Lung Foundation Australia is pleased by the announcement that Atezolizumab will be listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of locally advanced or metastatic non-small…
The treatment recommended for you will depend on your lung cancer type, the stage of the cancer, your general health and breathing capacity. It can be difficult deciding on the type of treatment to have. You may feel pressured to decide quickly or feel anxious to get started. It is important to take the time to understand the options and make a decision that you feel comfortable with.
When making a treatment decision important points to consider are:
- Know your options
- Record the details
- Ask questions
- Consider a second opinion
- It’s your decision
Lung cancer treatments aim to:
- Shrink the tumour size
- Relieve symptoms
- Improve the ability to live comfortably from day to day
- Prolong life
Lung cancer treatments fall into three categories:
- Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy tumours in the lungs. If the cancer has spread to other parts of the body, local therapies may be used to control the cancer in those specific areas also.
- Systemic therapy: Chemotherapy and targeted therapies are systemic therapies. These drugs enter the bloodstream to destroy or treat cancer throughout the entire body. These therapies are given as oral tablets by mouth or by infusions directly into the bloodstream via veins.
- Immunotherapy: is a treatment that stimulates or suppresses the immune system to help the body fight cancer.
Depending on your needs and wishes, at different times throughout your lung cancer experience you will be cared for by a range of health professionals, each of whom specialises in a different aspect of your treatment and care. You may have different types of doctors, for example, a medical oncologist and a radiation oncologist, and a specialist lung cancer nurse, a physiotherapist, a social worker and a palliative care specialist, to name a few.
In some hospital settings, these health professionals work together in a formal arrangement called a multidisciplinary team, or MDT. The multidisciplinary approach to cancer care is considered best-practice in treatment planning and care provision. The benefits of this approach for patients include increased survival, shorter time frames from diagnosis to treatment, and improved access to information and psychosocial support.
Ask your doctor about the arrangements of your treatment and care. If the hospital where you are attending does not have an MDT to manage your treatment and care, ask your doctor about how you can be linked with other health professionals that can assist with your supportive care needs, for example, a specialist lung cancer nurse or physiotherapist.
Alternatively, a list of the locations and details of lung cancer MDTs in Australia can be found here.
Treatment options for lung cancer
There are different treatment options available for lung cancer patients. Treatment decisions about which option/s are suitable for you are dependent on:
- Sub-type and stage of NSCLC
- If certain biomarkers are present
- How well your lungs are working
- Other health problems which may increase the toxicity of therapy
- Your ability to perform activities of daily living without assistance, like eating, bathing and dressing.
Surgery for lung cancer can be offered to people with Stage 1 or Stage 2 lung cancer. The type of surgery offered depends on the location of the cancer, its size, and your general well being and fitness including your lung function.
The main types of surgery are:
- WEDGE RESECTION: Part of the lobe of a lung is removed.
- LOBECTOMY: An entire lobe of a lung is removed.
- PNEUMONECTOMY: An entire lung is removed.
All surgeries should include testing of the nearby lymph nodes that are associated with the affected part of the lung. This is important to check if cancer has spread to lymph nodes. If cancer is detected in the lymph nodes you may require further treatment with chemotherapy or radiation therapy.
Radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread. Radiation therapy may be offered on its own or in combination with surgery or chemotherapy. Radiation therapy can be delivered over a period of a few weeks for curative treatments or for one to five days for palliative treatments. Radiation therapy is usually only given Monday to Friday.
The two most common forms of radiotherapy are described below.
- EXTERNAL BEAM RADIATION THERAPY (EBRT) – the radiation is delivered from x-ray beams that come from a machine outside the body.
- STEREOTACTIC BODY RADIATION THERAPY (SBRT) / STEREOTACTIC ABLATIVE RADIATION THERAPY – (SABR) – the delivery of higher doses of radiation to the cancer using a small number of treatments, usually four treatments over a couple of weeks.
Radiation therapy may be prescribed to you as a stand-alone treatment or in combination with chemotherapy. There are a variety of protocols for delivering radiotherapy for lung cancer and you will be offered what is appropriate for the individual circumstances of your lung cancer after consultation with a Radiation Oncologist.
Chemotherapy is the use of drugs to kill cancer cells or slow their growth. It is usually given intravenously (directly into a vein) or sometimes given as pills or tablets. Chemotherapy can be a single drug or a combination of two or more different drugs. The drug combination, number of doses, and how often you receive chemotherapy is decided by a Medical Oncologist and is dependent on the individual circumstances of your lung cancer.
Chemotherapy can used at different points of the treatment journey.
- NEOADJUVANT CHEMOTHERAPY – given before surgery to try to shrink the cancer and make surgery possible.
- CHEMORADIATION – before or during radiation therapy to increase the effectiveness of radiation therapy.
- ADJUVANT CHEMOTHERAPY – given after surgery to reduce the risk of recurrence.
- PALLIATIVE CHEMOTHERAPY – for advanced lung cancer to reduce symptoms and improve quality of life.
Targeted therapies are aimed at a specific mutation within cancer cells Molecular testing results of your lung cancer will identify if you are a candidate for targeted therapy. Targeted therapies will only be offered as treatment if your cancer contains the target that a drug takes action against. The most common “targets” in NSCLC are gene changes in EGFR, ALK and ROS1. Targeted therapies are not currently available for SCLC. Targeted therapies are currently only prescribed for advanced or recurrent lung cancer.
Immunotherapy is treatment that works by allowing the immune system to destroy cancer cells. Immunotherapy drugs are often called “checkpoint inhibitors” and are approved for use in NSCLC. They work by blocking proteins called PD-1 or PD-L1 that are produced by some cancers. Your lung cancer should be tested for the presence of PD-1 or PD- L1 to find out if immunotherapy is a treatment option for you.
Immunotherapy is given intravenously (into a vein) and can be prescribed as a stand-alone treatment, in combination with chemotherapy, or after chemotherapy. The appropriate protocol for your lung cancer will be determined by a Medical Oncologist.
Clinical trials are research studies to evaluate new cancer treatments. There are many different circumstances where you may consider a clinical trial. Participating in a clinical trial may be an option you choose even if you have the option of other active treatments. Alternatively, you may have already tried the standard treatment or there may be no further options for active treatment available.
Clinical trials look at new ways to prevent, detect, or treat a disease. Treatments might be drugs already approved for use but in different combinations, or new surgical procedures or devices. These trials can also look at other aspects of care, such as improving the quality of life. Talk to your healthcare team about whether a clinical trial is right for you.
Palliative treatment aims to manage symptoms without trying to cure the disease. It can be helpful at any stage of advanced lung cancer to improve quality of life and does not mean giving up hope. Palliative care aims to help you live as long as possible in the most satisfying way you can.
Chemotherapy, radiation therapy, targeted therapy and immunotherapy may be used palliatively the slow the spread of cancer and/or control symptoms. The Palliative care team is a team of health professionals who aim to meet your physical, practical, emotional, spiritual and social needs. The palliative care team support patients, families and carers.
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