FIRS The Global Impact of Respiratory Disease – Second Edition | Page 26

intent surgery or radiation therapy. Selective
patients may benefi t from chemotherapy after
surgical resection, while patients with local
advanced disease may benefi t from concurrent
chemo-radiotherapy with or without surgery.
Although advanced stage lung cancer is not
curable, many patients may have symptom
improvement and survival prolongation
by effective treatment. Molecular targeted
therapy against epidermal growth factor
receptor (EGFR) mutations and anaplastic
lymphoma kinase (ALK) re-arrangements
attain tumour response rates of around 70%.
However, cost is a major barrier to these
treatments. Symptom relief and palliative care
must be considered throughout an individual’s
lung cancer journey to provide patient-centred
care. The benefi ts of treatment must be
balanced against the risks of adverse effects
in individual patients in order to achieve high-
value healthcare.
Access to care remains a major challenge in
lower- and middle-income countries, which
emphasises the global need for affordable,
cost-effective treatments and optimal care.
“Personalised therapy” directed to factors such
as specifi c mutations may improve the results
of treatment. Such “precision medicine” and
promising immunotherapeutics involve costly
tests and treatments, which are not universally
available.
Identifying and treating early cancer is a
potential lifesaving strategy. A recent large-
scale study showed that screening with CT
scans compared to chest radiography resulted
in a 20% reduction in lung cancer-specifi c
deaths [41]. The use of screening for lung
cancer has been demonstrated, in principle,
in high-income countries, but much cheaper
and more accessible methods are needed for
low-income settings.
Control and elimination
The overarching strategy for elimination of
lung cancer depends on smoking cessation
by helping current smokers to stop, and by
reducing the number of people who start
smoking. Legislation to regulate tobacco
use and its promotion, to eliminate exposure
to cigarette smoke in public areas, and to
raise taxes on tobacco products are proven
techniques that decrease tobacco use. These
efforts are particularly important in countries
where smoking rates are high or rising.
Reducing the risk from other lung carcinogens
such as air pollution, which is now classifi ed as
carcinogenic to humans [42], is needed.
Comparative effectiveness research into
strategies aimed at tobacco use reduction
and cessation through public policy is
needed. Better screening, early diagnosis
and identifying molecular targets for effective
and cost-effective modern treatment should
improve lung cancer outcomes. Globally,
efforts to reduce inequity of care and access
to effective and affordable treatments are
also vital for addressing the lung cancer crisis
around the world.
Forum of International Respiratory Societies
25