Awareness isn't about fear; it's about time. The sooner we see what's hiding in plain sight, the more lives we can save.
Clips Played How Long Can You Survive With Stage 4 Lung Cancer? - Oncology Support Network - YouTube
Music: The Byrds - Turn! Turn! Turn! (To Everything There Is A Season) (Audio)
What happens in every stage of lung cancer? | Cancer: Explained | Macmillan Cancer Support - YouTube
Can a CT Scan Kill You? Know The Risks - Life Extension
CT Scan Drawbacks: Important Risks and Side Effects
Only had back pain: How I Learned I had Stage 4 Lung Cancer - Anne | The Patient Story
Doctors Assured Me It Wasn't Cancer! - Shirley | Stage 4 Lung Cancer | The Patient Story - YouTube
A great channel: 3 Steps to Make Sure Your Medical Wishes Are Followed
My Stage 4 Cancer Symptoms Were DISMISSED! - Leah | Stage 4 Lung Cancer | The Patient Story - YouTube
CT Scans and Cancer: What Are the Risks? | Chris Kresser
Can a CT Scan Kill You? Know The Risks - Life Extension
My Stage 4 LUNG CANCER Symptoms: "It all Happened So Fast!" | The Patient Story
Palliative Chemotherapy: What You Need to Know
Why Doesn't Smoking Weed Give You Lung Cancer Like Cigarettes? | by Tierney Finster | MEL Magazine | Medium
Marijuana & Lung Cancer Risk - Mayo Clinic Health System
Cannabis use among recently treated cancer patients: perceptions and experiences | Supportive Care in Cancer
Is Marijuana a Risk Factor or a Treatment Option for Lung Cancer?
Marijuana and Lung Health | American Lung Association
Over 3.8 million lung cancer deaths prevented in the United States due to smoking decline
Big Banks Found a New Way To Trap You In Medical Debt
Marijuana IS Medicine
Bulk Delta 8 THC Distillate
Delta 8 Shake - Fern Valley Farms
$24.99 No Membership Required: The Wayy Big Hoodie Unisex | Costco
Dryer Rack: Mainstays Oversized Collapsible Steel Laundry Drying Rack, 7 Levels, Silver - Walmart.com
Russia-UK and USA Nuclear Power Plants-First Nuclear Power Plant in RUSSIA -UK and USA ALL lied to public. Nuclear Plants create Dirty Electricity over time as bad or worse than Ionizing Radiation. Directly INTO our homes.
Lifetime risk of dementia after age 55 is double previous estimates – White House and Illegal Drug Use by Musk and Trump. Alzheimer and Dirty Electricity. What is the connection? Tests on RATS confirm how we are getting Alzheimer, no HUMAN studies.
The Romanov Gypsy Takeover -Disguised as Kings, Priests and Generals. They Firebombed Nations, Erased Muslims, and Unleashed the Silent War of Dirty Electricity Eugenics to Destroy Our DNA.
The U.S. Army explored using radioactive poisons to assassinate important individuals such as military or civilian leaders, according to newly declassified docs. Approved at the highest levels of the Army in 1948, the effort was a well-hidden secret….
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Experts Historically Underestimated Radiation Risks
When radiation was first discovered, doctors were wildly enthusiastic about being able to peer inside the body of a living human.
Sadly, radiation killed its early pioneers, who had no idea of its dangers.
Even as knowledge of radiation's lethal properties became apparent, experts consistently underestimated the risks.
One tragic example was an individual named Clarence Dally who intentionally exposed himself multiple times to ionizing radiation from Thomas Edison's "fluoroscope" invention. Within a few months, Dally began suffering debilitating fatigue, body aches, and multiple burn-like lesions on his hands. These lesions turned out to be cancer that rapidly spread throughout his body. Dally lost both his arms to these malignant lesions, and died a painful death in 1904. Thomas Edison was said to be haunted for the rest of his life by Dally's cancer and death, and refused to have anything more to do with ionizing radiation.24
In the 1950s, our federal government routinely conducted above-ground testing of nuclear bombs in the Nevada desert and claimed the radioactive fallout that spread throughout much of the United States was "harmless." In 2002, the federal government admitted that the radiation emitted from these nuclear weapons tests caused 15,000 American cancer deaths.25 Critics claim this number grossly understates the actual number of cancer
"…there is little evidence to support the use of dental X-rays ' in search of occult pathoses in the asymptomatic patient' or 'routine dental radiographs at preset intervals for all patients. Although dental X-rays are an important tool in well-selected patients, efforts to moderate exposure to ionizing radiation to the head is likely to be of benefit to patients and health care providers alike.'"
