Lung Cancer Toolkit

Lung cancer is not a single disease; rather, it is a group of cancers that originate in the lung and associated tissues. There are several classifications of lung cancer. On a practical basis, lung cancers are clinically divided into three major types, small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC) and lung carcinoid tumors.

Lung cancer accounts for more deaths than any other cancer in both men and women.1 In Indiana, during 2014, approximately 5,204 residents were diagnosed with lung cancer, and 4,040 died as a result of the disease.2

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Who gets Lung Cancer Most Often?

  • Smokers. Lung cancer mortality rates are about 23 times higher for current male smokers and 13 times higher for current female smokers.3 Over 1 million adults in Indiana still smoke and Indiana’s adult smoking rate (20.6 percent) remains among the highest in the nation (median adult smoking prevalence in the United States: 17.5 percent in 2015).4 Cigarette use causes premature death. According to the Centers for Disease Control and Prevention, quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent.
  • Those exposed to secondhand smoke. According to the Indiana Cancer Facts and Figures 2015 report, each year, an estimated 50,000 people in the United States die from exposure to secondhand smoke, and an estimated 1,240 people die each year as a result of secondhand smoke exposure.
  • Those exposed to other cancer-causing agents.1 Exposure to radon gas is estimated to be the second leading cause of lung cancer in the United States. Exposure to asbestos, certain metals, some organic chemicals, radiation, air pollution, and diesel exhaust can increase risk for developing lung cancer, especially if an individual also smokes tobacco. Occupational exposures include rubber manufacturing, paving, roofing, painting, and chimney sweeping.
  • Males. During 2010-2014, Indiana males, compared to females, had a 45 percent greater lung cancer incidence rate and a 66 percent greater mortality rate.2 This is mainly because a higher percentage of males have been smokers compared to females. According to the Indiana Behavioral Risk Factor Surveillance System, during 2015, 21.9 percent of adult males and 19.3 percent of adult females reported being current smokers. However, national data indicates the gap between men and women is narrowing.

Common symptoms include, but aren’t limited to:

  • Persistent cough
  • Sputum streaked with blood
  • Chest pain
  • Voice changes
  • Recurrent pneumonia or bronchitis

Early Detection

The United States Preventive Services Task Force recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30-pack per year smoking history and currently smoke, or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years, or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Prevention

Behaviors can have a direct impact on preventing lung cancer. Individuals can:

  • Be smokefree. Quitting tobacco smoking substantially decreases your risk of developing cancer and other chronic diseases. Smokers who quit smoking, regardless of age, live longer than people who continue to smoke.
  • Avoid all secondhand smoke exposure.
  • Visit Indiana’s Tobacco Quitline at in.gov/quitline/, or call 1-800-QUIT-NOW (1-800-784-8669), for free, evidence-based assistance to help quit smoking.

What Factors Influence Lung Cancer Survival? 

Due to advances in treatment and earlier screenings, more and more people are living after a cancer diagnosis. The American Cancer Society (ACS) defines a cancer survivor as any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life. According to the Indiana State Cancer Registry, as of December 31, 2014, there were an estimated 300,626 cancer survivors for all cancers combined; the four highest-burden cancers in the state (breast, colorectal, lung and prostate) account for approximately 54 percent of these survivors. Survivorship, like cancer itself, is complex and can be difficult to navigate.

According to the Indiana Cancer Facts and Figures 2015 report, there are three phases of cancer survival – the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival. More often than not, the terms “survivor” and “survivorship” are associated with the transitional period after treatment ends; however, survivorship includes a wide range of cancer experiences and paths, including:

  • Living cancer-free for the remainder of life;
  • Living cancer-free for many years, but experiencing one or more serious, late complications of treatment;
  • Living cancer-free for many years, but dying after a late recurrence;
  • Living cancer-free after the first cancer is treated, but developing a second cancer;
  • Living with intermittent periods of active disease requiring treatment; and
  • Living with cancer continuously without a disease-free period.

The preferred path for most cancer patients is to receive treatment and be “cured.” This is the primary goal of all cancer treatment, when possible. For many cancer patients, the initial course of treatment is successful and the cancer does not return.

Many cancer survivors must still cope with the mid- and long-term effects of treatment, as well as any psychological effects – such as fear of returning disease. It is important that cancer patients, caregivers, and survivors have the information and support needed to help minimize these effects and improve quality of life and treatment.

The ACS reports that the one-year relative survival rate for all lung cancers combined increased from 37 percent during 1975-1979 to 45 percent during 2006-2009, largely due to improvements in surgical techniques and combined therapies. The five-year survival rate is highest (55 percent) if the lung cancer is diagnosed when it is confined entirely within the lung (i.e., localized).1 However, in Indiana, during 2010-2014, only 19 percent of lung cancers were diagnosed during this stage.2 The five-year survival rate is different for SCLC, NSCLC and lung carcinoid tumor. For SCLC, the five-year survival rate is 7 percent. The five-year survival rate for NSCLC is higher at 21 percent.1 According to the American Cancer Society, the five-year survival rate for lung carcinoid tumor varies by type and stage. In general, the five-year survival rate ranges from 93 percent for Stage I diagnoses to 57 percent for Stage IV diagnoses.

Treatment options are determined by the type (small cell, non-small cell and lung carcinoid tumors) and stage of cancer and include surgery, radiation therapy, chemotherapy and targeted therapies. For localized cancers, surgery is usually the treatment of choice. Because the disease has usually spread by the time it is discovered, radiation therapy and chemotherapy are often used, sometimes in combination with surgery.

Lung cancer survivors often have impaired lung function, especially if surgery is part of treatment. Respiratory therapy and medications can improve the ability to resume to normal daily activities and improve fitness. Lung cancer survivors who continue to smoke should be encouraged to quit. Survivors of smoking-related cancers are at an increased risk for additional smoking-related cancers, especially in the head, neck and urinary tract. Some survivors may feel stigmatized because of the connection between smoking and lung cancer. This is especially difficult for lung cancer survivors who never smoked.

In 2006, the Institute of Medicine (IOM) issued a report titled From Cancer Patient to Cancer Survivor: Lost in Transition. The report recommends that every cancer patient receive an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to the IOM recommendation, many groups have now developed various types of “care plans” to help improve the quality of care of survivors as they move beyond their cancer treatment.

A treatment summary is critical for cancer survivors. The summary should describe the cancer diagnosis and medical treatments that were received (or that may be needed moving forward). Not only does the treatment summary provide survivors with a record of cancer treatments, but it helps survivors talk with other health care providers who may not have been part of the cancer care team.

According to the ACS, in addition to a treatment summary, a survivorship care plan should include a description of what follow-up appointments and tests will be needed and when they will be needed, a description of preventive measures that can be taken to help stay well, a description of any possible side effects from cancer treatments and ways to manage those side effects, and a description of ways to manage physical and mental health.

There are several organizations that assist with the development of survivorship care plans, including the American Society of Clinical Oncology, Journey Forward and LIVESTRONG Care Plan. A list of additional organizations can be found on the ACS website.

Resources

Additional Resources:

 

References

  1. American Cancer Society. Cancer Facts and Figures 2016. Atlanta: American Cancer Society; 2016. Available online at http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/index.
  2. Indiana State Cancer Registry Statistics Report Generator. Accessed online at http://www.in.gov/isdh/24360.htm on October 19, 2016.
  3. S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Accessed online at http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm on October 19, 2016.
  4. Indiana State Department of Health, Data Analysis Team. (2016). Indiana Behavioral Risk Factor Surveillance System, 2015.