A survey of the general population in France identifies knowledge gaps in the perception of lung cancer
A prospective nationwide survey on perceptions of lung cancer in the general population of France highlights a need for increased public education on the benefits of lung cancer screening, the good survival rates of early-stage disease and the improved outcomes with new therapeutic strategies, including targeted-therapies.
Lung cancer management in recent years has improved patient outcomes because of screening, improved surgery and radiotherapy in early and locally-advanced stages of disease, new chemotherapies, validated maintenance therapy, and effective targeted therapies. However, fears or misperceptions about lung cancer may alter physician-patient communications and could delay lung cancer screening, diagnosis, or treatment. Evaluating lung cancer perceptions in the general population may ameliorate these potential obstacles by identifying the knowledge gaps which could be filled in with public education programs.
A questionnaire and lexical approaches survey prospectively assessed 2200 healthy subjects over the age of 18 in France on their perception and knowledge of lung cancer with specific regard to etiology, epidemiology, diagnosis (including screening), therapeutic treatments and prognosis. This survey was designed by an interdisciplinary group of oncologists involved in lung cancer management as well as chest physicians, general practitioners and social psychologists not involved in lung cancer treatment.
Results published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC), show that of the 1469 responders, 40% realize that the incidence of lung in men is the same as it was 10 years ago, whereas three-quarters know that the incidence in women has increased. The vast majority, 93%, recognizes the causal role of active tobacco smoking in lung cancer, but only 67% appreciate the role of passive smoking. Lung cancer is considered a severe cancer by 83% and 85% incorrectly presume symptoms are present in most cases. A third overestimate that lung cancer can be cured at any stage, whereas only half think it can be cured if diagnosed early, an underestimate. When queried about treatments most are aware of chemotherapy (91%), surgery (71%) and the benefits of smoking cessation (90%), but less are aware of radiotherapy (64%) and targeted therapies (15%). Lexical analysis revealed that most consider lung cancer as a tobacco-induced, life-threating disease, imposing heavy treatment and a minority consider it an environmentally- induced disease. Finally, compared with breast cancer, lung cancer is characterized by a greater feeling of guilt and more frequently associated with lifestyle.
The authors note that "the general population appears to be aware of the main risk factors of lung cancer but efforts should be made to convince them that passive smoking is a well-recognized risk factor". Additionally, "the general population should be educated on the fact that lung cancer is not symptomatic at the early stages and that the best survival is observed for small asymptomatic tumors that can benefit from, and many times be cured by, surgery. It is well known that the efficiency of a screening program is directly related to the public being aware that a diagnosis performed before the onset of symptoms is associated with better survival." Finally, "since the general population had poor knowledge on new treatment opportunities in radiotherapy and on targeted agents, educational and awareness campaigns in this area may help the enrollment of patients in clinical research programs evaluating therapeutics regimens using these new tools in the fight against lung cancer".