CANCER


treatments, will work together to improve survival.’


In an effort to address inadequacies in lung cancer care in Scotland and across the rest of the UK, the new report ‘25 by 25: a ten-year strategy to improve lung cancer survival rates’, provides invaluable insights from both patients and healthcare professionals (HCPs) regarding the perceived barriers to five-year survival - and sets out a number of key recommendations on how to overcome them.


According to the report, nearly two-thirds (65 per cent) of HCP respondents in a UKLCC survey, believe early-stage diagnosis to be the most important factor for improving five-year survival rates - yet only 27 per cent of patients questioned said they visited their doctor because they recognised the signs and symptoms of lung cancer. These statistics indicate – once again – that HCPs such as community pharmacists have a major role to play in signposting patients they suspect may have lung cancer to the GP.


‘Both patients and clinicians need to be aware of the signs and symptoms of lung cancer to ensure patients are diagnosed as early as possible,’ the UKLCC said in their report. ‘Polling GPs, as well as HCPs, allowed us to ask those working with patients early on in the pathway what the greatest barriers in achieving this are, and how they can be overcome.


CASE STUDY


Tobacco use is the most important preventable cause of lung cancer in the UK. While a proportion of patients who have never smoked who have developed lung cancer, the majority of cases are preventable, with 86 per cent of cases caused by smoking alone. However, whilst also reducing the number of cases, the risk of total mortality and rate of recurrence of lung cancer is also substantially lower in smokers who manage to quit smoking following diagnosis of early stage lung cancer or small cell lung cancer.


Here, ex-smoker Jane Petto tells SP how she couldn’t quit smoking until after she was diagnosed with COPD.


When I was diagnosed with lung cancer, I really thought it was all over. Then one of my friends told me ‘nothing is set in stone’. And I’m still here, 16 years later.


However, our findings suggest that a lack of awareness from patients on the symptoms themselves, and when to see their doctor, still act as major barriers to early presentation.’


The Scottish Government has already introduced a number of measures on prevention in line with a national ambition to ensure patients present as early as possible in order to have the best chance of survival.


It has, for example, placed a large amount of resource on supporting a reduction in smoking rates, most recently evidenced in the publication of ‘Creating a tobacco-free generation’ in 2013.


Also in 2013, it launched the Detect Lung Cancer Early programme, aiming to improve awareness of symptoms and therefore encourage early diagnosis. Since the launch, the latest statistics show that the percentage of lung cancer patients diagnosed at the earliest stage has increased by 24.7 per cent.


NHS Scotland has also supported a screening study, ECLS, which is trialling a new blood test called Early CDT-Lung, to test whether small lung cancers can be detected before they cause any issues amongst those who are at risk


RECOMMENDATIONS In order to make the next steps to improve five-year survival for lung cancer and meet the UKLCC’s


I started smoking young, and, by the time I was twelve, I was addicted. My home life was going pear-shaped. My mum went absent, and I didn’t like being there much after that. I would often go away on the weekends.


I was hungry so often. It was easier to beg for cigarettes than food, and they helped with the hunger pangs. Things were different when I was a child – I could go into any shop and buy five Woodbines if I had enough money.


I tried to stop so many times - but gave in every time, thinking it was impossible.


Then one of my singing friends got emphysema.


He was in such a bad way. He couldn’t sing at all anymore or play his melodeon. It was awful. He was so frail, and his wife would have to look after him everywhere he went.


But I still couldn’t stop smoking.


25 by 25 ambition, a number of recommendations for Scotland have been set out below based on the UKLCC’s survey findings and the most recent data and evidence:


• The Scottish Government published the latest cancer strategy Beating Cancer: Ambition and Action in 2016. However, whilst the UKLCC welcomed the actions and recommendations, UKLCC was disappointed that there were no dedicated actions for lung cancer and recommends that the Scottish Cancer Taskforce should publish annual reports to assess progress made in delivering the ambitions set out in Beating Cancer: Ambition and Action and set targeted recommendations accordingly.


• The Scottish Government should continue to promote smoking cessation services to improve survival for those who smoke and have recently been diagnosed with lung cancer. The government should also commit to providing adequate resources in order to meet its ambition of reducing prevalence of smoking to five per cent or less in Scotland by 2034, as set out in Beating Cancer: Ambition and Action, and also commit to reviewing progress against meeting this ambition annually.


• NHS Scotland should establish local screening initiatives, utilising the £5 million announced in Beating


A few years after that, in the winter of 1996, I was taken into hospital with pneumonia. My chest x-ray showed I too had emphysema, plus ‘moderate’ COPD. I smoked my last cigarette that day.


Quitting was so hard, but I overcame my cravings using nicotine gum. But then I became addicted to that instead! I bought so much gum. For four years, this went on.


In early 2000 I came down with a bad flu and a cough that just wouldn’t clear. After lots of back and forth from the doctors, I found out some awful news - I had lung cancer.


Words can’t express the terrible devastation I felt.


I love my husband so much, and I didn’t want to go to sleep anymore because I felt like it was using up the time I had left with him. He just hugged me all the time. My mum had died of lung cancer. I was


Cancer: Ambition and Action for addressing health inequalities.


• The Scottish Government use the Scottish urgent referral guidelines to facilitate appropriate referral between primary and secondary care for patients with suspected cancer.


• The national standard from decision to treat until first treatment for all cancers is 31 days. However the UKLCC’s survey found that from the lung cancer patients surveyed, 43 per cent waited over one month to initiate treatment after a diagnosis was confirmed. More needs to be done to optimise treatment as well as referral and diagnostic pathways in order to achieve the best outcomes possible for patients.


Fifty per cent of patients and carers consider surviving lung cancer for more than five years to be achievable


Only 27 per cent of patients saw their doctor because they recognised that they were experiencing signs and symptoms of lung cancer Forty-three per cent of patients waited over one month for initiation of treatment after a diagnosis was confirmed by their clinician


positive I was going to die as well.


Then I found out a month later that the cancer was operable.


You wouldn’t believe the relief – to go from feeling like you have a death sentence, to feeling like you’ve been given a chance to live again. It was wonderful.


In the end they removed my entire lung. At first I felt too weak to eat proper food let alone chewing gum – hence I was weaned off the gum and became a proper 100 per cent non-nicotine addict for the first time since I was twelve.


It’s been a hard road, though my oxygen saturation was really good for a long time, even by the standards of a healthy person!


I just feel really lucky. Life is so valuable.


(Courtesy of British Lung Foundation www.blf.org.uk)


SCOTTISH PHARMACIST - 11


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