Running head: IMPACTS OF LUNG CANCER 1

Impacts of Lung Cancer

Kenneth R. Williams
University of San Diego
IMPACTS OF LUNG CANCER 2

Abstract
Lung Cancer is one of the leading causes of death worldwide, and a diagnosis can often have a

grim outlook. A Lung Cancer diagnosis can carry a heavy financial burden, with the average cost

of health care in the month of initial diagnosis exceeding twenty-five thousand dollars; this isn’t

considering the societal burden of lack of productivity, lack of wages, or personal burdens

(Dieguez, 2017). Environmental factors play a large part in mutating the genes that can lead to

Lung Cancer; currently governments have been making strides to reduce these factors. These

include providing Lung Cancer screenings and aggressive anti-smoking campaigns. There has

been a great deal of Lung Cancer therapy research and current patients now have a multitude of

treatment options, such as immunotherapy, proton therapy, and personalized targeted therapies.

These additional methods can be used in combination to reduce the severity of the cancer and

increase overall chances of survival.

IMPACTS OF LUNG CANCER 3

Lung Cancer (both small and non-small cell) is the third most common cancer, after skin

and prostate/breast cancer (American Cancer Society, 2018). The American Cancer Society

(ACS) estimates that there are about 234,000 new cases of lung cancer each year, as well as

154,000 deaths from lung cancer. According to the ACS, lung cancer takes more lives than any

other cancer, killing more people than colon, breast and prostate cancer combined. The ACS

states that the probability of being diagnosed with lung cancer is high, 1 in 15 men will develop

lung cancer while 1 in 17 women will.

Non-Small Cell Lung Carcinoma (NSCLC) constitutes 80-85 percent of all lung cancer

diagnosis (American Cancer Society, 2018). The ACS states that NSCLC is especially dangerous

in that symptoms are not evident until the cancer has metastasized. Yet the ACS has documented

cases where symptoms arrive before the cancer spreads, these can include: a constant cough,

chest pain, or reoccurring lung infections. The root cause for nearly all causes of NSCLC are

genetic mutations in one of five genes: EGFR, ALK, ROS1, BRAF and KRAS (Zhu, 2017). Zhu

(2017) goes on to describe these genetic mutations as largely attributed to environmental factors

including: smoking, exposure to radon, exposure to asbestos, and air pollution. Zhu (2018) also

states that a personal or family history of lung cancer can increase an individual’s odds of

developing NSCLC.

Steps must be taken to reduce the overall rate of NSCLC. For an average patient who has

stage 3 or 4 cancer, they can expect to pay on average, $20,106 per month on treatment (Skinner

2018). A cost this high, can mean life or death for patients with NSCLC. The overall cost

demonstrates the imperativeness of the Affordable Care Act, without the ACA patients would
IMPACTS OF LUNG CANCER 4

have to choose between life or paying $20,000 for every month of treatment, regardless of the

treatments efficacy.

Background

Lung Cancer is the leading cause of cancer death around the world, this is likely due to

poor prognosis, where incidence likely means mortality. As of 2016, the five-year survival rate

was less than 18% (Zappa, 2016). According to Zappa (2016), the single largest contributor to

this disease is smoking, and as smoking rates fall, the rate of lung cancer decreases as well.

Zappa (2016) goes on to discuss that there are other factors such as genetics and environment

which can be alleviated through targeted therapy and environmental regulations respectively.

In 50-70% of Non-Small Cell Lung Cancer (NSCLC) cases, the patient experiences a

cough due to a mass present in the airwaves, and in some cases this obstruction leads to post-

obstructive pneumonia, and distal atelectasis (Wu, 2018). As mentioned by Wu (2018), this

mass in the airwaves causes hemoptysis in 25-50% of cases and dyspnea in another 25%, it also

observed that 20% of all cases experience chest pain. Patients can frequently experience fatigue

(98%), loss of appetite (98%), respiratory problems (94%), cough (93%), pain (90%), and blood

in sputum (70%) (Polanski, 2016).

Treatment options very greatly by cancer stage. According to ACS (2018), stages I and II

will require surgery to remove the tumor, and radiation therapy may be considered based on

tumor size. The ACS suggests that Stage III will require a mix of chemotherapy, radiation and

hopefully surgery. The ACS describes Stage IV as being very difficult to treat, and treatment will

include the mix from every stage prior, but considering the situation is dire, other methods can be
IMPACTS OF LUNG CANCER 5

used. Stage IV patients will also receive targeted therapies, immunotherapy, or photodynamic

therapy (American Cancer Society, 2018).

