Lung Cancer Survival After Forgoing Treatment

Why Would Someone Forgo Treatment and What May Happen?

woman holding her hand up to mean no
What is the survival rate for lung cancer without treatment?. Istockphoto.com/Stock Photo©dolgachov

 Over the years I've had many people ask me what their lung cancer survival would be without treatment. A few have asked because they have chosen not to pursue treatment. But more were interested due to another reason. They wanted to know the survival advantage, in terms of time, that treatment was giving them.  A 2010 study set out to answer this question, but first, we need to talk about why someone would forego treatment

Value of Cancer Treatment

It's important to note up front that most people choose some form of treatment. Early stage lung cancers may be curable with treatment, and even though advanced lung cancers aren't curable, they are treatable. There are many myths about lung cancer, and one is that when people hit a certain age they are too old for treatment. Another myth is that when lung cancer reaches a certain stage, nothing really helps. In contrast, older people often do well with lung cancer treatments. And many of the newer treatments for lung cancer - 7 approved in 2015 alone - are designed for people with advanced lung cancer.

Goals in Treatment

A first step when considering any treatment for lung cancer is to consider the 4 goals of any medical treatment.  What do you intend to accomplish with the treatment?  These include:

  • Preventive
  • Curative
  • Disease management
  • Palliative

What is sometimes overlooked with lung cancer treatment, is that even if treatments may not cure the disease, or even extend survival, they may improve the quality of life for people living with the disease.

Reasons Some People Have Forgone Treatment

There are many reasons people have decided against treatment for their cancer. Whether it is you or a loved one who has declared a wish to skip treatment, it's important to first clarify the reason. It may be due to a lack of knowledge about something related to lung cancer, or in contrast, after hearing the reason you may agree it is the best choice.

Survival Benefits vs Quality of Life

Sometimes the survival "benefits" are small. For example, a particular chemotherapy regimen (there are many) may only extend life by a few weeks, and would come with negative side effects. Someone may choose to skip treatment to feel as healthy as possible with the time they have left. Unfortunately, many people do not realize that there are options other than chemotherapy for advanced lung cancer.  Targeted therapies - treatments which directly target cancer cells - may offer benefits with symptoms that are significantly milder than some chemotherapy drugs, and side effects due to chemotherapy are much more manageable than in the past. 

Religious or Beliefs

Some people may have religious beliefs which forbid cancer treatment. This is a very personal issue that those with cancer will have to weigh based on their own convictions.

In contrast, some people may believe that treatment is permitted with their beliefs, but feel that prayer alone is the answer.

If you are feeling this way it is important to talk to others of your faith and ask yourself the question: "Could it be that the answer to prayer is having good medical treatments available to treat the cancer?"

Financial Concerns

Unfortunately, we live in an era in which I've heard people say that they want to forego treatment for financial reasons. There are many resources for those who are uninsured or under-insured, as well as other ways of finding assistance for medical care. Talk to a social worker at your cancer care center or hospital if this is an issue for you.

A comment I've sadly heard a few times is that someone does not want to exhaust their resources - they want to have something left to pass on to their family. If you are struggling with this thought, try thinking about it another way. Wouldn't your family members rather have your presence in their life instead of your money? And if the answer is that your family would rather have your money than your presence - do you really want to leave it to them? That may sound a bit sassy, but the point is to think about your decision from many different angles and sides.

Fear of Treatment Side Effects

Treatment can have challenging side effects. Sometimes treatments like chemotherapy and radiation therapy can be grueling at best. Before making any decisions make sure to list out all of the possible treatments available. Often there is more than one alternative or a combination of treatments. It's also extremely important to note that the side effects of chemotherapy are managed much better now than even just a few short years ago. In fact, the management of chemotherapy-induced nausea and vomiting has come so far that many people have little or no nausea even on the most nauseating chemotherapy regimens. 

