diagnosis of LEMS and cancer.
SCREENING SCLC PATIENTS FOR LEMS
3 WAYS TO CHECK FOR SYMPTOMS OF LEMS
1. Observe your patient’s gait as they walk
A waddling gait is a key sign of LEMS1,4
See a video example of “LEMS gait.”
2. Ask your patient if they are experiencing any of these hallmark signs and symptoms of LEMS4
LEMS can progress rapidly in
patients with SCLC
Median time from onset of LEMS
symptoms to maximum disease
severity was just 4 months in
patients with SCLC vs 12 months
for patients with LEMS not
associated with cancer.40
3. Order confirmatory testing when LEMS is suspected
Confirm suspected LEMS cases with an anti-voltage-gated calcium channel (anti-VGCC) antibody test and/or electrodiagnostic testing7
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