Follow-up

After surgery for operable lung cancer, there is an increased risk of developing a second primary lung cancer, as well as a risk of the original tumor returning.

• Many lung cancers reoccur within the first two years after treatment.
• Regular testing is essential to detect any recurrence early.
• Patients who've had surgery should follow the recommended follow-up care and examinations from their treatment team.

Palliative and terminal care

Palliative care or hospice care focuses on reducing symptoms and suffering without attempting to cure the underlying disease, as a cure is often unlikely for many lung cancer patients.

• The patient, their family, and the doctor can recognize when palliative care is needed.
• Planning for palliative care should ideally begin in advance, with a discussion between the patient, their representative (if necessary), and the healthcare provider.
• These discussions can address likely outcomes, medical concerns, and any fears or uncertainties.

Palliative care can be provided at home, in a hospital if home care is not feasible, or in a hospice facility. It mainly includes treatments for relieving shortness of breath and pain.

• Breathlessness is managed with oxygen and medications like opioids, such as opium, morphine, codeine, methadone, and heroin.
• Pain is addressed with anti-inflammatory medications and opioids. Patients are encouraged to participate in determining their pain medication doses, as the required amount can vary from day to day.
• Other symptoms, like anxiety, sleep disturbances, and depression, are managed with appropriate medications and, in some cases, complementary therapies.

Prevention

Lung cancer is highly preventable, with 90% of cases occurring in smokers or former smokers. The best way to prevent lung cancer is by not smoking.

• Quitting smoking can be challenging due to its high addiction potential, but smoking rates have decreased in recent years in many parts of the world.
• Healthcare workers play a vital role in identifying smokers and helping them quit.
• Various products like nicotine gum, nicotine sprays, nicotine inhalers, and other medications have been successful in aiding smoking cessation.
• Reducing exposure to passive smoking is also an effective preventive measure.
• Home radon test kits can detect and address elevated radon levels, which can also lead to lung cancer.
• Smokers who use a combination of supplemental nicotine, group therapy, and behavioral training experience a significant reduction in smoking rates.

Lung cancer screening includes the following:

• The American Cancer Society does not recommend routine chest x-ray screening for lung cancer. This means that many health insurance plans do not cover screening chest x-rays or CT scans.
• Periodic chest x-rays may be suitable for current or former smokers; discuss the pros and cons with a healthcare provider.
• Low-dose CT scans have shown promise in detecting early-stage lung cancer, but their impact on saving lives or reducing the risk of death is still being studied through ongoing trials.

Outlook

Overall, the survival rate for lung cancer, across all types and stages, is 16%, significantly lower than other cancers like colon cancer, breast cancer, and prostate cancer.

• Stage I NSCLC patients who undergo lung surgery have a 60%-70% chance of surviving for five years.
• Stage II NSCLC patients have a 30%-40% chance of cure, while those with stage IIIa have a 20%-30% chance of cure.
• Extensive nonoperable lung cancer patients typically have an average survival of nine months or less.
• Limited SCLC patients receiving chemotherapy have a two-year survival rate of 20%-30% and a five-year survival rate of 10%-15%.
• Less than 5% of people with extensive-stage SCLC (small cell cancers) are alive after two years, with a median survival ranging from eight to 13 months.