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 two major types, small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC).

Lung cancer accounts for more deaths than any other cancer in both men and women.1 In Indiana, during 2015, approximately 4,932 residents were diagnosed with lung cancer and 3,858 died as a result of the disease.2

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Who gets Lung Cancer Most Often?

  • Smokers. Men and women who smoke are about 25 times more likely to develop lung cancer than nonsmokers.1 Over 1 million adults in Indiana still smoke, and Indiana’s adult smoking rate (21.1 percent) remains above the national average  (median adult smoking rate in the United States: 17.1 percent in 2016).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 approximately 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 in Indiana 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, radioactive ores such as uranium, inhaled chemicals or minerals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, coal products, mustard gas, and chloromethyl ethers, as well as radiation therapy, air pollution and diesel exhaust are all risk factors for lung cancer. Occupational exposures include rubber manufacturing, paving, roofing, painting and chimney sweeping.
  • Males. During 2011-2015, Indiana males, compared to females, had a 43 percent greater lung cancer incidence rate and a 62 percent greater mortality rate. This is mainly because a higher percentage of males have been smokers compared to females. In Indiana, during 2016, 23.6 percent of adult males and 18.8 percent of adult females reported being current smokers.4 However, national data indicates the gap between men and women is narrowing. Women’s disease risks from smoking have risen sharply over the last 50 years nationally and are now equal to men’s for lung cancer.

Common symptoms include, but aren’t limited to:

  • A cough that does not go away or gets worse
  • Coughing up blood or sputum streaked with blood
  • Chest pain that is worse with deep breathing, couching or laughing
  • Voice changes or hoarseness
  • Weight loss and loss of appetite
  • Shortness of breath or feeling tired or weak
  • Recurrent pneumonia or bronchitis
  • New onset of wheezing

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.
  • Get homes tested for radon. Radon, which is released from soil and building materials, is the second leading cause of lung cancer deaths, and can exacerbate the risks of lung cancer due to smoking. Home radon testing is important in order to reduce the risk of exposure.
  • Visit Indiana’s Radon Hotline: 1-800-272-9723 for more information and assistance. For more information, including where to get a test, visit the Indiana State Department of Health website. Check with your local health department on availability for free testing.

Communities can also help prevent lung cancer by:

  • Support smokefree air policies and increased costs forall tobacco products.
  • Support tobacco control program funding to help reduce smoking rates and lessen the health care costs, including more than $170 billion a year in healthcare costs, nationally.5
  • Support the continued adoption of smokefree workplaces. The United States Surgeon General has concluded that smokefree workplace policies are the only effective way to eliminate exposure to secondhand smoke in the workplace and lead to less smoking among workers.
  • Support health care provider outreach efforts that help decrease tobacco consumption and increase quit attempts.

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 October 2017, there were an estimated 428,681 cancer survivors for all cancers combined, and 20,044 total lung cancer survivors; the four highest-burden cancers in the state (breast, colorectal, lung and prostate) account for approximately 56 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 2011-2015, only 19.6 percent of lung cancers were diagnosed during this stage.2 It’s also important to note that the five-year survival rate is different for SCLC and NSCLC. For SCLC, the five-year survival rate is 7 percent. The five-year survival rate for NSCLC is slightly higher (21 percent).1

Treatment options are determined by the type (SCLC, NSCLC, or lung carcinoid tumor) 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.
  5. Xu et al. Annual Healthcare Spending Attributable to Cigarette Smoking. American Journal of Preventive Medicine. March 2015, Volume 48, Issue 3, Pages 326–333. Accessed online at ajpmonline.org/article/S0749-3797(14)00616-3/fulltext on November 2, 2017.