CANCER STORY: Success & Hard Truth

Lung cancer has an overall poor prognosis and low survival rate. The expected five-year survival rate in the US is about 15%. Sixty percent of patients die within one year of diagnosis and 80% die within five years.

For those with advanced disease, the median survival is four to six months if untreated, and 10% to 15% will remain alive for one year.

Lung cancer is often diagnosed too late, and it has often spread beyond the chest to other parts of the body before being detected.

Smoking 

Approximately 90% of lung cancers in men and 80% in women are attributed to cigarette smoking (in Clinical Oncology, American Cancer Society, pg. 269). CA Care experience showed that 82% of those who came to us with lung cancer were smokers or ex-smokers.

The Director General of the World Health Organisation, Dr. Gro Harlem Brundtland, said: A cigarette is a … cleverly crafted product that delivers just the right amount of nicotine to keep its user addicted for life before killing the person. 

Types of lung cancer 

There are two major types of lung cancer and they differ in their response to treatment:

1) Non-small cell lung cancer (NSCLC) accounts for about eighty percent of all lung cancer. It spreads more slowly and is usually not responsive to chemotherapy.

2) Small cell lung cancer (SCLC) or oat cell carcinoma. It makes up approximately 15% to 20% of all lung cancer. It is nearly universally smoking-related. It grows rapidly and often spread to distant parts of the body. It responds well to chemotherapy and radiotherapy but the response usually lasts for only a limited amount of time.

Metastasis

Metastasis to the brain is more frequent when the primary tumour is greater than 3 cm. Brain metastasis seems to occur in approximately 10% of small-cell-lung cancer patients at the time of initial diagnosis. Besides the brain, other sites of metastasis are bone, liver and the adrenal gland. 

The Deadly Disease and The Truth That You Need to Know

1.      Lung cancer is the most common cancer that afflicts mankind. Unfortunately, it is also the most deadly. A review of medical literature on lung cancer revealed a dismal track record in the treatment of lung cancer.

2.      Let me share with you CA Care’s experience with lung cancer. Based on the data of 627 cancer cases covering the period from September 2000 to February 2004, the following facts were apparent:

• Lung cancer represents 13.1% of all cancer cases and is the second most common cancer we have seen (the most common being breast cancer).
• A total of 40 patients were asked specifically if they were a smoker or non-smoker. Eighty-two percent of them who smoked for some 30 to 60 years
• ended up with lung cancer.
• Lung cancer patients were treated with chemotherapy (31.5%), radiotherapy (24.7%), surgery (11.9%) and oral drugs (2.6%). Do these treatment cure lung cancer? Unfortunately no. See below.
• From what we were told, 23.4% of those who came to us were medically given up. They were given three to six months to live or advised to go home and find some kind of alternative treatment.

Medical Treatment of Lung Cancer 

I have made a lengthy review of medical literature on lung cancer and I must say I am indeed saddened to learn of the dismal track record in the treatment of lung cancer. I did not expect such a poor performance at all.

People with lung cancer are asked toundergo surgery, chemotherapy and radiotherapy.  Most of the time patients die soon afterwards, irrespective of the treatments they had undergone. Can this be true? I wish that what I have read is not true.

Often we hear people parroting that medicine is based on solid, scientific research. Here is a body of research data on lung cancer, quoted from the world’s respected journals, and all seem to be pointing to the same conclusion: 

• Despite years of research, the prognosis for patients with lung cancer remains dismal.(Alexander Spira and David Ettinger. 2004. Multidisciplinary management of lung cancer. New England J. of Med. 350:379-392).

• Although chemotherapy may be a logical approach, there is virtually no evidence that it can cure NSCLC. The monetary cost … is high. The other cost of chemotherapy is its toxicity and its potential detriment to quality of life (Stephen Spiro and Joanna Porter, 2002. Lung cancer – where are we today? American Journal of Respiratory and Critical Care Medicine. 166:1166-1196). 

Disappointing as it may sound, the above statements sum up the reality of the situation. That’s about chemotherapy and lung cancer. What about radiotherapy?

Dr. Jeffrey Tobias, an oncologist whom I have very great respect for (Dr. Jeffrey Tobias and Kay Eaton in Living with Cancer) was very explicit when he wrote:

• For patients with NSCLC who are inoperable … radiotherapy is worth considering but in truth is likely to be more valuable for palliation of symptoms rather than a treatment with a real prospect of cure. 

Although it appears logical that patients need to undergo radiotherapy after surgery, a report by PORT Meta-analysis Trialist Group, 1998. Postopertive radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. The Lancet 352: 257-263, showed that:

• giving radiotherapy after surgery for early-stage lung cancer resulted in more death (66.9% of patients) than if patients were treated with surgery alone (61.6%).

This research report clearly carried this message:  radiation after surgery may cause death to lung cancer patients. In practice, are patients told about this risk? On the contrary, often they are told that radiation treatment is very safe, especially with the high-tech machine we have today.

In 2002, Eric Vallienes of the University of Washington, Seattle, USA, Adjuvant radiation therapy after complete resection of non-small-cell lung cancer. J. Clinical Oncology 20: 1427-1429, summed up the current position clearly:

• The role of adjuvant postoperative thoracic radiation therapy remains controversial.  There is no proven curative role for the use of adjuvant radiotherapy.  Despite this, adjuvant radiotherapy is still considered the standard … by many in the US.

I don’t intend to paint a pessimistic view about chemotherapy and/or radiotherapy for lung cancer, but I feel it is also my duty to point out the reality of the current situation. I do this with a strong belief that it is extremely unfair if patients were misled, mis-informed or dis-informed. Patients must be told the truth of their chances of a cure. If there is none, say is out loud and clear. It is no fault of anybody if no cure exists. After being told the truth, it is then up to the patients to decide what to do – to go for the invasive treatments or to seek other options. At the very least, patients should be given the option to make their own decision, after being told the bare truth about the treatments.

