What if I told you that there are things you can do to raise your chances of survival with lung cancer - and those things don't include surgery, chemotherapy or radiation therapy? The truth is, there are things you can do to help improve your odds. Things that are natural and non-medical, such as lifestyle factors and social support.
In the same breath as I say that, I don't want anyone feeling that they are not doing enough. We all know of people who did everything right and developed cancer and it progressed anyway. The fact remains that the survival rate from lung cancer is not what we wish. But even if these tips don't improve your own survival, they may improve the quality of life you are living today.
1. Find Support
Feeling socially isolated certainly doesn’t feel good, but having a strong support system may actually improve survival with lung cancer. Not all studies have shown this. One recent study found that patients undergoing surgery for lung cancer did not appear to fare better or worse if they had good social support.
Yet reviews of other studies suggest otherwise. One large study (one that looked at the results of nearly 150 studies) looked at the effect of social relationships on illness and mortality from a wide range of medical conditions. It appeared that people with stronger social relationships had a 50% increased likelihood of survival. Looking at cancer alone, another study (that compiled nearly 90 studies) found that high levels of perceived social support were linked with a 25% lower relative risk of death.
Having a support network alone can help, but we also need to ask and receive. After I was diagnosed with cancer, one of the best bits of advice I received was to learn to receive. Not just because I needed the help, but because it is actually a gift we can give others. As one friend told me, "The best way to express gratitude for a gift is to receive it fully." People want to help. It’s important to keep in mind that one friend or loved one can’t do it all. Cancer can literally take a village. Some people enjoy listening. Others enjoy cleaning. Yet others enjoy providing rides.
2. Know the Symptoms of Depression
Studies have shown that psychological distress, such as ongoing depression and anxiety, are a predictor of survival for people with cancer – and this connection is especially strong among people living with lung cancer.
In people with advanced lung cancer, those who were depressed at the time of their first chemotherapy treatment lived only half as long as those who were not depressed. In another study median survival (that is, the amount of time after which 50% of people are still living and 50% have died), was four times shorter in people who were depressed.
The risk of suicide is also two to 10 times higher among people with cancer than the general population. The risk is greatest for men and in the first months after a diagnosis of cancer.
It’s important to distinguish between depression in the setting of cancer and normal grief. Most everyone feels sadness and grief as they cope with a diagnosis of cancer, but clinical depression is less common. It can be helpful to familiarize yourself with the symptoms of depression, and to talk to your doctor if you feel depressed.
3. Ask for a Palliative Care Support Visit
I’m sure some of you said "huh?" when you read the headline above. Isn’t that like hospice? Why are you talking about that in an article about ways to improve lung cancer survival?
The term palliative care is largely misunderstood. It's an approach that seeks to improve the quality of life for people experiencing a serious medical condition, by addressing emotional, physical as well as spiritual needs and concerns. During a palliative care support visit, most people meet with a team that includes a physician, a nurse, and a social worker, in order to address the full spectrum of concerns you may have during your cancer treatment.
A 2010 study demonstrated that people with advanced lung cancer who had a palliative care consult following their diagnosis, survived on average 2½ months longer than those who did not have a consult.
Some cancer centers are now routinely providing a palliative care consult early after a diagnosis of cancer. If you haven’t been given this option, it might be worth asking your oncologist what is available at your particular cancer center.
4. Nurture Your Spiritual Life
Even though the medical profession has been slow to incorporate spirituality into cancer treatment plans, an active spiritual life may play a role in lung cancer survival.
First, it is important to define spirituality. The National Cancer Institute defines spirituality as an individual's belief about the meaning of life. For some people, this may take the form of organized religion. For others, it may be represented by meditation, yoga or communing with nature.
A few small studies on people with Stage IV lung cancer found that people with a more active spiritual life not only had a better response to chemotherapy, but survived for a greater length of time.
That said, I know of many people with very active spiritual lives who lost their battle with lung cancer. Yet even if an active spiritual life does not improve survival, other studies have found that spirituality clearly plays a role in coping with cancer and quality of life while living with cancer.
5. Get Past the Stigma
Most people with lung cancer are too familiar with the stigma of the disease. What is one of the first comments people make? "How long did you smoke?" Insensitive remarks can be stressful when you are trying to cope with the rigors of treatment. But beyond that, the stigma of lung cancer has actually kept some people from getting the care they need and deserve. Studies have also shown that physicians, at times, are less aggressive in treating lung cancer patients than patients with other forms of cancer.
Make sure to read the section in this article about being your own advocate (below).
6. Have an Understanding of Blood Clots and Their Prevention
Blood clots, also known as deep vein thrombosis, occur in 3% to 15% of people with lung cancer. Blood clots usually form in the legs or pelvis and can be life-threatening if they break off and travel to the lungs. In one study, there was a 70% increased risk of dying in people with lung cancer who experienced blood clots.
7. Eat a Healthy Diet
We know that eating a healthy diet can make us feel better, but it may also lower the chances of the cancer recurring. The American Institute for Cancer Research (AICR) has come up with dietary recommendations for people who hope to prevent cancer in the first place. For cancer survivors, they recommend following these guidelines to try to prevent a recurrence.
