In Romania, broncho-pulmonary cancer is the most common form of cancer among men, respectively the fourth most common form of cancer among women. As for lung cancer, the incidence and mortality rate are continuously increasing, demonstrating an 11% rise compared to the year 2000, an aspect mainly generated by the increase in the smoking rate. (3)
Dr. Sorina Pop, primary care physician specializing in family medicinePhoto: Bristol Myers
Also, lung cancer is the main cause of cancer mortality in Romania. However, with early detection, survival rates can double. It is also one of the main causes of preventable deaths.
Although cancer survival rates are improving, Romania is still well below the European average (15%), with a survival rate of 11%.3 Considering the discrepancies between the incidence rate and the cancer mortality rate in Romania, compared to the figures recorded at the European level, currently there is a significant difference in terms of early diagnosis. (3)
In the diagnosis of bronchopulmonary cancer, as in the case of any other serious health problem, the first step is to consult the family doctor. Dr. Sorina Pop, primary care physician specializing in family medicine, recommends everyone who thinks they are healthy to consult their family doctor at least once a year.
“When the patient comes to the family doctor, even if they are apparently healthy, they benefit from a history, an interview and a clinical examination. Certain risk factors are identified, the family doctor can recommend additional investigations, and if the patient comes to the doctor in time, a health problem or certain hidden diseases can be identified in time. An important disease that remains much under-diagnosed is broncho-pulmonary cancer, and in its case there are several symptoms that should constitute an alarm signal. They are the symptoms of the respiratory system: any cough that lasts for more than a week, regardless of whether it is with sputum or without; a tiredness when walking, a lack of air or a slight difficulty in breathing; repeated pneumonias without an obvious cause. And last but not least, it is actually the first alarm sign that sends the patient to the doctor – the blood in the expectoration, in the sputum. The second category of symptoms are the general ones: a patient who, without an obvious cause, loses weight, tires more than before, has low fevers, sweats more profusely, especially at night, is pale, asthenic, it is important to present to the doctor to evaluate these general signs, which say that something bad is happening in the body. And thirdly, certain indirect symptoms, due to the compression made by the possible tumor mass. And I would say here: if the patient is hoarse for no reason, if that hoarseness persists for a long time, if he has difficulty swallowing, if abnormal noises are heard during breathing, such as wheezing. Sometimes it can be a trivial disease, a bronchial asthma, but other times it can hide a more severe disease. And other signs, such as bone pain or pain in any other part of the body, especially in the chest area, require the presence of a doctor.” attracts the attention of Sorina Pop.
There are two main types of lung cancer (7)which differ in aggressiveness and the possible evolution of the disease:
- The small cell form of lung cancer is growing rapidly and represents about 15% of all cases of broncho-pulmonary cancer. According to the name in English, this form is also abbreviated as SCLC (“small cell lung cancer”).
- The non-small cell form is more often diagnosed and comprises approximately 85% of bronchopulmonary cancers. According to the name in English, this form is also abbreviated NSCLC (“non-small cell lung cancer” = broncho-pulmonary cancer other than small cell). Depending on the type of cells from which the cancer starts inside the lung, non-small cell tumors are further divided into squamous carcinomas and nonsquamous carcinomas, among which adenocarcinomas and large cell lung carcinomas are also described (6)
Early detection and screening substantially increase the chances of treatment and survival.4 Starting from the objective of reducing the mortality rate by 3.5% per year, the National Plan to Combat Cancer advances as a priority, the implementation of a national screening program. In efforts to achieve this goal, the Ministry of Health together with the National Institute of Public Health will design and implement a pilot program for the screening of broncho-pulmonary cancer.4 Up to this point, Romania has partially implemented a program aimed at detecting this type of cancer. However, increasing awareness among health care personnel (in addition to pulmonologists and oncologists) of the existence of the screening program is a necessity, especially among general practitioners and nurses. This approach would ensure an increased level of accessibility among people in risk categories. (5)
Given the high incidence, mortality rates, and substantial economic burden, efforts to prevent, early detect, and improve treatment strategies are essential in combating this disease. In this context, the Romanian Society of Pneumology (SRP), together with the Romanian Radiotherapy Society (SRR), the Romanian Society of Radiotherapy and Medical Oncology (SRROM), the National Society of Family Medicine (SNMF), the Association of Family Doctors Bucharest-Ilfov ( AMF-B), the National Society of Medical Oncology in Romania (SNOMR), the Federation of Associations of Cancer Patients (FABC), with the support of Bristol Myers Squibb, continues the campaign Listen to your cough!, a bronchopulmonary cancer awareness project among the general public. Through constant and ongoing awareness efforts to understand the risks and symptoms of the disease, with the support of health professionals, pulmonologists, family oncologists and patient representatives, the chances of survival of those suffering from broncho-pulmonary cancer can increase significantly in the coming years.
