If detected early, lung cancer curable

Lung cancer cases in India tend to be detected at an advanced stage. Currently, lung cancer survival is poor but by early detection, patients will have access to more treatment options, including surgery, leading to improved survival and quality of life. We are witnessing a revolutionary shift in surgical approach for lung cancer; from large, open approach thoracotomy surgery to minimally invasive keyhole surgery known as Uniportal VATS (Video-Assisted Thoracoscopic Surgery) using a single incision of 5 cm or less.

On average, there is a four-and-a-half month delay in consulting a doctor after noticing possible symptoms of lung cancer. Although early detection is one of the primary goals under a cancer control programme, the time lapse that occurs between the onset of symptoms to the initiation of treatment is usually referred to as “stages of delay”.

Diagnostic delays can occur, both due to patients not approaching a hospital or due to inappropriate referrals. Appraisal delay refers to the time taken from symptom detection to recognising the need to seek medical assistance. This delay has a higher occurrence in males and in lower socioeconomic strata.

Other reasons for delay include unawareness regarding the symptoms of cancer, consultation with unqualified local practitioners/no consultation, use of alternative medication, poor socio-economic conditions and lack of a proper referral infrastructure. Sometimes, patients delay treatment as they do not have anybody to escort them to a hospital or due to speciality hospitals being far, family commitment or even fear of death.

Many patients delay consulting a doctor because they initially think the symptoms are not serious. Once they do visit a doctor they often receive prescriptions such as antibiotics, inhalers or cough syrup. There is an essential role of general practitioners in proper and timely diagnosis and referral of cancer patients. Attempts must be mandated in this regard to educating the general practitioners.

Proper education is an imperative tool in the battle against cancer. To reduce secondary delay, initiation of intervention programmes to raise awareness on cancer as well as to equip doctors to make a confirmed and quicker diagnosis of cancer is required. The general population, especially those residing in the rural regions need to be made aware regarding the common signs and symptoms of cancer, and of the available cancer care facilities.

Private institutions should accept a patient only after due understanding, with the willingness to provide complete management, and shouldn’t stop the treatment due to monetary considerations. If a person is eligible for financial assistance, it should cover the entire treatment cost rather than a fraction of it.

Overlap of symptoms

Common symptoms at the time of presentation of lung cancer include cough, breathing difficulty, chest pain, fatigue, chest infection, blood in sputum and weight loss. Significant overlap occurs between these symptoms and symptoms of other chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD).

Such overlap in symptoms might lead to delay in recognition of lung cancer. Patients with typical lung cancer symptoms wait for around 30 days for referral for investigation. However, patients with atypical symptoms such as bone and joint pain, or fatigue wait for 105 days for a referral. One solution would be the establishment of diagnostic assessment units (DAUs).

DAUs offer a number of advantages including ease of access, access to multidisciplinary teams and training opportunities. Community health camps should be set up to help screen cancer at a much earlier stage than waiting for a patient to visit a hospital at an advanced stage. Identification of potential patients with typical symptoms at the village level by Asha workers and Anganwadi workers needs appreciation.

Screening of heavy smokers and those working in rock mining, haematite mining, asbestos, arsenic, nickel refinery, metal industries, chloromethyl chemical industries etc. should be made mandatory.

The real potential to reduce the burden of lung cancer in our community comes from smoking cessation programmes and effective tobacco control programmes. However, lung cancer remains the largest cause of cancer death and there is a need for effective early detection programmes.

There is a possibility of reducing delay at primary/secondary level by sensitisation training, counselling, intensive health education activities and appropriate referral to higher centre.

(The writer is Consultant Cardiothoracic Surgeon at BGS Global Gleneagles Hospital, Bengaluru)