Stage 4 Lung Cancer Life Expectancy
Black Men With Advanced Prostate Cancer Are Less Likely To Get The Most Effective Therapies
About 1 in 8 men will be diagnosed with prostate cancer in his lifetime.[1] Although prostate cancer is the second leading cause of cancer death in men, behind only lung cancer, the average patient with prostate cancer will not die from the disease.
[1] Recent advances in treatment, notably the new hormone therapy agents enzalutamide (Xtandi), apalutamide (Erleada), and darolutamide (Nubeqa), have extended the lives of people with advanced prostate cancer.
[2]
But for certain patients, the statistics are not quite as rosy. Black men are 1.5 times as likely as white men to be diagnosed with prostate cancer in the United States, and advanced prostate cancer is 2.4 times more lethal in Black men than in white men.[3] Could differences in the use of these novel hormonal therapies play a role in this discrepancy in mortality rates? A study published in December 2023 in JAMA Network Open discovered that despite their proven benefits, these novel hormone therapies are not prescribed at the same levels for men of different races, with a significantly lower rate of use in Black men.
Novel Hormone Therapy Is More Effective Than Traditional Therapy in Advanced Prostate Cancer Because male sex hormones called androgens are responsible for the growth of prostate cancer, treatment involves lowering the levels of these hormones.[4]
In traditional hormone treatment for prostate cancer, known as androgen deprivation therapy, a drug is administered to shut down the production of testosterone, the main androgen.[4] "That is still the foundation of hormonal treatment of prostate cancer," says Michael Xiang, MD, PhD, an assistant clinical professor of radiation oncology at the David Geffen School of Medicine at UCLA and an author of the study.
However, the newer hormone therapies in question, known as second-generation androgen receptor inhibitors, are especially effective at stopping cancer growth when used with traditional androgen deprivation therapy. These novel therapies "inhibit the synthesis of testosterone or cause its direct blockade," Dr. Xiang says.
The problem is that Black men with prostate cancer are not taking these therapies at the same rates as other men are. Xiang's study found that Black men with advanced or high-risk prostate cancer had the lowest two-year utilization rate of these therapies compared with white men, Hispanic men, or men of other races and ethnicities.
Xiang and his colleagues examined records from 3,748 men with prostate cancer who were on Medicare between 2011 and 2017. In any two-year period during the study, white men received one of these drugs at a rate of 27 percent, Hispanic men at a rate of 25 percent, and men of other races or ethnicities 23 percent. Black men received these therapies at a rate of 20 percent over any two years, a significantly lower rate of use. And this difference held steady over the entire period of the study.
Disparities Caused by Systemic Inequalities, Provider Bias, and Barriers to CareWhy are Black men much less likely to be prescribed these novel hormone therapies? Xiang feels that systemic inequalities in the healthcare system may be to blame. "Part of it could be provider-related implicit biases," he says. "Possibly, some providers are just less inclined to think of [novel therapies] for underserved populations."
The gap could also have to do with the patient's factors, he notes, such as lack of knowledge and education, reduced access to care, insufficient insurance coverage, or a dearth of financial resources.
Xiang acknowledged that it's possible that some Black patients might have been offered these therapies but declined them because of distrust of medical providers and the medical community, which has historically been common among Black people.
How Can This Pattern Be Changed?Equity in prescribing novel hormone therapies needs to start with physicians. "Ideally, all doctors would stay up to date with the current evidence and the current guidelines," Xiang says. He stresses that providers need to be mindful about applying the same guidelines and recommendations to all of their patients, although some cases may be complicated by the fact that copays for certain medications and procedures can be prohibitive, and the type of insurance a patient has may impact the care they receive.
One important way that people can optimize their outcomes, according to Xiang, is to be proactive about screening and testing protocols for prostate cancer. "It's something to discuss with one's primary care doctor," he says. "I think some of the racial or ethnic disparities around prostate cancer might stem from differences in screening patterns."
He adds that patients can educate themselves on newer therapies for their condition and ask their physicians about trying them.
