Authors: Karen Kane McDonnell PhD, RN, Associate Professor, Co-Director, Cancer Survivorship Research Center; Amanda R. Bennett MSN, RN, PhD Student; & Vera Bratnichenko MSN, RN, PhD Student; College of Nursing, University of South Carolina, Columbia, SC, United States

November brings awareness to individuals living with lung cancer and their family members and friends. Regardless of the prognosis, a diagnosis of lung cancer creates substantial physical, emotional, and financial challenges on individuals, families, communities, health systems, and countries.¹ Lung cancer continues to be the most common cancer type and the leading cause of cancer death worldwide. Around the globe, the general cancer burden is high and increasing.¹ The highest incidence rates of lung cancer are observed in parts of North America, in East Asia, and in parts of central and eastern Europe.¹

There is good news which fosters HOPE! The number of new lung cancer diagnoses is declining steadily in some countries. The American Cancer Society describes trends in cancer death rates as the best measure of progress against cancer. In the United States, lung cancer death rates declined by 56% since 1990 in men and 32% since 2002 in women. These improvements in lung cancer survival are due to declines in cigarette smoking and advances in early detection and treatments, mostly for non-small cell lung cancers (NSCLC) the more common classification of lung cancer (NSCLC; 82%).² In recent years, more individuals with lung cancer are being diagnosed when the cancer is at an early stage and living longer as a result. The rate of localized-stage disease diagnoses increased by 4.5% yearly from 2014 to 2018, while there were steep declines in advanced disease diagnoses. The result was an overall increase in 3-year survival rates (from 21% to 31%).^2.3

It is widely accepted that the major cause of lung cancer is tobacco smoking, which is responsible for 80–85% of lung cancer cases worldwide. The World Health Organization describes tobacco use as a global epidemic.⁴ Tobacco smoke contains more than 7000 chemicals and at least 69 carcinogens, including polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, and benzene. About 8 out of 10 (81%) deaths from lung cancer are expected to be caused from smoking cigarettes. Both the amount and how long someone smokes increase the risk of dying from lung cancer. People who smoke are about 25 times more likely to develop lung cancer than those who never smoked. Second-hand smoke causes almost 3% of new diagnoses of lung cancer and is expected to cause about 3% of deaths. After smoking, the next leading cause of lung cancer is exposure to radon gas, which is released from soil and can build up indoors. Relative to the hazards of smoking cigarettes and cigars, the full hazard profile presented by electronic nicotine delivery systems (NEDS) and by cannabis smoking are largely unknown at this time.^2,3,4

Chronic obstructive pulmonary disease (COPD) is the most common smoking-related illness in the world and the most common co-morbidity for persons with lung cancer. Even though, it is well established that COPD is associated with the risk of lung cancer it is often under-emphasized as a comorbidity for those with lung cancer.⁵ Clinically, the co-existence of lung cancer and COPD can have a dramatic impact on the patient’s quality of life (QOL) and survival.⁵

Optimal treatment of concurrent lung cancer and COPD is crucial to the success of lung cancer therapy. Oncology and advanced practice nurses can play an essential role in these patients’ care, which requires early and close attention to prevention, assessment, treatment, and surveillance of both diseases, related symptomatology, and lifestyle behaviors. Patients with lung cancer and COPD benefit from a multidisciplinary disease management approach throughout their illnesses to ensure maximum QOL and functional status. In collaboration with a team that includes pulmonologists and oncology physicians, oncology nurses can help improve these patients’ health outcomes using pharmacologic and nonpharmacologic treatments and symptom management. More clinical research is needed to expand our understanding of the management of patients with this twofold disease burden, to increase the use of existing evidence-based interventions, and to develop, and test new QOL-boosting interventions.⁵

The outlook is more promising than ever for individuals with lung cancer at all stages of disease with and without COPD. Around the world, nurses who care for persons with a history or current diagnosis of lung cancer can make a positive impact. The Position Statement on Cancer Nursing’s Potential to Reduce the Growing Burden of Cancer Across the World describes nurses as “essential” to cancer control.6 The Call to Action is clear. It is our role as nurses to reduce the global burden of cancer across the cancer trajectory.