with 7.5 million canadians living with lung disease, the lack of a national strategy is costing lives
inadequate lung cancer screening, underfunded research and unaffordable treatment has advocates wondering when governments will recognize the severity of lung disease and its impact on the health-care system.
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from a breast cancer diagnosis to lung cancer, angus pratt is just one of thousands of canadians who would have benefited from lung cancer screening. supplied
for angus pratt, it was an incidental finding. a ct scan — ordered to determine whether the breast cancer he had just been diagnosed with had spread elsewhere in the body — showed a large mass on his lung. the assumption was that it was metastatic breast cancer, but following additional tests, pratt was diagnosed with stage iiic lung cancer, and was told by a doctor that 50 per cent of patients make it to 17 months, and that only five per cent of people may live for five years.
over the next eight weeks, treating lung cancer became a priority over the breast cancer, and pratt received intense chemotherapy and radiation. two days before starting a new immunotherapy drug that had shown promising results in lung cancer patients, he had a bilateral mastectomy.
in canada, lung cancer, one of many types of lung disease, continues to be the most commonly diagnosed cancer. about 70 per cent of patients are diagnosed at an advanced stage, and roughly 20 per cent of people, including pratt, have never smoked. for many, lung cancer can feel like a death sentence, but research, screening and new targeted therapies have contributed to improved patient outcomes over the past few decades.
whether it’s chronic obstructive pulmonary disease (copd), asthma or lung cancer, marginalized and at-risk communities are particularly vulnerable to lung disease and are more likely to experience poor respiratory health outcomes. according to one report, inuit communities have the highest incidence of lung cancer in the world, while another study suggests that first nations adults are 35 per cent less likely to survive lung cancer five years after diagnosis than their non-indigenous counterparts. similarly, copd is also more prevalent among indigenous peoples, and asthma tends to be underdiagnosed in inuit children due to reduced access to medical services and lung health specialists.
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many people with lung disease can’t afford treatment
in canada, there are more than 7.5 million people who live with some form of lung disease, and many can’t afford their daily medications. a report by the lung health foundation suggests that 24 per cent of patients with copd — one of the leading causes of death and hospitalization in canada — lack an adequate private health insurance plan that covers the cost of all available treatment, often forcing them to choose a less effective, but more affordable, option.
and yet, there is still no national strategy in place for lung disease, leaving patients to rely on provincial and territorial health systems — this inconsistent and uncoordinated approach is affecting lung health outcomes and costing the health-care system $42 billion annually.
to help change the course of lung disease in canada, the lung health foundation has developed the lung health agenda. this comprehensive plan is built around awareness and prevention, disease detection and management, as well as research and surveillance. it outlines concrete strategies to increase lung cancer survivorship, reduce disease incidence and improve overall disease data collection.
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“the federal government has developed national strategies for virtually all other major chronic diseases, such as diabetes, heart disease and dementia, but lung disease continues to be overlooked and underfunded,” says jessica buckley, president and chief executive officer at the lung health foundation. “one in five canadians suffer from lung disease and the underfunding of screening, research and other areas has led us to where we are today.”
buckley uses current lung cancer screening programs as an example. right now, people who are active or former smokers aren’t getting screened early enough and those who have never smoked aren’t being screened at all. lung cancer is usually discovered spontaneously or after first symptoms develop, at which point, the disease has already progressed.
part of the reason for the gap in adequate screening is the fact that the disease doesn’t have the same funding appeal as other types of cancer because of stigma (its connection to smoking), says dr. dawn bowdish, the executive director of mcmaster university’s firestone institute for respiratory health (firh). the result is fewer medical professionals building research careers in lung cancer treatments and diagnostics, and fewer people with specialized skills to perform the treatments that patients need.
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“lung cancer is a major killer in canada, and we need to reframe the focus to make sure it’s given the research and training dollars and clinical trial support it needs,” says bowdish, who is also canada’s research chair in aging and immunity, and a member of the board of the lung health foundation. “i feel passionately that there is no reason to assign blame. none of us deserves to get cancer.”
to help pave the way for a better future, the firh is investing in interventional pulmonologists — specialists who learn the skills and treatments to care for people with lung cancer, perform surgeries, and work closely with other clinicians. bowdish is hopeful that programs like this may give more patients access to specialist care, which may be particularly beneficial for those who live in rural areas.
another strategy is addressing lung health in our youth by steering teens and young adults away from using cannabis, tobacco and vaping products. the lung health foundation has introduced a smoking and vaping cessation program — its quash app — which is available for download for teens, or anyone who wants to quit, at no cost.
still, without the support of governments, the wheels of change move slower, costing more and more lives as time passes. it’s what drives pratt to advocate for people living with lung cancer, more funding dollars to support screening, research, treatment and, of course, a cure.
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when asked about the reasons he may have developed lung cancer, pratt says that at this point, “it’s useless to speculate.” he is focused on his recovery, staying present in every moment, and saving his energy for the many advocacy initiatives he is involved in. he is also carving out time for personal interests, including watercolour painting, poetry and exercise.
“it’s been more than four years since the lung cancer diagnosis and i’m running 15k a week,” says pratt. “that tells you where i’m at.”
maja begovic is a toronto-based writer.
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