Desire for Alternative or  "Natural Treatments" or Skepticism About Medicine

You don't have to look far online to hear about "natural treatments" that can knock the socks off of cancer.  There are a few thoughts to consider. If these treatments honestly worked well, wouldn't researchers use them - at least for their own families? 

When reading about some of the "miracle cures" out there, it's important to also realize that cancer isn't a single disease but rather hundreds of diseases, and within each of those hundreds, many more varieties. If you were to talk to 100 lung cancer survivors in a room they would have 100 unique cancers from a molecular standpoint. To say there is a "treatment for cancer" would be like saying there is one treatment for all infections - all types of parasites, bacteria, fungi, and viruses. We know that these all require different treatments, and even with the same bacteria of the same class, one may be sensitive and another resistant to an antibiotic. Sometimes it takes more than one antibiotic to cure an infection.   Sometimes it takes 3 days of an antibiotic and sometimes it takes 6 months. Our bodies even know that cancer doesn't have one simple fix. We have an elaborate immune system with countless numbers of immune cells and mechanisms designed to kill cancer cells.

The Stigma of Lung Cancer

As a last note, some people forego treatment because of the stigma of lung cancer - that unspoken thought that says that people who have lung cancer deserve to have cancer because they smoked. Not only does lung cancer occur in smokers and non-smokers alike, but it doesn't matter. Nobody deserves cancer. There are many other "habits" that similarly raise the risk of cancer, such as obesity raising the risk of breast cancer and lack of exercise increasing colon cancer risk. Everyone has, at some point in their lives, done something which increases cancer risk. But absolutely nobody is less deserving than another of compassion, care, and the best medical treatments available.

The Study on Survival Without Treatment

It's uncommon to find studies which talk about foregoing lung cancer treatment. Most people choose at least some form of treatment, and it would be unethical to compare groups of people with and without treatments that have been found to make a difference.

So researchers pooled together electronic databases, pored through bibliographies, and contacted experts in lung cancer to get an idea about what happens when lung cancer is not treated. Lumped together by stage they found that people with untreated non-small cell lung cancer lived an average of 7.15 months.

While survival rates for lung cancers aren't what we would wish, they are in general much better than these results found in untreated people.

For Those Who are Considering Foregoing Treatment

Since foregoing lung cancer treatment is literally a life and death situation, think about the reasons for your decision.  Get a second opinion, or a 3rd or a 4th. Give it some time. There is often a little time when you are newly diagnosed to consider all options.

For Loved Ones of People Considering Foregoing Treatment

For those who have loved ones who are considering this heart-wrenching decision, it can be very difficult. It is important that you raise your concerns, but there comes a time when you need to respect that your loved one's decision may be different than what you would choose in the same situation. It's easy to care for someone when they agree with us. But it's much harder when we need to put our own wishes and decision making aside and accept that of another. In the end, it may come down to choosing to love, knowing that in loving someone we accept them no matter the choices they make.

A Word About Statistics and Survival Rates with Lung Cancer

Statistics are great for looking at trends, but actually, say very little about what an individual person may expect. There are many factors in lung cancer survival that are different for each person.

With lung cancer, it's incredibly important to note that treatments are improving. Between 2011 and 2015 there were more new treatments approved for lung cancer - some of which work well for the most advanced lung cancers - than were approved in the 40 year period leading up to 2011. Since many of the statistics for lung cancer are based on people who received the older treatments, it's hard to know how accurate any list of survival rates may be. What it comes down to is that lung cancer survival rates give us an estimate of how well you would do if you were treated with treatments that may no longer the best treatments for the disease. Not very helpful.

And on a final note, it doesn't hurt to adopt the attitude of one 10 year survivor of advanced lung cancer. "They told me that the survival rate for my cancer was only 5 percent and I said wonderful! That means that there are 5 out of a hundred people who make it with this disease and I'm going to be one of those 5!"

Source:

Wao, H. et al. Survival of patients with non-small cell lung cancer without treatment: a systematic review and meta-analysis. Systematic reviews. 2013. 2:10.

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