Lung Cancer

Lung Cancer and Esophageal Cancer

Lung cancer accounts for the second largest patient population in our hospital.   In 2011 alone, 2.1% of the total LC patients island wide, were seen here.  Surgery is our main treatment approach for patients with early stage lung cancer (stage I & II), confirmed on PET and CT scans, followed by chemotherapy or radiotherapy depending on the pathology results.  For late stage lung cancer, the treatment plan is usually chemo and radiation therapy. 

During the period of 1990-2011, 3,190 new lung cancer patients were diagnosed and treated in our hospital - 1,805 males (56.6%) and 1,385 females (43.4%) with a median age of 63 years (18 - 96).  The majority  ( 76.1%) of these patients had stage III or stage IV disease.  In the stage I and II patients, we've seen a 5-year survival of 73.0% and 48.0%; in the late stage patients, the survival is generally 10% less.  

 

Five- and Ten-year AJCC Lung Cancer Survival in KFSYSCC 1990-2011

Survival Rates by Stage
Stage	0	I	II	III	IV	Unclear	Total
# of patients	2	385	125	832	1,596	250	3,190
% of patients	0.1%	12.1%	3.9%	26.1%	50.0%	7.8%
5-year survival	-	73.0%	48.0%	16.0%	6.9%		19.6%
10-year survival	-	52.8%	32.2%	9.2%	5.2%		14.4%

Data source: KFSYSCC Annual Report 2011

 

Five-year Early Stage Lung Cancer Survival in KFSYSCC 1990-2011

Cancer Stage	I	II	III
# of patients	336	84	141
5-year survival	80.9%	60.4%	29.3 %

Data source: KFSYSCC Annual Report 2011

 

 Stage IV Lung Cancer Survival in KFSYSCC 2004-2011

	Male	Female	Small Cell LC	Non Small Cell	Stage IV
# of patients	541	476	707	310	1,017
1-year survival	45.5%	67.0%	62.4%	40.0%	55.6%
2-year survival	19.7%	36.7%	33.0%	15.6%	27.7%

Data source: KFSYSCC Annual Report 2011

 

Comparison of Survival Rates of Lung Cancer 2006-2010:                                   

 KFSYSCC Rates vs. National Rates （%）

	KFSYSCC				Island wide
	Patient Total		Male	Female		Male	Female
	1990-2011	2006-2010	2006-2010	2006-2010		2006-2010	2006-2010
1-year	62.1	68.8	61.7	77.3		40.7	60.1
2-year	39.8	46.7	39.6	55.3		23.5	41.7
3-year	28.6	34.3	28.1	41.8		16.2	30.7
4-year	23.1	27.7	22.9	33.5		12.7	24.3
5-year	19.4	23.9	20.7	27.3		10.7	20.3

Data source: Health Promotion Administration, Ministry of Health and Welfare（2013）
                        KFSYSCC Annual Report 2011

 

Relative survival rate reported by SEER in the US vs.the KFSYSCC breast cancer survival rate  (2004-2010) 

	KFSYSCC			SEER#
	Patient Total	Male	Female	Patient Total	Male	Female
Survival (%)	20.5	16.7	25.2	16.8	14.4	19.6

# SEER Cancer Statistics Review 1975-2011
Data source: KFSYSCC Annual Report 2011

 

Patient-centered care

The patient to physician ratio in our hospital is 1:5 and the patient to nurse ratio is 5:1.  With the new-patient assessment from our First-time Patient Desk, assistance from Patient Service Center, case managers, and the PAS system, we are able to complete the complex exams needed for treatment in a timely manner without subjecting the patients to hospitalization for the work-up.

 

Cancer diagnosis and staging

Eight-five percent of our lung cancer patients and almost 100% of our esophageal cancer patients are given confirmed diagnosis before their treatment.   

 

CT guided fine needle aspiration

CT-guided fine needle aspiration of the lung is used as a diagnostic step when tissue biopsy is needed to confirm a finding on an imaging test.  Our staff is well equipped in experience and skill to lower the risks of bleeding or pneumothorax during the aspiration. 

 

PET/CT Scan

A PET/CT scan is a must-have staging procedure for lung and esophageal cancer.  With the exception of terminal stage patients with obvious long distant mets, other patients receiving aggressive treatment will be given a PET/CT scan to determine the treatment area.  This procedure is covered by the National Health Insurance in Taiwan.

 

Our chest surgeons

Both our chest surgeons have more than a decade of experience in minimally invasive laparoscopic surgery.  Together they have operated on more than 300 patients since 2005.  Since 2008, they have also been holding international workshop conferences where over 20 chest surgeons have come for experience sharing.   They have also been invited to speak in Japan, Hong Kong and China. 

 

Protocol renewed annually 

In our hospital, a multidisciplinary approach is not a slogan.  It IS indeed an important weekly routine where all teams put their heads together to tailor make a best possible treatment plan for the patient to combat the disease.  In the weekly multidisciplinary meeting, new ideas are shared, consensus reached and decisions are made.   We are also backed by the nation’s best tumor tissue research lab for gene tests so we can identify the most suitable targeted therapy for the patients. 

 

Facing cancer

Facing cancer is facing a threat to one’s very existence.  The blow from cancer hits not just the physical being but often scars the mental and emotional presence of the patient as well as the patient’s family.  The different phases of reactions, from shocking blank to angry denial, are normal and expected. But if not managed well, they could add more pain and damage on top of the cancer itself.   Anxiety, sense of loss, fear of uncertainty, insomnia, guilt, depression, despair, and anger are among the commonly seen symptoms which require professional help as well as social support. 

 

Stress Screening

About 50% of cancer patients worldwide develop psychological symptoms but only 8 – 10 % would voice their concerns and seek help.  In our hospital, a Distress thermometer is offered to every patient upon their first visit to assess their distress level.  When necessary, the social psychotherapy team and the social workers are asked to join the multidisciplinary team to help the patient and the family cope with cancer and to safeguard the quality of life for the patient.   There are also various cancer support groups and religious support organizations that will offer to accompany the patient in their walk with cancer and fight against cancer.

 

A letter to the family

Being there for the patient means the world to the patient.  Support and company from the family and relatives are a critical part in cancer care.   Listening to the patient and respecting the patient’s wishes bring positive energy.    When a member in the family gets cancer, the rest of the family is affected in many aspects: physical, psychological, financial, and emotional, to where the whole family system could collapse.  When providing the much deserved and much needed care to the patient, the family members must remember to also provide an equal amount of care to one another and to oneself.   In the event of exhaustion or burn-out, remember to seek professional help.