The increasing number of people living after lung cancer is mainly because of recent improvements in treatment and screening. Many survivors have received treatments such as surgery, radiation therapy, chemotherapy, and immunotherapy, and they often live with several other health problems at the same time.
During diagnosis, treatment, and follow-up care, many patients notice a decline in their quality of life, which may persist for a long time. Survivors often face different problems, including physical health issues, emotional stress, and financial difficulties.
This article explains some less-discussed problems, such as stigma, money-related stress, and sexual health concerns, and reviews recent studies on the main problems faced by lung cancer survivors.
What Is Lung Cancer Survivorship?
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A person is called a cancer survivor from the time they are diagnosed and for the rest of their life. Survivorship care is an important part of cancer treatment.
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In the next 10 years, the number of people living five or more years after a cancer diagnosis is expected to increase by about 33%.
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The number of survivors continues to increase each year because of low-dose CT screening, early detection, and better cancer treatments.
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Many cancer survivors do not always receive proper care from cancer doctors, along with regular primary health care.
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Even after treatment ends, survivors need regular health check-ups and preventive medical care.
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They also need monitoring to check if the cancer returns and to look for the development of new cancers.
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Survivors may experience long-term physical and emotional effects from cancer and its treatment, so these problems also need care and support.
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Lung cancer survivorship is still not widely studied, and there is limited information about the problems survivors face and the best ways to provide long-term care. Since long-term disease-free survival is much less common in patients with small cell lung cancer (SCLC), most of the patients discussed in this article have non-small cell lung cancer (NSCLC).
What Are the Challenges of Lung Cancer Survivorship?
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Follow-Up After Treatment: The chance of cancer coming back remains high even when early-stage lung cancer has been completely removed, and most recurrences happen within the first two years. Because of this, the American Society of Clinical Oncology recommends close follow-up with medical history and physical examination every 3 to 6 months for the first 2 years, and then once a year for the next 3 to 5 years. Low-dose chest CT scans that include the adrenal glands, preferably with intravenous contrast, are recommended at least every six months during the first two years and then once a year after that. It is still unclear whether continuing low-dose CT scans beyond 5 years helps detect late recurrence.
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Effects of Regular Monitoring: Repeated imaging tests can expose patients to radiation and may also cause worry before each scan. When planning follow-up care, doctors must carefully balance the benefits and possible risks, especially in younger patients, because of concerns about radiation-related second cancers.
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Long-Term Effects of Treatment: Long-term problems may include emotional stress, reduced quality of life, and complications from surgery, chemotherapy, immunotherapy, and radiation therapy. After chest surgery, many patients develop a condition called post-thoracotomy pain syndrome (PTPS), which can cause long-lasting, severe pain. Early referral to pain specialists and a team approach can help manage these symptoms.
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Physical Symptoms: Many lung cancer survivors report physical symptoms such as tiredness and shortness of breath, which can greatly limit their daily activities. Some of these symptoms may slowly improve within 6 to 12 months after initial treatment, but long-term effects on physical function and quality of life can continue for several years.
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Psychological Symptoms: Up to 80% of lung cancer survivors experience emotional distress, which is about three times higher than in survivors of other cancers. This may include anxiety, stress, and depression, which can affect social life and thinking ability. Even so, the use of mental health services remains low. During regular follow-up visits, it is important to check survivors for depression, anxiety, and emotional distress using tools such as the patient health questionnaire, generalized anxiety disorder (GAD) scale, and the distress thermometer.
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Stigma: Many lung cancer patients feel that society does not fully understand that lung cancer can also occur in people who have never smoked. Some survivors feel blamed for their illness because of smoking, which can lead to guilt and emotional pain. This stigma can affect mental well-being and may lead to social isolation, anxiety, and depression. It can also stop patients from seeking medical care. Older patients specifically become easily upset. So it is wise to explore palliative care options for older patients with lung cancer.
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Cognitive Problems: Because brain metastases are common in both SCLC and NSCLC, chemotherapy drugs such as cisplatin and cranial radiation therapy have been linked to thinking and memory problems in lung cancer patients. A pilot study showed that 62% of patients with NSCLC experienced cognitive decline one month after chemotherapy, while 71% already had some cognitive problems before starting treatment. However, most of these problems improved within 7 months after treatment, suggesting that cognitive changes may be only temporary during and soon after chemotherapy.
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Sexual Health Problems: Sexual problems in lung cancer survivors are not well understood and are often overlooked. Healthcare professionals should know that sexual health concerns can occur in lung cancer survivors, not only in patients with reproductive or urinary cancers. Sexual anxiety is commonly reported and is closely linked with both emotional and physical symptoms. These concerns may continue even long after treatment has ended.
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Continued Tobacco Use: In a large population-based survey, 39% of lung cancer patients reported smoking at the time of diagnosis, and 14% were still smoking five months later, showing that smoking remains common among survivors despite the known risks. Long-term quitting can be very difficult, especially for survivors who experience physical and emotional stress. One study found that about 40% of patients who had previously quit smoking started again after surgery. Among patients with non-metastatic lung cancer, factors linked to continued smoking included not receiving chemotherapy, not undergoing surgery, receiving less emotional support, and having a higher history of daily smoking.
Conclusion
A diagnosis of lung cancer and its treatment can have many, often unnoticed, effects on patients and their families, which may negatively affect both physical and mental health. There are many chances to improve cancer care by addressing the important survivorship issues faced by this group of patients. If you or your loved ones are facing similar cancer-related concerns, consult a cancer specialist and clear your doubts.
Key Takeaways
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Lung cancer survivorship means living with and beyond lung cancer from the time of diagnosis and continuing after treatment.
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It is becoming more common because survival rates are improving; about 20% to 25% of people with lung cancer live five years or longer after diagnosis.
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Regular follow-up care is important to check if the cancer returns and to manage health after treatment.
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A healthy lifestyle and emotional support can help survivors maintain better physical and mental health.
