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I think I can, I think I can — I can do anything for 15 minutes. Nothing could have prepared me for the hijacking of my body the way cancer did. How long had those mutating cells been slowly taking over my lung? Had I been feeling healthy for a year, or two, or three, on the outside while inside my chest a mass began to build and then spread. It has taken me weeks to absorb the diagnosis. It could have been better. What could I have done to find this sooner? Why did I think it was possible to walk or run a half-marathon if I trained for a year? Cancer changes everything. On top of all things health-wise, it was a challenging winter. We almost didn’t make that first appointment on March 1. Snow began falling on February 28 at the rate of one inch per hour. Our driveway was impassable. We don’t own a large tractor, so we usually blew the snow into the trees with walk-behind snow blowers. Looking at the wind pushing the snow across the driveway, I panicked. My husband wanted me to cancel the appointment. I said, “No, I will walk to the main road if I have to, but I cannot give up an appointment that could save precious time in beginning treatment.” He dutifully dressed for the cold and began creating a path for the blade on the ATV. Eventually, he had moved enough snow for a vehicle to exit. That was only the first step of that morning’s commute. We had no idea what we could find on the farm-to-market road to Highway 1806. Depending on the wind’s direction, storms can build three-foot finger drifts across the road, making it difficult to see where the road ends and the ditch begins. Sinking into the ditch at 7 a.m. would be bad. Thank goodness, the road appeared to be fairly clear in the growing light of dawn. Northwesterly winds were continuing to blow the snow across the adjacent fields. Traffic moved slower than usual on the main roads and in town, but we made it to the Sanford Cancer Center by 8 a.m. It was the doctor who was a few minutes late, but I didn’t care. I was on the road to dealing with my diagnosis. In addition to the MRI that afternoon (which showed no cancer in my brain), several appointments were scheduled for the next two weeks. First — back to “Irrational Radiology” for another biopsy. This time my lymph node at the base of my neck. Second — after that biopsy, there would be a port placed. That’s a story for next week. Third — I will be doing chemoradiation followed by immunotherapy. Okay. Without question, I followed along as best I could with all this information. Fourth — A referral to a radiologist and the Bismarck Cancer Center. Things began to happen fast. I felt weightless in the atmosphere of the clinics, my thoughts focused on accepting the fact that I might not be here by the end of the year. These thoughts were only in my head because no one said a word about survival — except Google. And we all know better than to Google your way to good health. My referral to a radiologist began by filling out the same forms, different building, different staff, different MyChart medical portal, same me. Check the boxes — no illnesses, no drugs, no nothing, except this new cancer. Strangely enough, when I was told I would be seeing Dr. Reynolds, I asked if it was my Dr. Reynolds who had by chance re-entered the workforce. No. This would be a different Dr. Reynolds. Hmmmm. This Dr. Reynolds had piercing blue eyes and I still see him nearly every day on a television promo around the time we watch the news. Bismarck Cancer Center was a couple blocks away from the infusion center. Infusion center? I looked up the word. It means introducing a new element or quality into something. In medical terms that quality was liquid and varied from patient to patient. That experience comes later. We didn’t talk about that aspect of treatment in detail. Yet. Dr. Reynolds said radiation would be fairly painless, until the end of the six weeks when my esophagus would be “sunburned” and swallowing would become difficult. “Bulk up,” he said, after looking me up and down in the chair across from his. Nobody has ever suggested that to me before. I was trying to maintain my weight for my first-ever trip to Cancun in November. I had three new swimsuits and several other goodies ready to be packed into a new suitcase. I was hoping to make it to November and not be a different size — whether my weight goes up or down. You know what the images in my mind are at this moment. Again, the new doctor and new nurses explained what was going to happen over the next few months. Most of the information fell on deaf ears. It was only later that someone suggested recording these visits with my phone and reviewing the instructions at home. I think I was done with radiation by the time that information soaked into my brain. Somehow, the scheduling and treatments would be happening at the Bismarck Cancer Center in tandem with Dr. Rocket and the Sanford Cancer Center. Every week beginning when? March 20 — that’s two weeks away. “Treatment planning takes time,” Dr. Reynolds said. “And, there are a few more things we need to do. Are you claustrophobic?” YES. Really claustrophobic. Remember the story about burying people with a bell back in the day? Radiation didn’t involve being slid into a tube like the MRI, but it would take place on an open bed like a CT scanner. I can do that, I thought. That was NOT the gist of that question about claustrophobia. The doctor ran his hand over his