Changing trends in lung cancer treatment

Lung cancer takes more lives than any other cancer in the world. Quite interestingly, since smoking cigarettes is the most common cause of lung cancer, it is also an easily preventable cancer. According to the GLOBOCAN 2012, the estimated incidence of lung cancer in India was 70,275 cases, which included 53,728 new lung cancer cases among males and 16,547 new lung cancer cases among females. The National Cancer Registry Program found that rising cases of lung cancer are seen in the major metropolitan cities of New Delhi, Chennai, Mumbai, Bengaluru, and Kolkata.

Males are usually more affected by lung cancer than females. However, in the last decade, there has been an increase in the incidence of lung cancer in females. In a 2012 study conducted in the country, it was found that the ratio of male to female lung cancer incidence was 3.5:1 which has now narrowed to 2.5:1 over the last decade. This change in the male and female ratio might reflect the trend of decreased smoking worldwide as well as a shift in smoking practices with more females taking up smoking. What surprises the medical fraternity is that even though there seems to be a decline in smoking worldwide, overall lung cancer incidence has not correspondingly decreased. Doctors are now seeing cases of lung cancer in non-smokers as well.

Another trend is the change in the subtype of lung cancer is detected. Squamous cell carcinoma which was often the most common type of cancer diagnosed earlier and usually involves the more central part of the lung has now given way to Adenocarcinoma as the most common type of lung cancer (affecting the periphery of the lungs). This change could be attributed to people moving towards low tar cigarettes and filtered cigarette which means that carcinogens now reach the peripheral airways. Adenocarcinoma is also the most common type of lung cancer found in non-smokers.

Over the past decade, it has become evident that subsets of lung cancer can be further understood at the molecular level. Newer smokers with adenocarcinoma tend to have a higher incidence of a certain set of mutations. The heterogeneity of lung cancers suggests that mutation profiling of the lung tumour samples of all patients might have corresponding implications in lung cancer management as well. Some of these newer targeted therapies have not only been promising in alleviating patient suffering but there have been some game-changers in improving the progression-free survival time in the patient.

There is also a dire need for low dose CT scan to be introduced as a screening tool during regular health check-ups to catch lung nodules early. Most lung cancers in India are inevitably diagnosed in their advanced stages (Stage III and Stage IV).

The final and most important need in the Indian scenario is to develop more experts in palliative care practice to manage pain, weight loss, opportunistic infections and familial support groups to help the family sail through the difficult time. Beyond in-hospital based palliative care, home-based palliative care becomes important so that the patient can be in the vicinity of his family members during the course of illness. This not only gives immense peace of mind to the patient but also hope to fight the disease.

There is light at the end of the tunnel looking at the strides of progress that have been made over the last few decades in managing lung cancer.
The future holds bigger promises as the world is driving its energy and resources to find and curtail this lung cancer epidemic.

(The writer is a consultant and Interventional Pulmonologist at Aster CMI Hospital)