Check out the article below for the AICR's recommendations and to find out about studies that have looked at the effect of diet on lung cancer.
8. Get a Little Exercise
Physical activity has been shown to play a role in lung cancer prevention, but it's a little less clear whether it can improve survival in people already living with the disease.
For those who can tolerate exercise, it may lower the likelihood of premature death and also reduce the risk of death due to other age-related diseases. Survival aside, studies do show that exercise improves the quality of life for people living with lung cancer. Currently, we don't know what type of exercise or the amount of time spent on it that is most helpful. Ask your oncologist what she recommends.
9. Quit Smoking
I chose to include smoking near the bottom of this list because I don’t want to add to the stigma of lung cancer. But continuing to smoke after a diagnosis of lung cancer can mean lower survival.
In the past, studies suggested that people who quit smoking after a diagnosis of lung cancer do better with surgery and respond better to radiation therapy. For people with early stage lung cancer, a more recent study showed an even more dramatic effect of quitting. In people with early stage non-small cell lung cancer and limited stage small cell lung cancer, five-year survival more than doubled in those who were able to kick the habit after their diagnosis.
If you are struggling to quit, check out the quit smoking toolbox article below as a start.
10. Be Your Own Advocate
We don't have any clear statistics that tell us that being our own advocate raises survival. But we do know that getting the best care possible is important.
Finding an oncologist and hospital system you feel comfortable with is a start. Asking questions and doing your research (and having loved ones help if needed) may help with those decisions. For example, some studies suggest that survival from lung cancer surgery is higher at hospitals that do greater volumes of surgery. The option to explore clinical trials may also be important to you. Despite the fact that the National Cancer Institute recommends looking into clinical trials if you have Stage III or Stage IV lung cancer, only a small number of lung cancer patients do so.
Check out the articles below on being your own advocate:
American Institute for Cancer Research. AICR’s Guidelines for Cancer Survivors. Accessed 11/13/11. http://preventcancer.aicr.org/site/PageServer?pagename=patients_survivors_guidelines
Anguiano, L. et al. A Literature Review of Suicide in Cancer Patients. Cancer Nursing. 2011 Sep 23. (Epub ahead of print)
Arrieta, O. et al. Association of Depression and Anxiety on Quality of Life, Treatment Adherence, and Prognosis in Patients with Advanced Non-small Cell Lung Cancer. Annals of Surgical Oncology. 2012 Dec 22. (Epub ahead of print).
Chen, M. et al. Depressive symptoms during the first chemotherapy cycle predict mortality in patients with advanced non-small cell lung cancer. Supportive Care in Cancer. 2011. 19(11):1705-11.
Giannousi, Z. et al. Nutritional status, acute phase response and depression in metastatic lung cancer patients: correlations and association prognosis. Supportive Care in Cancer. 2011 Oct 1. (Epub ahead of print).
Hamer, M. et al. Psychological distress and cancer mortality. Journal of Pscyhosomatic Research. 2009. 66(3):255-8.
Holt-Lunstad, J. et al. Social relationships and mortality risk: a meta-analytic review. PLoS Medicine. 2010. 7(7):e1000316.
Jones, L. Physical activity and lung cancer survivorship. Recent Results in Cancer Research. 2011. 186:255-74.
Levi, D. et al. Determining incidence and predictors of deep vein thrombosis in patients with non-small cell lung cancer. Journal of Clinical Oncology. 2006. 24(18S):7159.
Lissoni, P. et al. A spiritual approach in the treatment of cancer: relation between faith score and response to chemotherapy in advanced non small cell lung cancer patients. In Vivo. 2008. 22(5):577-81.
Lissoni, P. et al. Efficacy of cancer chemotherapy in relation to synchronization of cortisol rhythm, immune status and psychospiritual profile in metastatic non-small cell lung cancer. In Vivo. 2008. 22(2):257-62.
LeConte NK, Else-Quest NM, Eickhoff J, Hyde J, Shiller JH. Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer. 2008. 9(3):171-8.
Parsons, A. et al. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. British Medical Journal. 2010. 340:b5569.
Pinquart, M. and P. Duberstein. Associations of social networks with cancer mortality: a meta-analysis. Critical Reviews in Oncology/Hematology. 2010. 75(2):122-37.
Pinquart, M. and P. Duberstein. Depression and cancer mortality: a meta-analysis. Psychological Medicine. 2010. 40(11):1797-810.
Pirl, W. et al. Depression after diagnosis of advanced non-small cell lung cancer and survival: a pilot study. Psychosomatics. 2008. 49(3):218-24.
Saito-Nakaya, K. et al. Marital status, social support and survival after curative resection in non-small-cell lung cancer. Cancer Science. 2006. 97(3):206-13.
Tagalakis, V. High risk of deep vein thrombosis in patients with non-small cell lung cancer: a cohort study of 493 patients. Journal of Thoracic Oncology. 2007. 8:729-34.
Temel, J. et al. Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine. 2010. 363(8):733-42.
Wassenarr TR, Eickhoff JC, Jarzemsky DR, Smith SS, Larson ML, Shiller JH. Differences in primary care clinicians’ approach to non-small cell lung cancer patients compared with breast cancer. Journal of Thoracic Oncology. 2007. 2(8):722-8.