OUR NEW RESEARCH SHOWS
THAT PERCEPTION AROUND LUNG CANCER MAY BE CHANGING. LEARN MORE

OUR NEW RESEARCH SHOWS
THAT PERCEPTION AROUND LUNG CANCER MAY BE CHANGING.

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The Lung Cancer Project™ is a movement to identify, understand and emove stigma and other barriers faced by people with lung cancer - so everyone receives the care they deserve.

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Lung cancer is the most commonly diagnosed cancer worldwide,1 and the leading cause of cancer deaths in the United States.2 In fact, more Americans die from lung cancer each year than breast, colon and prostate cancer combined.2 But there is hope for people diagnosed with lung cancer. Through scientific research and developments, we are making significant progress in understanding, detecting and treating the disease.

More than 228,000 new cases of lung cancer will be diagnosed in the U.S. in 2016. 2
Lung cancer accounts for 1 in 4 of all cancer deaths. 3
1 in 16 Americans will be diagnosed with lung cancer in their lifetime. 3

Yet, surprisingly, studies have shown that many people with advanced lung cancer never receive cancer care.

More than 1 in 5 people with advanced-stage NSCLC do not receive treatment. More than 1 in 5 people with advanced-stage NSCLC do not receive treatment 4, 5
Nearly 20 leading advocacy and industry organizations joined together to form the Lung Cancer Project and find out WHY barriers exist in lung cancer care... Nearly 20 leading advocacy and industry organizations joined together to form the Lung Cancer Project and find out WHY barriers exist in lung cancer care...
  • 1.Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Lyon, France: International Agency for Research on Cancer; 2018. http://gco.iarc.fr/. Accessed July 10, 2019.
  • 2.American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.
  • 3.SEER Cancer Statistics Factsheets: Lung and Bronchus Cancer. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/statfacts/html/lungb.html. Accessed July 10, 2019.
  • 4.David EA, Daly ME, Li CS, Chiu CL, Cooke DT, Brown LM, Melnikow J, Kelly K, Canter RJ. Increasing rates of No treatment in advanced-stage non–small cell lung cancer patients: a propensity-matched analysis. Journal of Thoracic Oncology. 2017 Mar 1;12(3):437-45. https://www.sciencedirect.com/science/article/pii/S1556086416334761
  • 5.Arya Amini, Vivek Verma, Scott M. Glaser, Ashwin Shinde, Sagus Sampath, William A. Stokes, Chad G. Rusthoven, Erminia Massarelli, Ravi Salgia, Laurie E. Gaspar & Arthur K. Liu (2019) Early mortality of stage IV non-small cell lung cancer in the United States, Acta Oncologica, 58:8, 1095-1101, DOI: 10.1080/0284186X.2019.1599138 https://doi.org/10.1080/0284186X.2019.1599138
Behind the Barriers

Lung Cancer. Stigma. Blame. Hopelessness?

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Emerging research suggests that specific perceptions of lung cancer such as stigma, blame and hopelessness may be a factor in people not receiving the care they deserve.1 The Lung Cancer Project has conducted research to better understand the social psychology of lung cancer in order to change the way people think about the disease.

Since the 1950's, society's attitudes and the understanding of lung cancer have played a role in shaping perceptions of people with the disease. To understand where we are today, we need to first take a look back.

