According to a recent study comparing Nordic statistics, lung cancer treatment outcomes are worse in Finland than in other Nordic countries.
The study compared a million men and a million women. In Finland, about 13 per cent of men and 19 per cent of women are alive five years after the diagnosis. The corresponding figures are 19 and 24 per cent in Sweden and 17 and 23 per cent in Denmark.
In Finland, lung cancer is the second most common cancer in men, and the third most common in women.
Outdoor air is good for the lungs. That is why Marjo Forsblom takes her dog Sulo, outside for a daily walk, rain or shine.
The daily walks help structure Forsblom’s day. She was diagnosed with lung cancer in August, and her cancer is spreading.
"Of course it feels really bad to know the prognosis for lung cancer is worse here than in other countries. It feels bad because there are so many reasons why treatment outcomes aren’t as good," Forsblom says.
In June, she noticed a burning sensation and pain in her chest, which she first thought was heartburn. Then, she developed a strange cough and she sought medical advice.
"The first chest x-ray showed something, and the doctor initially suspected walking pneumonia. However, the antibiotics I was prescribed did not work and I was sent in for another lung x-ray. Something was still visible in it, and the doctor referred me for further examination," says Forsblom.
According to Forsblom, shared experiences in peer groups have highlighted differences in treatment practices.
"Through networking and sharing information with other lung cancer patients, we know what’s going on elsewhere. It feels pretty miserable when one hospital has more time for a patient than another. In one hospital, the patient gets assigned a relatively permanent care team, whereas somewhere else, their doctor might change often, fragmenting the team’s overall picture and knowledge of the patient’s history. Common good practices should be introduced across the country," says Forsblom.
Forsblom is one of about 100 non-smokers who get diagnosed with lung cancer every year in Finland.
"Lung cancer often gets associated as a disease for old men who are heavy smokers. I often get asked how much I smoked, but I’ve never been a smoker," Forsblom says.
"The reality is that every third Finn will get diagnosed with some form of cancer at some point in their lives," she continues.
According to statistics from the Finnish Cancer Registry, the incidence of lung cancer in men has been steadily declining for decades. In women, conversely, lung cancer has increased. Lung cancers in non-smoking women have also increased alarmingly in recent years. The exact reason for this is unknown.
“There are differences in the treatment of non-smokers with lung cancer and in the treatment of smokers compared to other Nordic countries. The reasons for the differences should be carefully investigated in Finland,” says Tuula Vasankari, Secretary General of Filha, an expert organisation in tuberculosis and lung diseases.
"In Denmark, for example, people smoke more than people in Finland do, but their survival rates are significantly higher. In Denmark, there has been a lot of investment made in the cancer treatment path. In addition, in many countries, a lot has been invested in lung cancer screening, which does not exist in Finland," Vasankari states.
Lung cancer is diagnosed too late in Finland
Last year, around 1,700 men and 1,035 women were diagnosed with lung cancer in Finland.
Lung cancer is often only diagnosed when it has already spread. Lungs do not have nerve endings, so a person with cancer does not feel pain, even if something might be wrong. Pain usually only occurs when the cancer has spread to the pain-sensitive pleura around the lung.
If lung cancer is detected in time, it can be surgically removed. According to Vasankari, lung cancer screening could help the situation. In Finland, screening has been considered in the past, but so far it has not been introduced, as it has not been deemed to be cost-effective enough.
According to Vasankari, there is evidence, based on research from around the world, that screening would be beneficial. The screening would target smokers, who make up 80 to 90 per cent of people with lung cancer.
Other Nordic countries are further ahead on lung cancer screening. In Sweden and Denmark, for example, regional screenings have already been launched.
At Oulu University Hospital (OYS), a regional pilot for lung cancer screening has been considered, but no funding has been arranged for the screening experiment yet.
"Lung cancer screening would allow us to detect small cancers, which could be surgically removed," says Vasankari. "At the moment, unfortunately, small cancers are often only found by chance, when investigating another issue."
In Finland, the implementation of screening is also hampered by a shortage of radiologists and pulmonologists.
Vasankari encourages everyone to go in for a lung x-ray.
"During medical training, we tell doctors to avoid unnecessary x-rays. But I warmly recommend that primary care physicians refer a patient who has been coughing for more than three or four weeks, for a chest x-ray. Patients’ lung conditions are often overlooked and bundled into one category, especially now, during the coronavirus pandemic," Vasankari says.
Targeted drugs are not suitable for everyone
The type of cancer also has a significant impact on treatment outcomes. For example, the five-year prognosis for small cell lung cancer is poor, while that for non-small cell lung cancer is often better.
Forsblom sees her situation as bright, as there is a specific drug for the type of non-small cell cancer she has, and the drug stops the cancer from spreading.
Not everyone is as lucky. Targeted drugs developed for the treatment of genetic cancers are not suitable for everyone, and sometimes patients get used to the drug over time, and a new drug is needed to prevent the cancer from spreading.
The process to get new drugs approved for state funding from the Insurance Institution Kela also takes a long time.
The Finnish Pharmaceuticals Pricing Board (Hila), which operates under the Ministry of Social Affairs and Health, makes decisions on the medical products included in the reimbursement system.
Without Kela compensation, cancer treatment drugs can cost more than 5,000 euros a month.
"Fortunately, the drug I have been prescribed is reimbursed, so I don’t have to worry about the cost of the medicine. But there are situations where both the doctor and the patient are frustrated when an existing new medicine has not been granted special reimbursement status from Hila. Not everyone has the opportunity to pay several thousand euros a month for drug treatment," says Forsblom.
At the end of her sick leave, Forsblom plans to return to work.
"Sometimes it is difficult to remember I am sick, as the medicines are working well. I am doing relatively well, despite the fatigue and side effects from certain medications. I no longer complain about small things. These days, it has to be a pretty big deal for me to lose my cool," she says calmly.