Strategies to optimize lung cancer outcomes

Since the 1950s, lung cancer has been the leading cause of cancer deaths among men in the United States. In the 1980s, this expanded to women, including a growing incidence in those who had never smoked.¹ 

Lung cancer is estimated to be the leading cause of cancer deaths, resulting in more than 4,900 estimated deaths every day around the world – more than colorectum and liver cancers combined, which are the second and third leading causes of cancer-related deaths.² Accelerating earlier diagnoses is one of the most crucial elements in improving outcomes and saving more lives.

Image Credit: Sebastian Kaulitzki/Shutterstock.com

Key challenges in lung cancer

We are at a critical moment in the need to address low survivorship in lung cancer, and there are several reasons for this. Amongst patients, there is a lack of symptom awareness as well as strong feelings of stigma and guilt, i.e., that the cancer is their fault.³ This can cause delays in presentation to the doctor and, therefore, a delay in diagnosis. Diagnoses also vary widely by country: whilst Japan leads the way in early detection with 50 % of patients diagnosed with stages I-II, in India, less than 7 % are diagnosed in the early stages.^4,5

Screening and early diagnosis are key drivers of improved survival outcomes. However, screening accessibility and the path to diagnosis and subsequent treatment can be complex. There can also be challenges in terms of communication between primary and secondary healthcare practitioners (HCPs) and this, coupled with inadequate resources, negatively impact the patient’s experience.

In addition to late diagnosis, there are also variations in the time between diagnosis and treatment, which adversely affects survival outcomes. Clear disparities exist around the world when it comes to patient pathways. For example:

• A US study found that the average time from lung cancer patients’ first recorded symptoms/signs to their formal diagnosis was 570 days.⁶
• In India, a study found that the referral to a specialist center took 50 days, with an additional 23 days for a lung cancer diagnosis and another 24 days to start treatment.⁷
• In Europe, a study found that 42 % of lung cancer patients wait more than two months from their first medical consultation (specialist or primary care) to receiving their diagnosis.⁸

There are further barriers when looking at treatment pathways. Although biomarker testing has revolutionized the way cancer treatments are being developed, disparity exists around the world in access to high-quality biomarker tests. Sometimes, the low awareness of available diagnostic tests among HCPs has led to relatively few tests being ordered.⁹

Supporting HCPs working in lung health and lung cancer 

There is a clear need for further education, support and changes across the lung cancer care continuum in order to accelerate advances in diagnosis, access and treatment in lung cancer survival. 

Early lung cancer does not always present with signs or symptoms, which adds to delays in diagnosis.¹⁰ Furthermore, early symptoms such as a persistent cough¹¹ could be mistaken for other conditions by both patients and HCPs, particularly in those who have never smoked, causing further delays in opportunities to test and diagnose. Primary care HCPs may benefit from heightened awareness and understanding of this deadly condition. 

More education is also needed around testing for specific biomarkers given that mutations in particular genes are the most common oncogenic drivers in non-small cell lung cancer (NSCLC) which accounts for 80-85 % of all lung cancer cases.^12,13 Regional and in-country health ecosystem findings also need to be reflected in decisions made about the inclusion of biomarker testing following a lung cancer diagnosis to ensure that individual country incidence, diagnosis, and testing are reflected.

The Lung Ambition Alliance’s vision and goals 

Formed of three partners – AstraZeneca, Global Lung Cancer Coalition, and Guardant Health – the Lung Ambition Alliance (LAA) was set up to advance lung cancer survival and improve patient outcomes and has an ambitious vision: to one day eliminate lung cancer as a cause of death. Since its establishment in 2019, the LAA has worked tirelessly on this goal, focusing on the three following priorities:

• Increase screening and early diagnosis
• Deliver innovative medicine
• Improve the quality of care 

The LAA Ambition, Improvement, Measurement (AIM) reports published in 2022 and 2023 were developed to provide details of the barriers currently preventing screening, diagnosis, and treatment for lung cancer and strategies for tackling these barriers.

Resources for HCPs: the AIM reports 

Two of the AIM reports Optimising Access to Care Through Timely Referral Pathways and Improving Coordination of Lung Cancer Care and Patient Support, demonstrate the opportunities that can be taken to improve the speed of diagnosis and access to treatment for lung cancer. There is a responsibility on all groups within the lung cancer care space across the globe to work together to make changes. 