John Gofman, MD, PhD, was a medical doctor, nuclear chemist, Manhattan Project scientist, co-discoverer of isotopes of uranium and protactinium, the first to separate plutonium in usable quantities, and an early member of the Life Extension Foundation.
Dr. Gofman fought to end policies that allow plutonium and other radioactivity from the nuclear power/weapons fuel chain to be dispersed into the environment. He repeatedly stood up to government pressure to suppress the truth about radiation health dangers.
Dr. Gofman's accomplishments extend to his groundbreaking research in cardiac medicine, which includes the identification and distinguishing of HDL cholesterol and LDL cholesterol. The Journal of Clinical Lipidology named him the "Father of Clinical Lipidology," honoring him for discoveries he made decades ago, which are now part of conventional cardiology.43
His tireless work to reduce unnecessary radiation exposure from medical procedures is finally taking hold with Consumer Reports disseminating data that emanated from work that Dr. Gofman initiated many decades ago.
Dr. Gofman firmly believed there is no safe threshold of ionizing radiation one should needlessly be exposed to. He used a linear no-threshold model of radiation risk and argued that far more cases of cancer and other diseases are caused by unnecessary exposure to medical radiation than what the "authorities" admit.44,45
Not everyone agrees with Dr. Gofman's "linear model of radiation risk" and a debate continues as to whether there is a low level of X-ray exposure that can be accepted as "safe."
Radiation Dose Comparison
Different types of medical diagnostic imaging tests pose varying degrees of risk from ionizing radiation exposure.
A brief list of different medical diagnostic imaging tests that utilize ionizing radiation are provided to better identify scans that generate relatively high exposure in comparison to natural background radiation exposure.
Diagnostic Procedure Typical Effective Dose (mSv)46 Number Of Chest X-rays (PA film) For Equivalent Effective Dose47 Time Period For Equivalent Effective Dose From Natural Background Radiation48 Chest X-ray (PA Film) 0.02 1 2.4 days Skull X-ray 0.1 5 12 days Lumbar Spine 1.5 75 182 days Intravenous (IV) Pyelogram 3 150 1.0 year Upper GI Exam (Barium Swallow) 6 300 2.0 years Lower GI Exam (Barium Enema) 8 400 2.7 years CT Head 2 100 243 days CT Abdomen 8 400 2.7 yearsReferences
CT = Ionizing Radiation
A CT scan uses X-rays, which are ionizing radiation.
The dose is much higher than a plain chest X-ray:
Chest X-ray: about 0.1 mSv (millisievert)
Chest CT: about 5–7 mSv
Abdomen & pelvis CT: 8–10 mSv
A whole-body trauma CT can be 20 mSv or more
For comparison: natural background radiation in the U.S. is about 3 mSv per year.
2. Informed Consent in PracticeEmergency settings:
If the patient is conscious and able, the staff usually give a brief explanation: "We're going to do a CT scan to check for bleeding / clots / injuries. It uses X-rays."
In life-threatening situations (e.g., stroke, major trauma, internal bleeding), the scan is done under implied consent because the benefit of a rapid diagnosis outweighs the small long-term radiation risk.
Outpatient or non-urgent settings:
Patients often sign a general imaging consent that covers CT, X-ray, and similar tests.
Some facilities give a printed information sheet mentioning that CT involves ionizing radiation and noting why it's being ordered.
Usually there is not an extensive discussion of the exact dose, unless the patient asks or is part of a higher-risk group (for example, a child or a pregnant woman).
Studies show that many patients:
Do not realize that CT uses radiation.
Tend to underestimate the dose compared with a plain X-ray.
Are often focused on the immediate health problem rather than the long-term risk.
Clinicians and radiology societies have been trying to improve this by:
Adding plain-language information to consent forms
Posting notices in waiting rooms ("CT uses X-rays")
Training staff to mention radiation risk in routine explanations
The long-term cancer risk from a single diagnostic CT is very small — on the order of 1 in 10,000 to 1 in 1,000 depending on age, body part, and dose.
