To view the graphics that complement this report, please contact Dawn Wilson in the public relations office for a paper copy. Dawn may be reached at 252-443-8766 or via e-mail at ddwilson@nhcs.org

Nash Hospitals Inc. Lung Cancer Study Summary 1999 – 2003

Lung Cancer is the leading cause of death in both men and women. In 2004, the American Cancer Society (ACS) estimated that there will be about 173,770 new cases of lung cancer in the United States: 93,110 among men and 80,660 among women. About 160,440 people will die of this disease: 91,930 men and 68,510 women. Lung cancer is fairly rare in people under the age of 40. The average age of people found to have lung cancer is 60.

Researchers have discovered several factors that can cause lung cancer. The use of tobacco is the most important: About 90% of lung cancers are related to smoking. Harmful substances (carcinogens) in tobacco smoke damage the cells in the lungs. Over time, these damaged cells may develop into lung cancer. Exposure to other harmful substances, such as asbestos, radioactive dust, and radon, also increases the risk for lung cancer.

NHCS

During the time period 1999 – 2003, NHCS treated 419 lung cancer cases from a five county region. The percentage of cases treated was on a steady decline from 1999 (105) to 2002 (65). In 2003, there was a slight increase to 77 cases. 65% of the diagnosed cases during this five year period were men; 35% women. The 70 -79 year old patient age bracket had the largest percentage of patient diagnosed with cancer each year for this five year time period followed by the 60 – 69 year old bracket. 2 cases were thirty-six years and 2 cases were thirty-eight years during this five year time period. 65% of the patients were Caucasian; 35% were African-American. The majority of the diagnosed cases during the five year period were from Nash County (68%) followed by Edgecombe County (17%), Halifax County (8%) and Wilson County (6%).

SMOKING

A person living with a smoker has a 30% greater risk of developing lung cancer compared to a person living in a nonsmoking environment. Women appear to be more at risk from the chemicals in tobacco smoke that cause cancer. Therefore, they may be at greater risk of developing lung cancer when they smoke or are regularly exposed to secondhand smoke. Unfortunately, former smokers still are more likely to develop lung cancer than nonsmokers for many years after they quit smoking, and the risk never decreases to the low risk for a person who has never smoked. More than 50% of people newly diagnosed with lung cancer are former smokers who quit smoking more than a year before diagnosis.

NHCS

47% of the patients during this five year study between 1999 and 2003 were actively smoking at the time of initial diagnosis. 31% had previously smoked but were not currently smoking and 14 % had never smoked. Less than 5% were currently using a smokeless form of tobacco at the time of diagnosis. 35% of the smokers were women; 65% of the smokers were men.

STAGES

In the early stages of lung cancer, no symptoms may be present. As a result, only about 15% of lung cancers are diagnosed in the early stages when treatment is most effective.

NHCS

In 1999, 4% of the patients were diagnosed at the early stage 1A and 10% at stage 1B. This correlates with the national statistic. 18% were diagnosed at stage 3A. 85% of these patients had never had cancer; 10% had a previous history of cancer at another site. In 2000, 13% were diagnosed early at a 1A stage and 14% at a 1B stage. 17% were diagnosed at stage 3A. Of the total 95 cases for 2000, 84% had no history of previous cancer, 13% had had previous cancer. In 2002, the total cases diagnosed were at a low of 65. There was both an increase in early stages at 1A (6%) and 1B (18%) as well as late stages at a five year high of 22% Once again, 86% had no previous history of cancer.

Depending on the type and stage of the cancer, surgery may be used to remove the tumor and some of the lung tissue around it. Surgery offers the greatest chance for cure for many types of cancer, especially those that have not yet spread to other parts of the body. Most people with cancer will have some type of surgery. Non-small cell lung cancer (NSCLC) is a heterogeneous aggregate of at least 3 distinct histologies of lung cancer, including squamous carcinoma, adenocarcinoma, and large cell carcinoma.

Squamous Cell Carcinoma (29%) was the most diagnosed type of cancer for the five years under review followed by Adenocarcinoma/Adenoma at 20%. Large Cell Carcinoma (17%) was the third most diagnosed cancer type.

TREATMENT

At diagnosis, patients with NSCLC can be divided into 3 groups that reflect the extent of disease and treatment approach. The first group of patients has tumors that are surgically resectable (generally stages I and II). This is the group with the best prognosis, depending on a variety of tumor and host factors. Surgery is the most effective treatment for the early-stage non-small cell lung cancers.

NHCS

During 1999 – 2003, 85% of the diagnosed patients did not receive any surgery. 7% of the patients had a partial Pneumonectomy. In 2003, (5%) of the patients had a Lobectomy with Mediastinal lymph node dissection and 1% in 2000 had a lobe or bilobectomy extended.

The second group includes patients with advanced lung cancer. This group is treated with radiation therapy or, more commonly, with radiation therapy in combination with chemotherapy or other therapy modalities. Radiation is sometimes used as the main treatment for lung cancer. It might be used for people who may not be healthy enough to have surgery. For other patients, radiation might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. Radiation can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain.

The final group of patients has distant metastases found at the time of diagnosis. This group can be treated with radiation therapy or chemotherapy for palliation of symptoms from the primary tumor. 55% of the patients in the 1999 – 2003 study did not receive any chemotherapy as adjunct therapy or for palliative care. 39 % of the patients did however receive three chemotherapy agents as primary therapy for their lung cancer.

SURVIVAL RATE

The 5-year survival rate refers to the percent of patients who live at least 5 years after their cancer is found. Because these rates are based on patients first treated more than 5 years ago, recently diagnosed patients may have a more favorable outlook. The graph below shows the comparison of survival rates for Lung CA with the CIRF (Cancer Information Reference File). A total of 237,688 lung cases are in this national comparison file. NHCS survival rates follow the national trend.

Summary

Smoking is the leading cause of Lung Cancer in the five county region. While the number of diagnosed cases were decreasing from 1999 – 2002, there was an upward trend in 2003 that will bear watching. The importance of continued public awareness for anti-tobacco campaigns can not be under emphasized. NHCS offers inpatients anti- smoking education as well as an outreach Smoking Cessation Program: Kick Butts.

Cindy Worthy RN, MSN Vice President Community Outreach

GLOSSARY

Analytic Case

Cases diagnosed and/or receiving any part of their first course of treatment at the accessioning facility after the registry's reference date are analytic.

Non-Analytic Case

Cases diagnosed elsewhere and received all first course therapy elsewhere and presents to the reporting facility with recurrence or persistent disease are considered non analytic.

Reference Date

The reference date is the start date after which all eligible cases must be included in the registry. This date is a reference point for many standards and activities of the Approval Program. Nash Health Care Systems, Inc has an established reference date of January 1, 1992 as set by the Cancer Committee.

Class of Case

All accessioned cases are assigned a Class of Case based on the nature of involvement of the facility in the care of the patient.

Accessioned

The accession number is a unique number assigned to each patient sequentially as entered into the registry database.

AJCC TNM Staging

The TNM staging system is a shorthand notation of the anatomic extent of disease and is based on the assessment of three elements: T– size or extent of primary tumor; N – evaluation of node involvement; M– distant metastasis evaluation.

1st Course of Treatment

Treatment given or planned at the time of the initial diagnosis (i.e. surgery, radiation, chemotherapy, hormone, etc.)