September 5, 2017

Lung Cancer: Hope for Survivorship

Lung cancer takes the lives of more Canadians than breast, prostate and colorectal cancer combined. Lung cancer is the leading cause of cancer death in Canada. It accounts for one in eight of all new cancer diagnoses and one in four of all cancer-related deaths. Fifty-seven Canadians die as a result of lung cancer every day.

Cells in the lungs sometimes mutate and behave abnormally, which can lead to the development of lung cancer. Lung cancer tumours can then metastasize, or spread to other parts of the body.

Lung cancers are divided into two categories, based on the type of cell in which the cancer started. Non-small cell lung cancer begins in glandular cells on the outer part of the lung or in flat, thin cells called squamous cells which line the bronchi, or airways, connected to the trachea. Small cell lung cancer starts in the cells that line the bronchi in the centre of the lungs.

A number of signs could point to lung cancer, including a worsening or persistent cough, constant chest pains aggravated by deep breathing or coughing, blood-stained mucus and other fluids from the lungs, shortness of breath, a collapsed lung and severe shoulder pain.

While patients cope with the changes to their bodies, their spouses, parents, siblings and other caregivers must cope with managing those symptoms alongside them.

Lung cancer can be heartbreaking for anyone it touches. For patients, lung cancer means having to deal with some of the most challenging symptoms including difficulty breathing, wheezing, fatigue, a lack of energy and even depression. A patient once told me her diagnosis left her crying every day, and she needed to hide herself in the shower just so her children wouldn’t hear her sobs. And while patients cope with the changes to their bodies, their spouses, parents, siblings and other caregivers must cope with managing those symptoms alongside them. About half of Canadians caring for a loved one with lung cancer say they’ve had to reduce at least some hours of work because of their responsibilities as a caregiver. The disease has cost families time, energy and financial stability.

Smoking causes most lung cancers, but about half of patients have either never smoked in their lives or have quit. Patients and their families suffer from the prejudice of smoking, and many feel hesitant to talk about their diagnosis.

In our experience, the smoking stigma has been a huge barrier to lung cancer awareness support and funding. Patients would say, “When I tell people I have lung cancer, they don’t ask about how I’m feeling or how I’m doing. The first thing they ask is whether or not I smoked.” Everyone assumes lung cancer is self-inflicted; if you get it, you deserve it. Lung cancer accounts for more than 25 per cent of all cancer deaths in Canada but only gets about seven per cent of the overall funding. That smoking stigma is not just a roadblock to further research or support, it’s a roadblock to hope.

With lung cancer, the symptom burden is high, the socio-economic burden on families is high and, when treatment options are limited, the level of anxiety is high. Treatment options are precious assets that help keep patients and their loved ones fighting. For many, they are Hope Realized.

