With targeted treatment and a strong support group, she is now living a full life, while serving the community that had her back.
Eight years ago, Ms Lee Hong Eng, then 38, battled a persistent cough for three months. Then she developed shortness of breath and an unexplained pain in her right shoulder.
An X-ray at a polyclinic revealed shadows in her lungs, and she was immediately transferred to the hospital, where she would spend almost three months under supervised medical care.
Further tests revealed she had fluid in her lungs that was pressing against her shoulder. This was her body’s reaction to the cancer cells, which had spread from her right lung, where the tumour originated, to her left lung, affecting her spine and lymph nodes.
“I couldn’t walk for more than 50m without feeling breathless,” recounts Ms Lee, now 46, who did not expect her initial symptoms to lead to a life-changing diagnosis.
According to the 2022 Singapore Cancer Registry, lung cancer has one of the lowest five-year survival rates in both males (21.9 per cent) and females (37.8 per cent). It is also often diagnosed only in the advanced stage.
Dr Teh Yi Lin, a consultant at the Division of Medical Oncology at the National Cancer Centre Singapore, explains that the cancer’s poor outcomes are largely due to its silent progression in its early stages1.
She adds: “The growth of lung cancer may not cause any obvious swelling, discomfort or breathlessness at first, and symptoms become more apparent once it has started to grow and spread to other areas.”
With Ms Lee’s lung cancer at stage 4 – the most advanced stage – the mother of two knew she faced significant challenges ahead. Her daughters were only in primary school then.
She recalls: “After the initial shock and tears, I knew I had to fight the cancer. I could not let myself be taken away from my girls.”
Today, Ms Lee’s cancer is in remission – her journey shows how advances in treatment and comprehensive care are helping more lung cancer patients live fuller lives.
Navigating lung cancer treatment
During Ms Lee’s hospital stay in 2016, doctors arranged for a biopsy, followed by genetic testing on a cancer-stricken lymph node to check for mutations causing non-small cell lung cancer (NSCLC).
The test revealed that Ms Lee has the c-ros oncogene 1 rearranged NSCLC mutation, or ROS-1.
Dr Teh explains: “In general, NSCLC with gene mutations are more common in non-smokers and younger people.”
In Western and Asian populations, she adds, ROS-1 rearranged NSCLC is among the rarer mutations often found in females and non-smokers like Ms Lee. A similar rare mutation is the Anaplastic Lymphoma Kinase (ALK).
“Depending on the type of lung cancer and stage of disease, patients may need to undergo surgery, chemotherapy, radiotherapy and targeted therapy or a combination of treatments,” says Dr Teh.
“Advanced-stage lung cancer is incurable, and treatments are used to limit the spread of the disease, manage symptoms and prolong life.”
These treatments are also tailored to a patient’s medical fitness and response to the treatments.
In Ms Lee’s case, she began with a cycle of chemotherapy every three weeks for about 1.5 years. She was then switched to a ROS-1 targeted therapy treatment for another 18 months, which helped to shrink the cancer.
However, during a routine magnetic resonance imaging (MRI) scan, doctors discovered that the cancer had spread to Ms Lee’s brain, resulting in 11 lesions. This is a common progression in lung cancer patients, Dr Teh notes.
As such, Ms Lee had to endure a brief but intensive course of gamma knife radiotherapy – her head fixed in place for hours during treatment.
She was then put on a new type of long-term targeted medicine, which has helped to control the cancer to date. She experiences side effects such as slurred speech, brain fog, hand numbness and constipation, which she manages through medication adjustments, diet and exercise.
While the journey has been challenging, Ms Lee has found strength in support groups, and has even gone further by helping cancer patients like herself.
A support network for lung cancer patients, caregivers and survivors
Led by Dr Teh since 2019, Lung Cancer Education and Advocacy for Patients (Leap) has helped over 600 lung cancer patients with comprehensive services – from coordinating medical appointments and treatments to financial assistance and emotional guidance.
“Each patient’s journey is unique,” says Dr Teh. “Through Leap, we’ve created a space where patients, families and survivors can connect and support one another while learning about the latest developments in lung cancer care.”
Initially a beneficiary, Ms Lee received valuable assistance through patient navigators who helped her manage hospital appointments and access various support services. Today, she serves as a Leap patient advocate, working to improve cancer care services for fellow patients.
“I want to share my journey and show them there’s hope,” says Ms Lee. “I understand that when patients are first diagnosed, it feels like a death sentence. But it’s not.”
As part of the Leap community, she also facilitates and participates in its monthly activities, which range from educational talks to exercise sessions, art therapy and coffee appreciation. These activities create informal opportunities for the lung cancer community to connect and seek emotional support.
For Lung Cancer Awareness Month, Leap held its recent Resilience in Bloom event on Nov 2, 2024. Around 60 patients and caregivers attended to share their experiences.
Despite her cancer journey, Ms Lee has remained optimistic. A homemaker when diagnosed, she took up a few part-time roles on top of her advocacy work after her condition stabilised. She has since completed a data engineering course and now has a full-time job as an operations manager at a tech start-up.
Family time is also precious, and she cherishes being able to watch her daughters, now aged 16 and 19, blossom into young adults.
Understanding lung cancer: Facts and statistics
Dr Teh Yi Lin, consultant at the Division of Medical Oncology at the National Cancer Centre Singapore, shares some key facts about lung cancer:
What is lung cancer?
Lung cancer is the third most common cancer that affects both men and women in Singapore, after prostate, breast and colorectal cancers. Non-small cell lung cancer (NSCLC) accounts for about 85 per cent to 90 per cent of all lung cancers, while small cell lung cancer (SCLC) makes up the remaining 10 per cent to 15 per cent.
What causes lung cancer?
While lung cancer is strongly linked to smoking, an increasing number of non-smokers are being diagnosed due to factors like second-hand smoke, environmental pollutants and family history.
In NSCLC cases, genetic mutations play a crucial role. The most common is the Epidermal Growth Factor Receptor (EGFR) mutation, found frequently in East Asian women who are non-smokers.
Rarer mutations include c-ros oncogene 1 (ROS-1) and Anaplastic Lymphoma Kinase (ALK), which are also more prevalent in females and non-smokers. Doctors test for these specific mutations to determine the most effective treatment plan.
What are the first signs of lung cancer?
Symptoms of lung cancer typically reveal themselves at a more advanced stage, and include a persistent, worsening cough; shortness of breath; blood in phlegm; chronic chest pain; recurrent chest infection; fever and weight loss.
When do I visit the doctor?
See a doctor early if you have any of the symptoms above, especially if you are experiencing two or more such symptoms. If cancer is detected after an initial evaluation, your doctor will arrange for further tests, such as scans and genetic testing, and discuss possible treatment plans with you. You may also request to speak to a medical social worker to understand the financial support you are eligible for.
References:
1Guirado, M., Fernández, E., Fernández, A., Navarro-Martín, A., Sánchez-Hernández, A. Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review. Clin Transl Oncol. 2022 Aug;24(8):1549-1568. doi: 10.1007/s12094-022-02796-w. Epub 2022 Mar 7. PMID: 35257298; PMCID: PMC8900646.