The diagnosis of broncho-pulmonary cancer does not only have consequences on the body. For the patient, but also for the relatives, it can be a mental burden. Patients diagnosed with cancer also need emotional support in managing the disease and can benefit from psycho-oncological counseling, which is offered by numerous patient associations. Psycho-oncological measures support the affected persons and their relatives in the emotional approach to the tumor condition and in the management of the changed life situation, which appeared as a result of the diagnosis.
Dr. Sorina Pop draws attention to the fact that the role of the family is huge in the entire process, from the initiation of medical investigations to diagnosis and treatment:
“Family support, even before the disease is confirmed, is extremely important. Often, the patient refuses to go to the doctor, but someone in the family hears that he is coughing at night or sees him not eating. The family must also be with the patient during smoking cessation sessions, recommending a healthy lifestyle. After the disease has been detected and when the patient enters a specialized oncological treatment – chemotherapy, radiotherapy, the family accompanies him to the treatment. And when the therapeutic resources no longer exist for him, the patient enters palliative care, where the family doctor has a special role, and one of the family members takes on the role of primary caregiver.”, says Sorina Pop.
For patients with early detection of lung cancer, the end of treatment does not mean the end of care. Cancer must be constantly monitored, and a good management of healing requires regular visits to the doctor for individual counseling and control of the evolution of the disease. After the end of a treatment, an individual follow-up care plan is created for each patient, adjusted according to the stage of the disease and the treatment followed (1).
The aftercare plan has three (1) essential objectives:
• to recognize and treat in time a possible recurrence of cancer
• identify and treat conditions associated with cancer
• to provide support to patients for their emotional, physical and social problems.
Aftercare scheme
4 – 6 weeks after the end of treatment:
- Clinical examination, blood count, lung function tests, lung X-ray. In the case of drug treatment: control of responsiveness, side effects and charges.
12 weeks after the end of treatment:
- Clinical examination, blood count, lung function tests, lung X-ray.
- Other imaging procedures (eg, CT or MRI) may be necessary if there is an increased risk of disease recurrence or progression.
- In the case of drug treatment: control of responsiveness, side effects and charges.
Month 3 to the end of the 2nd year
- Regular checkup every three months.
- once a year chest computed tomography (chest CT).
- Other imaging examinations (e.g. abdominal ultrasound, X-ray, CT/MRI or bronchoscopy) may be additionally performed in case of suspicion of recurrence or in case of metastases.
- In case of disease progression: if possible, adjustment/change of drug treatment.
Years 3 to 5
- Regular check-ups every six months and chest CT once a year
- Imaging examinations depending on the patient’s symptomatic picture.
From the 6th year
- control examination per year
Footnotes:
(2) Ciuleanu, T., E. (2012). Research and standard of care: lung cancer in Romania. American Society of Clinical Oncology Educational Book, Vol. 32 (1), 437-441. (Online) Available at https://pubmed.ncbi.nlm.nih.gov/24451777/
(3) OECD, European Observatory on Health Systems and Policies. (2021). Romania: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris. (Online) Available at https://health.ec.europa.eu/system/files/2021-12/2021_chp_romania_english.pdf
(4) Ministry of Health. (2022). The National Plan to Combat Cancer. (Online) Available at https://www.ms.ro/wp-content/uploads/2022/01/Plan-National-de-Combatere-a-Cancerului.pdf
(5) European Alliance for Personalized Medicine. (2020). Revolutionizing Lung Cancer Care: The Situation in Romania. Fact sheet Romania. (Online) Available at https://www.euapm.eu/pdf/EAPM_revolutionising_lung_cancer_care_all_together_romania_feb_2021.pdf
(7) Molina, J., R., Yang, P., Cassivi, S., D., Schild, S., E., Adjei, A., A. (2008). Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. In the Mayo clinic proceedings, Vol. 83(5). 584-594.
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