Living with lung cancer

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Living with lung cancer

By SAMEH FAHMY

The Tennessean

May 30 2005

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When Connie DeWitt was first told that she had lung cancer, two words popped into her head: death sentence.

''My mother was perfectly active at 72, and they told her she had lung cancer and she lived six months,'' the 56-year-old says.

DeWitt was diagnosed three years ago. But looking at her now, you wouldn't know she was undergoing treatment for cancer unless you asked.

Lung cancer is the No. 1 cancer killer in both men and women, but new drugs that target tumors while sparing healthy tissue and advances in administering radiation therapy and chemotherapy are helping patients live longer - and giving doctors reason to reassure DeWitt and others like her.

''They said, 'We've come a long way in 10 years,''' DeWitt recalls. '''You're not your mother.'''

DeWitt, of LaVergne, was one of the fortunate few who was diagnosed with lung cancer early. She had an unrelated cyst on her neck that doctors X-rayed, and they happened to find a 2-centimeter tumor.

A study of nearly 50,000 current and former smokers is under way to better understand how - or if - X-rays and more detailed spiral CT scans are useful for detecting lung cancer.

Results from the National Lung Cancer Screening Trial won't be available for several years, but already some people are asking their doctors for a CT scan.

There are risks. Anywhere from 25 percent to 60 percent of current or former smokers have some kind of abnormality that a CT scan would find. These abnormalities could be scar tissue, areas of inflammation or other conditions that aren't lung cancer but can look like it.

The test might also find small tumors that would never be life threatening.

To examine these abnormalities, doctors remove a small piece of lung tissue.

With this procedure, patients risk infection or other complications. Doctors might have to perform open lung surgery, which carries even more risk.

''The main risk in my view of screening is you can hurt the patient by trying to find out what's wrong when they really don't have cancer,'' says Dr. F. Anthony Greco, medical director of the Sarah Cannon Research Institute. ''And this is not rare.''

He and others generally don't recommend it for former or current smokers.

Targeted drugs

In addition to early detection, DeWitt had another advantage that her mother didn't. Doctors treated her with chemotherapy and an experimental drug called Avastin.

It's one of two main types of so-called targeted therapies that attack cancer cells while sparing non-cancerous cells. Avastin prevents the growth of blood vessels that feed tumors, so tumors essentially starve to death.

Dr. Alan Sandler, associate professor of medicine at the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., is leading a study of nearly 900 patients that compares combined treatment with the drug and chemotherapy versus chemotherapy alone.

Sandler presented preliminary results of his study this month at the annual meeting of the American Society of Clinical Oncology in Orlando, Fla.

The study found that patients with the most common type of lung cancer lived an average of 12.5 months with the drug compared to an average of 10.2 months without it.

''This the first time that an agent that targets new blood vessel development has shown a survival benefit in lung cancer,'' Sandler says.

Patients enrolled in the study had relatively advanced lung cancer, and Sandler expects the drug might be used with earlier stage disease with better results.

DeWitt credits the drug with holding her cancer at bay for a year, but her cancer has ''outsmarted the drug,'' she says, and is growing again.

She is currently being treated with Iressa, another targeted therapy that has shown mixed results. While Avastin targets blood vessel growth, Iressa and a similar drug called Tarceva target a protein that's mutated in some cancer patients.

Iressa was approved by the U.S. Food and Drug Administration in 2003 based on preliminary data for use in patients with lung cancer who have tried two chemotherapy treatments without success.

Although preliminary data suggests a benefit for Iressa, more recent data found no statistically significant benefit. The FDA is waiting for more complete data, which the drug maker expects in June, before deciding whether to pull the drug.

Tarceva, which a study found to have increased average survival from 4.7 months to 6.7 months, is still approved by the FDA.

Advances in chemo, radiation

As researchers search for and test new drugs, advances in delivering chemotherapy and radiation therapy are giving patients better treatment results.

Sandler says doctors are increasingly giving chemotherapy to patients after surgery to improve the survival rate of patients, and newer anti-nausea drugs and the use of antibiotics is making chemotherapy more tolerable for patients.

Study: Cancer patients suffer much more than physical pain

The Tennessean

A new study finds that the emotional and social effects of cancer can be the most difficult issues survivors face.

Dr. Steven Wolff, chairman of internal medicine at Meharry Medical College, surveyed more than 1,000 cancer survivors through the Lance Armstrong Foundation.

Wolff, a member of the foundation's board of directors, found that more than half say that emotional issues are more of a burden than the disease itself.

Among the findings:

70 percent of respondents had suffered depression due to cancer.

53 percent felt that emotional issues were more difficult to handle than the physical effects of cancer and its treatment.

49 percent said they had nonmedical cancer needs that were not being met, including emotional distress, financial problems and sexuality concerns.

''These findings show that cancer is a burden that never leaves an individual, even after therapy is completed,'' Wolff says in a statement.

''Most patients rate their psychosocial issues as the most devastating issues they face during cancer, saying they are more difficult to deal with than the treatment itself,'' says Wolff, who presented his findings recently at the annual meeting of the American Society of Clinical Oncology.

Survival rates

New advances in treatment offer hope that people diagnosed with lung cancer will be able to live longer.

Still, the percent of patients alive five years after diagnosis is significantly lower than many other cancers.

Five-year survival rate:

Pancreas, 4 percent

Lung, 15 percent

Ovary, 44 percent

Colorectal, 63 percent

Cervix, 73 percent

Breast, 88 percent

Melanoma, 91 percent

Prostate, 99 percent

- Source: American Cancer Society, Cancer Facts and Figures 2005

On the Web

American Cancer Society: www.cancer.org

American Lung Association: www.lungusa.org

American Society of Clinical Oncology: www.peoplelivingwithcancer.org

Lung Cancer Alliance: www.lungcanceralliance.org

Lung Cancer Institute: www.lungcanceronline.org

National Cancer Institute: www.cancer.gov

''Most patients rate their psychosocial issues as the most devastating issues they face during cancer, saying they are more difficult to deal with than the treatment itself.''

Dr. Steven Wolff, chairman of internal medicine at Meharry Medical College

THE PSYCHOLOGICAL EFFECTS OF DISEASE