Rx: Quality of life for lung cancer patients

Recently, we were invited to a symposium on the advances in the treatment and management of lung cancer. Did you know that lung cancer was the leading cause of cancer deaths in 2010? This and more we learned from pulmonary healthcare expert Dr. Antonio Ramos of the Lung Center of the Philippines who talked on “better patient outcomes, quality of life with minimally invasive options for lung cancer treatment. Here are excerpts from our exclusive interview with Dr. Ramos:

PHILIPPINE STAR: Is having weak lungs a risk factor for lung cancer?

DR. ANTONIO B. RAMOS: The term “weak lungs” is usually associated with pulmonary tuberculosis or PTB. This is caused by a common chronic infection which is now very treatable with available medications in our country. Pulmonary tuberculosis is fortunately not a risk factor for lung cancer.

Today, there are cases of non-smokers getting lung cancer. Could second-hand or even third-hand smoke be the reason?

Not all lung cancer patients are smokers. Second-hand smoking could also trigger lung cancer. This is why we advocate total smoking cessation.

Another possible environmental trigger for lung cancer is air pollution.

What would you say can cause lung cancer? Who are at risk of lung cancer?

Seventy to 80 percent of lung cancers are associated with tobacco smoking. The present incidence of lung cancer will be reduced by 80% if tobacco smoking is eradicated. The so-called “light” cigarettes are no less dangerous. It has been shown that since the impression is that there is less nicotine per stick, smokers compensate by smoking more and inhaling more deeply. This can only result in more lung cancer cases.

So, the populations at risk are smokers and the people around them who are second-hand smokers.

Another significant risk factor is having a relative with cancer. This is the reason why people with relatives who are cancer patients should be vigilant in having themselves screened on a regular basis. For lung cancer, having a regular chest x-ray is important.

What is the incidence of lung cancer in the Philippines?

According to the 2010 Cancer Facts and Estimates by AV Laudico et al, the estimated age-standardized incidence rate for lung cancer in 2008 was 17.4 per 100,000 population for both sexes. For males, it was 27.9/100,000 and for females, it was 7.7/100,000.

In 2008, 3.5 out of 100 men and 0.9 out of 100 women would have a likelihood of getting lung cancer before the age of 75. For the same year, 2.8 out of 100 men and 0.7 out of 100 women would have died of lung cancer before the age of 75.

In 2010, lung cancer was the number one cause of cancer deaths.

How old are the victims?

Pulmonary healthcare expert Dr. Antonio B. Ramos of the Lung Center of the Philippines

In the past, the population at risk for lung cancer were males in their 50s. The data is now changing. We are seeing more females and younger patients being diagnosed with lung cancer.

Could you share with us the current advances in lung cancer treatment as well as management?

For earlier stages of lung cancer, survival benefits are maximal with surgical removal of the affected lobe or lung and this may or may not be followed by added treatment such as chemotherapy and/or radiotherapy.

For the late stages of lung cancer wherein the tumor is beyond resection, the treatment usually is non-surgical. This involves chemotherapy and or radiotherapy.

Logically, lung cancer diagnosed during the early stage and thus treated earlier is associated with better survival results.

The recent advancement in surgical treatment of lung cancer involves the use of minimally invasive surgical techniques. This is called Video-Assisted Thoracic Surgery or VATS. This technique makes use of a single or several small incisions (three to four centimeters at the most) in the chest instead of the traditional 20 to 25-centimeter-long thoracotomy incision which usually starts at the back and extends up to the front of the chest. Most chest surgical procedures can be done using VATS. There are, however, still some procedures in which the traditional approach is needed and that is for locally advanced lung cancers.

The advantage of VATS is not primarily the better cosmetic result, but the better quality of life for the patient since there is noticeably less pain after the procedure due to the smaller incision/s. This ultimately results in a significantly shorter hospital stay and less pain medications, and therefore a quicker return to work and normal life. So, while the cost of the operation of VATS is higher because of the use of certain equipment, the overall hospital cost is the same as with open surgery.

Other factors which result in better results of treatment for lung cancer include: better imaging equipment, which gives the surgeon a clearer picture of what to expect during the surgery; the chemotherapy agents being more available today, and which are much better than the ones we had 10 years ago in terms of effectiveness and occurrence of side effects; newer modes of pain relief like patient-controlled analgesia and the incorporation of Eastern medical techniques like acupuncture.

If everything else fails, would you recommend alternative/holistic treatment?

While we still have to come across good scientific evidence saying that alternative or holistic medicine is associated with better survival results for patients with lung cancer, we also have no data saying that it is detrimental. The advice is to go for standard, scientifically proven treatment for diseases and to ask your physician if it is okay to also do alternative or holistic treatment.

Even if curative treatment, meaning to say prolongation of life, cannot be offered when lung cancer is diagnosed in its late stage, palliative treatment is available. Palliative treatment is done to improve the quality of life. This involves pain management and measures to lessen the other discomforts of the patient.

What diet would you recommend for somebody stricken with lung cancer?

The American Institute for Cancer Research’s 10 recommendations for cancer prevention are as follows:

1. Be as lean as possible without becoming underweight.

2. Be physically active for at least 30 minutes every day.

3. Avoid sugary drinks. Limit consumption of energy-dense foods.

4. Eat more of a variety of vegetables, fruits, whole grains, and legumes such as beans.

5. Limit consumption of red meats (such as beef, pork, and lamb) and avoid processed meats.

6. If consumed at all, limit alcoholic drinks to two for men and one for women a day.

7. Limit consumption of salty foods and foods processed with salt (sodium).

8. Don’t use supplements to protect against cancer.

9. It is best for mothers to breastfeed exclusively for up to six months and then add other liquids and foods.

10. After treatment, cancer survivors should follow the recommendations for cancer prevention.

What should we do to safeguard ourselves against lung cancer? What preventive measures can we take?

While we have not identified specific measures which will prevent cancer, there are things which we can do to lower our chance of being a cancer patient or at least detect it at the earliest possible time since treatment of early stage lung cancer is associated with better survival results.

• Have a regular annual chest x-ray if you are a smoker or a previous smoker and have a family member who was diagnosed to have lung cancer. If you have a cough which is persistent, have a chest x-ray. If you have any doubt, see your physician.

• Do not smoke. Do not go near people who smoke.

• Have a healthy lifestyle. Being physically active, having a healthy diet, and maintaining an ideal body weight have been shown to help lower the risk of getting cancer.