Unfortunately, failure to receive one of these newer hormone therapies during prostate cancer treatment tends to lead to worse outcomes. The study did not examine survival rates, but Xiang notes that lower survival rates is a logical conclusion. Until Black men receive this therapy at the same rate as other men, these outcomes may not improve.
Early Detection May Help Kentucky Tamp Down Its Lung Cancer Crisis
Anthony Stumbo's heart sank after the doctor shared his mother's chest X-ray.
"I remember that drive home, bringing her back home, and we basically cried," said the internal medicine physician, who had started practicing in eastern Kentucky near his childhood home shortly before his mother began feeling ill. "Nobody wants to get told they've got inoperable lung cancer. I cried because I knew what this meant for her."
Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate. For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.
Anthony Stumbo is among a group of Kentucky clinicians and researchers working to improve outcomes for lung cancer patients and their families by increasing screening rates and thereby catching tumors earlier, when they're more treatable. Veronica Turner for KFF Health News The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which in 2014 launched to improve screening and prevention, to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia. But, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested, namely the fear and stigma that swirl around smoking and lung cancer.
Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to data from the Centers for Disease Control and Prevention.
It's a bit early to see the impact on lung cancer deaths because people may still live for years with a malignancy, LEADS researchers said. Plus, treatment improvements and other factors may also help reduce death rates along with increased screening. Still, data already shows that more cancers in Kentucky are being detected before they become advanced, and thus more difficult to treat, they said. Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to Kentucky Cancer Registry data. By 2020, that number had declined to 72%, according to the most recent data available.
"We are changing the story of families. And there is hope where there has not been hope before," said Jennifer Knight, a LEADS principal investigator.
Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health, a nonprofit health system that serves Kentucky and Indiana.
"A lot of them will say, 'It doesn't matter if I get lung cancer or not because it's going to kill me. So I don't want to know,'" said Shemwell. "With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers." But she reminds them that lung cancer is much more treatable if caught before it spreads.
The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, state lawmakers established a statewide lung cancer screening program based in part on the group's work.
Jacob Sands, a lung cancer physician at Boston's Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. "What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale," said Sands, who isn't affiliated with the Kentucky program and serves as a volunteer spokesperson for the American Lung Association.
In 2014, Kentucky expanded Medicaid, increasing the number of lower-income people who qualified for lung cancer screening and any related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called "Saved By The Scan," to figure out likely eligibility for insurance coverage.
Half of U.S. Patients aren't diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%.
But regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.
Some adults, like Lisa Ayers, didn't realize lung cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at UK King's Daughters, a hospital in far eastern Kentucky. The scan didn't take much time, and she didn't have to undress, the 57-year-old said. "It took me longer to park," she quipped.
She was diagnosed with a lung carcinoid tumor, a type of neuroendocrine cancer that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely.
Ayers, a lifelong smoker, recalled her doctor said that her type of cancer isn't typically linked to smoking. But she quit anyway, feeling like she'd been given a second chance to avoid developing a smoking-related cancer. "It was a big wake-up call for me."
Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start. The goal is to avoid stigmatizing people and instead to build rapport, meeting them where they are that day, he said.
"If someone tells us that they're not ready to quit smoking but they want to have lung cancer screening, awesome; we'd love to help," Studts said. "You know what? You actually develop a relationship with an individual by accepting, 'No.'"
Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.
That data likely doesn't capture all California screenings, as it may not include CT scans done through large managed care organizations, said Raquel Arias, a Los Angeles-based associate director of state partnerships at the American Cancer Society. She cited other 2022 data for California, looking at lung cancer screening for eligible Medicare fee-for-service patients, which found a screening rate of 1%-2% in that population.
But, Arias said, the state's effort is "nowhere near what it needs to be."
The low smoking rate in California, along with its image as a healthy state, "seems to have come with the unintended consequence of further stigmatizing people who smoke," said Arias, citing one of the findings from a 2022 report looking at lung cancer screening barriers. For instance, eligible patients may be reluctant to share prior smoking habits with their health provider, she said.
