Recently, a disheartening study from JAMA Oncology came out, showing that less than half of all people with metastatic non-small cell lung cancer receive treatment. This is despite there being many options available which can increase life expectancy by years. The study looked at over 250,000 people over a 15-year period.

So why aren’t people receiving these treatments?

A little background

Non-small cell lung cancer is a type of cancer with very high mortality rates. It is the most common type of lung cancer. A cancer that has metastasized has spread to other areas. While many years ago there were not as many treatments available, that has changed and continues to change. There are more treatments available that are life-extending, particularly targeted therapies that look at specific genetic changes in an individual. Targeted means just what it sounds like- the treatment is precise. These targeted treatments work in different ways. Some attach to proteins on the outside of cancer cells. Some enter cancer cells to block growth. And added bonus- side effects with these treatments aren’t always as hard on patients as traditional chemo.

Study findings

The study found different reasons that people aren’t getting treated. Part of the problem is that they never even receive a referral to an oncologist. The lung cancer pulmonologists who led this study that was funded by the American Cancer Society were surprised by this finding, to say the least. Their research initially started with wanting to know how prevalent biomarker testing is, but before they could look at that, they examined how often people are even getting treated. What they found is that it is not nearly often enough.

There is work to be done here, if half of these patients are not even making it to the oncologist. Of the ones who make it to the oncologist (by means of the referral), 80-90% get treated. Sadly, about 40% of all the patients in the study had died within 90 days of diagnosis. Lung cancer, incidentally, is the leading cause of cancer death in the U.S.

Here’s what we can do

First- We need to understand that while early diagnosis is important, there are few if any symptoms of lung cancer at the beginning. So knowing risk factors helps determine who should get screened (if they qualify), and how.

Second- Know the risk factors. Smoking is the number one risk factor. Other risk factors include having a history of COPD or a history of tuberculosis. A history of chronic inflammatory diseases is also a risk factor. Exposure to second-hand smoke and radon are risk factors. The environment and our work can present risk factors too. Second-hand smoke exposure, exposures to chemicals like arsenic, benzene, diesel exhaust and air pollution can all be risk factors. If someone has had radiation in the past for other cancers, this is a risk factor.

Third- Know when and if you (or a loved one) should get screened, and how to go about doing that. Here is a link to the American Cancer Society’s guidelines. Basically they say that if someone smokes or used to smoke and has at least a 20 pack-year smoking history, they should get screened. What does 20 pack-year mean? It means a pack a day for 20 years, or it could mean 2 packs a day for 10 years. If you think you meet this criteria, talk to your doctor about yearly screening. Here’s a second link with information on screenings from the American Cancer Society.

Fourth- If you don’t qualify for screening but are having lung problems that don’t seem to go away and seem to be a mystery, talk to your doctor. There are times when we need to be our own advocates. If something seems wrong, don’t give up until you find a healthcare provider who listens and is willing to help. There is a real stigma attached to smoking and there are times people think they “did it to themselves” or aren’t deserving of treatment.

To sum up, while non-small cell lung cancer is common, patients don’t always make it to the oncologist. Early screening is the key to catching more of these cancers, since there are oftentimes no symptoms at first. So if you or a loved one smokes, talk to your doctor! Share information! There is help out there for people with lung cancer.

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