What I’ve Learned from my Patients about the Challenges of Inoperable Lung Cancer

By David Mannino, MD, medical director and co-founder, COPD Foundation, as told to Janie McQueen

Inoperable lung cancer is a tough diagnosis to give or receive. It means one of two things – your cancer has spread to the point that surgery can’t remove all of it, or your medical condition (typically related to your lungs and/or heart) is such that you wouldn’t be able to tolerate surgery to remove part of your lung (or your entire lung). 

But I think the outlook for inoperable lung cancer has changed fairly dramatically. 

About 20 years ago, a diagnosis of inoperable lung cancer was pretty much a death sentence. Your likelihood of living beyond a year was about 5%. Lung cancer today is very different from what it was 20, or even 10, years ago. Survival rates now can be much higher. 

Patients – and Doctors – Can Be More Hopeful Now

Along with immunotherapy – a type of biological therapy that uses your immune system to fight cancer – we now have advanced therapies targeted to specific types of lung cancer. When you have those, you have a much better survival rate.

Targeted therapies zero in on proteins that control the growth and spread of cancer. These treatments have really given hope. The 1-year relative survival rate is now more than 50%. 

It’s still a bad diagnosis to have, but it’s not nearly as bad as it was a few short years ago. 

You’re able to beat the odds because of new treatments, and improvement in surgical procedures, too. For example, surgery is more and more being done with video-assisted thoracoscopic surgery (VATS), a less invasive procedure than traditional open surgery. 

Your surgeon inserts tiny tools through smaller cuts, while a camera sends images they can follow on a video monitor. It leads to better recoveries. It’s amazing what’s been accomplished.

Flipping the Downside

Any time a new therapy comes up, it adds months to survival rates.

Among things that’ve emerged are cancer treatments that differ from traditional chemotherapy, which tends to make you really sick. Some newer, more targeted therapies don’t have a lot of side effects. So, you can see the benefit without the downside.

For some, if you look at the overall survival rate, they have more of a dramatic improvement that can be looked at in years instead of months. There’s also better treatment for metastatic disease.

Team Treatment

Lung cancer treatment is a team approach. Our teams include lung doctors, cancer doctors, and radiation therapists – and a wonderful support team of nurses, pharmacists, and social workers – to make this very difficult time less challenging for you. 

If the time comes to transition to palliative/hospice care, there’s an equally incredible support team that lets you pass with dignity, surrounded by people who love you.

It’s made my job different because now, as a pulmonologist, my main role is to refer patients to the lung cancer team. 

Screening Is a Game-Changer

In general, lung cancer numbers have been drifting downward. Typically, it’s because we have lung cancer screening programs. They’ve increased the likelihood of finding cancers that can be treated with surgery. Also, due to new findings, research, and technology, the number of lung cancer types that can be treated with surgery are higher than they were.

The “go-to” screen test in use for lung cancer is called low-dose computed tomography (LDCT). A small amount of radiation is used while a machine X-rays your lungs. It’s brief and painless. 

Screening can be key, even if you never smoked. 

About 10% to 20% of lung cancers each year happen to nonsmokers, or those who’ve been very occasional smokers. Secondhand smoke, exposure to radon, genetics, and air pollution can factor into lung cancer, too.

That being said, if you look at the entire mix of lung cancers detected from screenings, the proportion of inoperable lung cancers has naturally decreased.

Hard but Not Hopeless

This is still a tough diagnosis. To say, “This is lung cancer. We can’t do much for you” is devastating.

I have a good friend who has inoperable lung cancer. It’s sad. He’s gotten radiation to his back, and to his head. I don’t know if he qualifies for any other therapies. 

A group of us got together for brunch a couple of weeks ago. People had questions, and it’s helpful to be a pulmonologist who can answer some of them, but it’s still very sad. 

Then there are always people who beat the odds. I had one fellow whose lung cancer was inoperable, but who had radiation therapy – he’s still alive 10 years later with nothing going on. It’s not common, but it happens.