Senator Miriam and lung cancer

(Conclusion)

It’s never an easy question for a doctor to answer when his/her cancer patient asks: “How long more do I expect to live?”

There are cancers which are curable when diagnosed and treated early. These are breast, cervical, uterine, ovarian, bowel, prostate and even lung cancers, as well as some types of leukemia. The long-term outlook is excellent and many cancer survivors are likely to die of something else than the cancer they originally had.

Prognosis

When talking about the prognosis of a disease (outcome or course of the disease), experts usually speak of survival rates. Cancer survival refers to how long afflicted patients live after cancer is diagnosed. This is reported as the percentage of people (actual number out of 100 cases) who live for a given period of time after the cancer is diagnosed. When one says X percent of 1-year survival rate or 5-year survival rate, he/she refers to the number of patients out of 100 who will still be alive after one year or five years, respectively.

But these survival statistics are just a fair estimate of survival, based on data from large groups of patients. Individual patients can always deviate from the statistics. So many factors come into play. For example, cancer patients who maintain a positive outlook despite their disease generally live longer.

I have just talked on the phone to an elder cousin, who was diagnosed with stage 4 thyroid cancer which has spread to the lungs almost two years ago. She experiences some discomforts every now and then, but by God’s grace, she still remains upbeat about her health condition and is enjoying every minute of it.

Her social schedule has not changed since she was diagnosed with late-stage cancer. She plays mahjong regularly, and would be among the first one to visit when a friend or relative gets hospitalized.

I’d say the prognosis would not be as good in a patient who was exactly the same type of cancer and extent of metastasis (spread), but who has become depressed and has chosen to isolate himself or herself.

Generally, prognosis of lung cancer depends on the type of lung cancer, stage at which it is diagnosed, patient’s age and general health, his/her response to treatment, and if the lung cancer has just been diagnosed or has already recurred (initially responded to treatment but has come back).

Based on lung cancer statistics, the overall 5-year survival for lung cancer is 16 percent. That means that 16 of every 100 patients diagnosed with the disease will still be alive after five years.

Based on the stage of the lung cancer upon diagnosis, estimates of 5-year survival are:

• About 52 percent for those with localized lung cancer;

• About 25 percent of people with lung cancer that has spread to nearby lymph nodes;

• About 4 percent of people with metastatic lung cancer that has spread to other parts or organs of the body (stage 4 cancer).

Breakthrough drug

But cancer researches have accelerated in pace in the past decade with the discovery of markers leading to a more effective, personalized and tailor-fit approach in the treatment even of stage 4 cancers.

Two years ago, I had the privilege to be invited to the presentation of clinical trials in Vienna, Austria, of a breakthrough drug in the treatment of stage 4 lung cancer. The new drug—afatinib—comes in tablet form, and is now approved as monotherapy for the specific or targeted treatment of a certain type of lung cancer more prevalent in Asians than in Caucasians. The cancer is characterized by mutation(s) of the cells in the lungs called epidermal growth factor receptor (EGFR). It requires a special testing for the mutation of the receptor (EGFR) to identify which patients are suitable for this targeted approach.

Clinical trials have shown that afatinib could really benefit patients with this type of lung cancer by significantly delaying tumor progression, accompanied by improvements in their lung cancer-related symptoms like shortness of breath, cough and chest pain. Their overall quality of life is also improved.

After the meeting, I had a lengthy discussion with some of the clinical investigators, and I could judge from their enthusiasm in discussing the specific results of their researches that they were really convinced on the safety and efficacy of afatinib, and how it could really help many stage 4 lung cancer patients by adding additional survival time, while at the same time maintaining a reasonable quality of life despite being afflicted with a late stage cancer.

Indeed, treatment of stage 4 cancers does not only mean adding years to life, but adding life to one’s remaining years.

Praying

We join the rest of the nation in praying for Sen. Miriam Defensor Santiago’s victory over such a formidable foe. But she has the kind of mental and emotional stuff that can successfully engage in battle even the most intimidating and daunting enemy, and force it into submission.

This is the same kind of mental toughness and positive expectation that can also tame cancer cells into remission.

God be with you in this fight, Senator Miriam.