Although the diagnosis and treatment of lung cancer have improved significantly in recent years, lung cancer is still the most common malignant tumor in clinical practice. Moreover, the difficulty of early diagnosis and poor prognosis of lung cancer still seriously endanger human health.
I. Most lung cancer patients have reached advanced stage of the disease when they get the diagnosis
Generally speaking, early detection of lung cancer relies on health examination. In China, due to the economic conditions and the lag of people’s health awareness, regular health checkups are still far from popular. Most of the early stage lung cancers have no clinical symptoms, or are treated as cold or bronchitis because the symptoms presented are not specific, and thus delay the diagnosis. Therefore, most lung cancer patients are already in advanced stage when they are diagnosed, and often have lost the chance of radical surgery. Although some patients can still be treated surgically, they cannot be cured by surgery alone and often need adjuvant chemotherapy or radiotherapy.
Why are many patients with advanced lung cancer not given the last chance to receive treatment for their disease?
Due to the current health awareness, in many cases, cancer patients and their family members fail to proactively seek the most appropriate treatment plan. At the time of consultation, if the doctor tells the patient or his/her family that surgery is still available, most people will still accept it. However, if they are told that surgery is not appropriate at an advanced stage or that they cannot tolerate surgery due to factors such as cardiopulmonary function, many people are often unwilling to accept or even reject etiologic treatment options such as chemotherapy or radiotherapy according to their own understanding. Therefore, some patients are given up the last chance to prolong their lives under the decision of their families.
Why would family members of advanced lung cancer patients give up chemotherapy or radiotherapy?
When lung cancer is diagnosed, doctors will usually inform the family members first and discuss the initial treatment plan with them first. This can prevent the patient from receiving a sudden and direct psychological shock. However, this brings another problem, that is, the choice of treatment plan is also influenced by the family’s awareness of the disease. Many family members often choose to conceal the diagnosis from the patient and sometimes even forgo etiologic treatment such as chemotherapy and radiation therapy outright in order to more effectively conceal the disease.
The reasons why patients’ families choose to forgo final etiologic treatment are broadly summarized as follows.
①, if surgery is not possible, lung cancer cannot be cured, and death is a matter of time, so chemotherapy or radiotherapy is not very meaningful;
②, both chemotherapy and radiotherapy require strong financial support, and many families have to undergo chemotherapy and radiotherapy because of financial reasons;
③, chemotherapy has a lot of side effects, and patients are worried that they cannot tolerate it;
④, after the patients know the real condition, the psychological burden is heavy, which may accelerate the death of patients.
Fourth, analysis and countermeasures
1.On whether chemotherapy is meaningful
Many patients and their family members, including a considerable number of primary care doctors, believe that after lung cancer, unless surgery is still possible, other treatments are meaningless, and death will come faster with chemotherapy. But is this actually the case?
From the results of recent clinical studies around the world, the remission rate (RR) of small cell lung cancer combined with chemotherapy has increased from 20% to 40% 30 years ago to more than 80% to 90%, and even the clinical cure rate (CR) can reach 30% to 40%. As for chemotherapy chemotherapy for non-small cell lung cancer, the program is concentrated to NP, GP, TP and DP, and the sensitivity of chemotherapy has been improved from 15%-20% of the remission rate of combination chemotherapy in the 1970s to 20%-40% at present.
In particular, the introduction of new drugs such as pemetrexed and the new targeted therapy drug gefitinib in recent years has provided new alternative approaches to chemotherapy for NSCLC. In the advantageous population, targeted therapies such as PP regimen and gefitinib can achieve remission rates of more than 50% to 70% in lung adenocarcinoma. Moreover, after the remission of lung cancer chemotherapy, the patients’ clinical symptoms also remitted at the same time. The other part of patients whose cancer did not shrink due to chemotherapy, but their disease was stabilized, and no more than 20% of patients were really completely ineffective.
In terms of overall survival, the median survival time after diagnosis of advanced lung cancer without effective etiologic treatment is 3 months to 6 months. In contrast, the median survival time after diagnosis with aggressive chemotherapy and radiotherapy is generally 8 to 10 months. According to our recent data, the median survival time after diagnosis of advanced stage (clinical stage III and IV) lung cancer can be 11 to 12 months in small cell lung cancer and more than 15 months in non-small cell lung cancer if chemotherapy-based combination therapy is used.
It can be seen that, like other chronic diseases, effective treatment can improve patients’ quality of life and control the progress of the disease to a certain extent. Active treatment is very different from passive waiting. The concept of simply classifying lung cancer as a terminal disease and giving up chemotherapy is at least stuck at the level of 30 years ago.
2.About the adverse effects of chemotherapy
It is undeniable that all commonly used chemotherapeutic drugs for lung cancer still have different degrees of toxic side effects. They are mainly manifested in gastrointestinal reactions, bone marrow suppression, cardiac and bone muscle toxicity, liver and kidney function damage, hair loss, neurological and reproductive system toxicity, skin damage, allergy, etc. Compared with previous chemotherapeutic drugs, the third generation chemotherapeutic drugs for lung cancer currently used have stronger anti-cancer activity, while the toxic side effects are relatively mild and generally last for less than a week, and with proper treatment, most of the toxic side effects can be limited to a tolerable range.