Lung Cancer Therapies Available in Canada Benefit of Treatment Possible Side Effects
Surgery Various types of surgery can be used to treat non-small cell lung cancer by completely removing the tumour. Pain, bleeding, breathing problems, pneumonia, bronchopleural fistula (an abnormal opening in the lung that prevents it from inflating properly), collapsed lung, nausea, vomiting, infection, heart problems, blood clots, fatigue.
Radiation Radiation therapy destroys cancer cells using high-energy X-rays. It can be used as a primary treatment for lung cancer tumours that cannot be removed by surgery, to shrink tumours and to relieve pain or control symptoms of advanced non-small cell lung cancer. Fatigue, skin reactions, breathing problems, difficult or painful swallowing, nausea, vomiting, radiation pneumonitis (inflammation of the lungs), heart problems, pulmonary fibrosis (scarring of the lungs from inflammation).
Chemotherapy Chemotherapy is a systemic therapy that circulates anticancer drugs throughout the body to destroy cancer cells and stop them from growing or multiplying, including those that have broken away from the primary tumour. Pain, irritation or swelling at the injection site, allergic reactions, hair loss, nausea, vomiting, diarrhea, constipation, fever, and other flu-like symptoms, sore throat, fatigue, loss of appetite, muscle or joint pain, numbness or tingling in the hands and feet, difficulty breathing, changes in the skin or nails, vision changes, liver problems, kidney problems, low blood cell count, unusual bleeding or bruising, swelling, fluid retention, irregular heartbeat, chest pains, seizures.
Endobronchial therapy Endobronchial therapies are used to shrink tumours blocking the airways or to treat non-small cell lung cancer that has spread outside the bronchial wall. Some examples of endobronchial therapies for lung cancer include bronchial debridement (the use of cutting tools passed through a bronchoscope to remove cancerous tumours and open airways), stent placement (the use of a small metal or plastic tube to keep airways open), laser surgery, brachytherapy (internal radiation delivered in the airway) and electrocoagulation (the use of a high-frequency electric current to shrink tumours blocking the airways or seal blood vessels to stop bleeding from tumours). Bleeding, coughing, heart problems, lung problems, bronchial or esophageal stricture (narrowing of the bronchus or esophagus that can be caused by scar tissue), broncho-esophageal fistula (abnormal opening between the bronchus and esophagus).
Tyrosine Kinase Inhibitors Tyrosine kinase inhibitors are treatments that target specific growth related protein kinases, or enzymes that influence protein function. These treatments bind with these protein kinase receptors that are expressed on the surface of cancer cells and inhibit tumour cell growth and proliferation, and promote cell death. Tyrosine kinase inhibitors are oral treatments. Nausea, vomiting, diarrhea, constipation, rash and other skin changes, headache and dizziness, hair thinning, changes in weight and appetite, fatigue, difficulty breathing, swelling, fever, cough or other signs of infection, muscle and joint pain, abnormal taste in the mouth, severe stomach pain, gastrointestinal bleeding, inflammation of the intestines, serious lung, liver or kidney problems, blood in urine, abnormal heart beat, changes in vision, clotting problems, changes in health test results (blood count, kidney and liver function and level of enzymes).
Immune System Targeted Monoclonal Antibodies Monoclonal antibodies are laboratory-created molecules designed to assist the body’s immune system in destroying cancer cells. These treatments help reactivate immune responses in the tumour microenvironment that lead to identifying and killing cancer cells. Nausea, vomiting, headache, fatigue, persistent muscle or joint pains, dizziness, changes in weight or appetite, changes in behaviour, rash and other skin changes, dark or bloody urine, stomach pain, serious lung, liver or kidney problems, swelling in the ankles, difficulty breathing, cough, fever, changes in vision, blood sugar problems, memory and other cognitive problems, chest pain, abnormal heart beat, changes in health test results (blood count, kidney and liver function and level of enzymes).

For instance we worked with a patient who just entered retirement when she received her devastating lung cancer diagnosis. At first, she received the “gold-standard” of chemotherapy treatments. But it turned out chemotherapy wasn’t the right option for her cancer and she needed another way to fight against the disease. After months of tests and doctor’s appointments, she found a targeted treatment that worked for her. Despite facing many challenges in gaining access to the treatment, the new option allowed her to be part of important family milestones. And when that first alternate treatment stopped working, she found another option, and then another.

Treatment options give patients time, but more importantly quality time. Some patients want to have more time to play with their grandchildren or take a holiday with family. Others want to go back to work. For others it’s just the time to properly organize their affairs so that their employees, family and other loved ones are taken care of.

A cure for stage 4 lung cancer is not here yet but some patients tell us that “stable” has become their new favourite word. One patient even said he feels spoiled because his daughter gets to take care of him and help manage his stage 4 lung cancer like a chronic illness. Another patient I work with who had run out of options after six months and was told he wouldn’t make it to Christmas made it to that year’s holiday season and a few more after.

“If I had a do-over moment in lung cancer, I would say I want to keep families together for a longer period of time. I want to reduce the stigma, reduce the mortality and give patients more hope.”

– Christina Sit

At Lung Cancer Canada, our goal is to give Canadians affected by the disease a voice. Our aim is to help them throughout the different stages of their journey – from diagnosis to treatment and hopefully to remission – however long that journey may be. And through it all, our hope is that each of our patients lives a good, meaningful life.

Invite others to learn more and participate in the Rewrite Cancer Innovation Challenge.