For this episode of Karger’s The Waiting Room Podcast, we spoke with Dr Anne-Marie Baird, who currently serves as the president of Lung Cancer Europe (LuCE). She is a Senior Research Fellow at Trinity College Dublin, Ireland, and a patient advocate.

LuCE is the voice of Europeans impacted by lung cancer. The aim of LuCE is to destigmatise the disease and ensure that those impacted by lung cancer get the care they need to achieve the best possible outcomes.

Note: The statements and opinions contained in this podcast are solely those of the speaker.

Podcast Interview

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Transcript

It’s great to have you here, Anne-Marie. As you are a cancer researcher and a patient advocate, let’s jump right in with the first question: What is lung cancer? What are the different kinds of lung cancer?

So very simply put, lung cancer is a disease that starts in the lung cells. So, it just means that the cells within the lung start to grow and divide abnormally. And then over time, they create a mass of cells otherwise known as a tumor. And it’s really important to understand that if you have a lung cancer that goes to another part of the body, such as the liver or the brain, this is still a lung cancer.

In terms of the different types of lung cancer, there are two main subtypes:

• non-small cell lung cancer, which accounts for about 85% of lung cancer cases, and also
• small cell lung cancer, which is about 15% of cases.

Non-small cell lung cancer is then further divided into a number of subtypes, such as adenocarcinoma, squamous cell carcinoma and so on.

And then within that adenocarcinoma can be further divided based on the different markers that are on the surface of the tumor. And one that people might be more aware of is something like EGFR positive lung cancer, which would mean that there’s an alteration in EGFR on the tumor cells in the lung.

So that’s quite a big family of lung cancers. What are the signs and the symptoms of lung cancer?

You’re absolutely right. There’s a huge variety of different lung cancers. It can also be very complex in terms of the signs and symptoms. There are also many of those, and some of these can be overlooked or maybe normalized. One of the main driving symptoms is that of a persistent or a long-term cough or a long-term cough that has changed in some way. Breathlessness is also one of the common presenting symptoms of the disease. And then there’s others, such as fever, appetite loss, weight loss, fatigue, feeling weak. You can have bone pain, particularly shoulder, chest or rib, and you can also get finger clubbing, which is where the tops of your fingers look very different. So, there’s definitely quite a large range of different symptoms that people can present with.

This will probably make it difficult to diagnose. But we come to the diagnosis question later. I first wanted to ask you: What are the risk factors and the causes for lung cancer?

The one that people are going to be more aware of is that those with a smoking history are more at risk of developing lung cancer. However, it is very, very important to understand there are other risk factors outside of smoking history. And these can be if you have exposure to secondhand smoke, radon, asbestos, certain chemicals in water such as arsenic or uranium; there can be certain chemicals within your workplace or in the environment that you live in that can also increase your risk.

If you have had previous radiation therapy to your chest, this can also increase your risk. And then when we look at things such as infections, if you’ve had a lot of different infections within your lung, air pollution is another big cause of lung cancer.

A family history of the disease. And then there are some other diseases that can increase your risk, such as chronic obstructive pulmonary disease, also known as COPD.

It is very important to understand that you do not have to have a history of smoking to be at risk of developing lung cancer, approximately 15 to 20%, depending on the population you look at, can have lung cancer where there is no history of smoking. Anyone with lungs can get lung cancer.

That’s important to know and to listen to your body if you have symptoms like this. So, how is lung cancer diagnosed?

So, usually a person would present to their primary health care with maybe one of the symptoms I have described, such as the persistent cough or breathlessness or fatigue or whatever it might be that they’ve identified, that is not normal. They will then be taken through their medical records. Usually you’ll have a physical examination to see things like weight, pulse, blood pressure, all of the usual suspects, I guess. And then you can have a range of blood tests that are done. And then most importantly, you’ll have a number of diagnostic imaging tests performed as well, such as a CT scan.