The immediate benefit — finding a bleed, a clot, a ruptured organ, or a hidden lung mass — is usually far greater than the theoretical risk.
The highest concern is for children and young adults, who are more sensitive to radiation and have more years ahead for a radiation-induced cancer to develop.
You have the right to ask:
Why the CT is needed
Whether an ultrasound or MRI could give the same answer without radiation
How the dose will be kept as low as possible ("ALARA" principle — As Low As Reasonably Achievable)
You can also ask the facility to keep a record of your imaging history so you don't get unnecessary repeat scans.
CT scans in emergencies are often performed very quickly, sometimes without a detailed radiation discussion, because speed can save a life.
In non-emergent cases, patients usually sign a general consent but may not be told the dose unless they ask.
The radiation risk is real but small; the decision to scan is a risk–benefit calculation, generally in favor of scanning when serious disease is suspected.
General Rule
CT scans are avoided during pregnancy whenever possible.
Ultrasound and MRI are preferred because they do not use ionizing radiation.
CT is only used if the information is urgently needed and cannot be obtained by a safer method.
Situations where CT is sometimes chosen even in pregnancy include:
Life-threatening emergencies for the mother:
Suspected pulmonary embolism (blood clot in the lungs)
Severe trauma (e.g., after a car accident)
Suspected internal bleeding in the chest or abdomen
Stroke, brain bleeding
If the mother's life is at risk, doctors will prioritize her diagnosis and treatment, as this also benefits the fetus.
Radiation risk depends on:
Stage of pregnancy: The first trimester (especially weeks 2–15) is most sensitive.
Body area scanned:
Head or chest CT: The fetus is not in the primary beam; the dose to the fetus is very low (often
Abdominal or pelvic CT: The fetus is in the beam; typical dose is 10–25 mGy.
For context: – Risk of birth defects rises noticeably above about 100 mGy. – A single CT of the abdomen or pelvis is well below that threshold, but is associated with a small increase in lifetime cancer risk for the child.
4. Risk EstimatesThe baseline risk of a child developing cancer is about 1 in 500.
A fetal exposure of 10–20 mGy (typical for one abdominal CT) may increase that risk by about 1 in 1,000–2,000.
There is no evidence of birth defects from typical diagnostic CT doses.
The main concern is the small increase in lifetime cancer risk.
Doctors weigh the immediate danger to the mother against the small, delayed risk to the fetus.
Stabilizing or saving the mother's life is the best protection for the fetus.
Modern CT scanners use dose-reduction protocols for pregnant patients:
Limiting scan area
Lowering exposure settings
Using shielding when it does not interfere with imaging
Patients should be told that CT uses X-rays and that every effort is made to minimize fetal exposure.
If the scan is of the head or chest, patients can be reassured the radiation to the fetus is negligible.
If the scan is of the abdomen/pelvis, the decision should involve:
The treating physician
A radiologist
Sometimes a maternal–fetal medicine specialist
Ultrasound and MRI are first choice for imaging in pregnancy.
CT is only used when truly needed and with precautions to reduce dose.
For most CT exams not involving the belly/pelvis, fetal radiation exposure is extremely low.
Even when the pelvis is scanned, the absolute risk increase is small, and the mother's health remains the top priority.
Maternal Mortality in the U.S.
According to the CDC:
In 2021, the U.S. maternal-mortality rate was about 33 deaths per 100,000 live births.
This is 2–3 times higher than in Canada, the U.K., or most of western Europe.
The risk is much higher for Black women — in some years 2–3 times the rate of white women.
Many deaths occur after delivery, often from:
Hemorrhage
Hypertensive disorders (like pre-eclampsia/eclampsia)
Infections
Cardiovascular disease
Countries such as Norway, Germany, Japan, Australia report fewer than 10 deaths per 100,000 live births.
Some lower-income nations have improved dramatically through:
More accessible prenatal care
Skilled birth attendants
Rapid emergency response for complications
The U.S. rate is therefore high not because modern care isn't available, but because it's not equally accessible or consistently delivered.
Access and inequality:
Many women, especially in rural areas or without insurance, have limited access to prenatal care.
Chronic health conditions:
Higher rates of obesity, diabetes, hypertension.
Fragmented health-care system:
Gaps in coordination between prenatal, delivery, and postpartum care.
Systemic racism and implicit bias:
Documented in research as contributing to delays in recognition and response to complications in Black women.
