Removing the blame game from lung cancer

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IB: Ingrid Booth, digital content specialist, Investec
MDS: Monica Dos Santos, Investec
GD: Professor Georgia Demetriou
GS: Grant Statham, clinical psychologist, Maureen Kark and Associates
SN: Sinenhlanhla Nzama, Investec Life head product actuary

• 00:00: Monica’s story

  Monica Dos Santos: Hi my name is Monica and I am 25 years old. I was admitted to hospital when I was around 32 weeks pregnant, I had pneumonia and a pleural effusion in my lung, and so breathing was really difficult – I couldn’t breathe, I couldn’t speak, so I had to go to hospital… And I was also diagnosed with a pregnancy-related liver failure.

   

  So, my daughter had to be delivered 6 weeks early because of my failing liver.  We didn’t know about the tumor then. Two days after her delivery I was sent for a CT scan so they could check the condition of my lung and they discovered a 15cm mass in my lung, in my right lung. I’ll never forget the day the doctor came in – my thoracic surgeon – he delivered the bad news.  

• 0:39: Introduction

  Ingrid Booth: That was Monica Dos Santos – a very courageous Investec woman who is telling her story as part of Investec Life’s latest women’s health campaign. Through sharing these stories, the campaign aims to highlight information and insights that will help women make informed decisions about their health.

   

  My name is Ingrid Booth and I am part of the Digital Content team at Investec. This is the second podcast in a three-part series. The first dealt with dispelling myths around breast cancer. Today’s podcast looks at lung cancer in women and the third episode will shine a light on liver cancer, both topics that don’t get nearly as much airtime as breast cancer.

   

  We’ve brought in renowned oncologist Professor Georgia Demetriou to talk us through the medical side of the disease and address issues like “does vaping cause lung cancer?” and why a simple pill can now be used in place of chemotherapy to treat certain types of the cancer.

   

  Clinical psychologist Grant Statham from Maureen Kark and Associates also tackles the emotional side of a diagnosis and why a positive attitude can significantly improve a person’s experience of cancer and indeed their prognosis. And finally, Sinenhlanhla Nzama, Investec Life head product actuary, talks about what insurance cover is available to ensure you get the best possible treatment.

   

  If you find this podcast insightful, please subscribe to our channel and have a listen to part one of this series.

   

  Back to today’s podcast…

   

  Monica was only 23 when she was diagnosed with lung cancer – she was healthy and fit and did not smoke. Oncologist Professor Georgia Demetriou explains that more than two-thirds of non-smokers with lung cancer are women, and most of them have a type of cancer called adenocarcinoma.

• 2:30: Taking the blame game away from lung cancer

  Professor Georgia Demetriou: We need to firstly, before we go anywhere else, take away the blame game from lung cancer.  Because so often everybody was like “oh you smoked”.  And yes, there are certain types of lung cancer that are more common in smokers but not every patient who gets lung cancer is a smoker. In fact, in patients who are female and non-smokers, adenocarcinoma of the lung is probably the most common of the lung cancers that occur and in a strange way it’s also one of the lung cancers we often have a lot more treatments for. 

   

  If someone is going for a routine chest x-ray, an insurance medical for whatever reason, changing jobs jobs, moving country - they go for a medical, they sometimes pick up small little lesions when they are tiny and those ones can be cured because they can be cut out and that's the end of that, and that's always the cancers I like, the ones that we pick up by screening or we pick up when they’re really tiny.

   

  But in the ones which aren’t picked up early, where we do need to then just try and reduce size, hold back, rein in – for the  ones that are non-smokers often a tablet is the thing to do, and that's really a huge advance in terms of where we're at.  

• 3:43: Should women get screened for lung cancer?

  IB: As Professor Demetriou mentioned, the most common type of lung cancer in women is adenocarcinoma. In men, it’s squamous cell carcinoma, which produces more symptoms and is easier to detect. I asked Professor Demetriou whether we as women should therefore be screening ourselves for lung cancer…

   

  GD: We don't do screening for lung cancer per se in South Africa, so there is no screening for lung cancer programme, even in western countries if they do screen with CT scans it’s usually your high-risk population which would be the ones who are smokers. 

   

  So, you’re never going to be screening a young female population because it's just not the demographic and the cost effectiveness of it is just not there, you're going to expose a lot of people to extra radiation that they don't need to be exposed to. 
  

  So, the main thing is if you have symptoms, if you’ve got a cough and it’s gone within a week, you know you've had a cough and you’ve had an infection and it's okay, but something that sits there and starts to nag a bit, you know I always things that sit there for two weeks and get a little bit worse and not better, go and see someone and have it investigated.  
  

• 4:48: Does vaping cause lung cancer?

  IB: Vaping is the new smoking. Indeed, the number of vapers has increased rapidly - from about seven million in 2011 to 41 million in 2018. This is according to market research group Euromonitor who estimate that this number will grow to 55 million by 2021. While e-cigarettes currently carry a fraction of the risk of cigarettes, Professor Demetriou believes that it is only a matter of time before the link with cancer is established.