face ear to ear and said they would be building me a plastic mask. To hold my head still. Accuracy was an important improvement to current radiation treatment. Okay, a mask like the ones we wore during Covid. I can handle that. I’m not that claustrophobic. “You mean like with a 3-D printer?” I said. He seemed puzzled at my question. I found out why a wee bit later. After a short wait, some young technicians appeared to escort me to a room I would become all too familiar with in the near future. While they did whatever they did to prepare me for what came next, I stood by observing the large area with cupboards and an enclosed “office” with large windows. In that area were computers under very low light. They prepared the scanner, which didn’t appear to be very scary at all, and collected the supplies needed for the next steps. Using a step stool and some helpful hands, I laid down on the scanner bed — a metal or hard plastic mattress covered with a clean sheet. We worked together to make it comfortable and made sure my body was positioned correctly. And, yes, when offered, I would love a warm blanket. I’m always cold. Then came building the mask. The mask was not a mask at all like I envisioned. I watched from my prone position as one of the two techs unwrapped a large piece of plastic with blue trim about an inch wide. This perforated white sheet reminded me of that new packing paper that folds like little accordions to protect things made of glass. I missed seeing the snaps around the outer edge. This sheet was warmed somehow somewhere beyond my field of vision until it became pliable. With a person on either side of me, they laid the sheet like a shroud over my face. It felt great, like being in a spa for a kinky facial. While it was still warm, they used their fingers to shape the plastic around my facial features, opening a small area around my nose. The girls took their time and carefully smoothed the plastic from the top of my head, over my face, around my neck to my breast. Their touch was light and soothing and it was a pleasant experience. Then they let it cool. The next step was tattoos. These tiny marks would be used to position my torso so the radiation would accurately enter my body where it was most needed. This would require the use of the computers originating from behind the glass-enclosed area. When all the instruments were adjusted, they were ready for the test scan, they brought it back. The mask. My plastic likeness was snapped down on the scanner bed pressing my head and neck in place with a rather loud sound. I panicked. I felt like I was choking. I waved my arms and the mask was quickly removed. Twice. I couldn’t do it. It had to be done and I knew it. But the thought terrified me. “Would you like something to hold in your hands?” “Yes, I think that would help.” I could not have been the first person to freak out in this situation because they knew how to talk me through the next steps. The girl to the right of the platform (it didn’t deserve to be called a bed) allowed me to hold her hand for a short time. It probably didn’t make her job any easier to work with only one hand. She had to leave, so her hand was replaced with a rubber ring. However, I was not allowed to hold it across my body like I wanted with both hands because that would interfere with whatever tattoos they were planning. My arms had to be by my side. “I can hold onto the bed,” I said white-knuckling the edges of the platform. That wasn’t a good idea. “We don’t want to pinch your fingers.” So they added handles like joysticks on either side like grips you would use when taking off in your rocket ship as the G-force presses down on your body. “I can do this. I’m ready.” I allowed them to snap the mask in place gripping the handles and slowing my breath so I wouldn’t cough. Somehow, I vaguely remember how I made it through the third time they snapped that mask into place. As unpleasant as the moment was, I concentrated on the praise music playing in the background. The thing about most songs is the length is approximately three minutes. They said my time under the mask would be about five minutes so I counted songs and envisioned Jesus right there in the room with me. It took what felt like an eternity as I counted the seconds of each tune until they came back and quickly released me from my prison. I made it. After the scan, which I am assuming required computer-generated positioning to match the areas in the PET scan that lit up bright pink in the middle of my torso. (Yes, I accidentally saw the scan at this appointment on Dr. Reynold’s computer.) As he turned the computer screen towards me, his exact words were, “You are really lit up.” “Thanks.” I was okay with glowing in the dark on the outside, but did not feel very comfortable about the fluorescent pink area glowing in the middle of my chest. To assist with positioning the “beam,” directly at those pink areas, those two kind and patient technicians dropped some ink in three places across my torso and poked it in place with a needle. The first drop and poke didn’t hurt, but a large black and blue mark appeared around the area. The second drop was lost in my belly fat, but the third must have hit a nerve because that poke hurt. Once home, when I looked for those tats, the marks were so small I could barely find them after scrubbing the Sharpie’s dots away in the shower. “For that kinda money, I would have expected larger tattoos,” I said to no one within earshot.

