[ad_1]
SINGAPORE, April 29 – When he learned that he was suffering from stage four lung cancer, Jeffrey Leong first worried about how to announce the new to his daughters.
"We are a very united family. If something happened to their father, I knew it would be difficult for them to accept it, "said Leong, 57, who works on his own.
His daughters were aged 17 and 21 when, in July 2016, an MRI of a muscle tendon injury accidentally revealed three huge tumors in his lungs.
The largest, inside his right lung, was 10 cm long.
Lung cancer is one of the most deadly cancers and an advanced diagnosis is considered a quick death sentence.
"My wife and I decided to present my diagnosis as a 'business plan' and see how we would evolve from there. With cancer, you must not only stay positive, but also instill a sense of positivity to the people around you, "said Leong.
Despite his optimistic attitude and his two series of exhausting chemotherapies, the cancer continued to spread. As he grew up and blocked one of the key arteries leading to his heart, breathing became a challenge.
Four months after diagnosis, Leong has been seen to offer immunotherapy as a last resort. The relatively new cancer treatment, combined with chemotherapy, has mobilized the immune system to fight cancer.
"I knew that with stage four lung cancer, there would be no miracle cure. The biggest challenge at the time was whether I should continue to try (standard treatment) or opt for something new, "he said.
The new treatment worked, greatly reducing large tumors in a few months. Starting in mid-2017, badyzes showed that he was not suffering from cancer.
In Singapore, lung cancer is the second and third most common cancers for men and women, respectively. But it is the main cause of cancer deaths.
Between 2011 and 2015, about 930 new cases of lung cancer were diagnosed in men each year and about 500 new cases among women each year, said Dr. Kong Hwai Loong, medical oncologist at Icon SOC Singapore's Medical Center. Paragon, who treated Leong.
Lung cancer accounts for 27.1% of cancer deaths among men and 16.6% among women, said Dr. Shang Yeap, another oncologist at Icon SOC.
Non-smoking non-immune
Smokers are at greater risk of getting lung cancer, but non-smokers are not exempt, experts said.
New evidence shows that environmental factors such as second-hand smoke can contribute to risk. Lung cancers in non-smokers are more likely to harbor a specific mutation, allowing patients to initially be treated with a targeted oral drug, said Dr. Kong.
"Nobody is immune to lung cancer. Non-smokers for life may also be affected by lung cancer, particularly non-squamous non-squamous cell lung cancer, "said Dr. Kong.
Non-squamous non-small cell lung cancers – which Leong, a former smoker, had – accounted for the majority of lung cancers. These are mainly adenocarcinomas, or cancers that form in the mucus-secreting glands throughout the body, Dr. Yeap said.
Stage four cases are generally considered incurable, said Dr. Kong.
Until two or three years ago, these patients would be treated with either oral drugs or chemotherapy, "said Dr. Kong. Targeted cancer treatment blocks the growth and spread of cancer by interfering with specific molecules responsible for the spread and progression of cancer.
The goal of treatment is to manage the symptoms and allow the patient to live longer, he said.
On average, patients who respond to initial treatment can live between one and three years, but those who do not, live a few months to a year, said Dr. Kong.
"While a significant proportion of treated patients would initially show a response to treatment, tumors in regression would invariably rebound," said Dr. Kong.
Exploit the immune system
New therapies that exploit the immune system to fight cancer aim to extend the time allotted to patients whose lung cancer has spread.
"Immunotherapy, especially pembrolizumab, has dramatically changed the landscape of lung cancer treatment," said Dr. Kong.
Last November, the Health Sciences Authority approved pembrolizumab, in combination with chemotherapy, as a first-line treatment for patients with metastatic non-squamous cell lung cancer who lacked certain responsible mutations. cancer.
The approval was based on promising data from a multicenter and randomized clinical trial.
The life-saving treatment of Leong is also used for other cancers such as melanoma (skin cancer), bladder cancer and clbadical Hodgkin's lymphoma.