Under-prioritizing postpartum care:
A large share of deaths occur in the weeks to months after birth, when follow-up may be inadequate.
In an acute emergency (e.g., suspected pulmonary embolism or internal bleeding), physicians generally do prioritize saving the mother's life first, because the fetus cannot survive if the mother dies.
The concern you raise reflects a broader systemic problem: many women in the U.S. do not get timely preventive or emergency care in the first place.
The U.S. has advanced medical technology, but maternal health outcomes lag behind many peer nations because of access, inequality, and system failures, not because clinicians deliberately disregard mothers' lives.
In emergencies requiring CT scans or other interventions, the ethical standard is to prioritize maternal survival, which in turn is usually the best chance for the baby.
Improving maternal survival overall depends on:
Early and continuous prenatal care
Rapid recognition of complications
Equitable access to quality care before, during, and after delivery
Information and Support Gaps
Historically stigmatized: for decades lung cancer was thought of as a "smoker's disease." Many cancer centers built their educational materials and support programs first for breast, prostate, colon and childhood cancers.
Result: people who never smoked often find no brochures, few support groups, and a focus on smoking cessation rather than on the needs of those already diagnosed.
Patient impact: many describe feeling as if they had to learn a new medical vocabulary, navigate insurance and treatment options alone, and explain repeatedly that they never smoked.
Targeted therapy pills (like EGFR or ALK inhibitors) can cost tens of thousands of dollars per month in the U.S. without insurance or assistance.
Even in countries with public health care (like Canada), patients sometimes face delays in confirming coverage or accessing newer targeted drugs.
Many people start chemotherapy first simply because it is more immediately accessible, then transition to targeted pills when coverage or drug supply is arranged.
The experience you quoted reflects a fairly typical modern pattern for EGFR- or ALK-positive lung cancer:
Initial chemotherapy (if pill not yet available or coverage uncertain)
First targeted pill → good response, often for 1–2 years
Progression → switch to a newer targeted pill
Repeat until there is no longer an effective targeted option
Sometimes radiation or clinical trials added for local progression
Patients often describe:
Rapid symptom relief (cough, breathlessness) within days or weeks after starting an effective pill
Cycles of hope and setback each time a drug eventually stops working
Regular imaging (CT every 3–4 months, sometimes PET or brain MRI) to monitor for progression
Lung cancer, especially adenocarcinoma, can progress without obvious new symptoms. Routine scans often detect changes before the patient feels them.
This fuels the sense that it is a "sneaky" disease and underscores why routine surveillance is standard once a diagnosis is made.
Patients often report that the most difficult period is at diagnosis — telling children and family, learning new terminology, trying to understand treatment choices.
Peer support (in person or online) and well-informed friends or neighbors often become essential for:
child care
transportation to appointments
cooking and daily household tasks
Where a cancer center lacks disease-specific materials or navigators, patients may feel as if they're "on their own."
The scarcity of lung-cancer-specific support and educational materials is being recognized as a barrier to care.
Modern advocacy groups (e.g., GO2 for Lung Cancer in the U.S., Lung Cancer Canada) now push for:
better patient navigation services
financial-access programs for targeted therapies
updated educational resources that reflect the needs of never-smokers and the role of targeted drugs
These efforts are gradually reducing the informational void that patients like the one you quoted have faced.
The confusion and sense of abandonment you noted are unfortunately common among lung-cancer patients, especially never-smokers.
Lack of early detection programs and of visible, disease-specific support resources has contributed to late diagnoses and unnecessary suffering.
Treatment advances (targeted therapies, immunotherapy, palliative radiation) now mean that timely diagnosis and good care coordination can prolong life for years, but navigating the system remains a major challenge.
Especially worrisome is the fact that some physicians have a financial investment in the very medical diagnostic imaging centers to which patients are referred.
Consumer Reports magazine now urges patients to ask if their doctor has a financial interest in a diagnostic imaging center. It should not come as a surprise that when physicians invest in a CT scanner or other radiology equipment, they then have a financial incentive to refer more of their patients for CT scans and other imaging tests.
Consumer Reports urges all patients to question their doctor when a CT scan or X-ray is ordered, as some problems can be managed without powerful doses of radiation.8
Widespread Ignorance Of The DangersConsumer Reports conducted a survey and found that only 4% of patients prescribed a CT scan had the knowledge to say "no" to their doctor.1 This prompted one enlightened doctor to state that patients need to take the lead in questioning whether a CT scan or X-ray is necessary.
