I just gave a continuing medical education talk to a group of general physicians at an out of town community hospital, and in that process I stepped out of my bubble. Spending most of my life working with cancer patients, oncologists, and other physicians at my own tertiary hospital, I primarily encounter people who share a commitment to dedicating resources and a great deal of research effort to cancer patients in general, including lung cancer. While we know that there is a terrible lack of awareness that lung cancer is the leading cause of cancer death in the US (about 28% for both men and women) and that it's woefully underfunded, we're all preaching to the choir here. In my talk today, though, to physicians who don't have a particular focus on or interest in cancer, I was saddened and disappointed that I was interrupted so that someone could ask why we're even treating people who continue to smoke and whether our treatments are beneficial enough to treat people with metastatic lung cancer at all.

To some, having the limitation of not offering curative therapy, especially if we're considering expensive treatment, makes it tempting to be derisive that treatment is of value. We see far more patients with improvements in survival measured in years, but even if it's months, the vast majority of my patients consider a survival benefit of "good time" with minimal side effects to be exceptionally valuable. The irony is that its often physicians who will be tenacious about pursuing every treatment that is remotely useful, and then many others beyond that, without a remote concern about the costs for the health care system, if it's their family member affected. But in the abstract, people who I expect would be more sensitive and insightful can be painfully nihilistic.

There have been a few recent trials that have demonstrated that a surprisingly high proportion of people diagnosed with lung cancer are never referred to another physician for treatment. As oncologists, it's hard for us to imagine why we wouldn't be offered the opportunity to at least discuss the potential value of treatment. But today I saw a glimpse of the mindset of "why bother?".

There are certainly many very sensitive and proactive physicians. And the general public and media are often complicit in these perspectives. Of course, we need to be sensitive to the costs of treatments and the value that they provide vs. the expense, but it's clear that we have more work to do in educating not just the public but also the medical community that lung cancer patients deserve the opportunity to be treated, even if they smoked or continue to smoke.

I welcome your thoughts. I'm glad I'm heading home to my bubble of enlightenment.