Small Cell Lung Cancer Treatment
A question we are asked often when someone is diagnosed with small cell lung cancer is “what are small cell lung cancer survival rates?” This isn’t unexpected, given the reputation of lung cancer as having a poor prognosis relative to some other forms of cancer. Before answering the question, though, it is important to talk a little about how the answer—the statistical answer—is derived.
It’s impossible to talk about the prognosis of small cell lung cancer without beginning by talking about the many ways in which these numbers may vary from person to person.Small cell lung cancer survival can vary considerably among different people. Some of these variables include:
- The stage and possible spread of your cancer: Small cell lung cancer may be localized to your lungs (limited stage small cell lung cancer) or have spread to regions of your body beyond your lungs (extensive stage small cell lung cancer). Spread to the brain and liver, in particular, are associated with poorer survival.
- Your age: Younger people tend to live longer than older people with lung cancer.
- Your sex: The survival rate is higher for women with lung cancer at each stage of lung cancer.
- Your general health at the time of diagnosis: Being healthy overall at the time of diagnosis (something known as performance status) is associated with longer survival and a greater ability to withstand treatments that may extend survival.
- How you respond to treatment: Side effects of treatments, such as chemotherapy and radiation therapy, vary among different people, and may limit your ability to tolerate treatment.
- Other health conditions you may have: Health conditions such as emphysema may lower small cell lung cancer survival.
- Complications of lung cancer: Complications such as blood clots can lower lung cancer survival.
- Level of LDH or ALK: An increased level of the substances lactate dehydrogenase (LDH) or alkaline phosphatase, or a low level of sodium in your blood, is associated with poorer survival.
- Smoking: Continued smoking after a diagnosis of small cell lung cancer likely lowers survival.
When looking at survival rates, it’s important to keep in mind that these numbers are an “average: and can vary among individual people, Over the past several years, survival rates have improved with the use of radiation therapy and prophylactic cranial irradiation (PCI).
Although small cell lung cancer usually responds very well initially to treatment, long-term survival remains low. Survival rates for small cell lung cancer are different for different stages of the disease. Currently, the 5-year survival rate for stage 1 is 31 percent, for stage 2, 19 percent, for stage 3 it is 8 percent and only 2 percent for stage 4 disease. The median survival with treatment (that is, the time at which half of people are still living with the disease and half have died) is 18 to 24 months for people with early stage (limited) small cell lung cancer. For extensive stage small cell lung cancer, the median survival is 6 to 12 months with treatment and only 2 to 4 months without treatment.Keep in mind that these are statistics, and say nothing about individuals. Also, remember that statistics are by definition a few years old. In this way, they do not reflect newer treatments that may now be used to treat the disease.
In addition to the TNM staging, small cell lung cancer can also be staged by using a staging system developed by radiation oncologists. According to radiation oncologists, small cell lung cancer is defined as “limited stage” when the tumor is encompassed within a tolerable radiation field. Small cell lung cancer is defined as “extensive stage” when the tumor is too large or too widespread to be encompassed within one tolerable radiation field. When cancer has spread to distant sites (metastatic disease) it is always considered extensive.
There’s one last thing that is very important to keep in mind. While small cell lung cancer is not usually curable, it is treatable. These treatments may not only improve survival but help with the symptoms of lung cancer as well. Several treatments are currently being evaluated in clinical trials, and offer hope that small cell lung cancer survival will improve in the future.
Support and Coping
Even though fewer new treatments have been found for small cell lung cancer than non-small cell lung cancer, that is beginning to change. Clinical trials are looking at new treatments ranging from targeted therapies to immunotherapy, and several of these studies are currently in progress. Take time to learn as much as you can about your disease. Become your own advocate in your care. We are learning that being an active part of your healthcare team not only improves quality of life but may even play a role in survival. Lastly, become involved in the lung cancer community. The hashtag for finding people online is #LCSM. Joining in with others not only provides support from those who are living what you are, but can help you learn about new treatments for the disease.
Finally, a mindset that has helped many people cope with the challenging prognosis of small cell lung cancer is to “reverse” the statistics in your mind. You may hear of a cancer having only a 5 percent 5-year survival rate and think that means the odds are 95 percent that you will not survive. Some people with lung cancer have taken a different approach. Instead, you may want to look at the 5 percent of people who survive and say that you would like to be one of them. Then, by being your own advocate in your care as you look at options (such as clinical trials that may be appropriate) and look at the variables above (such as the fact that quitting smoking appears to raise survival for at least some people with the disease) and control what you can.
The face of lung cancer is changing. Treatments are improving, becoming both more effective and having fewer side effects. Survival rates are improving. Even those these numbers are saddening, there is reason for hope.