Lung cancer is lethal. It kills more people in Canada than breast cancer, colon cancer and prostate cancer combined; it is responsible for over 21,000 deaths per year. And yet, according to a new report by the Canadian Cancer Research Alliance (CCRA), lung cancer receives just six percent of the country’s total cancer research investment, while having among the highest projected incidence rate among Canadians, and the highest mortality of all types of cancer.
In Canada, research investment for specific types of cancer has resulted in advances in treatments and early detection methods, improving patient survival, and lessening the overall burden of the disease. The investment is often strongly linked to societal burden, with more common forms of cancer, such as breast and prostate, receiving more funding. But lung cancer, the most commonly diagnosed cancer in the country, does not enjoy corresponding levels of research funding. Why is this the case?
As someone who treats people with lung cancer, I believe there continues to be an unfair stigma and a certain nihilism attached to smoking-related illnesses. Smoking is one of the leading causes of lung cancer alongside other environmental factors such as radon exposure. Like obesity, another disease predominantly related to lifestyle choices, lung cancer may be viewed differently when organizations consider where to allocate research dollars.
Lung cancer, unlike other major cancers, has a challenging history in Canada. It continues to have a high mortality rate and for a long time, treatments were not very effective. This went against the trend of decreasing mortality and improving therapies for most major types of cancer over the past 20 years. While Canada ranks high in lung cancer survival compared to other countries, lung cancer may still be viewed by organizations as a lost cause and may be pushed aside in an atmosphere of supporting other more treatable cancers.
But Canadians need to know that times are changing for the better. Our efforts to address lung cancer in this country and investments in the disease need to follow suit.
Despite the relatively poor research funding to date, lung cancer is one of the most dynamically changing areas of oncology. In this era of personalized medicine, we now have novel targeted and immunotherapies that offer exciting treatments for advanced lung cancer. We also have focused radiation and new minimally invasive surgical techniques that allow more people with lung cancer to have curative surgery and recover faster.
Lung cancer is no longer a death sentence and outlooks for people with the disease today are more hopeful than ever before. It is time for our health care system to provide the programs and resources so these research findings can benefit patients.
In addition to emerging treatments, better screening has the potential to play a role in improving the state of lung cancer in Canada. Organized programs would provide routine screening, usually every two to three years, for high-risk individuals including long-term, daily smokers. As with all cancer screening programs, such programs have potential to catch lung cancer earlier. Early stages of lung cancer have a better prognosis than later stages.
Studies in the United States and Europe have shown that lung screening in individuals at high risk for the disease with computed tomography (CT) scans reduces mortality by over 20 percent. Despite this evidence, routine lung cancer screening does not exist in any province or territory.
Could we be saving more lives?
I would implore provincial and territorial governments, health authorities and organizations to start moving forward in addressing lung cancer and taking this disease, and the potential for people surviving it, more seriously.
This starts with increased investment in research to further build on effective treatments, followed by organized screening programs to help at-risk Canadians catch the disease earlier. Combining these efforts with tobacco cessation support for all newly diagnosed patients, which has proven to be effective in improving treatment outcomes, would offer better support and better outcomes to people with lung cancer.
I’m pleased to see that work has started. An organization I work with, the Canadian Partnership Against Cancer, is creating a framework to support any province or territory that wants to introduce organized lung cancer screening. The partnership is leading efforts to have organized lung screening available to all Canadians who can benefit, in all parts of the country, in the next decade.
I should be clear that smoking continues to be the leading cause of lung cancer. From a public health and prevention perspective, continued efforts on smoking cessation and harm reduction are needed. But for those who continue to smoke, we need to strive to move the bar on lung cancer treatment and screening to increase their chances of survival. We should not leave them behind.
There has never been more reason for optimism in the early detection and treatment of lung cancer. If we want to start saving more lives, we need to start putting money in areas where people are dying.
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To Lung Cancer Oncologists:
Does anyone know more about CIMAvax EGF vaccine developed in Cuba by Cuban researcher at the Centro de Immunologia Molecular for non small cell lung cancer ..it was approved as clinical trial by U.S. FDA in 2016. It apparently stops diagnosed lung cancer tumors from growing. Would this be available or made available in Canada ?
