Lung cancer is among the most commonly diagnosed cancers in Canada, and a leading cause of cancer death. Understanding risk factors, obstacles, and emerging treatments can help you better support lung cancer patients in your practice.

Lung Cancer in Canada

Every day, an average of 82 Canadians are diagnosed with lung cancer. Several risk factors increase the risk of developing the condition, and some unique obstacles in Canadian healthcare hinder early detection. 

Incidence

Lung cancer is the leading cause of death for males and females in Canada and is the most commonly diagnosed cancer. The incidence is higher in males at 61 per 100,000 cases compared to 57.2 per 100,000 in females. 

In 2022, reports estimated that 30,000 Canadians would be diagnosed with lung cancer, representing 13 percent of all new cancer diagnoses. Lung cancer would also cause 24 percent of all cancer-related deaths. 

Risk Factors 

Smoking is the most notable risk factor for lung cancer. About 72 percent of lung cancer cases develop from smoking tobacco, and exposure to second-hand smoke increases the risk for non-smokers by 30 percent. 

Exposure to asbestos, radon, radiation, and occupational chemicals such as silica dust or welding fumes are also important risk factors. A history of lung cancer, lupus, or lung conditions like tuberculosis and COPD may also increase the risk. 

Obstacles 

One of the biggest obstacles to lung cancer care is a delay in diagnosis and treatment, which leads to worse outcomes and higher mortality. These delays may happen because of challenges in Canadian healthcare, such as:

• Low lung cancer research funding
• Lack of full-scale lung cancer screening
• Care inequity for underrepresented populations
• Stigma around smoking and nicotine addiction 
• Complex drug approval process

When Should you suspect Lung Cancer? 

In many instances, symptoms of lung cancer do not appear until the disease is in an advanced stage. As lung cancer progresses, patients might experience:

• a cough that gets worse or doesn’t go away
• shortness of breath
• consistent chest pain that worsens with deep breathing or coughing
• blood in mucus 
• wheezing
• weight loss
• fatigue
• hoarseness or other changes to patient’s voice
• difficulty swallowing
• swollen lymph nodes in the neck or above the collarbone
• headache

Patients presenting any of these symptoms should be screened for lung cancer. 

Treatment Options for Lung Cancer in Canada

As with many other types of cancer, local and systemic treatments are standard. While treatment varies depending on the specific type and stage of cancer, patients may benefit from one or more of these lung cancer treatments.

Local Therapy

Surgery is a key treatment for non-small cell lung cancer (NSCLC). Depending on the disease progression, you may need to remove sections of or the entire lung via:

• Video-assisted thoracic surgery 
• Robotic-assisted thoracic surgery 
• Thoracotomy

Endobronchial therapies or radiation may be necessary to treat metastases or to help ease cancer symptoms in palliative stages. Endobronchial therapies remove tumours or kill cancer cells using a bronchoscope and cryotherapy, laser surgery, electrocautery, or brachytherapy.

Systemic Therapy

Systemic therapies affect the entire body and include chemotherapy, immunotherapy, and targeted therapy. These treatments include medications, infusions, and injections such as:

• Gefitinib or erlotinib — epidermal growth factor receptor protein-tyrosine kinase (EGFR-TK) inhibitors
• Crizotinib — a ROS1 gene inhibitor often used as a first-line treatment
• Alectinib, brigatinib, ceritinib — ALK gene inhibitors
• Atezolizumab, durvalumab, pembrolizumab — PD-1/PD-L1 or immune checkpoint inhibitors

Emerging Therapies

A new drug called nivolumab may improve NSCLC survival rates. In clinical trials, patients received the drug with chemotherapy before surgery. The study found that the combination reduced the risk of recurrence and cancer progression or death by 37 percent compared to chemotherapy alone. It also increased the event-free survival time by almost a year.

Supporting Lung Cancer Patients

Lung cancer has a significant burden on both patients and the Canadian healthcare system. Understanding key risk factors and obstacles can help you understand steps to take in your practice. Learn the current guidelines for detecting lung cancer early with MDBriefCase.