Social and Economic Impact

Lung cancer is a very costly form of cancer. For most individuals prior to a diagnosis,

they can expect to pay under $1,000 for all health-related expenses per month (Dieguez, 2017).

Dieguez (2017) goes on to discuss that it was found that upon diagnosis, most cancer patients

have a health-care bill as high as twenty-five thousand dollars in the month of diagnosis. Diegues

(2017) has shown that this number does decrease in the following months, but it will never return

to the costs prior to the diagnosis. In fact, in usually stays just under $4,000 per month up to 36

months after diagnosis.

Cancer puts a very large strain on the U.S. health care system. Over $87 billion dollars

was spent on cancer related healthcare in 2014, which was paid by all sources; employers,

insurers, tax funded programs and families (American Cancer Society, 2017). Fourteen percent

of all cancer diagnoses are lung cancer, and assuming costs are consistent among cancer types,

over fourteen billion dollars is spent each year solely on lung cancer. These values do not even

consider the non-medical values associated with cancer, such as job loss, relocation fees,

caregiving costs.

When individuals are given a diagnosis of a late stage lung cancer, it can be compared to

a death sentence. Long term survival is very low, with a median survival time of under a year

(Prabhash, 2013). This can lead to the development of additional social support groups, primarily
IMPACTS OF LUNG CANCER 6

among primary providers and close family members to deal with the stress. Social support has

been shown to inhibit tumor growth, and reduce the severity of cancer (Hinzey, 2016).

Emerging Trends

While in most cases late stage cancer is a very grave diagnosis, there are emerging

treatments that may potentially help extend the life of patients. With the completion of the

human genome project (HGP), the new information provided by this research has led to the study

of genetic mutations and how they cause Lung Cancer (Wheeler, 2013). The HGP has led to the

development of big data science in mapping genes and proteins that are related to cancer (Hood,

2013). Pharmaceutical study of these genes allows for the development of targeted therapies;

specific drugs that address the cancer-causing mutations and either repairs, replaces or kills the

cancerous cells (Skinner, 2017). This process is an alternative to chemotherapy and has a

different host of side-affects than traditional chemotherapy; instead of targeting all rapidly

dividing cells, targeted therapies can uniquely target the cancer cells (Skinner, 2017).

There are a host of additional methods that manage lung cancer, these include:

immunotherapy, traditional chemotherapy, and radio therapy/surgery. The ACS describes

Immunotherapy as the process of changing signaling proteins on cancerous cells, so that the

body’s own immune system can attack and kill these cells. A serious side effect of

immunotherapy is that there is no way to specifically target cancer cells, so healthy cells are

sometimes killed in the process (American Cancer Society, 2018). Chemotherapy is a series of

drugs that cause apoptosis in rapidly dividing cells, typically considered the gold standard in

cancer treatment, it proves most affective in stages II and III in Lung Cancer, as it will typically

prevent the cancer from returning (CancerCare, 2018). Chemotherapy drugs also aid radio
IMPACTS OF LUNG CANCER 7

surgery by potentially reducing the size of the tumor. Radiotherapy or radio surgery, is the

process of applying radiation to a cancerous area to kill off the tumor. The current hotspot of this

area is targeted proton therapy (National Association for Proton Therapy, 2018). If cancer is

limited to the chest, medical professionals can use a proton beam to deionize, and ultimately kill

cancerous cells in a three-dimensional space completely bypassing healthy tissue (National

Association for Proton Therapy, 2018).

Federal and State Programs

Considering the largest factor in developing lung cancer is smoking, the best way to

reduce cancer rates is educational programs on the negative effects of smoking. These anti-

smoking campaigns have significantly reduced lung cancer rates, from 2005 to 2014, the total

percent of smokers in the US dropped from 20.9 percent to 16.8 percent (Dennis, 2015). Over

this same period, the rate of new lung cancer cases in the same population dropped from 59 per

100,000 individuals to 48 per 100,000 (National Cancer Institute, 2018). As in terms of how

much smokers are smoking, Dennis (2015) reports that the percentage of smokers who smoke 30

or more cigarettes per day has also dropped from 12.7 percent to 6.9 percent.

