LUNG CANCER
Lack of funding plagues cancer sufferers
September 25, 2008
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Elvira Cordileone
STAFF REPORTER
In 1992, Diane Maas had a malignant breast tumour carved out of her. But even though a few cancer cells had snuck into nearby lymph nodes, surgery and radiation followed by nine years of preventive drug therapy assured her survival.
Today, more than 80 per cent of women stricken with breast cancer survive, in no small measure thanks to armies of women who have raised many millions for research. The medical advancement made possible by money has resulted in new life-saving treatments.
Maas's second tussle with cancer, however, leaves her future grim. Last December, a lump blossomed at the base of her skull and it contained lung cancer cells, proving the disease had spread to her brain. Doctors told her the cancer's proliferation ruled out surgery to remove the two tumours, one of them 6.4 centimetres.
Maas, 68, describes herself as a "rusty" registered nurse, having quit the profession 43 years ago to raise three children. She wonders how the deadly disease could have reached such proportions while she'd felt perfectly well.
"If it had been found sooner..." Maas stops speaking abruptly and turns away.
The diagnosis – Stage 4 – came in January, three days after her husband, John, was rushed to hospital and soon placed on life support. While he slowly died of pulmonary fibrosis, a disease he didn't know he had, Maas snuck away from his bedside for radiation treatments.
But neither radiation nor chemotherapy, cut short because it so sickened her, did much good, she says.
Maas pins her hopes on a drug called Tarceva. Considered a medicine of last resort, and an expensive one, the province's drug benefit program won't pay for it without first assessing each case. It took three months for the bureaucratic okay to come through, she says.
Maas, a tall woman with pale, penetrating eyes, resents her loss of independence most. No longer permitted to drive, she frets over the difficulty in arranging for someone to take her to medical appointments, or to buy groceries. To get around her tidy North York townhouse, she has to use a walker – likely the cancer doing its work in her brain.
Yes, Maas admits, she did smoke, but she quit in the early 1980s.
Elizabeth Eisenhauer, a medical oncologist, a senior scientist and a professor at Queen's University, points out that 15 to 20 per cent of lung cancers have no relationship to smoking.
Still, patients like Maas are disadvantaged because their type of cancer doesn't draw the same levels of supportive feedback from the public and money for research as other forms of the disease.
Eisenhauer confirms that advances in lung cancer treatments have been slow in part because its share of research funding is relatively low. And this is where the world of cancer funding gets interesting, because it seems to indicate that the cancers with the highest fatalities aren't the ones getting the most research funding. The issue of perceived patient culpability appears to play a role.
Eisenhauer chairs the Canadian Cancer Research Alliance, a coalition of 24 organizations, including federal, provincial and voluntary cancer organizations that fund research, which released its second report parsing how Canada divvied up $390 million in research funds in 2006.
Although slightly more than half went to projects applicable to all cancers, a hefty $180 million reached researchers working on specific cancers. Breast cancer received almost a quarter of the site-specific funds: $49 million. Lung cancer got just $12 million, roughly 7 per cent.
"In Canadian women, lung cancer will continue as the leading cause of cancer death in 2008, increasing to an estimated 9,200 deaths, compared with the 5,300 deaths expected for breast cancer," notes the Canadian Cancer Society's 2008 report. And it warns the incidence of lung cancer among women continues to rise, occupying second place, right behind breast cancer.
There's no doubt the absence of a strong grass roots lobby for lung cancer translates into fewer research opportunities, which has an indirect impact on mortality rates, says Richard Wells, cancer research director at Sunnybrook Research Institute.
"Breast cancer is very well and cleverly organized for fundraising," says Wells, who is also a physician.
"The notion that you have a chance to go out and help support your mothers and sisters and friends has tremendous emotional resonance.
"In contrast, it's much more difficult to create a tremendous sympathetic narrative around lung cancer. There's a taint of culpability in people who suffer from this terrible disease."
Magdalene Winterhoff, a Sunnybrook oncology social worker specializing in lung cancer, says many of the women she sees are in their 40s, with young children, and many don't smoke.
Unlike breast cancer patients, who have good survival rates, Winterhoff says women with lung cancer don't live long enough to organize fund-raising movements. Most live a year or two, she says, overwhelmed by their disease.
The Princess Margaret Hospital is the only Canadian member of the International Early Lung Cancer Action Program. It is conducting a screening study for smokers and ex-smokers over 50. The study involves low-dose computed tomography (CT) scans that can detect tumours at their earliest, most-treatable stage. The scans show several hundred 1-mm-thin cross-sections of the lungs from top to bottom, whereas a conventional X-ray only shows two views of the chest.
Terry Sullivan, president and CEO of Cancer Care Ontario, which manages the province's cancer services and programs, agrees investment in lung cancer research, including building data to assess the usefulness of screening, hasn't kept pace with the scale of mortality.
He suggests, however, early detection, the key to reducing mortality from all cancers, resides in the work underway to map the specific biomarkers each type of cancer releases in the blood. These early-stage protein markers would provide a safe way of pinpointing patients who need further, more invasive testing.
In the meantime, Sullivan states people need to stop smoking in order to reduce lung cancer.
"We've worked very closely with the tobacco control community to reduce tobacco consumption, which is responsible for more than 85 per cent of lung cancers," he says. "In fact, 40 per cent of cancer deaths, including esophageal and stomach, are driven by tobacco."
Toronto Star