Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD

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1 Public Outcomes Report Lung Cancer Submitted by Omar A. Majid, MD Lung cancer is the most common cancer-related cause of death among men and women. It has been estimated that there will be 226,1 new cases of lung cancer in the United States in 212 alone, accounting for about 14 percent of cancer diagnoses. This is up from 164,1 in 2. Cancers that begin in the lungs are divided into two major types, non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer is the most common type of lung cancer generally accounting for approximately 8 percent of all lung cancers. This cancer generally spreads to distant organs more slowly that small cell. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are three types of non-small cell lung cancer. Small cell lung cancer, also called oat cell cancer, is the less common lung cancer type, accounting for about 1-1 percent of all lung cancers. This type of lung cancer grows more quickly and is more likely to spread to other organs in the body. Histology type is important in determining what treatment modality would be most appropriate. The symptoms of lung cancer vary depending on several factors, including where in the lung the tumor is located. Symptoms include, but are not limited to, chronic cough, hoarseness, coughing up blood, weight loss, shortness of breath, wheezing, chest pain and recurring bronchitis or pneumonia. Smoking is the number one cause of lung cancer. It is believed that more than 8 precent of lung cancers result from smoking. The incidence of lung cancer in women has climbed at an alarming rate. These increases are clearly attributed to the increases in the number of women who smoke. Treatment depends on a number of factors including the type of lung cancer, size and location of the tumor, extent of the disease and the general health of the patient. Many different treatments and combinations of treatments may be used to control lung cancer and/or improve quality of life by reducing symptoms. Surgery is done on localized lung cancer in the form of a wedge resection, lobectomy or pneumonectomy. Some tumors are inoperable due to size or location. Chemotherapy may be used to control cancer growth or to relieve symptoms. Chemotherapy may also be used in conjunction with surgery, in more advanced stages of the disease, and in all stages of small cell carcinoma. Radiation therapy is a form of high energy x-rays. It is used in combination with chemotherapy and sometimes with surgery. It can also be used to offer relief from pain or blockage of airways. The radiation can also come from an implant placed directly into or near the tumor. Some small cell cancer patients have radiation to the brain even though no cancer is found there. This treatment is called prophylactic cranial irradiation and is given to prevent tumors from forming in the brain.

2 Clinical trials to evaluate new ways to treat lung cancer are an option for many cancer patients. In some studies all patients receive the new treatment. In other studies doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group. Through research doctors are exploring new and more effective ways to treat lung cancer. In 211, Lima Memorial Health System an estimated 18 precent of our tumor registry cases diagnosed were lung cancer. In the latest Cancer Database (NCDB) comparison study of our registry cases, 1,94 cases of lung cancer from 2-21 that were treated at. This data is compared with the national data in respect to histology, types of treatment, stage comparison and survival. The Cancer Committee reviewed all lung cancer cases from 2-21, and compared data with the NCDB Figures 1-8. each year, from 2-21 physicians cared for 9 new cases of non-small cell lung cancer and new cases of small cell lung cancer. OBSERVATIONS: Figure 1. Age at diagnosis in mirrors and Data. Age at 7 years is the peak incidence in,, and ages for lung cancer. Figure 2. The gender of patients with lung cancer, the male-female ratios in M:F, 1.4:1, 1.32:1, 1.27:1 indicating more male lung cancers are picked up in in contract to and gender ratios. Figure 3. There are more stage IV lung cancer cases in in contract to and. There are less stage III lung cancer cases in contract to and. Stage I and II lung cancer cases at the same proportion in,, and. Figure 4. A less number of lung cancer cases get radiation alone compared to and. More cases of lung cancer get no treatment compared to and. We conclude because many more cases in are advanced and choose comfort care only (see Figure 3 also). Figure. Here is the noticeable difference In histological types of lung cancer in and and. Figure 6. Survival trends of lung cancer cases are similar between and. With these observations in hand, instituting a lung cancer screening program would be beneficial to the service population to detect lung cancer earlier and decrease higher stage cases and provide treatment earlier and improve survival.

3 Figure 1- Age at Diagnosis-,, Figure 1- Age at Diagnosis 2-21-, and Figure 2- Gender of Lung Cancer Patients -, and NCDB 2-21 MALE FEMALE Figure 2- Gender of Lung Cancer Patients-,, (2-21) MALE FEMALE FEMALE MALE

4 Figure 3- Stage of Lung Cancer at Diagnosis -,, (2-21) Stage Stage I Stage II Stage III Stage IV Other UNK Figure 3- State of Lung Cancer at Diagnosis -,, (2-21) Stage Stage I Stage II Stage III Stage IV.7.1 Other UNK

5 Figure 4- First Course of Treatment of Lung Cancer -, and (2-21) Surgery OnlyRadiation Only Surgery & Chemotherapy Radiation & Chemotherapy OnlySurgery, Radiation Other specified & Chemo No 1st treatment Course Treatment Figure 4- First Course Treatment of Lung Cancer -, and (2-21) Surgery Only Radiation Only Surgery & Chemotherapy Radiation & Chemotherapy Chemo Only Surgery, Radiation & Chemo Other specified treatment No 1st Course Treatment Figure - Histology of Lung Cancer Cases-, and (2-21) Large Cell Carcinoma Non- Small cell Squamous Carcinoma Cell Adenocarcinoma, Carcinoma, Bronchio-Alveolar NOS NOS Other Specified Adenocarcinoma types Figure - Histology of Lung Cancer Cases-,, (2-21) Large Cell Carcinoma Non- Small cell Carcinoma Squamous Cell Carcinoma, NOS Adenocarcinoma, NOS Bronchio-Alveolar Adenocarcinoma Other Specified types Figure 6- Observed Survival for Lung Cancer Cases, and (23-2)

6 Overall year Survival for Lung Cancer- and (23-2) Overall Year Survival for Lung Cancer- and (23-2) Years Comparing and the Lung Cancer cases, the overall survival rates are similar. Survival rates may vary due to multiple factors including the stage of the disease, age, and response to the treatment as well as a patients decision to seek treatment.