Better educational resources for both patients and HCPs, prioritizing early diagnosis by increasing resources, adaptive diagnostic pathways to cater to different points of entry, and collaborative working practices can all help increase access to the most effective treatments. When it comes to lung cancer care and patient support, clear communication with patients must be established to alleviate the psychological burden for patients, and centers of care should establish consistent, holistic communication strategies across the care continuum. 

The LAA’s two additional AIM reports, Establishing a Pathway to Biomarker Testing and Optimising Multi-Disciplinary / Tumour Board Care, go deeper into which areas need to be addressed to ensure a successful level of care, including the accessibility of effective, innovative treatments. 

Topics covered include the need to establish well-defined pathways for biomarker testing, the set-up of essential data collection, and the impact of testing on patient outcomes. Additionally, the reports explore how cost analyses can demonstrate the value of biomarkers for early-stage, advanced, or recurrent NSCLC, which in turn can lead to better outcomes. 

Regarding Multi-Disciplinary Teams (MDTs), there must be a review of treatment options and decisions for each and every patient; expertise represented within MDTs should include those working in lung cancer specialties and targets for increasing reviews of new patients seen by MDTs.

Whilst the main responsibility for the improvements listed above falls to leading professional societies who should develop recommended global guidelines for biomarker testing infrastructure and national implementation of MDTs, these practices can be integrated within today’s lung cancer clinics (depending on available resources). Clear benchmarks and KPIs would allow teams to measure the effectiveness of their MDTs, e.g., assessing the time taken from diagnosis to treatment and access to biomarker testing. 

Working together to make changes 

Fundamental changes need to be made in terms of symptom recognition, early screening, and ensuring access to effective, innovative treatments. Only then can tangible improvements be made and more patient lives saved. Working together, we can successfully address current challenges and work towards a global shift in improving outcomes in lung cancer care. 

At the LAA, we have made it our mission to accelerate advances, decrease lung cancer mortality and improve patient outcomes. Our AIM reports provide resources for HCPs to build a deeper understanding of lung cancer symptoms, screening and diagnosis, ensuring accessible screening and timely referrals as well as changes needed to allow biomarker testing and innovative treatments for all those affected. Our goal to decrease lung cancer mortality and eliminate lung cancer as a cause of death is ambitious, but with our resources we can share knowledge and support learnings so that outcomes can be improved, and more lives saved.

Caius Kim, Global Director, Lung Ambition Alliance, AstraZeneca

References

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3. Dirkse, D., Lamont, L., Li, Y., Simonič, A., Bebb, G., & Giese-Davis, J. (2014). Shame, guilt, and communication in lung cancer patients and their partners. Current Oncology, 21(5), 718. https://doi.org/10.3747/co.21.2034
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7. Garg, A., Iyer, H., Jindal, V., Vashistha, V., Chawla, G., Tiwari, P., Mittal, S., Madan, K., Hadda, V., Guleria, R., Sati, H. C., & Mohan, A. (2022). Evaluation of delays during diagnosis and management of lung cancer in India: A prospective observational study. European Journal of Cancer Care. https://doi.org/10.1111/ecc.13621
8. Lung Cancer Europe. Disparities and challenges in access to lung cancer diagnostics and treatment across Europe. 2020. Available from: https://www.lungcancereurope.eu/2021/12/16/disparities-and-challenges-in-access-to-lung-cancer-diagnostics-and-treatment-across-europe/ Accessed May 2024.
9. EFPIA. Unlocking the potential of precision medicine in Europe: Improving cancer care through broader access to quality biomarker testing Policy recommendations. 2021. Available at: https://www.efpia.eu/media/589727/unlocking-the-potential-of-precision-medicine-in-europe.pdf Accessed May 2024.
10. Lung Cancer in Nonsmokers. (2024, April 18). Yale Medicine. https://www.yalemedicine.org/conditions/lung-cancer-in-nonsmokers
11. Lung Cancer Cough: What to Know. (n.d.). WebMD. https://www.webmd.com/lung-cancer/lung-cancer-cough
12. LUNGevity Foundation. Types of Lung Cancer. Available at: https://lungevity.org/for-patients-caregivers/lung-cancer-101/types-of-lung-cancer. Accessed May 2024. 
13. American Cancer Society. What Is Lung Cancer? Available at: https://www.cancer.org/cancer/types/lung-cancer/about/what-is.html. Accessed May 2024. 

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