P R E S S   R E L E A S E

        Lung cancer is one of the commonest cancers in the world, ranking as the commonest in men and second commonest in women.  Incidence of lung cancer in men and women in Hong Kong are 72.5 per 100,000 and 28.1 per 100,000 respectively.

        There are two types of lung cancer: non-small cell lung cancer (NSCLC) accounting for about 80-85% of all lung cancers, and small cell lung cancer (SCLC).  The curative treatment for NSCLC is complete surgical resection at the early stages (stage I, II).  Unfortunately about 80 to 85% of patients with NSCLC present with either unresectable or metastatic disease.  Chemotherapy and/or radiotherapy are the major forms of treatment with the purpose of prolongation of survival, relief of symptoms and improvement of the quality of life.  However, many patients are resistant to this kind of treatment as they have the impression that these therapies are generally toxic.

        People's worries over the side effects of these therapies are reflected in a survey "Prevention and treatment of lung cancer: A population survey on smoking, Western and Chinese medicine" conducted on 1003 subjects (male: female = 472:531; age: 18 to 54; median age 36) by Professors Tony MOK Shu-kam,  Benny ZEE Chung-ying and Philip JOHNSON at the Department of Clinical Oncology of The Chinese University of Hong Kong.

        Although most (76.3%) subjects agree that surgery can cure early stage lung cancer, almost 60% would decline surgery if they have cancer.  Only 41% will agree to chemotherapy/radiotherapy if they have late stage lung cancer.  They also prefer less toxic treatment.  Half subjects expect the chemotherapy/radiotherapy to prolong the average life span to one or more years.  They expect longer prolongation if they are told that the treatment is associated with side effects such as hair loss, weakness and vomiting.  63% expect the average duration of survival to be one year or more.  Patients with early stage disease are more likely to comply to doctor's advice than patient with late stage disease.  75% of the subjects said they will take doctor's advice on treatment for early stage lung cancer but only 57.3% of subjects will do so for late stage lung cancer.

        With recent advent of new anti-cancer drugs, such as gemcitabine, the Comprehensive Cancer Trials Unit of the Department of Clinical Oncology has conducted clinical research in seeking a better regimen that can achieve the objectives of survival prolongation with fewer side effects.  A randomized phase II study on combination of gemcitabine plus cisplatin versus gemcitabine plus etoposide was done between 1997 and 1999 on 89 patients with stage IIIb or IV NSCLC.  Current treatment usually combined cisplatin and etoposide.

        Patients are randomized to receive either: GP: gemcitabine 1000mg/m² at day 1, 8, 15 plus cisplatin at day 15, or GE: gemcitabine 1000mg/m² at day 1, 8, 15 plus oral etoposide at day 1-14.  Both groups reported improvement in life quality and their emotional status with reduction in disease related symptoms including cough, shortness of breath and chest pain.  27.2% patients in GP group suffered from nausea comparing to 15.4% in the GE group.  15.9% of patients in GP group suffered from vomiting with 13.3% in the GE group.  Significant hair loss (grade 2) occurred in 2.3% and 2.6% of patients in GP and GE group respectively.  Combination chemotherapy of gemcitabine with either cisplatin or etoposide attains tumor reduction in 46% and 36% of patients respectively and is well tolerated with acceptable toxicity to bone marrow, kidney and liver.  Median survivals of both groups are not different, and overall speaking, longer than historic control of those who have never received chemotherapy.

        The survey also finds that the general population appears to have only shallow understanding on the role of traditional Chinese medicine (TCM) in the treatment of lung cancer.  Many people use TCM and Western medicines interchangeably for health problems ranging from influenza to advanced malignant disease.  Patients and family, facing the diagnosis of a fatal illness such as lung cancer, commonly resort to TCM for hope of cure or improvement.

        The survey finds that a large portion (70%)of subjects agree that TCM can cure early stage lung cancer and of which 80% also agree that surgery can cure early stage lung cancer.  However, if diagnosed of early stage lung cancer, only 19% choose TCM.  Only 33% believe TCM can cure late stage lung cancer and of which 53% would rather choose chemotherapy as the prime therapy for his/her illness.  If diagnosed of late stage lung cancer, only 17.2% choose TCM.  Over 60% of the population chose no therapy for late stage lung cancer.  Concern about toxicity is likely the key factor that prevents patients from choosing chemotherapy for advanced lung cancer.  However, most of those who chose no therapy still have an expectation to prolong survival with Western medicine if possible.

        Cigarette smoking being recognized as the major cause of lung cancer is still on the rise in China and the rest of Asia in spite of the recent slow down in North America.  Attitude taken by the population and government towards cigarette smoking contributes to formation of the habit in our younger generation.  The survey also studied the people's views on cigarette smoking that would aid the government and health care provider to develop policy and guideline on smoking control as prevention for lung cancer.

        Among the subjects, 16.6% are smokers.  58% of smokers start smoking at an age less than 20, 32% at age 20 to 25.  94% non-smokers agree smoking may cause lung cancer.  While 85% smokers also think so, only 11.5% said they would stop smoking completely.  36% prefer no change.  58.6% of non-smokers will avoid second hand smoking after knowing smoking may cause lung cancer.  As most smokers started smoking at teenage or early twenties, the Government should take proactive effort to provide anti-smoking education to teenagers.