Lung Cancer in Canada
Lung Cancer in Canada
Problem Identification
Lung cancer is the most commonly diagnosed cancer in Canada, not counting non-melanoma skin cancers. Lung cancer is also the most common cause of death in Canada for both men and women. Particularly high rates are seen in the elderly, especially those over the age of 75. While Canada’s system of socialized medicine is applauded as a model for other countries struggling to establish government subsidized healthcare, there are also problems in Canada’s system. In a socialized medicine system, cost is always a factor, and there are rarely as many services as needed not are there enough healthcare professionals available or space in health care facilities open to account for all those in need of care. Wait time is also an issue when it comes to the ability to have surgical treatment for cancer. The waiting time for referral and surgery is a problem for those with both benign and malignant lung disease. Since cancer cells proliferate at a rapid rate and the longer the cancer has to grow the more likely treatment-resistant cells will develop, surgical intervention as early as possible is crucial for those with lung cancer. This waiting time is a particular problem since over half of those diagnosed are diagnosed in late stage, so these patients should be treated immediately.
Even with treatment there is a human burden for lung cancer in Canada. Those with lung cancer undergo distressing treatment and have a symptom pattern that drastically effects their quality of life. Additionally, there is a financial burden involved with lung cancer. In a country with socialized medicine cost is an important consideration and it is not as if there is an endless amount of funds for healthcare. Thus, policy based on financial considerations, often impacts the human condition for those with lung cancer. This could be accomplished through early care that would decrease the suffering experienced and possibly save lives, and the availability of palliative care that could ease some of the symptoms not decreased through traditional care. Additionally, overall quality of life related to current symptoms and outlook and concern about the future and relapse or increase in symptoms could also be improved.
Supporting Documentation/Evidence
Of all the individuals diagnosed with new cancer (not relapse) in Canada in 2014, estimates suggest that 14%t will be diagnosed with lung cancer. This percentage represents more than 26,100 Canadians. Estimates further suggest that more than 20,500 Canadians will lose their lives to lung cancer, representing more than 27% of deaths from cancer this year. The incidence rates of lung cancer increase as one ages and more than 50% of cases in Canada involve those over the age of 70. While incidence rates of lung cancer appear to have begun falling, this is not true in those age 75 and older, an age group which shoes significantly higher rates than younger age groups (Canadian Cancer Association, 2014).
Gender differences exist in incident rates and mortality rates with men being diagnosed with and dying from lung cancer at higher rates than women. In 2014, it is estimated that over 13,400 men will be diagnosed with cancer of the lungs. Of those, estimates suggest 10,800 men will die from their disease. It is predicted that 12,700 women will be diagnosed with lung cancer in 2014 while 9,700 will fail to survive the disease. In addition to these staggering statistics, a report from the Canadian Cancer Association (2014), states, “On average, 72 Canadians will be diagnosed with lung cancer every day. On average, 56 Canadians will die from lung cancer every day.” Five-year survival rates of those diagnosed in Canada with lung cancer average 14% for men and 20% for women. These low rates are of concern to health care professionals, politicians and consumers alike (Whiting, Brown, Alvi, & Tonita, 2010).
About 8% of all Canadian men are predicted to develop lung cancer over the course of their lives while almost as many men are expected to die from the disease. In terms of Canadian women, it is predicted that approximately 7% will develop lung cancer over the course of their lives and 6% will lose their lives to the disease (Canadian Cancer Society, 2014). The difference in prevalence and mortality rates between men and women are likely, at least in part, due to more men being smokers than women.
As over 50% of those diagnosed with lung cancer are over the age of 75, it is important to consider their ability to tolerate treatment. One study showed that of those treated with chemotherapy, only 68% were deemed fit to begin chemotherapy. Of those who began chemotherapy 48% failed to complete their regimen, 44% had their doses reduced due to intolerance and 69% completed their regimens with a lowered dosage. Those who did not complete their regimens were at 2.72 times greater risk of dying while those who completed their regimen but at a reduced dose were at 1.02 times greater risk of dying compared to those who completed their cycles at dosage. It is possible that the elderly who receive chemotherapy for lung cancer receive some benefit from reduced treatment as opposed to stopping when toxicity occurs (Fisher et al., 2010).
The economic burden of lung cancer is substantial. It is estimated that treatment and other incidentals related to the disease cost Canada over 12 billion in 2010. The main risk factors for lung cancer include smoking, second hand smoke and poor indoor and outdoor air quality. It is predicted that if risk factors are not reduced the cost will increase to 24.1 billion by 2030 while lung cancer rates would increase by 32%. Under a proposed plan to decrease risk factors, estimates suggest that while lung cancer rates will still increase by 29%, the costs associated with lung cancer would fall by 1.67% (Canadian Partnership Against Cancer, 2011).
