Survivorship in Non-small cell lung cancer

Survivorship in cancer refers to the inclusion of no signs of cancer after the cancer treatment. Also, survivorship in cancer involves the conditions of the cancer patients living with, through, and beyond cancer. As per the definition, cancer survivorship begins at diagnosis and continues during cancer treatment and throughout the individual’s life. Therefore, survivorship involves the complexities of having cancer showing primary differentiation as per the individuals. 

The cancer survivors have experienced a mixture of feelings involving joy, concern, relief, guilt, and fear. Some individuals have revealed their experience of appreciating life more after a cancer diagnosis while gaining more acceptance of themselves. The other individuals also show anxiety regarding their health and uncertainties regarding coping with everyday life—the feelings of fear and anxiety that require effective communication with the healthcare team member. 

Coping Techniques

The survivors sometimes go through stressful conditions while interacting with their healthcare team by visiting them frequently after completing the treatment. The patient’s relationship with the healthcare team of cancer has provided a sense of security during treatment, and individuals often miss the required sources that support them. Some of the significant challenges, such as late treatment effects, emotional challenges, fear of recurrence, sexual health and fertility concerns, and financial and workplace issues, lead to significant patient problems. The primary coping techniques are needed for mitigating such challenges among the patients, which have been illustrated below:

• Understanding the challenges that the patient is going through
• Thinking about the possible solutions
• Asking for and allowing the support of others
• Making oneself comfortable with the significant course of action you choose

Support Groups

Many cancer survivors have joined the in-person support group or with an online community of survivors, which helps cancer survivors interact with individuals who also have similar experiences. Other choices for the support resources involve:

• Talking with a friend or member of your health care team.
• Individual counselling.
• Asking for assistance at the learning resource center where treatment is provided to the patient. 

Non-small cell lung cancer belongs to a broader category of lung cancers that originates within the lungs. Several factors such as age, stage of cancer, and overall health of the NSCLC patients’ have a significant impact on the chances of survival. Moreover, the considerable survival rate helps integrate the idea towards determining the patients’ living conditions after undergoing diagnosis compared with those without any of such situations. If the five-year relative survival rate is represented as 70%, it also implies that the individual with 70% tends to live for five years compared with others without such conditions. The calculation of relative survival rate depends upon every stage of cancer while providing a combination of close survival rates that relies on the average of all three phases. The results are often represented in the form of a percentage. 

The American Cancer Society (ACS) has revealed relative survival rates depending upon the Surveillance, Epidemiology, and End Results (SEER) staging. The SEER staging has also majorly involved three significant stages in the case of non-small cell lung cancer:

Localized

Cancer has not spread to other parts of the body. During the condition of NSCLC, when it has not been applied outside the lungs, the doctors considered it to be localized. The NSCLC patients are receiving a diagnosis at the localized stage show 63% chances of survival after five years. 

Regional

Cancer has spread to the nearby tissues and lymph nodes. The NSCLC patients receiving the regional diagnosis of NSCLC show a 35% chance of survival after five years.

Distant

Cancer has spread to remote parts and organs of the body. The NSCLC patients receiving NSCLC diagnosis at this stage show a 7% chance of survival after five years.

Combined

As per the recommendation of ACS, a combined 5-year relative survival rate is provided to the patients. This number also reflects the average 5-year survival rate of 25% for all types of NSCLC.

Survivorship statistics

Non-small cell lung cancer has been known to be one of the major causes of increased mortality rates due to lung cancer across the globe. The integration of several therapies for non-small cell lung cancer has not shown efficacy in attaining prolonged disease control ^​1​. Therefore, advanced cancer treatment for non-small cell lung cancer is provided to the non-small cell lung cancer patients that showed improved outcomes, resulting in inpatient care for different types of non-small cell lung cancer. The integration of the new cancer treatment has allowed the patients to live longer better. The clinical trials among NSCLC patients implicate the overall survival (OS) and the QoL of that survival.

The survival outcome varies according to the non-small cell lung cancer patients who belong to different groups having the same stage during the diagnosis with adhering to appropriate treatments. The individuals showing the survival rate for about five years after the diagnosis of primary NSCLC have been referred to as long-term lung cancer (LTLC) survivors ^​2​. Most LTLC survivors have undergone invasive treatment involving lung resection, radiation therapy or chemotherapy. Hence, comorbidities among these survivors are higher when compared with that of survivors of cancers at other sites ^​3​. The recurrence of NSCLC may tend to appear among the sub-groups of LTLC survivors after more than ten years after diagnosis and survivors who may be vulnerable to developing new aerodigestive tract tumors.

Further Studies

The advancement in the care of metastatic non-small cell lung cancer has been integrated among the patients involving the treatment such as palliative chemotherapy, histology-directed chemotherapy agents, improvements in supportive care, more recently targeted agents, and immunotherapy ^​4,5​. The long-term survival for the patients of EGFR-mutant metastatic lung adenocarcinoma has been represented by survivorship statistics 14.6% five-year survival with treating with erlotinib or gefitinib, and the immunotherapy has also achieved 13.4% five-year survival amongst patients with mixed levels of programmed death ligand-1 (PD-L1) expression ^​6​.

The metastatic anaplastic lymphoma kinase- (ALK-) positive NSCLC patients have been reported to have median overall survival (MOS) of approximately 4-5 years. The European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale suggested the treatment that increased the two-year survival rate among the patients receiving maximal support from the Oncologist community ^​7​. The reports have represented survival, including all types of lung cancer (small cell and NSCLC), also along with other stages (SEER, 2018). Other works have additionally focused on survival and treatment costs of squamous cell non-small cell lung cancer or older non-small cell lung cancer patients ^​8,9​. 

Survivorship towards health perspectives

Survivorship serves as a strong motivator for changing the lifestyle of cancer patients. The quitting of smoking habits has been the primary source of survivorship for most patients. Moreover, several tools and approaches are available for supporting survivorship to improve the patients’ quality of life. The contribution of the family, friends, nurses and doctors has helped the patients improve their life quality after a cancer diagnosis. The patients recovering from non-small cell lung cancer have been encouraged to follow the established guidelines for good health involving smoking, limiting alcohol, eating well, exercising regularly, and managing stress.

Adhering to regular physical activities has been effective in rebuilding their strength and energy level. The patients recovering from the cancer treatment, even the ones using oxygen, are also motivated to go for a walk for 15 to 30 minutes every day to improve the functioning of the heart and lungs. In addition, the healthcare team is responsible for creating an appropriate exercise plan depending upon the needs, physical abilities, and fitness level. Also, the significance of regular medical checkups and tests has been recommended to take appropriate healthcare through the follow-ups. Talking with the healthcare team for developing survivorship care plans is also the best option for survivorship for the patients. 

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