Occupational conditions also contribute to lung cancer rates. As a result, the government

has taken steps in addressing lung cancer. One such case is the Department of Energy providing

early Lung Cancer screening to its employees. Employees who had long term exposure to

carcinogens such as asbestos, beryllium, radioactive materials, nickel and chromium would meet

the screening criteria (Office of Environment, Health, Safety & Security, 2018). Even though

individual branches of the government may provide preventative care and screening for Lung

Cancer, Lung Cancer research is poorly funded across cancer types, when comparing across
IMPACTS OF LUNG CANCER 8

death rates. According to the Lungevity organization (2018), Lung Cancer receives about one

dollar per life lost, to every ten dollars that breast cancer receives. Where the 5-year survival rate

is currently 90% for breast cancer, it remains at 18% for Lung Cancer (Lungevity, 2018).

Conclusion

Cancer is the second leading cause of death in the United States (Center for Disease

Control, 2013), second only to heart disease, with lung cancer being the most fatal form of

cancer that affects both genders equally. Steps must be taken to reduce the overall rates of lung

cancer, a relatively preventable form of cancer. The leading cause of lung cancer is smoking, and

there has been a strong anti-smoking campaign in the past few decades. In 1965 the smoking rate

was 42.4% of all individuals (Center for Disease Control, 1999), to 16.8% in 2014 (Jamal, 2015).

The second leading cause is radon poisoning, which occurs naturally and can get trapped in

houses, a radon detector can alert individuals when radon is present (Center for Disease Control,

2018).

Considering the massive toll lung cancer takes in terms of health, productivity and

personal wealth, it is imperative to reduce its occurrence. While it may not be possible to outlaw

smoking, continued research into treatment must continue. Mankind is experiencing a

renaissance of technology with the current state of the Internet and the completion of the Human

Genome Project, and these technologies have spurred a breadth of alternative medical treatment

methods. Targeted Therapy, Immunotherapy, and Protein Therapy are all viable methods to treat

lung cancer and the funding for these methods must continue. Cancer is such a diverse complex

disease, that the best course of action, is to have a multitude of therapies to kill the disease

(Bukowska, 2015).
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There may also be upcoming methods for cancer research that are not commercially

released. What may be the most promising method for future treatment is a potential cancer

vaccine. Recently a cancer vaccine was developed that successfully removed the tumor in 87 of

90 of mice with various forms of lymphoma, breast cancer or colon cancer (Rettner, 2018). A

potential vaccine could be the most effective means for preventing, and treating cancer, and

shows how vital it is that research is funded.

IMPACTS OF LUNG CANCER 10

References

Achievements in Public Health, 1900-1999: Tobacco Use --United States, 1900-1999. (1999,

November 05). Center for Disease Control. Retrieved April 08, 2018, from

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a2.htm

American Cancer Society. (2017, April). The Costs of Cancer. Retrieved April 1, 2018, from

https://www.acscan.org/sites/default/files/Costs of Cancer - Final Web.pdf

American Cancer Society. (2018). Immunotherapy for Non-Small Cell Lung Cancer. Retrieved

April 01, 2018, from https://www.cancer.org/cancer/non-small-cell-lung-

cancer/treating/immunotherapy.html

American Cancer Society. (2016, May 16). Non-Small Cell Lung Cancer Risk Factors. Retrieved

March 19, 2018, from https://www.cancer.org/cancer/non-small-cell-lung-cancer/causes-

risks-prevention/risk-factors.html

Bukowska, B., Gajek, A., & Marczak, A. (2015). Two drugs are better than one. A short history

of combined therapy of ovarian cancer. Contemporary Oncology, 19(5), 350–353.

http://doi.org/10.5114/wo.2014.43975

Center for Disease Control. (2018, February 08). Lung Cancer. Retrieved April 08, 2018, from

https://www.cdc.gov/cancer/lung/index.htm

Center for Disease Control. (2013, March 01). QuickStats: Number of Deaths from 10 Leading

Causes -National Vital Statistics System, United States, 2010. Retrieved April 08, 2018,

from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6208a8.htm
IMPACTS OF LUNG CANCER 11

Dennis, B. (2015, November 12). Who still smokes in the United States — in seven simple

charts. The Washington Post. Retrieved April 1, 2018, from

https://www.washingtonpost.com/news/to-your-health/wp/2015/11/12/smoking-among-

u-s-adults-has-fallen-to-historic-lows-these-7-charts-show-who-still-lights-up-the-

most/?utm_term=.871de4fba378

Dieguez, G., Ferrero, C., & Pyenson, B. S. (2017, April 11). A Multi - Year Look at t he Cost

