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Young adults (less than 50 years of age) are being diagnosed with lung cancer at increasing rates. They tend to be women of Hispanic or Asian descent and are typically diagnosed with advanced-stage lung cancer. Research is ongoing to help us develop effective options to treat these patients medically, but little is known about the effects of the diagnosis on their mental, social, and financial health or their family planning.
To help us better understand the needs of this growing population, LUNGevity awarded one of its 2022 Health Equity and Inclusiveness Junior Investigator Awards to Narjust Florez, MD, thoracic medical oncologist, associate director of the Cancer Care Equity Program at Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School.
Recently, LUNGevity spoke with Dr. Florez to understand her research and discuss the results she recently presented at a major scientific conference—the annual meeting of the American Society of Clinical Oncology (ASCO).
LUNGevity Foundation: Why is it important to focus on younger adults with lung cancer?
Narjust Florez: This group of patients often gets missed or forgotten. Many of them never had significant tobacco exposure and they are less than 50 years old, so they are not eligible for lung cancer screening due to their age and other exclusionary criteria. Plus, they are part of the sandwich generation—already caring for their children and their parents at the same time. Who is going to care for them when they get lung cancer?
LF: How did you first become interested in the mental and social health of your patients?
NF: It was because of a patient I had several years ago. She was afraid to tell her family she had lung cancer. The stigma around lung cancer is strong. Even in her obituary, I saw her fear. It said she had breast cancer. She never told people that she had lung cancer. Only her husband and sister knew the truth. She hid her disease from the world.
That really woke me up to the broader effects of lung cancer on mental health and social interactions. I have always talked to my patients. I know how many grandkids they have. I know their wedding anniversaries. When you treat the whole patient, not just the disease, you immediately understand how important it is to consider these other aspects of their lives. It’s not just about the length of life, the quality of life matters too. It is not only about living long but also living well with lung cancer.
LF: How did this research come about?
NF: My patients drive my research. I have so many stories. One patient couldn’t afford her targeted therapy, so she was stretching her pills. Instead of taking a pill once a day, she would take one pill every three days. Her cancer started to grow again. When she finally told me what was going on, I helped her take care of it. But the effects of financial toxicity are real, and many patients feel ashamed to discuss them with their oncology teams.
Plus, there is mental and emotional stress from delays in diagnosis. Many physicians don’t realize that younger adults can get lung cancer, so their patients have to fight to be diagnosed properly. We have stories of patients waiting more than one year to be diagnosed with lung cancer.
By conducting this study with surveys and focus groups, I’m helping to raise awareness in physicians and researchers. The goal is to help them start paying more attention to younger adults with lung cancer. As we begin to generate data about the needs of this population, we can work to develop programs to help these patients in the areas where they need it most. The patients are excited about it. Our original goal was to recruit 200 patients in 2 years. The study has been open for less than a year and we already have 158 patients enrolled. These patients want to tell their stories. They want to be heard.
LF: What are the results of the study so far?
NF: We have just reported initial results of the study at the annual ASCO conference. So far, we’ve found that financial issues are really impacting these younger adults. These patients are also trying to manage physical, mental, and emotional issues. It was surprising to see that lung cancer permeates all aspects of our young patients’ lives. The study is ongoing and I’m looking forward to seeing the final results.
LF: Why is this area of research important?
NF: We have a blank space to fill. For example, at this time in their lives, many women have questions about fertility and pregnancy. But they do not receive adequate counseling or information. There isn’t any data on the relationship between lung cancer treatments and pregnancy. So, we started a worldwide registry to collect this data. In about six months, we had 25 cases in the registry. We are studying the data and drawing conclusions for the best ways to treat pregnant patients with lung cancer. No one else was looking into this.
LF: What are other ways this research award helped your career?
NF: The LUNGevity research award has been a tremendous springboard for my work. I was recently awarded a larger grant to continue my research and evaluate the effects of new lung cancer therapies on women’s fertility. I am thankful for these opportunities to bring better treatments and programs to help young adults living with lung cancer across the world.
More LUNGevity-supported research projects: