With limited options available, there’s an urgent need for new treatments for people living with small cell lung cancer.
Lung cancer is the leading cause of cancer death in Canada. There are two main types of lung cancer — non-small cell lung cancer (NSCLC), which accounts for about 80 to 85 per cent of lung cancer cases, and the less common, but much more aggressive, small cell lung cancer (SCLC) which accounts for about 15 per cent of cases.
“SCLC is a relatively rare form of cancer, but because it’s so aggressive, it’s often detected in the later stages after it has metastasized outside of the lungs,” says Dr. Shaqil Kassam, Medical Oncologist at the Stronach Regional Cancer Centre and Medical Director of Research at Southlake Regional Health Centre in Newmarket, Ont.
Significant impacts on patients and family members
“Often, a diagnosis of SCLC can affect a person’s quality of life, from impacting their ability to work to maintaining social relationships,” says Peter Glazier, Executive Vice President at the Lung Health Foundation. “An SCLC diagnosis can lead to increased stress, anxiety, and depression for patients as well as the family members or caregivers of those living with lung cancer who have the added responsibility of providing care.”
SCLC is a relatively rare form of cancer, but because it’s so aggressive, it’s often detected in the later stages after it has metastasized outside of the lungs.
Aside from being a devastating diagnosis, advanced SCLC can cause multiple debilitating symptoms, ranging from shortness of breath and cough to more generalized symptoms of fatigue, loss of appetite, and weight loss. While SCLC tends to grow rapidly, it can also respond rapidly to chemotherapy, which has been the standard treatment for over two decades.
“The major problem, though, is that the positive effects of current treatments generally don’t last, and after a while, the cancer almost inevitably starts to grow and spread again,” says Dr. Paul Wheatley-Price, Immediate Past President of Lung Cancer Canada. “It becomes easy to see why SCLC has such a major impact on the patient who is facing a life-limiting disease, as well as the family members who strive to support them.”
Treatments not advancing as rapidly as for other cancers
In contrast to the treatment of non-small cell lung cancer (NSCLC), which has had multiple breakthroughs in the past decade, advances in SCLC have been more modest. “One reason for that is we discovered that nearly 60 to 65 per cent of NSCLC cancers have a driver mutation that tells the cancer to grow, and we have effective drugs to target that mutation which patients respond well to,” says Dr. Kassam. “The problem with SCLC is that there are many driver mutations, so getting a single treatment to target them all is a challenge.”
Urgent need to do more for SCLC community when it comes to researching and accessing novel treatment options
There’s an urgent need for new and more effective SCLC treatments to be developed and made accessible to Canadian lung cancer patients, across all provinces and territories. “This requires both development of new treatments through research and then timely approval of effective treatments through our regulatory systems across Canada,” says Dr. Wheatley-Price.
Dr. Kassam believes that more research and understanding of the disease will be key to improving quality of life and increasing survivorship (what he refers to as “quantity of quality life”), so patients can have additional time with their loved ones. “We need to figure out what’s driving this cancer to be so aggressive and resistant, and then find ways to target those gaps to develop better treatments .”
As a small patient group often facing late-stage diagnosis, the SCLC community is frequently sidelined in the development of and access to novel treatments. “Because it’s such a resistant cancer, we aren’t necessarily going to see the same homerun types of improvements that we’ve seen, for example, with NSCLC, skin and breast cancers,” says Dr. Kassam. “It’s going to be along the lines of small incremental gains, which may not seem like a lot, but for patients with SCLC, those small incremental gains can be huge. It means they get to see a grandchild being born, go to a wedding, or experience one more holiday season.”
To help speed up the regulatory approval and public funding for new treatments, patient family members can play a role in advocating on behalf of their loved ones by reaching out to their government representatives. “Because these patients are so sick initially and the survival rate is not long, they can’t really advocate for themselves. It really falls on the family members to help governments understand what they and their families are going through,” says Dr. Kassam.
A need to change the conversation
One of the challenges with lung cancer is its association with tobacco exposure, which can lead to stigmatization. “As a society, we must recognize that lung cancer can occur in those currently, formerly, or never exposed to tobacco and that all Canadians are entitled to the best of cancer care, regardless of the type of cancer, their age, gender, or tobacco exposure,” says Dr. Wheatley-Price.
“We challenge Canadians to start asking why it’s the least funded of all cancers,” adds Glazier. “If we change the conversation, we can begin to eliminate some of the barriers that are leading to poor outcomes for SCLC.
If you are a family member of someone living with SCLC, connect with Lung Health Foundation or Lung Cancer Canada to learn more about becoming a lung health advocate and elevating your voice to become an agent.
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