A 2012 study was done of medical personnel who worked with patients undergoing abdominal CT scans (which often emit the most radiation). This study found that less than 50% understood that these scans could cause cancer.9
Another study revealed only 9% of emergency room physicians said they knew that CT scans increased cancer risk.10
This widespread ignorance amongst professionals on the front lines of medical care is alarming.
Until doctors get up to speed on the risks posted by radiation-emitting imaging devices, patients need to assert control and not capitulate to the exaggerated fears doctors instill to persuade patients to undergo unnecessary CT scans, X-rays, or other diagnostic imaging procedures involving ionizing radiation.
Defending Against LawsuitsA study presented at the 2011 meeting of the American Academy of Orthopedic Surgeons provided clear evidence of why CT scans and other medical diagnostic imaging tests are being so over utilized.
It turns out that 35% of imaging tests are being done by doctors out of fear of lawsuits.1,11-13 In other words, if sued by a patient (and zealous personal injury attorney) for malpractice, doctors need hard evidence showing the patient was aggressively diagnosed, as well as treated.
What Radon Is
Radon is a naturally occurring radioactive gas produced by the decay of uranium in soil and rock.
It seeps into houses through basements, crawl spaces, cracks, and sump pits.
Outdoors it is diluted and harmless; the risk comes from sustained indoor exposure over years.
The U.S. Environmental Protection Agency (EPA) sets an "action level" of 4 picocuries per liter (pCi/L) of air. Long-term exposure above this level is associated with a higher lifetime risk of lung cancer.
The World Health Organization recommends a slightly lower reference level: 2.7 pCi/L (100 Bq/m³).
Nationwide average: about 1.3 pCi/L.
EPA surveys:
Roughly 1 in 15 U.S. homes (~7%) test above the EPA action level of 4 pCi/L.
Higher rates occur in some regions:
Upper Midwest and Northern Plains (Iowa, North Dakota, South Dakota, Minnesota, parts of Wisconsin, Colorado, Pennsylvania): 30–40% or more of homes may test above 4 pCi/L.
Coastal regions and much of the Southeast: Usually
Newer well-sealed, energy-efficient homes can sometimes have higher radon levels because they trap soil gases indoors.
Areas with uranium-rich bedrock (parts of Canada, Czech Republic, Finland, Iran, China) also have higher radon in homes.
In many countries, 5–10% of homes exceed the national action level.
The absolute risk is still small on an individual level but important on a population level:
EPA estimates that radon exposure contributes to about 21,000 lung-cancer deaths per year in the U.S.
The risk is much higher in smokers, but even for never-smokers, long-term high exposure increases lifetime risk.
Radon is not rare, but it is not ubiquitous either:
In most U.S. regions only a minority of homes (about 7%) exceed the action level.
In certain high-radon regions, testing is strongly recommended for every home.
Testing is inexpensive and simple (home test kits or professional testers). If a problem is found, mitigation (ventilation or sub-slab depressurization) usually lowers levels below 2 pCi/L.
Bottom line: Radon is common enough that public-health agencies recommend testing every home at least once, especially in high-radon states, but the majority of U.S. homes are below the action level.
Palliative Chemotherapy – Communication, Practice, and Costs 1. Historical ContextChemotherapy in the 20th century: Originally developed as a curative tool for certain cancers (leukemia, lymphoma, germ-cell tumors).
Shift in solid tumors: For metastatic solid tumors such as lung and colorectal cancer, most regimens have palliative intent because cure is rarely possible once the disease has spread.
Integration with palliative care: Over the last two decades, randomized trials (notably Temel et al., 2010 in metastatic non–small cell lung cancer) showed that early palliative-care involvement improves quality of life and sometimes modestly prolongs survival.
Guideline development: ASCO, ESMO, and NCCN have formalized recommendations to limit aggressive therapy near the end of life and to prioritize comfort and shared decision-making.
Goal: Not to cure, but to:
slow disease progression,
reduce symptoms such as pain, cough, dyspnea,
sometimes extend life by weeks to months.
Typical use: Stage IV or otherwise inoperable cancer.
Contrast with Curative Chemotherapy:
Curative regimens aim to eradicate disease (e.g., early-stage lymphomas, germ-cell tumors).