1950's - October 15, 1951: The TV series 'I Love Lucy' premieres on CBS, sponsored by Philip Morris. By the end of the 50s, smoking had become the society 'norm'.
1960's - July 27, 1965: A year after the first Surgeon General's Report on smoking was released, President Lyndon B. Johnson signed a bill on July 27, 1965, requiring health warnings on all cigarette packages.
1970's - December 23, 1971: President Richard Nixon declared the 'War on Cancer' and called for improved research and development of more effective treatments.
1980's - December 19, 1984: Public interest was sparked about the link between radon and lung cancer when a home in Pennsylvania was found to have levels of the gas 1,000 times higher than the acceptable level.
1980's - April 6, 1988: The first study showed chemotherapy could extend survival in people with lung cancer compared to supportive care.
1990's - October 7, 1994: The discovery of cancer-causing genes allowed scientists to start identifying people who have a higher risk of developing certain types of cancer.
2000's - February 4, 2000: The first national anti-smoking campaign to discourage tobacco use among youths was launched.
2000's - The death of ABC News anchor Peter Jennings (August 7, 2005) and Christopher Reeve's widow, Dana (March 6, 2006), from lung cancer brought increased attention to the disease, particularly in non-smokers.
2010's - June 2, 2013: A study found 3 of 4 people have a negative bias towards people with lung cancer, including an association with smoking.
2010's - February 5, 2015: Medicare announced it will cover lung cancer screening for high-risk individuals.
2010's - Since the 1950s, lung cancer incidence has decreased and survival rates have improved to more than a year.
1950's - October 15, 1951: The TV series 'I Love Lucy' premieres on CBS, sponsored by Philip Morris. By the end of the 50s, smoking had become the society 'norm'.
1960's - July 27, 1965: A year after the first Surgeon General's Report on smoking was released, President Lyndon B. Johnson signed a bill on July 27, 1965, requiring health warnings on all cigarette packages.
1970's - December 23, 1971: President Richard Nixon declared the 'War on Cancer' and called for improved research and development of more effective treatments.
1980's - December 19, 1984: Public interest was sparked about the link between radon and lung cancer when a home in Pennsylvania was found to have levels of the gas 1,000 times higher than the acceptable level.
1980's - April 6, 1988: The first study showed chemotherapy could extend survival in people with lung cancer compared to supportive care.
1990's - October 7, 1994: The discovery of cancer-causing genes allowed scientists to start identifying people who have a higher risk of developing certain types of cancer.
2000's - February 4, 2000: The first national anti-smoking campaign to discourage tobacco use among youths was launched.
2000's - The death of ABC News anchor Peter Jennings (August 7, 2005) and Christopher Reeve's widow, Dana (March 6, 2006), from lung cancer brought increased attention to the disease, particularly in non-smokers.
2010's - June 2, 2013: A study found 3 of 4 people have a negative bias towards people with lung cancer, including an association with smoking.
2010's - February 5, 2015: Medicare announced it will cover lung cancer screening for high-risk individuals.
2010's - Since the 1950s, lung cancer incidence has decreased and survival rates have improved to more than a year.
Does a negative bias towards people with lung cancer really exist? YES. Does a negative bias towards people with lung cancer really exist? YES.

In 2012, we conducted a study of 1,778 people to understand the social psychology of lung cancer relative to breast cancer. For the first time, the study confirmed that people have a significantly negative bias and associate blame and hopelessness with lung cancer compared to breast cancer.2

3 out of 4 people have a negative bias towards people with lung cancer. 2
% Percentage of people who associate lung cancer with: Shame 67%, Stigma 74%, Hopelessness 75%. 3
86% associate lung cancer with smoking. 3
80% to 90% of decisions are made subconsciously so people may not realize they are biased. 4
Factors associated with explicit (conscious) and implicit (hidden) bias against lung cancer include race, renger, education, income levels, and cancer knowledge. Factors associated with explicit (conscious) and implicit (hidden) bias against lung cancer include race, renger, education, income levels, and cancer knowledge. 5
Cancer patients, healthcare professionals, caregivers, and the general public all may have a negative bias. Cancer patients, healthcare professionals, caregivers, and the general public all may have a negative bias. 2

Do you have a subconscious bias against lung cancer?

Do you have a subconscious bias against lung cancer? Find out by taking a sample of the Implicit Association Test (IAT) from our study. An IAT is a research tool designed to measure perceptions, stereotypes and other hidden biases that may influence judgment and action related to lung cancer.

The IAT was developed by researchers from The Lung Cancer Project in partnership with Project Implicit®, a team of scientists from Harvard University, the University of Virginia and the University of Washington, and with oversight from an Institutional Review Board (IRB). This research tool was introduced into scientific literature in 1998 and has since been widely used in the field of social psychology.