   

  GD: We haven't got a cancer link yet, OK, and I must say that, but then in the 50s and the 60s smoking was cool, and no one had the cancer link at that point, so we're not going to see a cancer link in a one-year, five-year [period], but in 10, 20, 30 years we going to see a cancer link potentially and there is absolutely no way that you can tell me inhaling chemicals into your lungs which changes them, which causes all sorts of triggers on a cellular level is not going to be carcinogenic and cause cancer.

   

  So we just haven't got that link, and I can't sit here as someone who says I believe in evidence-based medicine and say to you yes, because the data is not there. But it's only not there because we haven't had it long enough.

   

  Already in the US they’ve got at least 14 to 15 cases of respiratory failure and lung trouble related to vaping and the cancer will follow.  It's my belief, and cancer and medicine should never be a religion, it's a belief that we will get there, we just don't have the evidence yet.  I would rather say just don't smoke.
  

• 6:19: An end in sight for chemotherapy?

  IB: One of the most exciting advances in the treatment of lung cancer is the advent of immunotherapy drugs which harness the body’s immune system to fight cancer. Here’s Professor Demetriou on how it works and why it signals a move to a time where chemotherapy hopefully won’t be needed.

   

  GD: So immunotherapy is really where cancer care has moved to, and there’s a lot of studies currently on going that we are involved with, which look at immunotherapy in all sorts of cancers.  Immunotherapy is where you give medication to almost up-ramp your own immune system and your white cells to actually attack the cancers.

   

  And obviously any medication we have that will do that can potentially also up-ramp your body's immune system and cause inflammation in other areas of the body.  So, the immunotherapies have got a very particular side effect profile.  There's no hair loss, bonus. There's minimal nausea, bonus.  But you can get lung inflammation, liver inflammation, colon inflammation and a lot of skin rashes that come with the treatment, but we are hopefully moving to a time when we don't need to actually give chemotherapy anymore.  

• 7:31: The cost of new immunotherapy drugs

  IB: While some of the new generation immunotherapy drugs are available in South Africa, they do come with a hefty price tag, says Professor Demetriou.

   

  GD: So immunotherapy is registered in South Africa, there's a drug called Pembrolizumab which is available. It is very established in its use in melanoma, malignant melanoma - cancer of the skin.  In lung cancer it's a registered indication. 

   

  But those registered indications are expanding quite quickly. In lymphomas, and every two to three months we’ve got we've got the American FDA approving immunotherapy in another cancer or in another indication, so really a very exciting time to be treating patients because the more options you have the better off your patients are, the better the survival. 

   

  So, it unfortunately also comes at a huge cost.  All our new drugs come in at silly numbers and that becomes a challenge then from a funder point of view to fund treatments. 
  

• 8:30: Monica’s medical bill

  IB:  And it’s not only the new age treatments that are expensive. As a single mum, Monica experienced firsthand the hidden costs of cancer with routine treatments…

   

  MDS:  Thankfully I was covered from a medical aid perspective but unfortunately not from a life perspective.  Medical costs were quite high, and the medical bills were quite extreme.  I think we paid out of our own pockets, in addition to the medical aid about R60,000 for the blood tests, because you go for weekly blood tests.  You go for scans all the time – I’ve had every scan known to man.  So those scans you have to pay for out of your own [pocket]… so really it did work out to quite a lot.  It was a very expensive experience.

• 9:07: Alleviating the financial stress of a cancer diagnosis

  IB: I read a Sunday Times article that referred to the cost of cancer being a “debt sentence”. I asked Sinenhlanhla Nzama from Investec Life what insurance is available to alleviate the financial stress that comes with a diagnosis. Here he explains how severe illness cover can step in to pay for what medical aid or gap cover don’t.

   

  Sinenhlanhla Nzama: So with severe illness cover, the beauty of it, is that it pays out anything between R250 000 to up to R10 million, and then gives you and your treating doctor flexibility to actually structure your treatment regime or treatment plan, to ensure it’s effective and a success in terms of the treatment of the cancer.

   

  That treatment can vary from anything to new generation type of immunotherapy drugs and those can cost easily over a R1 million in South Africa, so that alone, let alone the consultations and the surgery that may also be needed, or chemo.  
  

• 9:59: How severe illness cover works

  IB: Severe illness cover is a lump sum cover that is triggered on diagnosis and is paid directly to the client to spend on whatever you need from treatment to support at home, says Sinenhlanhla.

   

  SN: The great thing about severe illness cover is that it is not prescriptive at all, so the pay-out that you get, it's really up to you, as a client, to decide how you use it. Some clients, especially if you're a parent, you can use it to hire an au pair to help you look after your kids, you can hire a home nurse to look after you, so it's really a supportive mechanism to ensure that you protect yourself and your family and really protect your finances.

• 10:32: What you need to ask when taking out severe illness cover

  IB: Of course, not all cover is created equal, so I asked Sinenhlanhla what questions one should ask when looking for the best severe illness cover.

   

  SN: The fact is, in South Africa especially, you've got a lot of variations in severe illness cover.  It's unlike life cover, where it’s more or less of the same, no matter where you go.  But with severe illness cover, the products are structured quite differently.