Palliative regimens accept ongoing disease and prioritize comfort and modest life prolongation.
Informed Consent: International guidelines require that clinicians explain:
The goal of treatment (control vs. cure),
The expected benefits and risks,
The prognosis with and without therapy.
Palliative-Care Team Role: Often brought in early to reinforce communication, manage symptoms, and support decision-making.
Legal/Ethical Foundation: Respect for patient autonomy requires truthful, comprehensible disclosure.
Language
"Palliative" derives from Latin palliare ("to cloak, to ease") – not widely understood as meaning non-curative.
Patients often interpret "chemotherapy" as inherently curative, reinforced by cultural depictions.
Hope vs. Acceptance
Patients may equate continuing therapy with "not giving up."
Clinicians sometimes soften or delay explicit statements about incurability to preserve morale.
Cultural and Family Influences
In some cultures, families request that prognosis not be disclosed directly to the patient.
Health Literacy and Timing
Complex terms (progression-free survival, response rate) can obscure intent.
Initial treatment discussions often occur during periods of emotional distress, reducing information retention.
NEJM (Weeks et al., 2012):
1,193 patients with newly diagnosed stage IV lung or colorectal cancer.
69% of lung-cancer patients and 81% of colorectal-cancer patients believed chemotherapy might cure them.
Subsequent studies: Across multiple countries, 30–60% of patients receiving palliative chemo believed it was intended to cure their disease.
Overestimation of Benefit: Many believe treatment will extend life by years, when median benefit is typically measured in weeks or a few months.
Implication: Misunderstanding is common even in well-resourced health systems.
Plain Language: e.g., "This treatment cannot remove the cancer. It may help you feel better and may help you live a little longer, but the illness will continue to grow."
Teach-Back Technique: Ask patients to repeat in their own words what they have understood.
Decision Aids: Charts, videos, and pamphlets showing expected benefits and side-effects in simple terms.
Repeated Conversations: Re-address prognosis as the disease progresses or as goals shift.
Early Palliative-Care Integration: Shown to improve understanding, reduce aggressive care near end of life, improve quality of life, and sometimes extend survival.
In the final weeks or months, oncologists must decide whether to offer further chemotherapy or focus solely on comfort.
ASCO, ESMO, NCCN: Recommend against cytotoxic chemotherapy in the final 2–3 weeks of life, as the likelihood of benefit is extremely low and the risk of harm is high.
Usually consists of one additional cycle or infusion, sometimes given because of hope for a reprieve or because a scheduled cycle was delivered before recognizing imminent decline.
Most regimens take weeks to show effect; little chance of meaningful benefit in final days.
Adverse effects (infection, fatigue, nausea) can worsen quality of life and sometimes shorten survival.
No evidence of systematic deception: Studies of recorded oncologist–patient conversations rarely find explicit false claims.
Common issues: Vague wording, euphemisms ("treatment to help"), lack of repeated clarification, patient hopeful interpretation.
Cross-national phenomenon: High misunderstanding rates also found in countries without financial incentives for infusion-based care.
Guidelines and Quality Metrics: Developed to counteract overuse, not to enable it.
Generic IV palliative regimens:
Drug cost: $100–$1,000
Total visit including infusion, labs, staff: $3,000–$7,000
New targeted / immunotherapies:
Drug cost: $10,000–$25,000+ per infusion
Total cycle including administration: $15,000–$30,000+
Oral targeted agents: $10,000–$18,000 per month
Patient's out-of-pocket cost depends on insurance, co-pays, deductibles, and financial-assistance programs.
In high-income countries with national health systems (e.g., Canada, UK, most EU states, Japan, Australia), patients usually pay little or nothing directly.
For common generic regimens, system costs are often hundreds of dollars per infusion.
Prices for branded targeted drugs remain high worldwide but are typically lower than in the U.S. due to negotiated purchasing.
In the U.S. fee-for-service system, infusion centers typically receive reimbursement above the drug's purchase price, producing a modest margin.
This margin, together with cultural and clinical factors, can encourage continued use of infusion therapies.
Major late-life spending, however, also arises from hospitalizations, ICU stays, and emergency care.
*Includes hospital, emergency, hospice, imaging, lab, and systemic therapy.
Late chemotherapy:
A cycle of standard generic IV adds $3,000–$7,000.
