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Improving Lung Cancer Survival: Challenges and Strategies

Discover why lung cancer survival rates vary, from late presentation to stigma. Explore diagnosis, treatment, and potential improvements, emphasizing the importance of early detection and access to care.

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Improving Lung Cancer Survival: Challenges and Strategies

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  1. Lung Cancer Elin Roddy, Lead Clinician for Lung Cancer at SaTH Elin.roddy@sath.nhs.uk @elinlowri

  2. Overview • Some depressing statistics • Some possible reasons for the depressing statistics • Brief overview of diagnosis and treatment of lung cancer, explaining why we sometimes take so long • Discussion around potential improvements

  3. Age-Standardised Ten-Year Survival for Common Cancers in Males and Females, England and Wales, 2010-2011

  4. Mesothelioma 2008 - 2012

  5. Reasons why lung cancer survival is still variable and poor? • Late presentation • Deprivation (not just smoking, but mainly) • Lack of advocacy & research • Stigma • Access to staff,diagnostics and treatment

  6. Late presentation • Late symptoms due to anatomy • Poor differentiation of symptoms by patients • Primary care gate-keeping? • Early diagnosis campaigns not a panacea

  7. Symptoms in patients who turn out to have lung cancer

  8. Red flags are not always reliable but……NICE says • Any haemoptysis • Three weeks of unexplained clubbing or….. • Cough • Breathlessness • Chest or shoulder pain • Weight loss • Hoarseness • Chest signs • Or just because smokes and tired? Unclear. But probably. • Don’t wait for antibiotics to work

  9. What about the radiation?

  10. What about the cost?

  11. We (you) do well in terms of routes of referral for lung cancer – very few ‘emergencies’

  12. Is there an ideal percentage?

  13. Lung cancer rates by deprivation quintile

  14. Smoking prevalence 22.8% vs. 19.5% national average vs. 30% highest

  15. Advocacy, stigma, research • Linked to deprivation and smoking • ‘It’s all my own fault’ • Deserving vs. undeserving cancers • Research spend per annum in the UK: Breast - £41million (£3500 per death) Leukaemia - £32million (£7000 per death) Lung - £15million (£400 per death)

  16. Diagnosis and Staging • Accurate diagnosis AND staging is important • CT should be before bronchoscopy • Most patients should have histology obtained • Nodal staging with EBUS is becoming important • ‘Radical’ treatment should be preceded by PET • ‘Open and close rates’ should be <5%

  17. TNM staging – T1 NO MO good, T4 N3 M1b bad At diagnosis 20% 10% 25% 45% 1 yr survival80% 70% 50% <20%

  18. Diagnostics

  19. Treatment • Surgery is preferred radical option • ‘Resectable’ versus ‘operable’ • Radical RT (or SBRT) should be considered even if patient not fit for surgery (‘operable’) • Performance status at diagnosis is crucial:

  20. Things that affect PS • Nutrition • Pain • Continued smoking • Low mood • Physical activity

  21. Surgery

  22. Radiotherapy • Radiotherapy – can be curative, good for pain, brain mets or in combination with chemo • Radical, long course palliative, single fraction • Side effects – skin redness, hair loss, fatigue • Spinal cord and lung damage concerns with higher doses but IMRT reduces risk • Previous RT (eg for breast) may affect current dose

  23. Chemotherapy • Neo-adjuvant • Adjuvant • Palliative – first-line, second-line, maintenance • Biologic treatments – gefitinib, erlotinib – oral, fewer side-effects – need receptor testing • Incremental gains • Histological diagnosis more & more important • In the future – a panel of receptors tested? • Treatment more likely with CNS support

  24. -

  25. Comparison LUCADA headline data 2013 (2012)

  26. Learning points • Smoking and deprivation influence incidence, treatment and outcomes • Improving early diagnosis is complex • X ray early • Aim to maintain PS - including smoking cessation • Surgery preferred treatment option • Accurate staging can be complex and time-consuming • Chemo is improving, individualised • Improving specialist nurse support improves outcomes • Inverse care law – perhaps equal resource not the answer?

  27. References • British Journal of Cancer (2015) 112, 207–216. doi:10.1038/bjc.2014.596 – evaluation of the early diagnosis campaign • http://www.bbc.co.uk/news/business-22310825 - Robert Peston on funding • http://www.rcgp.org.uk/clinical/clinical-resources/~/media/Files/CIRC/Cancer/ImprovingCancerDiagnosis • The Patient Paradox by Margaret McCartney • http://www.apho.org.uk/resource/item.aspx?RID=142221 – Health Profile for T&W • http://www.hscic.gov.uk/catalogue/PUB12719/clin-audi-supp-prog-lung-nlca-2013-rep.pdf

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