Making Sense of Lung Cancer Treatment Options
We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
Newly diagnosed lung cancer patients are often overwhelmed thinking about their treatment options. It is a stressful, often fearful period of time when new terms are being tossed about along with the heavy baggage of traditional medical treatments that are often misunderstood. Questions about whether the patient will be cut or burned or poisoned flood through many heads along with the miracle promises of using their own immune system to wipe the cancer away. Letters and numbers seem to mean so much, from PD-L to ROS1 or EGFR, but they refer to different types of therapy and apply to different patients, while the confusion grows.
Treatment Has Changed Over the Years
A few years ago, it was easy. If the cancer was caught in an early stage, it was surgery and perhaps some radiation or chemotherapy just to be safe. In more advanced stages, surgery might not be an option, but chemotherapy was there to ease the symptoms and, in some cases, possibly even put the cancer into remission. But times have changed. Not only has radiation been improved to the point where it can be administered with surgical precision, not only have the types of chemotherapy expanded dramatically to include more tolerable and more effective drugs, but entirely new types of treatment have become available to the mainstream. During the past decade, targeted treatments and immunotherapies have emerged from the experimental phase to become proven first-line treatments for qualified patients. And the options for treatment look like they will continue to grow.
The traditional first-line treatments of chemo, radiation, and surgery have been frequently vilified — not just by the purveyors of “alternative” treatments, but by Hollywood when a lazy plot point was needed to tweak an emotional response.
Ignoring the decades of advances that have been made in medical science, many people still believe that radiation treatments will mercilessly burn the body (perhaps causing new cancers in the process). While some patients certainly experience various side-effects from treatment, most now find that the radiation is considerably milder than they expect. New techniques allow a patient to receive radiotherapy as an outpatient, ready to go on with life as normal after the session is done. Surgical methods have also improved, though lung surgery tends to be reserved for cases where it will be potentially curative. In such cases, the added stress to the body is weighed against the probability of being cancer-free. Unfortunately, surgery is often the first option removed from the table because lung cancers are frequently discovered only after they have had time to spread.
Treatments Work Differently in Different Situations
Of all the treatment options available for lung cancer, perhaps none are as maligned as chemotherapy. It is often blamed for poisoning the patients who use it to fight their disease, and in some limited way of understanding, this is true. Not every patient can tolerate chemotherapy, or tolerate it for an extended period of time, which is why frequent bloodwork must be done to monitor organ function. But the chemotherapy of today is not the same as it was previous decades. Some forms of chemo are harder for some patients to tolerate, but different drugs have been developed that work well against different types of lung cancer, leading to a variety of more customized options. An oncologist today can look at a patient and determine a balance between chemical effectiveness and how easy a drug is to tolerate, often with great responses to the treatment. Some patients are able to remain on chemotherapy for years, continuing to enjoy functional, productive, high-quality lives.
The newer treatments that have come onto the market in the past few years offer more hope — and confusion. Targeted and immunotherapies sound promising to newly diagnosed patients, and often they are both excited and intimidated at the prospect of these options. While often considered only as second-line treatments, more and more oncologists are going to these new therapies before chemo. There are good reasons for this — if the patient’s cancer has the right genetic mutations or markers. Often these new treatments are far easier to tolerate. And when they work, they can make a dramatic difference in a short amount of time.
Ask Questions Until You Find the Right Solution for YOU
Making sense of the options, and determining which ones are right for any given patient, takes time. Sometimes it also takes getting a second opinion — something that most oncologists embrace and understand. Cancer treatment requires making a life-altering choice and this decision should involve as many questions as the patient needs to ask in order to fully understand the options. Bringing a friend, a notebook, even an audio recorder along to the consultation can be helpful. And there is no shame in asking the same questions again.
For most patients, this is entirely new territory. And it is territory that continues to expand. But this is a good thing — one that benefits all patients. And even when none of the available treatment options looks exactly right, there are often clinical trials going on that might suit a patient perfectly. So be ready to come into the doctor’s office with questions, and be prepared for more questions to arise. But also know that there are many approaches with proven track records. Patients are increasingly presented with customized treatment plans that often vary significantly from what the same diagnosis would have called for less than a decade ago.