The toxic side effects of chemotherapy drugs are related to the variety, dose, administration method and compounding scheme of the drugs used, as well as the patient’s age, physical and mental status, nutritional status and the presence of underlying diseases of vital organs.
Therefore, the following countermeasures can be used to resolve them.
(1) Individualized treatment as much as possible, and the most suitable dose and method can achieve the maximum anti-cancer efficacy while limiting the toxic side effects within a reasonable range;
②. Each anticancer drug has different mechanisms of action and different toxic side effects, so the toxic side effects of different chemotherapeutic drugs can be controlled or controlled within the tolerable range of patients by adopting corresponding methods to deal with and counteract the possible toxic side effects;
③. Improve the corresponding laboratory tests and examinations before chemotherapy, understand whether the patient has basic diseases and the functional status of important organs, make preliminary assessment of the tolerance of heart, liver, kidney and bone marrow functions in advance, select the most suitable chemotherapy drugs, adjust the dosage of drugs accordingly, and adopt corresponding protective measures and countermeasures in advance;
④. Pre-assessment of the patient’s physical condition, patients receiving chemotherapy should spend no more than 50% of their time in bed during the day, and patients whose general condition is too poor should avoid chemotherapy.
In short, as long as reasonable treatment, the side effects of chemotherapy can be controlled to a lesser extent in most cases.
3.Psychological factors of patients
Up to now, the subject of curing advanced lung cancer has not yet been overcome. People’s fear of lung cancer is still common. Many people believe that if a patient knows that he or she has lung cancer and is inoperable, the psychological impact on him or her will be catastrophic. Many people believe that if a patient is informed of the truth and treated for the cause of the disease, such as chemotherapy, he or she will die faster than if the patient does not know. Therefore, patient confidentiality has become the most important measure after diagnosis, and once chemotherapy is used, people with a little medical common sense will know the true condition of their own.
It is undeniable that psychological factors play an important role in the treatment and prognosis of lung cancer patients. However, if there is still a chance for chemotherapy, it is an unwise negative choice to give up chemotherapy in order to conceal the disease. First, through continuous efforts, chemotherapy has become one of the most effective etiologic treatments for advanced lung cancer, and patients who receive etiologic treatment have longer survival.
The median survival time is extended from 3 months to 6 months to 8 months to 10 months compared to patients who did not receive chemotherapy. The median survival time is even longer if the medical technology is better in large hospitals.
In fact, since patients have already developed lung cancer, they cannot expect to get relief by adjusting their psychology. The worsening of symptoms can also lead to pessimism of patients. Some patients do not think they are suffering from lung cancer, but in turn blame the doctors for their lack of seriousness in diagnosis and treatment, and blame their family members for their lack of dedication in seeking medical treatment, which leads to confrontation due to lack of understanding and naturally cannot cooperate with treatment properly.
4.The right to choose the cause of treatment
From the legal point of view, everyone has the right to know about their own health, and should not be decided by others (including relatives) when facing the choice of survival. In the case of serious health problems, patients should have the right to know their own health status and the right to choose medical treatment. It is also morally inhumane to conceal the true condition of a patient while there is still a chance of prolonging life, and to be placed on simple symptomatic treatment or to forgo treatment.
After learning that one has lung cancer, especially at an advanced stage, it is indeed a great emotional shock for the patient. However, like the two sides of a coin, there is a positive side to learning about the disease, and the desire to live cannot be underestimated. After the initial physical shock, if properly guided, the patient can better cooperate with the treatment.
Since the patient’s psychology has a great impact on the prognosis of the disease, it is very important to protect the patient’s psychology. The family can choose an appropriate time to tell the patient’s diagnosis with reservations, so that the patient can be aware of his or her condition, and at the same time comfort and encourage him or her so that he or she can actively cooperate with the treatment. And in this process, you can seek the help of doctors.
5.Economic support for chemotherapy
The social reality that we have to admit is that many families are not very rich at present, and the potential of advanced lung cancer patients to create wealth through productive labor is not much, and may even be close to zero. Chemotherapy drugs are not cheap, especially imported chemotherapy drugs are generally very expensive, and the cost of radiotherapy is not low either. This is a very heavy burden for low- and middle-income families to pay for the treatment of lung cancer patients. For many families, especially farmers and workers, a patient can easily lose his family’s money.
However, in recent years, domestic production technology has been greatly improved, and the quality of domestic therapeutic drugs is not much different from that of imported drugs, but the price is much lower. Patients and their families can communicate, communicate and negotiate with doctors about their own economic situation, so that they can develop suitable treatment plans according to their own economic strength and choose relatively inexpensive drugs as much as possible, so that patients can get the last chance to save their lives and achieve the purpose of prolonging their lives as much as possible. Moreover, with the gradual improvement of medical insurance at all levels, patients are expected to alleviate their financial pressure to a certain extent through various medical insurance.