Hi I’m a 35 year old female, non smoker diagnosed with NSCLC in May. I was pregnant when I was diagnosed and so it was based off an MRI which found a mass in my right lung and swollen lymph nodes. During pregnancy my only treatment option was taxol and carboplatin. I was allergic to the taxol and so we decided to wait until I delivered a few weeks later to do treatment after a ct and pet were done. After the scans they also found a spot on my hip and some nodules in my left lung and that classified me as stage lv. I just finished 4 rounds of cisplatin, pemetrexed, and keytruda done every 3 weeks. My scans after round two showed stability and even decreases. My scans now after round 4 shows increases as well as a few more spots on my hip. My doctor is looking for a clinical trial that might match one of the mutations I have before we have another regimen. I am currently being treated at MSK in NJ but this week while we are on a break from treatment we have decided to get second opinions from jersey shore and UPENN. Just wondering if anyone has had any experience with this regimen of chemo not working or any other types of chemo not working and what they did after it. I have read one story on here that was been truly inspiring. Any help, insight, or advice is greatly appreciated.

For the past 11 years, I’ve helped treat lung cancer patients as an RN in a cardiothoracic practice. Then last October, I developed a bad cough that lasted over a month. It was cold season, and my co-workers and I thought it might be pneumonia or even bronchitis. No one suspected it could be lung cancer, since I’m a nonsmoker and haven’t been exposed to common risk factors like asbestos, radon, or pollution. I had a chest ray taken, which showed fluid around my right lung. The tests of the fluid didn’t uncover anything extraordinary. I didn’t look sick, but I felt fatigued and at times, I had difficulty breathing. A few days later, I had a CT scan, which supported the pneumonia diagnosis, but it also showed a thickening on my chest wall. The doctors drained the fluid and tested it twice. Both times, the results came back negative for cancer cells. This didn’t completely rule out the possibility, but it gave us reasons to be hopeful. I started taking antibiotics and steroids, which were prescribed by a pulmonologist. But the second CT scan did not show any improvement. My first surgery was scheduled for late January. The doctors thought I had an infection and that they’d be able to clean it out. But during surgery, they discovered growths in my lung that had expanded into my chest wall. The hospital lab confirmed that it was lung cancer. My boss, cardiothoracic surgeon Carmine Frumiento, and my colleague, Danielle George, a longtime friend and physician assistant who I work with every day, had to give me, my husband, and my family the heartbreaking news that I have advanced lung cancer. It sounded so surreal that at first, I thought I was dreaming. I have a 6-year old daughter and a 2-year old son. All of the sudden, I went from being a care provider to being a patient. I had the surgery, and then later that week, I traveled to Massachusetts General Hospital to meet with some of the best specialists in the country. Danielle traveled to Boston with me and my husband, Chris. Before we left, Danielle and Dr. Frumiento helped us prepare a list of questions to ask the doctors at Mass. General. The doctors at MGH recommended starting a new targeted therapy without chemo or radiation. The results have been very promising on patients with my genetic mutation. But since the medication is so new, my insurance would not pay for it unless I tried an older treatment first. In order for her insurance to approve the new treatment, I would have to progress on the old treatment, or suffer from intolerable side effects. It felt like I was on an emotional roller-coaster. Fortunately, my colleagues helped me appeal the insurance company’s decision, and we won. I still work as a nurse, but I’ve cut down to just mornings, since I get very tired by the afternoon. I’m very grateful for the support of my work friends, who have become like extended family. They’ve helped to make sure I’m getting the best care. I realize that not all patients have those strong connections, and how important it is to advocate for yourself. I’ve been fortunate to have incredible support from my family, friends, and community. They’ve helped with everything from meals to child care to raising funds to help pay for my medical expenses. And my family was selected as the beneficiary of the Celebration of Courage Co-ed Hockey Tournament earlier this month. My husband has played in the tournament for many years to help support and raise funds for families affected by cancer. Now, our family is affected by cancer. It is likely that my cancer will never go away, but I have been told that the genetic mutation cannot be passed down to my children. The goal is to turn my cancer into a manageable chronic disease that I can live with until better treatments are available. I hope my story will raise awareness that lung cancer can happen to anyone, even young nonsmokers. It’s a fact I never fully realized myself, until I was diagnosed. There is so much blame and stigma surrounding lung cancer. I want to help raise awareness about the resources that are available for anyone who is diagnosed.