Burden of Cancer Care (Rep.). Retrieved April 15, 2018, from Pfizer, Inc website:

http://us.milliman.com/uploadedFiles/insight/2017/cost-burden-cancer-care.pdf

Hinzey, A., Gaudier-Diaz, M. M., Lustberg, M. B., & DeVries, A. C. (2016). Breast cancer and

social environment: getting by with a little help from our friends. Breast Cancer

Research : BCR, 18, 54. http://doi.org/10.1186/s13058-016-0700-x

Hood, L., & Rowen, L. (2013). The Human Genome Project: big science transforms biology and

medicine. Genome Medicine, 5(9), 79. http://doi.org/10.1186/gm483

Jamal, A., et al. (2015). Current Cigarette Smoking Among Adults — United States, 2005–2014.

Morbidity and Mortality Weekly Report, 64(44), 1233-1240. Retrieved April 15, 2018,

from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a2.htm.

Lungcancer.org. (2018). Non-Small Cell Lung Cancer Treatment. Retrieved April 01, 2018, from

https://www.lungcancer.org/find_information/publications/163-lung_cancer_101/269-

non-small_cell_lung_cancer_treatment
IMPACTS OF LUNG CANCER 12

Lungevity. (2017, November 21). Lung Cancer Funding Statistics. Retrieved April 16, 2018,

from https://lungevity.org/research/translational-science-research-program/lung-cancer-

funding-statistics

The National Association for Proton Therapy. (2018). How It Works. Retrieved April 02, 2018,

from http://www.proton-therapy.org/howit.htm

National Cancer Institute. (2018). Cancer Stat Facts: Lung and Bronchus Cancer. Retrieved

April 02, 2018, from https://seer.cancer.gov/statfacts/html/lungb.html

Office of Environment, Health, Safety & Security. (2018). Early Lung Cancer Detection

Program. Retrieved April 02, 2018, from https://www.energy.gov/ehss/early-lung-

cancer-detection-program

Polanski, J., Jankowska-Polanska, B., Rosinczuk, J., Chabowski, M., & Szymanska-Chabowska,

A. (2016). Quality of life of patients with lung cancer. OncoTargets and Therapy, 9,

1023–1028. http://doi.org/10.2147/OTT.S100685 Treatment Choices for Non-Small Cell

Lung Cancer, by Stage. (20). American Cancer Society. Retrieved April 1, 2018, from

https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/by-stage.html

Prabhash, K., Bal, M., Jiwnani, S., Thippeswamy, R., Noronha, V., Krishna, V., . . . Pramesh, C.

(2013). Stage IV lung cancer: Is cure possible? Indian Journal of Medical and Paediatric

Oncology, 34(2), 121. doi:10.4103/0971-5851.116207

Rettner, R. (2018, March 29). A Cancer 'Vaccine' Cured 97% of Tumors in Mice. What's That

Mean for People? RetrievedApril 08, 2018, from https://www.livescience.com/62161-

cancer-vaccine-trial.html
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Skinner, K. E., Fernandes, A. W., Walker, M. S., Pavilack, M., & Vanderwalde, A. (2017).

Healthcare costs in patients with advanced non-small cell lung cancer and disease

progression during targeted therapy: A real-world observational study. Journal of

Medical Economics, 21(2), 192-200. doi:10.1080/13696998.2017.1389744

Wheeler, D. A., & Wang, L. (2013). From human genome to cancer genome: The first decade.

Genome Research, 23(7), 1054-1062. doi:10.1101/gr.157602.113

Wu, Ke, et al. “Lung Cancer.” Pathophys.org, 2018, www.pathophys.org/lung-

cancer/#Pathophysiology_and_clinical_features.

Zappa, C., & Mousa, S. A. (2016). Non-small cell lung cancer: current treatment and future

advances. Translational Lung Cancer Research, 5(3), 288–300.

http://doi.org/10.21037/tlcr.2016.06.07

Zhu, Q., Zhang, S., Ding, X., He, B., & Zhang, H. (2017). Driver genes in non-small cell lung

cancer: Characteristics, detection methods, and targeted therapies. Oncotarget,8(34).

doi:10.18632/oncotarget.17016