I understand smoking continues to be the leading cause of lung cancer and yet receives only 6 percent of country’s total cancer research funding.Surely the tobacco companies and the more recent actions of legalization of cannabis bear some responsibility on lung health and second hand smoke. I lost two close people who are non smokers who were diagnosed with symptoms i.e. in one person back and shoulder pain and in the other pneumonia and both died of lung cancer in less than one year of diagnosis. The former had egfr targeted therapy and the cancer treatment worked for 6 months until it needed the 2nd generation drug..the blood work for the second testing took too long and the person died 3 months after.The cancer had spread and was so advanced right from the start and like all cancers very aggressive. The other person refused to take treatment after learning she was initially diagnosed with flu like then pneumonia and when the symptoms refused to clear in a month it was through MRI and xrays and cat scans found to be lung cancer and died in 6 months . Both were extremely healthy people that never got sick and both were non smokers. What is going on? If radon is something that is suspect then free and mandatory availability of testing should be provide in areas researched to have high incidence of radon. One person was from Kitchener ,canada and the other from arizona ..Something is happening and this is not normal and hospitals and doctors and cancer centres are not prepared for lung cancer patients especially those that have never smoked or quit over 20 years prior. …Funding and provincial cutbacks in canada were complaints provided by the cancer centre for lack of hospital beds and lung cancer research ..It all seems to me that proper allocation of money is highly important for prioritization which may need to be continuously reviewed…politicians are also to blamed .I feel preventive measures have to be taken rigorously at the general physician level..both these patients could probably have had better care at the general practitioner level…maybe we need to re train doctors so their primary focus is prevention and diagnosis which takes time and not 5 minute appointments… and not making profit and trying to get fake community accolades in health care. Lung cancer definitely needs to be investigated especially factors in the environment…like hair dyes, nail salons, pesticides, renovation of homes and use of materials like laminated wood, countertops, air quality in homes, radon etc…..all these possible factors need to be investigated.
This article in the Sudbury Star today, May 23, quoting Dr. Webster may be of interest to some:
“Sudbury doctor delivers blistering attack on PET scan policies – Worries new tool will be ‘obscenely under-utilized’ ” …
“In Ontario, however, it can take up to two years to get a proper diagnosis for lung cancer because “we are the only medical jurisdiction in the world where you have to stick the needle in the nodule first, before you can get the PET scan,” he says. “In the entire rest of the world, if you have a chest X-ray and a nodule, say a 3-cm mass, the first test you would do would be a PET scan.”
https://www.thesudburystar.com/news/local-news/sudbury-doctor-delivers-blistering-attack-on-pet-scan-policies
Actually not completely true. One strange side effect is that the sickest patients who likely wouldn’t survive LC treatment would qualify for a PET scan without a biopsy first. My 80+ neighbour, has COPD and Parkinsons. He received the PET scan prior to the biopsy due to his pre-existing conditions. The PET scan came back inconclusive and he then went for the biopsy anyway which originally was deemed too risky. The guidelines for a PET scan allow that based on “the existence of a contra-indication to the use of needle biopsy.”
In 2012, I was diagnosed with a Pancoast tumour located on the outside of my left lung. Because of my odd symptoms, it took several months to diagnose correctly by which time it had spread into my spine. The thoracic surgeon I first saw gave a grim prognosis, telling me that the best that could be done was to have aggressive chemo and radiation to try and shrink the tumour to then allow for the surgical removal of half my lung and three vertebrae. Even then, she explained, my survival time would be somewhat limited. The fact that I am writing this as I sit here with an intact left lung and spine speaks to the brilliance of my oncologist, Dr Mark Vincent at LRCP. I am grateful to be one of his “poster children”. During the course of my treatment, I certainly became aware of the stigma. CCO exerts a lot of control over permissible treatment protocols. Every time the two chemo drugs caused my immune system to crash, I had to pay $2780 for a single injection of Neulasta. This was a challenging financial burden. I was told that it was not covered because I had cancer deemed “untreatable” under the CCO guidelines. I have served as a patient advisor for five years at LRCP, sitting on committees and attending departmental meetings. This has afforded me a unique opportunity to “look behind the curtain” and to appreciate the many challenges facing medical professionals. I am of the generation raised to see doctors as kind of Demi-gods so I found it quite shocking that the autonomy of highly skilled professionals can be so markedly controlled by bureaucrats at both the local and provincial level. I am greatly heartened by reading your post about the need to give lung cancer more “legitimacy”. Lung cancer patients need advocates like you who want to challenge the current “beauty contest” view of the disease which ends up leaving us as the ugly ducklings in the line up. Thank you for letting me do this little rant.
Completely agree Debbie that patients are fortunate to have physicians like Dr. Finley and Dr. Webster as I mentioned earlier act as advocates on the part of their patients and do so with often restrictive government clinical practice guidelines that hover over how they can practice true best practice medicine.
I would have not qualified for early screening as a very healthy , physically fit , never a smoker .