FDA Grants Genentech’s Alecensa Priority Review for Initial Treatment of People with ALK-Positive Lung Cancer South San Francisco, CA -- August 2, 2017 -- Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY), announced today that the U.S. Food and Drug Administration (FDA) has accepted the company’s supplemental New Drug Application (sNDA) and granted Priority Review for Alecensa® (alectinib) as an initial (first-line) treatment for people with anaplastic lymphoma kinase (ALK)-positive, locally advanced or metastatic non-small cell lung cancer (NSCLC) as detected by an FDA-approved test. The FDA will make a decision on approval by November 30, 2017. “Phase III results showed Alecensa reduced the risk of disease worsening by more than half compared to the current standard of care and lowered the risk of tumors spreading to or growing in the brain by more than 80 percent,” said Sandra Horning, M.D., chief medical officer and head of Global Product Development. “We are working closely with the FDA to bring this medicine as an initial treatment for people with ALK-positive NSCLC as soon as possible.” This sNDA submission for Alecensa is based on results from the Phase III ALEX and Phase III J-ALEX studies. A Priority Review designation is granted to proposed medicines that, if approved, the FDA has determined to have the potential to provide a significant improvement in the safety or effectiveness of the treatment, prevention or diagnosis of a serious disease. Alecensa received Breakthrough Therapy Designation from the FDA in September 2016 for the treatment of adults with advanced ALK-positive NSCLC who have not received prior treatment with an ALK inhibitor. Breakthrough Therapy Designation is designed to expedite the development and review of medicines intended to treat serious or life-threatening diseases and to help ensure people have access to them through FDA approval as soon as possible. Breakthrough Therapy Designation was granted on the basis of the Phase III J-ALEX trial. Alecensa was granted accelerated approval by the FDA in December 2015 for the treatment of people with ALK-positive metastatic NSCLC who have progressed on or are intolerant to crizotinib. The ALEX study is part of the company’s commitment in the U.S. to convert the current accelerated approval of Alecensa in people with ALK-positive, metastatic NSCLC who have progressed on or are intolerant to crizotinib to a full approval as an initial treatment. Read the full press release here.

Hello everyone. My uncle was recently diagnosed with lung cancer, stage 3. Surgery is not an option, nor is radiation treatment. His only option is chemotherapy. He attempted to obtain a visa to the US in order to get treatment at MD Anderson Cancer Center in Houston, Texas but was denied the visa. He is now considering cancer centers in Germany. I have attempted to research the rankings of cancer centers in Germany, but have come to no conclusive result. I was wondering if anyone knows of a reputable cancer center (perhaps one that is particularly known for lung cancer) in Germany, based on past experiences or perhaps by word of mouth. Thank you all for your time.

Any body on Alimta? Side effects, success stories, etc. I start next Monday on alimta. First chemo platinum, then opdivo.

Hi: I am 52 years old and waiting for my biopsy results that I should have tomorrow. My Pulmonologist has stated to me that he believes this is Lung Cancer and a very aggressive form of it. He stated this again after doing the Bronchosopy. He took a lot of tissue when he was in there. I had a PET scan yesterday and should get those results tomorrow as well. Brain MRI scheduled the week after next (earliest I could get in). I have been searching the web for reasons to do, or not to do, Radiation and Chemotherapy. I am single with no SO or real family to speak of. This really is all about me. As this disease at the Stage III/IV is almost unbeatable. I am thinking more about the quality of the time I have left then the length of it. Thoughts and suggestions are greatly appreciated. Thanks for reading!