"When pembrolizumab is used in combination with chemotherapy, the risk of death in these patients would be halved compared to patients treated with chemotherapy alone. They were also much more likely to benefit from a longer period of stability than those treated with chemotherapy alone, "he added.
The treatment is relatively well tolerated although some patients may develop significant organic damage due to a hyperactive immune system attacking their own body, said Dr. Kong.
Two other immunotherapy drugs, nivolumab and atezolizumab, are also available in Singapore for the treatment of lung cancer, said Dr. Wong Seng Weng, medical director and oncology consultant at the Cancer Center.
All three therapies have reported prolonged control of advanced lung cancer, said Dr. Wong.
"Some patients who have started Phase 1 clinical trials, before treatment approval, are still doing well and remain after more than seven years," said Dr. Wong.
New targeted therapies are also available to treat patients with non-small cell lung cancer who have become resistant to their previous treatment, said Dr. Yeap.
Costs can be "a headache"
Immunotherapy is not cheap, however, and the cost of long-term treatment is a major consideration for many patients.
"Immunotherapy can sometimes reach a very long period of cancer control even for advanced lung cancer. This is good news from the point of view of the extension of life, but it is clearly a headache with regard to the cumulative cost of treatment, "said Dr. Wong.
According to him, the cost of immunotherapy treatment ranges from 7,000 to 15,000 every three weeks, depending on the dosage. If chemotherapy is added, there will be additional costs.
Chemotherapy costs between Singapore $ 3,000 and $ 7,000 every three weeks, depending on the choice of drugs, he said.
According to expert opinion, the immunotherapy treatment should be continued for at least two years, if the disease does not develop resistance to treatment and if the patients do not have significant side effects, said Dr. Wong.
Immunotherapies are generally claimed in the category of chemotherapy for Medisave and Medishield, subject to the limitations of individual regimens, said Dr. Wong. The Medishield Life and Medisave databases may not be enough to cover the total cost, he said.
Dr. Wong said that some patients who get remission after several months of treatment choose to stop treatment early because of its cost. But he observed some patients who showed no signs of cancer progression, even after a while.
"It seems that for some patients, once their immune system has been mobilized to fight cancer, the momentum can be maintained even in the absence of a continuous use of the drug," he said. said Dr. Wong.
The best way to get a good treatment result, however, would be early detection. In the early stages, surgery can be curative, said Dr. Kong.
Dr. Kong advised smokers to talk to their doctors about participating in a regular lung cancer screening program.
Smokers and non-smokers with persistent pulmonary symptoms, such as coughing or shortness of breath, for more than two weeks should seek medical attention for further evaluation. Unexplained weight loss and loss of appetite are other telltale symptoms.
Much to live for
Leong's greatest challenge during his cancer journey was his psychological impact, but he found ways to deal with the situation. Throughout his cancer treatment, he has been pushing to continue to exercise. He walked 45 minutes daily on the treadmill and lifted weights.
"I was so weak that I could not even do a 1 kg biceps loop when I raised 10 to 12 kg. But I did not want to stay in bed, stay home – that's when people give up life. I wanted to live life as normally as possible. Even if I walked more slowly, I could still move, "he said.
In addition to remaining optimistic, Leong advised cancer patients to find a doctor they trust.
"People have given me a lot of advice, from the boil of some root to the consumption of a certain leaf. Well, I did not do any. All I did was listen to my doctor, "he said.
Still on immunotherapy, Leong's thyroid gland was damaged as a side effect of treatment, but he considers himself lucky.
He has stopped smoking two packs of cigarettes a day and is now adopting a healthier lifestyle of consuming more fresh whole foods, less processed foods and getting regular exercise. He has also taken a step back in his career and is now working on a contract.
"I was the first person to enter the office and the last to leave. No need to pursue materialistic goals. There is too much life in which to live, "he said. – TODAY & # 39; HUI
Source link