   

  And if you look at the old types of products they will, generally, cover for the most advanced cancers, so it must be at least a stage 1 cancer for the pay-out, while the newer products like the Investec Life Severe Illness Cover, does look at the early stage cancers, because that's where we are seeing the claims coming through, and you do get the pay-out in that instance.  So it's very, very important to actually take care to look at the definitions and when the cover may be paid.

   

  But also, I think another point about severe illness cover, what is more important, is less about the number of conditions that are covered, but which conditions are covered and how they are covered in terms of the definitions.
  

  And lastly, also the costs are also important to take into consideration, the premiums you’re going to pay, I think the key message is that with severe illness you'd rather go for comprehensiveness than cost-effectiveness just to ensure for safety and for peace of mind. 
  

• 11:43: Can a positive outlook help you overcome cancer?

  IB: So there are solutions out there to alleviate the financial stress of a diagnosis, but what about dealing with the psychological impact? Here Monica talks about how her positive attitude got her through her ordeal.

   

  MDS: I think what kept me going was… I never for one moment thought “OK I’m going to die”.  I planned my life.  I started planning how I’m going to get back to gym and get my body back and how I’m going to do all these things and study and so I focused on what I want to achieve in life instead of focusing on how bad things are, and I looked at things from a different perspective. 

   

  Instead of seeing as the worst thing that could ever happen, I saw it as the best thing that could ever happen to me because I came to so many realisations when I was sick.  It’s like everything that I had become, throughout my life, wasn’t me, and when I was faced with death I unbecame all those things and I was forced to reflect, and I was forced to draw all my energy inward and discover who I really was as human being and what my purpose was.
  

  IB: I asked clinical psychologist Grant Statham whether a positive outlook, like the one that Monica has adopted, can result in a better prognosis.
  

  Grant Statham: Research does show that if people can be proactive in sort of reinstituting a sense of control over their process and over their journey, that is hugely influential on positive prognostic factors, so really that’s about a couple of things. 

   

  Firstly it’s about paying attention to your intra-psychic processes, so your own feelings, your own emotions attached, the way that you feel about yourself, your identity, your resilience and your coping mechanisms, and it’s about paying attention to your social support networks, your relationships, your family structures and community support networks. 

   

  It’s also about considering information pertaining to your diagnosis and being geared up and seeking actively the information that pertains to treatment options, prognosis, side effects and what can you really expect. 

   

  And also the professional resources – being proactive about seeking out support from those professionals that can be of assistance. And of those contribute to positive prognostic factors and actually and improved quality of the entire experience as well as and improved quality of life thereafter.

• 13:51: How do you tell your kids about your cancer?

  IB: A person does not travel a cancer journey on their own. Your loved ones also experience all the ups and downs with you. This is something Monica realised with her son who was only five when she was diagnosed…

   

  MDS: So, I found that through this experience my son has matured greatly, emotionally and psychologically as well, and I was always very open… about everything.  And I explained to him what was going on. 

   

  I’ll never forget the first time I started losing my hair and I got so frustrated because it didn’t happen fast enough, but I was upset that it was happening, so I took it into my own hands and I just shaved my head and my son came to me and he told me that I looked like a homeless person. A homeless man, that’s what he said.

   

  Children are a lot smarter and more resilient then what we think they are.  If you are open and honest and you communicate things properly in a way that they understand, they actually are put to ease.  So, honest communication is always very important.

   

  IB: Grant agrees that children are a lot more resilient than we think…

   

  GS: As parents I think this is a significant challenge for all of us, not only around cancer, but around other events as well in life.  We’re not sure about how much information to give to our children and we often tend to be quite cautious about how much we disclose.

   

  You know traditionally, kids see us as superwomen or supermen and infallible and just being, you know, highly available to them all the time and not ever being compromised, and in a sense they need that sense of security to be able to navigate their own development in their own lives. 

   

  At some point or other, the reality does kick in, and kids start to realise developmentally that their parents are not perfect, and in fact that we just as susceptible to illness and to disease and to stress.

   

  Traditionally kids are quite resilient though, and they do have a tendency to take in only what they can manage, but I’d always advocate professional support in being able to communicate the message to children.

• 15:43: The importance of self-love

  IB: Monica believed that her traumatic upbringing and lack of self-love played a big role in her not seeking medical help sooner. Her message to other women is to love yourself enough to go for regular check-ups and to listen to your body.

   

  MDS: I would definitely recommend getting check-ups done because I left things until the very last… and it always comes back down to self-love.  If you truly love yourself, you will do what’s best for yourself and at the time I didn’t, so I didn’t really care, but now that I’ve really found myself, I really do strongly advise that people go for these check-ups.  And if you feel something is wrong, always trust your instincts.  

• 16:18: Conclusion

  IB: Thank you for listening to this Investec Focus podcast. Please take the time to rate this conversation and to subscribe to wherever you get your podcasts. And stay tuned for part three of our Investec Life podcast series, where we speak to another inspirational young woman who has survived liver cancer. We find out from experts why Sub-Saharan Africa has one of the highest incidence rates of this disease in the world.

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