LUNGEVITY FOUNDATION INTRODUCES A NEW MOBILE APP TO HELP PATIENTS UNDERSTAND AND MANAGE LIFE WITH LUNG CANCER Lung Cancer Navigator is a Customized Communication Hub that Puts Education, Care Management and Personal Support in the Palm of Your Hand PR Newswire, WASHINGTON, DC (January 11, 2017) Click here to view the multimedia press release. LUNGevity, the nation’s leading lung cancer-focused nonprofit organization today launched a new mobile application designed to make understanding and living with lung cancer less daunting and considerably more manageable. The new Lung Cancer Navigator mobile app provides lung cancer patients with access to the latest medical and treatment information related to their specific lung cancer diagnosis, and serves as a convenient hub for organizing customized care and support networks, asking questions, describing and tracking symptoms, and managing multiple medications. Lung cancer is the second most commonly diagnosed cancer worldwide, with more than 1.8 million new cases diagnosed each year. The LUNGevity Lung Cancer Navigator app provides tools and forums to help those coping with the disease (including caregivers and support network members) communicate important details in real time, while handling care management needs with efficiency, medical guidance and less stress. “When someone receives a lung cancer diagnosis, it can be overwhelming,” said Andrea Ferris, President of LUNGevity Foundation. “Our goal with the LUNGevity Lung Cancer Navigator app is to empower patients and provide them with a forum for connecting to customized information and a support community that helps them navigate life with understanding and much less fear.” While lung cancer can affect anyone regardless of gender or ethnicity, only 18% of people diagnosed with the disease survive five years or more. LUNGevity Foundation strives to change outcomes for people living with lung cancer through research, education, support and advocacy. Through the LUNGevity Lung Cancer Navigator app, LUNGevity Foundation aims to provide patients and caregivers with a greater sense of empowerment, understanding and improved management of personal diagnostic, treatment and appointment information. The LUNGevity Lung Cancer Navigator was developed through an educational grant from Bristol-Myers Squibb. LUNGevity’s Lung Cancer Navigator Mobile App is available as a free download on iOS and Android devices. For more information and to view a demonstration video, visit https://www.lungevity.org/. About Lung Cancer: 1 in 15 Americans will be diagnosed with lung cancer in their lifetime More than 224,000 people in the U.S. will be diagnosed with lung cancer this year About 60% of all new lung cancer diagnoses are among people who have never smoked or are former smokers Lung cancer kills more people than the next three cancers (colorectal, breast, and pancreatic) combined Only 18% of all people diagnosed with lung cancer will survive 5 years or more, BUT if it's caught before it spreads, the chance for 5-year survival improves dramatically About LUNGevity Foundation: LUNGevity Foundation is firmly committed to making an immediate impact on increasing quality of life and survivorship of people with lung cancer by accelerating research into early detection and more effective treatments, as well as by providing community, support, and education for all those affected by the disease. Our vision is a world where no one dies of lung cancer. For more information about LUNGevity Foundation, please visit www.LUNGevity.org. ### Press Contact: Cynthia Inácio 212-561-7476 cynthia.inacio@kingcompr.com

Good afternoon, LCSC members! Every Friday, I will start sharing a weekly clip report in this forum. I encourage you to reply to each thread to let us know what kind of news stories are most interesting/relevant to you. I'll post the first weekly clip report this Friday, December 16! With gratitude, Lauren -- Digital Community Manager LUNGevity Foundation

I finished my chemo last Friday and got to ring the bell! But now the hardest part starts for me - waiting for the first post-treatment CT scheduled for July 1st. I'm an anxious person on a good day, so I would love to hear how any of you survive the period between scans. My wonderful oncologist said that if the CT is clear, I won't have to have another one for 6 months.

Cancer patients get a unique appreciation and understanding of the medical profession by the very nature of our disease. At the minimum, we interact with our GP, Oncologist or Radiologist, and a brace of medical testing and treatment nurses and technicians. This experience base gives us a lot of insight into the profession. Here is a synthesis of the insight I've accumulated over the years. Never go to a diagnostic "results revealed" medical consultation alone. If you don't understand the words the doctor uses, ask them to re-explain without the "medical/techno-speak." Tell the doctor your special circumstances or medical needs before hospitalization or infusion treatment. Ask these be captured in the admitting orders. Ask to see the admitting orders at admission or before first procedures. Don't get admitted if the order does not cover your special circumstance. Most procedures can be painless or discomfort can be minimized but you need to ask for relief before the procedure. For example, ask for a lidocaine injection before IV insertion or for Xanax to reduce anxiety during scans. These are examples of special circumstances that should be discussed with the ordering doctor at the time he orders the procedure. Don't be afraid to complain. Be kind at first but if the situation is not resolved to your satisfaction, add anger. Remember, you are paying for all this and you are a customer as well as a patient. People in the medical profession are like people in any profession. Some are good and some are not so good. The difference is medical professionals have unique authority and special powers that say a consulting engineer or a lawyer will not have. To get prospective on a new medical professional, pay attention to how he or she interacts with the office or clinical staff. They won't treat you any better than the people they work with every day. The best doctors treat people, not patients. Try and find ways to remind them you are a person. Tell them you are afraid or uncertain, for example, to help them recall they are dealing with a human being. I always find a way to ask if they pray before a procedure. Most medical professionals, unless also cancer survivors, won't have any idea how or what you are feeling. Tell them before, during and after a procedure.