Meanwhile, Kentucky screening efforts progress, scan by scan.
At Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. "We're just scratching the surface of the potential lives that we can have an effect on," said Stumbo, a lung cancer screening champion at the health system, which includes 14 hospitals, most located in eastern Kentucky.
The doctor hasn't shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. "Knowing that my children were born, and never knowing their grandmother," he said, "just how sad is that?"
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Early detection may help Kentucky tamp down its lung cancer crisis
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MoreHow Technology Can Revolutionise Cancer Care In India
Cancer remains a significant global health challenge, and India, with its large and diverse population, is no exception. The projected number of new cancer cases in India for the year 2022 stands at 1,461,427, with a crude rate of 100.4 per 100,000.Statistics indicate that one in nine individuals in India is at risk of developing cancer during their lifetime. Notably, lung cancer ranked as the most prevalent cancer among males, while breast cancer took the lead among females. For childhood cancers (0-14 years), lymphoid leukemia emerged as the primary site, accounting for 29.2 per cent in boys and 24.2 per cent in girls. Furthermore, there is an anticipated 12.8 per cent increase in cancer incidence by the year 2025 compared to the figures recorded in 2020.
Challenges in the realm of cancer care persist in India, marked by late-stage diagnoses, limited access to specialised care in rural areas, and the overwhelming volume of cases that continually strain the healthcare system. The complexity of managing and treating cancer demands innovative solutions, and this is precisely where technology emerges as a transformative force, poised to address these challenges, and revolutionise cancer care across the country.Early Detection through AI:
Late-stage diagnosis remains a significant hurdle in the effective management of cancer. Many individuals in India receive their cancer diagnosis at an advanced stage, limiting treatment options and diminishing the chances of successful outcomes. Technology offers a potential solution through advancements in early detection methods. Artificial intelligence (AI) and machine learning algorithms, when integrated into diagnostic tools, can analyse medical imaging data, such as mammograms and CT scans, with unprecedented speed and accuracy. Studies have shown that AI-based screening methods not only improve detection rates but also reduce the need for invasive procedures, leading to better patient outcomes.
Telemedicine for Rural Access:Access to specialised cancer care is another critical concern, particularly in rural areas where medical facilities may be scarce. Telemedicine and teleconsultation services Comparatively, developed countries also leverage telemedicine, but the focus is often on improving follow-up care and monitoring for patients undergoing cancer treatment. In both contexts, telemedicine offers a lifeline for those who would otherwise face barriers to accessing timely and quality cancer care.
Personalised Treatment Plans:
Advancements in genomics have paved the way for personalised cancer treatment plans. By analysing a patient's genetic makeup, oncologists can tailor therapies that target specific mutations, increasing treatment efficacy and reducing side effects. In addition to genomic analysis, advancements in imaging technologies play a crucial role in tailoring treatment plans. High-resolution imaging techniques, such as positron emission tomography (PET) scans and magnetic resonance imaging (MRI), enable oncologists to visualise tumors with unprecedented detail. This information helps in determining the precise location, size, and characteristics of the cancer, guiding the development of a targeted and effective treatment strategy.
Data Integration and Patient Management:The sheer volume of cancer cases places an immense burden on healthcare facilities and professionals. Technology-driven solutions can optimise healthcare processes and improve efficiency. Electronic Health Records (EHRs) streamline patient data management, ensuring that critical information is accessible to healthcare providers in real-time. This not only facilitates seamless collaboration among multidisciplinary teams but also enhances the speed and accuracy of decision-making, contributing to more effective and timely cancer care.
While technology holds great promise for improving cancer care in India, there are challenges to its widespread use. The high cost of advanced technologies, the need for thorough training of healthcare professionals, and ensuring data privacy are important factors to consider. Despite these challenges, technology is bringing positive changes to cancer care by improving early detection, tailoring treatments, and managing patients better. By learning from other countries' experiences, India can work towards overcoming these challenges and use technology to strengthen its cancer care system, ultimately reducing the impact of this disease on its people.
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