Life expectancy and lung cancer: In-depth insight from a specialist

In this article, highly esteemed consultant medical oncologist Dr Jay Naik shares his expert insight on the factors involved in determining life expectancy and assessing likely outcomes for patients with a lung cancer diagnosis. The revered specialist also sheds light on the various forms of treatment available for different types of lung cancer.

What is the most successful type of treatment for lung cancer?

This depends on the type of lung cancer the patient has and also how you define success in this context. I would say a successful treatment is one that shrinks the cancer and not only keeps the patient alive, but affords them a good quality of life. Clearly, if this can be done over a sustained period, this is the most successful treatment in my mind.

In terms of response rates, targeted treatment, with EGFR or ALK protein changes, for instance, is very successful and can generally give two to three years of control with the first part of treatment. However, once this treatment has run its course, it becomes difficult to find another effective treatment going forwards. One issue is that there are relatively few other treatments available, but hopefully in the coming years more treatments will be developed.

In terms of long term survival, certain patients, albeit a small selection, get a very good response to immunotherapy. In immunotherapy trials, patients who get a successful response and have control of their disease at 2 or 3 years, often go on to maintain this control for much longer. Although we are still waiting to see the full data on this, we believe that a proportion of those patients will go on to have a long term controlled cure. It's difficult to establish that somebody is completely cured and we will likely need to wait twenty years or so to see what happens with all these patients. However, we are seeing patients who seem to have long term control after five years - up to around twenty per cent of the patients involved in some of these trials.

When speaking about how successful a treatment is, we are assessing to what extent it can sustain a patient’s life, while also allowing them to live well. Unfortunately, we are not able to achieve this for all patients. Therefore, the discussion about the likelihood of achieving a good outcome and how our understanding of this will develop throughout the treatment journey is key. For patients, being well informed about this is crucial and it’s the job of an oncologist to try and help you understand your individual case so we can make decisions that make sense to you and give you a clear idea of what we are hoping for from the treatment.

Although we all would like reassurance that we will be in good health in the long term, this is unfortunately not the most likely scenario for patients with lung cancer. Therefore, it’s important to be aware of what you will face and what to expect from the potentially challenging side effects of your treatment, whether it is chemotherapy or a targeted treatment, so that you can make an informed decision about your next steps.

What is the life expectancy associated with lung cancer?

The life expectancy of a patient with lung cancer depends entirely on their individual case. If you have an early stage lung cancer and we are able to pick it up where it's localised, you can have an operation and go on to survive for years. This typically accounts for a small proportion of patients and historically, around one in twenty patients go on to live long term after having lung cancer. This is improving, and we are now moving towards a ten to fifteen per cent rate of long term survivors.

Another key factor is the spreading of cancer throughout the body. When patients have lots of cancer, not only in the chest but also in other organs as well, this influences how well they will respond to treatment.

Additionally, another key influence is the target for treatment with immunotherapy. If you have a standard lung cancer with a target for the immunotherapy, such as a protein, you have a better chance of responding to the treatment and are probably more likely to live for longer. Some such patients will go on to live for a short number of years, from to two to three years, while others may only have a few months.

Life expectancy with lung cancer is different for everybody and in my view, the best description of the prognosis for advanced lung cancer is something called performance status. If you are well and are able to manage your daily activities without any restriction, in my opinion, your prognosis is unrestricted as we cannot say exactly how long you should expect to live. You may have years and will certainly have long months in that situation. On the other hand, if the cancer is starting to make you poorly and we can't change that with treatment, you may find that you are resting quite often and you may unable to do some of your day to day tasks. In this scenario, as you may imagine, your outlook might be measured in months. When you are finding it very difficult to perform some of your daily activities and you are spending more than half your time in bed, this may indicate that your outlook may relate to weeks rather than months.

Life expectancy in cases of lung cancer really depends upon the patient’s wellbeing as a whole in relation to the cancer and the effectiveness of the treatments. After receiving a diagnosis of lung cancer, many people want to know what to expect straight away, and often ask “how long have I got?”. Unfortunately, we don't know. Life expectancy is determined on a highly individual basis. After going through a range of assessments, we will be able to establish a treatment plan for you but we also have to see how the treatment works. Some treatments work incredibly well for some people but not for others and we won't know in your individual cases until we try the treatments. Therefore, rather than giving you specifics, I can tell you what we understand about lung cancer patients as a whole. For you as an individual, however, we will assess the most likely outcomes as we see how well you progress throughout your treatment journey.

You can read more about different types of lung cancer and how they are treated in Dr Naik’s other detailed article on the topic.

If you wish to schedule a consultation with Dr Naik, you can do so by visiting his Top Doctors profile.