And then following that, if there’s evidence of something that’s abnormal within the lung, it is usual then to follow up with what’s called a biopsy, where there’s usually a little piece of tissue taken from the growth within the lung. And then this is used to determine whether or not what they find within the lung is a lung cancer. And then there can be other tests that they do to more accurately diagnose the specific type of lung cancer you have.

Because we’ve already mentioned lung cancer is very complex. There are many different types. So, the pathologist will do various tests to determine the histology, which is to do with the tissue. And then they could also do some biomarker testing, which is to do with those surface markers that I mentioned before, such as EGFR.

So, it’s quite a journey to be diagnosed with lung cancer. Once you have the diagnosis, the next or the most important question, of course, is how is lung cancer treated?

The way in which lung cancer is treated can really vary depending on the specific type of lung cancer you have. So this is why it’s really, really important to get an accurate diagnosis of your lung cancer, because this will then help to dictate treatment. Treatment will also depend on what stage of lung cancer you have. The stage of lung cancer is whether it’s still within the lung or whether it has spread outside the lung. It can also depend on how you are yourself. Do you have any other medical conditions? And it can also depend on what your goals are for your treatment so what is the best type of treatment you want to receive for your type of disease?

But depending on all of those factors, surgery could be an option, with the surgical removal of the tumor. Chemotherapy could also be an option depending on what type and stage. You can also have radiotherapy. You could have a combination of chemotherapy and radiotherapy, which is called chemo-radiation. There are also targeted therapies. So if your tumor has a specific marker, you can get a therapy that’s targeted towards that. There’s also immunotherapy. So, an immunotherapy is a drug that’s given that helps your immune system fight cancer cells.

And sometimes people might have one of these treatment options or they might have a mix of treatment options. That really just depends, again, on what your specific type of lung cancer is and what the stage is and how you’re feeling as well. So again, lung cancer is quite complicated and the care pathway in and of itself can also be quite complicated.

So there is a range of treatment options, which is the good news.

Yes, there are a lot of different treatment options depending on the specific type of lung cancer that you have. Although, it’s very important to note that not all diagnostic tests and not all treatment options are available to everybody because we have a lot of inequalities in lung cancer care. What we want to obviously strive for is if there’s something out there that can help someone have a better outcome. We want to try and ensure that everybody has access to that, whether it’s diagnostics, treatment or care.

So this is the vision and mission of LuCE, obviously.

Exactly. We want to have best possible outcomes, but as well as that, we also want to have the best possible quality of life, because sometimes that’s neglected, but it’s not just about living longer with the disease. It’s also being able to live longer with the disease, but also having a very good quality of life as well.

I think that’s an important aspect. Now, at the end of our interview, is there anything else you would like to add? Is there an aspect of this topic that is especially close to your heart?

So, especially close to my heart is the topic of the stigma around lung cancer. I have a personal connection to lung cancer. Both my aunt and my granny died of small cell lung cancer. And as a family, we experienced lung cancer stigma. And lung cancer stigma is something that makes a very difficult diagnosis even harder for a family. And it’s just very tough. It’s even hard to put into words how tough it is.

We also know that lung cancer has a huge psychosocial impact, more so than any of the other cancers. And when people perpetuate stigma in the language that they use or the images that they use, this just adds to that psychosocial impact. And it can make just things much darker and much harder for not only the person living with the disease, but also those around them, their family, their caregivers and so on. So, I would really ask people to think before you speak and break the cycle around lung cancer stigma and the blame game that so many people are experiencing with this disease.

Well, thank you, Anne-Marie, for sharing such a personal experience with lung cancer. And I think you’re absolutely right. I agree with you. And thinking before speaking is a very good sentence. So this was a really interesting conversation. And I think we should continue this. I hope you will come back to The Waiting Room for another podcast episode.

Absolutely happy to come back at any time.

So, thank you very much. It was a pleasure talking to you.

Thanks for having me.