This is my story of survival. It tells of an encounter with a disease of death - lung cancer - and significant life after, a very precious and rare thing. Who I am is unimportant; what I've experience is: eleven plus years of treatment and survival. These words are set down for but one reason - to raise a call to arms to fund lung cancer research. Enough have suffered. It is time for change. I am not a doctor; indeed I possess little medical knowledge. I am, however, a very experienced and long-tenured lung cancer patient. That gives me a unique prospective on the disease that kills more, many times more, than any other type of cancer. I'll avoid statistics. They are readily available form any number of reputable resources. But, I have a firm belief that lung cancer research is poorly funded because it is considered a self-induced disease. I believe my cancer was caused directly by cigarette smoke. I recall a time when many of my peers smoked but they stopped well before middle age. I couldn't. I am addicted to nicotine. Every time I'd try cessation, the addiction would draw me back. Of course, people make a choice to take up smoking but that choice is made primarily when we are young and influenced by peer behavior. Young people do dangerous things. Consult the ubiquitous YouTube "fail videos" for validation. However, there are other disease that we choose to give ourselves. Consider Human Immunodeficiency Virus (HIV) as just one example. Yes, some acquire it from medical transfusion or inadvertent needle sticks, but most are afflicted as a result of a behavior choice. HIV is described as a world-wide pandemic. It may be and in the US to address this largely self-induced disease, we invested $3.074 billion (billion with a B in 2012 for research. Consider further, we spent $1.052 billion on drug abuse funding and that is clearly self-inducted. Compare these with $314.6 million invested in lung cancer research (NIH Data). We spend about 10 times more on HIV/AIDS than lung cancer and drug abuse research garners 3.4 times more funding! In 2012, 47,989 people were diagnosed with HIV infection and about 13,834 died. In that same year, about 226,160 people were diagnosed with lung cancer and 160,340 died! Lung cancer kills 5 times more than HIV in the US. Lung cancer should be our pandemic! In 1998, the US and State Attorney's General entered into a Tobacco Master Settlement Agreement to collectively settle filed law suites against tobacco companies. This yielded $206 billion over a 25-year period. How much of that is dedicated to lung cancer research? About 0.065% or just over $1 billion is earmarked for federal research. Where does the money go? That is a very good question. We need to SCREAM about this inequity. If you are reading this, you are likely suffering from lung cancer or have a family member or close friend suffering. You've read or seen TV news coverage about the horrors of HIV/AIDS but thankfully, it is a problem most American families do not encounter. Yes there is a stigma of self-affliction for lung cancer but the same stigma should attach to HIV/AIDS. It does not and I wonder why my disease is so under accommodated! We speak of those who suffer or pass from lung cancer as engaged in battle. There is no battle for engaging in battle entails a choice. One can retreat. When diagnosed with lung cancer there are but two choices: treatment or death. Statistically for lung cancer, there is treatment and death! Treatment borders on barbarism that is repetitively endured, with uncertain outcomes, and with death looming closely. I was and still am to some degree overwhelmed by fear. I still get scanned once a year and the time between diagnostic scan and results is a nightmare to endure. My treatments nearly killed me, several times. I survived, not knowing why. My survival is hope for those who suffer, particularly for those 230,000 Americans who will receive a lung cancer diagnosis this year. If I can survive, so can you. But, we ought not rely on hope as an effective treatment method. We collectively need to speak out to those that decide on allocations of disease research dollars. Engage your elected officials. Ask them why they continue to under allocate research funding for our disease. Remind them that between 15 and 18-percent of lung cancer diagnosis arise from people who never smoke. Ask them if they are willing to rely on hope if they receive a lung cancer diagnosis.