Begin the Test
Do you have a subconscious bias against lung cancer?
We learned from the initial study that healthcare professionals are equally biased towards people with lung cancer. Does that factor in to how they approach care? We learned from the initial study that healthcare professionals are equally biased towards people with lung cancer. Does that factor in to how they approach care?

Results from a study published in the Journal of Thoracic Oncology found that primary care physicians were less likely to refer people with advanced lung cancer than people with advanced breast cancer to a cancer specialist. In fact, people with breast cancer were more likely to be referred for further therapy, whereas people with lung cancer were often referred only for symptom control.7

Doctors who specialize in lung health, called pulmonologists, often diagnose lung cancer. Do they refer people with lung cancer to cancer specialists? And if so, does it happen quickly?

We collaborated with the International Association for the Study of Lung Cancer (IASLC) to conduct two studies to answer these questions.

1 in 4 people with advanced lung cancer were not seen directly by a cancer specialist. 7
Approximately 1 in 10 did not receive any type of cancer directed therapy. 7
The proportion of people with metastatic lung cancer who receive a cancer directed therapy was larger among people seen by a cancer specialist. 7
Not seeing a cancer specialist may negatively affect access to optimal and timely treatment. 8

For more detail on this research, view the study abstracts on the American Society of Clinical Oncology (ASCO) and World Conference on Lung Cancer (WCLC) websites.

STUDY ABSTRACTS

Changing attitudes regarding lung cancer: shame, embarrassment, and hope (2019)

Changing attitudes regarding lung cancer: shame, embarrassment, and hope (2019)

The predictors and effects of explicit and implicit attitudes against lung cancer (2015)

The predictors and effects of explicit and implicit attitudes against lung cancer (2015)

Explicit and implicit associations toward lung cancer relative to breast cancer (2013)

Explicit and implicit associations toward lung cancer relative to breast cancer (2013)

Explicit and implicit attitudes toward lung cancer relative to breast cancer (2013)

Explicit and implicit attitudes toward lung cancer relative to breast cancer (2013)

Access to Cancer Directed Therapies and Cancer Specialists in Patients with Metastatic Lung Cancer (2015)

Access to Cancer Directed Therapies and Cancer Specialists in Patients with Metastatic Lung Cancer (2015)

Real-World Patterns of Access to Cancer Specialist Care among Patients with Lung Cancer in the United States: A Claims Database Analysis (2015)

Real-World Patterns of Access to Cancer Specialist Care among Patients with Lung Cancer in the United States: A Claims Database Analysis (2015)

Survival Gains From Systemic Therapy in Advanced Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities (2015)

Survival Gains From Systemic Therapy in Advanced Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities (2015)

Differences in primary care clinicians’ approach to non-small cell lung cancer patients compared with breast cancer (2007)

Differences in primary care clinicians’ approach to non-small cell lung cancer patients compared with breast cancer (2007)

Attitudes and Stereotypes in Lung Cancer Versus Breast Cancer (2015)

Attitudes and Stereotypes in Lung Cancer Versus Breast Cancer (2015)

We are committed to understanding the barriers to lung cancer care through research so that people with lung cancer receive the care they deserve. Tweet @LungProject and share your ideas for future research needed to understand barriers to care.

  • 1.LoConte NK, Else-Quest NM, Eickhoff J, Hyde J, Schiller JH. Assessment of Guilt and Shame in Patients With Non-Small-Cell Lung Cancer Compared With Patients With Breast and Prostate Cancer. Clinical Lung Cancer. 2008;9(3):171-8.
  • 2.Sriram N, Mills J, Lang E, Dickson HK, Hamann HA, Nosek BA, Schiller JH. Attitudes and stereotypes in lung cancer versus breast cancer. PloS one. 2015 Dec 23;10(12):e0145715
  • 3.Schiller J, Kolkey H, Cox M, Smith CT. Changing Attitudes Regarding Lung Cancer: Shame, Embarrassment, and Hope. Poster presentation at the 2019 World Conference on Lung Cancer on September 8.
  • 4.Mlodinow, L. (2012). Subliminal: How Your Unconscious Mind Rules Your Behavior. New York, NY: Pantheon Books.
  • 5.Tsung-wei M, Schiller JH, Tian J, et al. The predictors and effects of explicit and implicit attitudes against lung cancer (LC). Oral presentation at the 2015 World Conference on Lung Cancer on September 7.
  • 6.Differences in primary care clinicians’ approach to non-small cell lung cancer patients compared with breast cancer. J Thorac Oncol. 2007;2(8):722–728.59.
  • 7.Ganti AK, Hirsch FR, Wynes MW, et al. Access to Cancer Directed Therapies and Cancer Specialists in Patients with Metastatic Lung Cancer. Oral presentation at the 2015 World Conference on Lung Cancer on September 8.
  • 8.Ganti AK, Borghaei H, Hirsch FR, et al. Real-World Patterns of Access to Cancer Specialist Care among Patients with Lung Cancer in the United States: A Claims Database Analysis. Oral presentation at the 2015 World Conference on Lung Cancer on September 7.
Today's Progress