Also never had one if the lung cancer symptoms , one day I wake up with headache &
8’weeks later a 3 cm tumour found on my scull with a Ct scan & Mri . Tumour removed , proved to be a secondary tumour , now sporting a 4 cm titanium plate in my scull . Pet scan showed LC as my primary with mets to the pelvic bone , spine & femur . Lucky to be EGFR 19 + 7 weeks on Iressa / Getfitinib all mets gone & lung cancer tumour shrunk from 2.6 cm to 1.6 . I have been stable fsincenthen , lung tumour has remained the same no further shrinkage .Stable is great .
I have never been sick at all . Just a few minor side affects like brittle nails .
I wish provincial health plans were the same across Canada , some provinces like Ontario totally cover the cost of Irressa which is $2240’a month Tagrisso is also covered at &9000 a month Quebec provincial does not unless you are a lower income level with no private health ins . I have Sunlife plan
With my husbands military insurance, so I pay the 20% which is $440 per month out of pocket ,
It affects my budjet but a small price to pay for such a miracle drug .
I live in Gatineau Quebec & the cancer clinic & oncologists , neurosurgeons ,,radiation Onc are amazing . I belong to a wonderful lung cancer support grp , the first In Canada , it is in a Ottawa a short 25 min drive for me . We do lung awareness once a month at the Ottawa General H .
I just attended the annual LC conference in Washington DC , it was amazing to attend seminars with top notch LC specialists & to attend with about 450 other LC Survivors that came from many other
Countries .
I wish Canada could put on a similar conference butting to team of people from LUNGEVITY org
To put one on for the 7 th year .
I know such a long comment but thru awareness I have become so informed .
For those of us with LC we really need others to advocate for us. Our pockets of patients cannot do it alone. The stats in this cancer could change with early detection using low dose CT scans and with GP’s keeping the symptoms in the forefront of their minds so patients are not incorrectly diagnosed because they don’t fit a particular criteria.
I am curious to know if guidelines for lung cancer such as those of Cancer Care Ontario/Ontario Ministry of Health and Long-Term Care, created in accordance with the McMaster based Program in Evidence-Based Care, see link below for the various CCO/OMHLTC guidelines, are too restrictive and not liberal enough to allow for physicians to screen, diagnose and treat lung cancer in a proactive and leading-edge manner. This I don’t know but it would be interesting if medical experts did an analysis of these guidelines and compared these guidelines with other jurisdictions who have produced lung cancer guidelines.
https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer
This video from Dr. David Webster, a nuclear medicine physician who practices in Sudbury, Ontario may also be of interest:
https://youtu.be/yWb5br2PCR8
Mike Fraumeni,
I followed the link to Cancer Care guidelines, which actually is a list of relevant articles on the subject. But it did make me question the result of a diagnostic test i had, which stated no lung parenchymal alveolar tissue was identified in deeper levels of the sample, and cancer was not confirmed. Thus, I might conclude there was no analysis of any possible malignant tissue. One article in the list suggested that immunohistochemistry would be useful. I’m curious because they did a lot of testing on matters not related to malignancy. Thanks for the information. I will follow up on the second link later.
No problem. Below is a link to Dr. David Webster’s website and below is the link from this website to that video and another concerning PET and lung cancer. Just wanted to mention that guidelines are produced using a systematic review methodology and such methodologies do have some drawbacks as to exactly what studies will or will not be included in the guideline, inclusion and exclusion criteria if you will. Having our health care insurance provider, the Ontario government, providing funds for the creation of such guidelines, in this case to a department in the McMaster School of Medicine, does point to a red flag as to possible biases present for whatever reason including cost reduction of tests and procedures. Perhaps provincial guidelines should always be regarded with some caution however these guidelines do affect how our physicians in this province practice medicine.
http://petontario.org/cases/PET-CT-lung-cancer.html
https://qz.com/784615/the-man-who-made-scientists-question-themselves-has-just-exposed-huge-flaws-in-evidence-used-to-give-drug-prescriptions/
Heather,
Your post is spot on. I regularly have been having low dose CT scans, at least until recently when my respirologist conducted tests on me that led to a test result that was completely different from the suspected cancer diagnosis. As a result, I quit my respirologist, and am now attempting to find, through PHIPA, how on earth this happened. One test result, that should never have been conducted, led to a perceived result that was way off-track and has influenced anyone knowing it, including the radiologist who read the last CT scan. I am at a loss to know what to do except to continue to fight to get the respirologist and others responsible to correct the errors made and get that test result (seen incorrectly as a diagnosis) declared invalid or at least, unethically and irresponsibly obtained. Meanwhile, I still have a lung condition that is at risk of becoming malignant and no way of getting objective diagnostic treatment of it.