M. Cullen 2003. Chemotherapy for non-small cell lung cancer: the end of the beginning. Thorax 58: 352-356 wrote:

• In 1948 … was the first reference of chemotherapy in lung cancer … from this auspicious beginning there then followed a gap of almost forty years in which there was little progress, at least in SCLC. The absolute survival benefit for radical radiotherapy + chemotherapy was 4% at two years … 10% at one year.

Are patients told that they only have a 10% chance of survival after one year? (Note: the title of this paper is very interesting indeed – the end of the beginning!)

G. Silvestri. 20004. Chemotherapy for advanced lung cancer: is the glass half full or half empty?Thorax 59: 821 wrote:

• Respiratory physicians may not believe that the small survival benefit achieved with chemotherapy is enough to offset the toxicity associated with treatment. Perhaps we are biased against chemotherapy because we have seen the worst … neutropenic fever and sepsis after receiving chemotherapy. There is also a perception that the additional expense associated with chemotherapy does not outweigh the benefit, particularly as it relates to quality of life. Clearly, the benefit remains small and the toxicity remains real. The author suggested that patients with advanced lung cancer should share in the decision whether or not to undergo chemotherapy. 

After reading what Dr. Silvestri wrote, it dawned on me that in the US or UK, there seems to be two kinds of professionals: the respiratory physicians and the oncologists. Each of them may hold different views about lung cancer and they would probably advise you to do different things! So, pick your choice. 

The editorial of the Journal of Clinical Oncology 2000, Vol. 18(19): 3441-3445 had this curiously interesting title: Art of Oncology: When the tumour is not the target – Tell it Like It Is. The author wrote:

• When we honestly communicate the potential pros/cons of cytotoxic therapy for patients with incurable cancer, we allow patients the ability to make informed decisions. Some choose to proceed with cytotoxic therapy; some don’t. When we hold back the truth, either because it is too hard for us to do or because we don’t want to abolish hope, we diminish the chance for an appropriately informed decision to be made. I believe that this causes us to treat too many patients for too long, for little benefit, and without them knowing about it.

Take note of what the editorial said: I believe that this causes us to treat too many patients for too long, for little benefit, and without them knowing about it. Take note too that it comes from the Journal of Clinical Oncology.

If we ask patients what they expect or hope for, when they undergo chemotherapy, radiotherapy or surgery, most of them would say they expect to be cured. Period, or, if this is not at all possible, at least some degree of a fighting chance of a cure.

I have come across many patients, especially from Indonesia, who had used up all their life-time savings to pay the bills for their treatment. Some have even resorted to selling their land(s) or houses to raise funds to finance their search for a cure. One patient told me that one oncologist even asked his family to go home to Indonesia and sell their properties and then come back for more treatment. Sad indeed. In patients’ simple mind, after the treatments, their cancer will be gone forever. Does such a cure exist? Unfortunately not. That is if the research data published in the peer-reviewed journals are correct. Then, if a cure does not exist, were patients told about their odds?

Dr. Tom Smith (Medical College of Virginia, USA) puts all the cards on the table, allowing patients to make informed decisions about their care plans. I salute Dr. Smith for his dignified and honourable conduct. Let us pray that there are many more Dr. Smiths around. Dr. Mark Siegel of Yale University School of Medicine wrote: I support a model of shared decision making. However, many patients don’t seem to understand the jargons used in medical literature. There is a need for amore straightforward (and honest) way to describe these data … which will allow patients to understand. For example what does all these means: 10% survival at one-year, tumour response, etc? Why use complicated jargon? Trying to hide something? Why not just say how many died and how many cured after a treatment? Such concept is never used in cancer treatment. In oncology terms like response used to indicate tumour shrinkage is indeed mind-boggling. Let me explain.

Let me close with this quotation:

• Surgery, radiation therapy, combination chemotherapy or a combined approach … yet after 20 years the improvement in long-term survival has been slight. The current treatment is nonspecific, nonselective and toxic. New combinations of chemotherapy are not likely to make substantial improvements in survival. IT IS CLEAR THAT NEW APPROACHES ARE REQUIRED.( Lung Cancer – Time to Move On from Chemotherapy. Editorial, New England J. Medicine, 2002.46:126-128).
  

The above statement is made in one of the world’s most respected medical journal. Is there anyone still trying to deny that fact? Of course to the medical profession, new approaches means more of something of the same … more new chemotherapy or more of new machines or more of new drugs, etc.

But what about a new approach that involves a complete overhaul of the present, closed and lopsided mindset, to a new thinking altogether? What about a change of diet, lifestyle and use of non-toxic herbs instead?

Dr. Candance Pert was a research scientist at the National Institute of Health, USA and a Research Professor at Georgetown University Medical Centre, USA. She wrote (in Molecules of Emotion,pg.153) that her father was diagnosed with small-cell lung cancer in 1980. He underwent chemotherapy, bone marrow transplant and radiotherapy. After the seventh radio-treatment, she said: I noticed a distinct shift in my own feelings, from hopefulness to a numbing emptiness …  My father died almost a year to the day after being diagnosed. 

Dr. Pert wrote: Certainly, a new approach to the treatment of cancer … is desperately needed …Cancer continues to kill more people every year, often a slow and painful death made even more excruciating by toxic treatments. Most chemotherapy patients were dead within two years. 

State-of-the-art chemotherapy … was nothing more than different combinations of the same toxic drugs given on different schedules. If my father was going to survive, I knew that a new approach, a major breakthrough in understanding and treating this disease had to happen. 

Insanity: Doing the same thing over and over again and expecting different results. Albert Einstein.