Research. Progress. Hope.

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Should people with lung cancer be hopeful? We think so. Should people with lung cancer be hopeful? We think so.

In 2012, we conducted a study that revealed for the first time that a hidden negative bias existed towards lung cancer. Given positive external factors in lung cancer care in recent years, such as increased awareness of the disease and improvements in care, we recognized the need to conduct a follow-up study to assess potential changes in attitudes towards the disease.

The latest study findings are promising and show that attitudes towards people with lung cancer are improving.

Associations of lung cancer with stigma and hopelessness decreased. 1 *LC + Shame associations were descriptively weaker but not statistically significant (p = .067)
Negative bias towards people with lung cancer decreased. 1
Fewer people associate lung cancer with smoking. 1

While a negative bias still exists, the significant decrease in the number of people who associate lung cancer with shame, stigma, and hopelessness is encouraging. Past research in the field has shown implicit attitudes tend to remain stable over time, which makes this positive movement all the more important to understand and celebrate.

Attitude towards people with lung cancer are changing for the better, thanks to the collective efforts of patients, advocates, heathcare professionals, and caregivers, all working together to address lung cancer stigma. Attitude towards people with lung cancer are changing for the better, thanks to the collective efforts of patients, advocates, heathcare professionals, and caregivers, all working together to address lung cancer stigma.
Improving survival outcomes. Improving survival outcomes.

We also partnered with researchers at the Fred Hutchinson Cancer Research Center to quantify overall survival gains from 1990 to 2015 and determine how survival outcomes could be improved even further by increasing treatment rates.

The results were presented at the 2015 World Conference on Lung Cancer (WCLC) Meeting and published in The Oncologist.

One-year survival rate: 1990: 13.5%, 2015: 29.3% - In the last 25 years, one-year survival has more than doubled. 2
Treatment rates have increased as more options have become available. In 1990, best supportive care was the standard (meaning no anti-cancer treatment). In contrast, in 2015, ~40% of people completed treatment with anti-cancer therapies. As a result, more than 33,000 life years have been gained across the population of people with lung cancer relative to 1990. 2
A 10% increase in 2015 treatment rates would add more than 35,000 population life years relative to 1990. 2
A 30% increase in 2015 treatment rates would add more than 40,000 population life years relative to 1990. 2
The majority of survival gains are a result of medicines that have become available in the past 10 years. The majority of survival gains are a result of medicines that have become available in the past 10 years. 2

What does this all mean?

Survival gains in lung cancer have been modest compared to other cancers, but new treatment options have increased the time people with advanced lung cancer survive. Improved treatment rates can significantly increase the years of life gained by the population.2

Research and progress over the last 25 years. Research and progress over the last 25 years.

