Lung Cancer Treatment is Evolving

Treatment for lung cancer is evolving. The decisions that need to be made regarding your treatment are ultimately yours and your health care team’s to make. Most importantly, while many treatment options have similar statistics about the potential outcome, the side effects can vary widely from treatment to treatment. Therefore, not only should you talk to your doctor about the various treatment options available to you from an outcome perspective, but you should discuss which side effects may accompany each option and which are most acceptable for your lifestyle and goals of therapy. No one is more qualified than you to make decisions about your quality of life and your future. Seek information and advice, and then do what is right for you.

It is important for you to talk to one or more oncology specialists: a thoracic surgeon, a medical oncologist, and a radiation oncologist. Seek advice for the most up-to-date and appropriate treatment available for your cancer. Ask your doctor about clinical trials before you make any decision about your treatment.

Learn the Language

When you read about the success or failure rates of various treatments, you will encounter a number of new words and phrases. You will want to know how your cancer is responding to chemotherapy or radiotherapy. For instance, a “complete response” means that on x-ray or CT scan, the tumor appears to be completely gone as a result of treatment. A “partial response” usually means that the tumor has decreased in size by at least 50%. “Stable disease” means that the tumor(s) did not grow or shrink much either way and “progressive disease” means that the tumor is growing in spite of the treatment you received. When the disease progresses in spite of a specific therapy, that usually means the therapy will be discontinued or modified in some way.

Your doctors may use the words “apparently cancer-free” if your tumor(s) disappears after treatment. “First-line therapy” means a treatment, such as a particular type of chemotherapy, is the first therapy received, and it will be used before other treatments are used. Multimodality or “combined modality” therapy, which includes the use of a chemotherapy regimen along with surgery and/or radiation, is evolving as “first-line” (first choice) therapy for some patients.

“Palliative therapy” is given not to cure cancer, but to relieve symptoms, provide better quality of life, and, hopefully, extend life when cure is not probable.

The conversation you should expect to have with your doctor should include a discussion of the goals of therapy and what you desire in your treatment plan so that together, you can reach an agreement on what approach you would like to take.

Making Sense of the Numbers

The effectiveness of treatment can be seen “in the numbers,” meaning statistics. Be wary of letting statistics distress you and rule your life. Remember, individuals are not statistics. Statistics are numbers based on the experiences of large populations of people. Your experience with lung cancer will be unique and may vary greatly from the statistics.

Cancer survival statistics are based on 5-year survival rates. Five-year survival can and does happen for many people with all stages of lung cancer. You have the best odds for long-term survival if you are diagnosed with early-stage disease. Unfortunately, as the stage increases, the chance of long-term survival is reduced. However, many new treatments today make it possible to manage or even control lung cancer for a long period of time.

Preparing for Treatment

Smoking

If you are currently smoking, it is best for you to stop. Your treatment may be more successful if you do not smoke. Most surgeons will insist that you not be a current smoker. It is also helpful if you can reduce your exposure to second-hand smoke. Your doctor or nurse will be able to provide you with information about smoking cessation programs to help you or members of your family quit smoking.

Nutrition

Nutrition can make a difference in your ability to recover from the effects of treatment. Consider meeting with a nutritionist or dietitian prior to treatment whether it be surgery, radiation, or chemotherapy, to help ensure that you are getting the nutrients you need.

Physical Activity

Physical activity is also important in optimizing your cancer treatment. If you are already an active person, maintain your schedule as much as possible even if you may find it necessary to modify your routine. Any type of activity is helpful. Walk as much as you can. Keep light weights by your chair or bed and use them to exercise your arms. If you are too tired to exercise, make sure your doctor is following your hemoglobin levels. If you are anemic, request information regarding possible treatment. Be sure to discuss your exercise program with your health care providers.

Dental Work

It is also important to have any necessary dental care completed before starting therapy. Let your dentist know that you will be undergoing treatment for cancer.

How Quickly Should Treatment Start?

Your lung cancer has probably taken years to grow to its present size. So, unless your doctor tells you otherwise, it may be in your best interest to take a few days to get more information and additional tests before starting treatment. Use this time to learn more about your disease and treatment options, to talk with loved ones about your illness, and plan for your future.

Be sure to talk to your doctor about treating any symptoms you may already have, such as shortness of breath and fatigue, as well as any symptoms that may develop as a result of your treatment regimen. Some disease symptoms can be managed before you even begin therapy so that you may more easily tolerate the treatments. Often this can be done while you and your health care team are developing your treatment strategy.

Remember, the choice to receive any kind of treatment is yours to make. Discuss the goals of the therapy, its potential side effects, and the expected results with your health care team. Use these professionals as consultants to aid you in making your decisions, or, if it feels more comfortable, ask them to make the decisions for you.

How will you know if the Therapy is Working?

There are a number of ways to determine if the treatment is working. Most physicians routinely use something called a performance status as one of the indications to evaluate your overall health and physical functioning. If your pain or discomfort is lessened, breathing is easier, and there is less cough, it can be assumed that treatment is helping.

Your doctor will routinely perform a physical examination. Since lung cancer can affect many organs of the body, this exam should be thorough. The examination helps your doctor determine what tests he or she feels need to be done. For example, standard diagnostic procedures such as x-rays and CT scans can be used to determine whether tumor(s) have changed in size or disappeared. These tests are usually done after 3 or more “cycles” of therapy.

Recurrence

The risk of recurrence, or reappearance, of lung cancer in the original site or as a metastasis to another site can be high. When disease is advanced, the risk for recurrence increases. It is very important that people with lung cancer work closely with their health care team to be sure their condition is monitored on a regular basis. For example, following a course of therapy, people who have been treated for lung cancer should see their oncologist every 3 months, at a minimum, for the first 2 years; every 6 months for 2 more years; and annually after that.

Many people continue to see their oncologists or primary care doctor every 3 months so that any recurrence can be detected as early as possible. At these visits, your physician may order a CT or other scan. Your general health status will be monitored, blood work will probably be done, and other tests that your physician feels are important may be ordered, depending on your history with lung cancer.

Palliative Therapy

Palliative therapy is any kind of treatment that is given to control symptoms and improve quality of life when a cure is not probable. Palliative therapy can include surgery, radiation, and chemotherapy as well as pain management and oxygen therapy. Be sure to ask your physician about the purpose of any treatment you receive. Make sure you understand the possible benefits as well as the possible negative aspects of any treatment you undergo.

When making treatment decisions regarding your lung cancer, it is important to keep in mind the goal of therapy…

• Know what your goal of therapy is
• Be aware of what your doctor believes the goal of therapy should be for you
• Know about the anticipated benefits of each treatment option
• Understand which side effects go with what treatment
• Then, you will be ready to choose what treatment works best for you
• Treatment of Non-Small Cell Lung Cancer (NSCLC)