Lung Cancer Survivorship - Living Beyond Cancer

Introduction

The increased number of lung cancer survivors can be attributed to the recent improvements in treatment and screening. Most survivors have received invasive treatments (surgery, radiation therapy, chemotherapy, and/or immunotherapy) and are burdened with numerous concomitant conditions. During the evaluation, therapy, and follow-up phases, there is a general deterioration in quality of life, with a possible long-term decline. Survivors deal with various problems, including physical ailments, mental suffering, and economic instability.

This article identifies under-recognized difficulties like stigma, financial toxicity, and sexual dysfunction and gives a current literature overview on the main problems faced by lung cancer survivors. Future cooperative efforts will be required to understand better the various problems that affect the general well-being of lung cancer survivors and to create effective therapies for this growing survivor community.

What Is Lung Cancer Survivorship?

From the moment of diagnosis to the rest of their lives, a person is regarded as a cancer survivor. Survivorship care is a crucial component of cancer treatment. The percentage of individuals who have survived five or more years after receiving a cancer diagnosis is anticipated to rise by about 33% over the following ten years. The number of survivors is rising yearly due to screening with low-dose computed tomography (CT), early discovery, and improvements in treatment.

However, numerous studies have shown that, for various reasons, cancer survivors frequently do not obtain the appropriate oncology and primary care treatments. The survivors who have finished treatment have health needs that include routine preventive care, monitoring for the development of other primary cancers, managing the long-term and late physical and psychological effects of cancer and its treatment, and surveillance for recurrence. Unfortunately, this population is comparatively understudied, and there is a lack of information on the difficulties faced by lung cancer survivors and the methods employed to give them structured primary and oncology treatment over the course of their lifetimes.

Since prolonged disease-free survival of patients with small cell lung cancer (SCLC) is far less prevalent, most of the patient population on which this article is focused has non-small cell lung cancer (NSCLC).

What Are the Challenges of Lung Cancer Survivorship?

• Follow-Up Post-Treatment: Recurrence rates are significant even in early-stage lung cancer that has been entirely removed, and most occur within the first two years. As a result, the American Society of Clinical Oncology practice recommendations advise that survivors should be closely monitored with a history and physical exam every three to six months for the first two years, then once a year for the following three to five years. It is advised to perform low-dose chest CTs that include the adrenals, preferably with intravenous contrast, at least every six months for the first two years and then once a year after that. It is debatable whether monitoring with low-dose CT for longer than five years can detect late recurrence.

• Consequences of Surveillance: Radiation exposure and the stress of each test are risks for patients having routine surveillance imaging. Planning the surveillance strategy requires weighing the possible benefits and risks, especially in younger patients, given worries about second cancers brought on by radiation exposure.

• Long-Term Effects of the Treatment: Significant drawbacks include long-term psychosocial effects, declining quality of life, and significant problems from surgery, chemotherapy, immunotherapy, and radiation. Following thoracic surgery, a common consequence known as post-thoracotomy pain syndrome (PTPS) frequently causes severe agony. Prompt referral to pain management professionals and a multidisciplinary approach are advised to relieve symptoms.

• Physical Symptoms: Most lung cancer patients who have survived say that physical symptoms like fatigue and dyspnea have considerably reduced their level of function. After initial therapy, some of these symptoms will gradually improve for 6 to 12 months, but long-term impacts on physical functioning and quality of life may last for years.

• Psychological Symptoms: The rate of psychological discomfort among lung cancer survivors is up to 80%, three times higher than other cancer types. This can include anxiety, tension, and depressive symptoms, negatively impacting social and cognitive performance. The utilization of mental health care is often low. During routine follow-up with survivors, it is crucial to screen for depression, anxiety, and/or psychological distress using the patient health questionnaire, generalized anxiety disorder (GAD), and/or the distress thermometer.

• Stigma: Patients with lung cancer claim that they think society is unaware that some types of lung cancer can develop without a smoking history. Some people believe they are to blame for developing cancer because they smoked, which causes guilt and emotional suffering. The psychological well-being of lung cancer patients might suffer from perceived stigma linked to social isolation, anxiety, and despair. It may also deter patients from obtaining medical attention.

• cognitive Dysfunction: Given the high occurrence of brain metastases in both SCLC and NSCLC, chemotherapy, notably Cisplatin and cranial radiation, has been recognized as the main cause of cognitive impairment in lung cancer patients. According to a pilot study, 62% of individuals with NSCLC suffered cognitive decline one month following chemotherapy, whereas 71% of patients had cognitive impairment before starting treatment. However, most of these concerns disappeared seven months after treatment, indicating that cognitive impairment may only be temporary during and soon following chemotherapy.

• Sexual Dysfunction: Lung cancer patients' sexual issues are poorly understood and cared for. Healthcare professionals must understand that sexual issues are common among lung cancer survivors, not just in cases of gynecological or genitourinary cancers. Sexual anxiety is frequently self-reported, and it is strongly correlated with both emotional and physical symptoms. But these worries continue long after treatment is over.

• Consistent Use of Tobacco: In a sizable population-based survey, 39% of patients with lung cancer reported smoking at the time of diagnosis, and 14% reported smoking at five months after diagnosis, showing that smoking is common among survivors despite known dangers. Unfortunately, long-term quitting is quite difficult, especially for survivors who experience physical and psychological pain. In one study, approximately 40% of smokers who had previously given up the habit relapsed after surgery. Among patients with non-metastatic lung cancer, some characteristics independently linked to prolonged smoking included not receiving chemotherapy, not having surgery, receiving less emotional support, and having higher daily ever-smoking rates.

Conclusion

A lung cancer diagnosis and treatment may have many underappreciated effects on a patient and their family, which can negatively affect their physical and mental health. And there are numerous chances to improve oncology care while addressing important survivorship issues in this population.