The largest illness related burden for patients and their families comes during treatment. Treatment for lung disease is a very complex process and depends on many factors including malignant cell type, stage of illness, and treatment tolerance. Frequently, the treatment regimen includes surgery, radiation and chemotherapy all of which are difficult treatments to undergo.
Once a patient in Canada is diagnosed with lung cancer, the person is set up for treatment based on policy and availability of services. The gold standard in Canada for beginning services is four weeks. In and of itself one month until beginning treatment for lung cancer decreases the likelihood of success, however it also impacts the quality of life as more painful,l or toxic treatment may be necessary after waiting at least a month in addition to patients worrying about death and dying while waiting. Longer delays are more the rule than the exception when waiting for lung surgery due to lack of available operating rooms and qualified surgeons. Length of delays is not dependent on stage of cancer such that someone with advanced lung cancer must wait for treatment just as long as someone with Stage 1 cancer. In general, reports indicate significantly long delays between symptoms onset, initial connection with the health care system, evaluation and diagnosis and pulmonologist, surgeon and surgery referrals in patients who ultimately underwent surgery for lung cancer. There were also extensive wait periods reported post-operatively for patients needing chemotherapy and/or radiation (almost all).
Recommended Actions
Recommended public education actions include better preventive services aimed at health promotion and risk prevention. This would include better public education on a community wide basis. Ensuring a national program exists that can be carried out in individual communities to ensure that no one slips through the cracks is a crucial step in prevention. Public education focused on school systems should also be initiated in order to help prevent children from beginning to smoke. Smoke initiation is predicted by peer pressure and attempting to take on adult roles when before the child is fully mature. Public education targeting peer pressure and bullying can make a difference in smoking rates. Public education of adults who can intervene and help children learn how to respond to pressure along with public education methods aimed directly at training children and teens on effective methods for dealing with pressure to smoke can help decrease this preventable cause of lung cancer. Public education efforts aimed at instructing adults on how to provide acceptable opportunities for youth to take advantage of so they feel they are engaging in adult roles instead of being dismissed would also help in this endeavor.
As researchers have discovered other preventable causes of lung cancer, public education efforts should be focused on informing Canadian citizens of these factors also. In particular, avoiding second-hand smoke using radon detection monitors and having homes and business checked for asbestos are public service announcements which can be made as part of public education efforts. Ways to reduce environmental pollution and staying indoors when air pollution is high should be included public education campaigns. Finally, educating the public about the genetic links that exist in lung cancer and the need for regular screening for those who have first degree relatives who were developed lung cancer can help in early detection efforst.
Short Term and Long Term Goals
There are few if any short term goals in this system since there are many components, institutions, governmental officials, policies and financial realities that interact in complex ways. Long term goals would include a focus on research into prevention, and treatment or lung cancer in a larger framework of general health promotion. Studies which examine risk factors both those that can be controlled (e.g. smoking) and those which cannot be controlled (e.g. genetics) would be an important contributions. Longitudinal and cross sectional studies which look at the lung cancer prevalence and prevention across the age range and within specific age groups such as children, teens and the elderly would provide information to make differential prevention plans. Canada includes a number of different cultures within it and cultural investigations to determine what factors are important in high risk behaviors and the development of lung cancer in different populations would be important to protect different communities.
Focusing on short term and long term quality of life for lung cancer patients is another long term goal. It is not enough to treat someone medically, for complete healing to occur it is important to treat them mind, body and spirit. Helping the body but leaving the individual with anxiety, fear, blame and reluctance to rejoin life may fulfill the principle of beneficence or to do good for the patient but it does not fulfill the health care providers mandate of benevolence or the obligation to act when it is known a patient is in need. This is a conflict that occurs between health care providers and the socialized medical system in Canada in that the wait times before someone diagnosed with a life threatening illness can be treated is certainly not acting when someone needs help, doing good for the patient and it also skirts the boundaries of maleficence or do no harm since the delay could lead to the cancer spreading.
References
Canadian Partnership Against Cancer. (2011). Lung Cancer in Canada: A Supplemental
System Performance Report. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3207511/#!po=4.16667
Canadian Cancer Society (2014). Lung cancer statistics. Retrieved from
http://www.cancer.ca/en/cancer-information/cancer-type/lung/statistics/?region=pe
Fisher, S., Al-Fayea, T. M., Winget, M., Gao, H. and Charles Butts, C. (2012). Uptake and
Tolerance of Chemotherapy in Elderly Patients with Small Cell Lung Cancer and Impact on Survival. Journal of Cancer Epidemiology. Retrieved from http://www.hindawi.com/journals/jce/2012/708936/
Whiting, C., Brown, S., Alvi, R., & Tonita, J. (2010). A Call to Action for a Cancer Prevention
Plan for Saskatchewan: A Proposal for Discussion - Summary. Saskatchewan Cancer Agency.