Scientists have made significant advancements in our understanding of lung cancer. For example, we now know that lung cancer is not one disease, but many. Different types of lung cancer are defined by the type of lung cell from which the cancer originates or by the genetics of the cancer, often referred to as biomarkers.3

It can affect anyone. > 40,000 Americans living with lung cancer have never smoked. More women die of lung cancer than of breast, ovarian, and uterine cancers combined. More common in people > 45 years old, but genetics put younger people at risk. 3,4,5,6
It's not just one disease. Lung cancer is broken up into 2 major types. 1/10 small cell lung cancer. 9/10 non-small cell lung cancer. 3
An explosion of bio(marker)-diversity. The dawn of the 'genomics era' led to the discovery of several major mutations that are important for lung cancer. In recent years, progress has become even more rapid as expanded genetics testing revealed additional variations in genes like EGFR and ALK, as well as other biomarkers that may predict who is most likely to respond to certain treatments. An explosion of bio(marker)-diversity. The dawn of the 'genomics era' led to the discovery of several major mutations that are important for lung cancer. In recent years, progress has become even more rapid as expanded genetics testing revealed additional variations in genes like EGFR and ALK, as well as other biomarkers that may predict who is most likely to respond to certain treatments.

Lung Cancer Biomarkers Today

As a result of the explosion of biomarker diversity, we have an unprecedented understanding of the many types of lung cancer. Today, more than half of lung cancers - representing more than 1 million people - are covered by known genetic biomarkers.

In addition, many people have lung cancer with known protein markers, such as PD-L1.

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7,8,9,10 *Pie chart data are for adenocarcinoma only.

As a result of the explosion of biomarker diversity, we have an unprecedented understanding of the many types of lung cancer. Today, more than half of lung cancers - representing more than 1 million people - are covered by known biomarkers.

In addition, many people have lung cancer with known protein markers, such as PD-L1.

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†Pie chart data are for previously treated NSCLC only.
Progress is happening right now. We've made great strides in the screening, diagnosis and treatment of lung cancer.

Evolution of Lung Cancer Diagnosis

The techniques that pathologists use to diagnose lung cancer and help oncologists determine treatment have changed as we have learned more about the underlying biology of the disease. For years, the only distinction doctors could make was whether a person had small cell or non-small cell lung cancer based on the size of cells in a tumor sample viewed under a microscope.

Today

That's changed with the development of immunohistochemistry and fluorescence in situ hybridization, which can be used to find specific genetic or protein biomarkers in a tumor samples to determine if a targeted treatment is appropriate.

The approval of a less invasive test called a "liquid biopsy" is also changing how lung cancer is diagnosed, by identifying cancer mutations through a blood-based test. Previously, the primary method used to identify lung cancer biomarkers was to remove cells directly from the lung and look at them under a microscope, a procedure called a biopsy.

Progress in lung cancer treatment. Progress in lung cancer treatment.

More still needs to be done to substantially improve survival, from diagnosing lung cancer earlier to testing new medicines and combinations of medicines, and delivering the right treatment to the right person at the right time. We're heading in the right direction. Now is the time.

Join the Movement

We are on the brink of something Big. And you can help.

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We all have a role in improving the lives of people with cancer. Whether it's understanding the barriers to care, addressing the stigma, or participating in clinical trials to help bring new medicines to people, together we can help everyone get the care they deserve.

It starts with sharing the facts to help raise awareness, joining the conversation and being proactive about care for yourself or your loved ones.

Know the treatment options. Surgery, radiation therapy, chemotherapy, targeted medicines, and immunotherapy. 1, 2
Ask your doctor whether you qualify for annual lung cancer screening. People diagnosed early are 2x as likely to live 5 years+ compared to late-stage diagnosis. 3
Build a comprehensive care team with several specialists. Learn More.
Get tested. Genetic or protein markers can determine if a targeted treatment may be appropriate. 4
Be proactive. Talk to your doctor - early diagnosis is important. And, advocate for yourself or your loved one to receive the best possible care. Be proactive. Talk to your doctor - early diagnosis is important. And, advocate for yourself or your loved one to receive the best possible care.
  • 1.Roth JA, Goulart BHL, Ravelo A, et al. Survival Gains from Systemic Therapy in Advanced Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities. Poster presentation at the 2015 World Conference on Lung Cancer on September 7.
  • 2.Keedy V, Termin S, Somerfield M, et al. American Society of Clinical Oncology Provisional Clinical Opinion: Epidermal Growth Factor Receptor (EGFR) Mutation Testing for Patients With Advanced Non– Small Cell Lung Cancer Considering First-Line EGFR
  • 3.American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.