A cycle of immunotherapy/targeted therapy adds $10,000–$25,000+.
When given, accounts for 10–20% of spending in final month.
Hospice / Palliative-only approach:
Typically $5,000–$10,000 in last month, with better comfort and often no loss of survival.
Net difference:
Continuing active treatment plus hospital stays: $30,000–$50,000 in last two months
Hospice-centered approach: ≈ $15,000–$20,000
ASCO & NCCN: Emphasize avoiding cytotoxic chemotherapy in final 2–3 weeks of life.
Quality Metric: Proportion of patients receiving chemotherapy in last 14 days of life – lower rates seen as sign of better quality.
Early Palliative-Care Integration: Demonstrated to improve patient experience and reduce unnecessary late chemotherapy.
Value-based and bundled payment models: Being tested to lessen the incentive for infusion-based care.
Autonomy: Requires honest, comprehensible information so patients can choose in line with their goals.
Non-maleficence: Avoiding harm includes avoiding side-effects of futile late therapy.
Justice: Equitable access to hospice and palliative care is often lacking, particularly for uninsured patients.
Transparency: Health-care systems must recognize that both cultural and financial factors can distort decisions.
Palliative chemotherapy usually signals non-curative intent, yet one-third to two-thirds of patients misunderstand its purpose.
About one in five metastatic-cancer patients receive chemotherapy in the last month of life; 5–10% in the last two weeks, despite guidelines.
Misunderstanding is largely due to communication gaps, cultural expectations, and prognostic uncertainty, not deliberate deception.
In the U.S., late-life care with continued chemotherapy typically costs twice as much as hospice-centered care in the final two months.
Reducing unwanted late chemotherapy requires:
Honest, repeated, plain-language discussions of goals of care,
Early integration of palliative care,
Monitoring of late chemotherapy as a quality measure,
Policy alignment to reduce perverse financial incentives.
Overall Message:
Public Health, Lung Cancer in Non-Smokers, and Systemic Barriers 1. "Killer Inside the House" as a Public-Health MetaphorSmoking (1980s–1990s): Public-health campaigns shifted focus from smoking as a personal habit to the harm caused inside homes by second-hand smoke.
Messages included: "You're bringing the danger home," "The smoke inside your home harms your kids."
Highlighted that the most dangerous air could be indoors, not outdoors.
Environmental Hazards:
Lead paint, asbestos, mold, pesticides: dangers literally in the walls, pipes, carpets.
Often framed as "hidden danger in your own home."
Infectious Diseases:
COVID-19 emphasized that most transmission occurs in households and workplaces.
Messaging stressed indoor precautions: ventilation, testing, masking when a family member is ill.
Metaphorical Uses:
Applied to health-care system failures: preventable hospital infections, medication overuse, opioid over-prescribing, marketing of ultra-processed foods.
Implies the threat originates within systems meant to protect us.
Tone:
The phrase is powerful but used sparingly in formal campaigns because of its horror-story connotation.
Public agencies prefer terms such as "hidden danger in the home" or "the risk is already indoors."
Bottom line: Many serious health threats—smoke, radon, lead, infections, even some unsafe medical practices—come from our own environments or health-care systems.
2. Screening and Diagnostic Coverage in the U.S.Screening (USPSTF 2021):
Annual low-dose CT (LDCT) for adults 50–80 years with ≥20 pack-years smoking history and current smoker or quit within 15 years.
Under the Affordable Care Act, private plans and Medicare cover LDCT without co-pay for those meeting criteria.
Medicaid varies by state but usually follows USPSTF guidelines.
Gap: Never-smokers not eligible → no routine LDCT coverage.
Diagnostic Imaging for Symptomatic Patients:
If symptoms present, imaging is diagnostic and usually covered.
Chest X-ray and CT generally reimbursed by Medicare, Medicaid, and private insurance if physician documents "medical necessity."
Prior authorization sometimes required.
PET-CT, bronchoscopy, biopsy also typically covered with documentation.
Barriers:
Delays due to authorization processes.
Stepwise approach (X-ray before CT) may miss peripheral tumors.
Patient factors: co-pays, transport, misunderstanding of urgency.
State-by-state Medicaid differences.
Key point: For symptomatic patients, including never-smokers, diagnostic CT is usually covered with proper documentation. The main gap lies in screening of asymptomatic never-smokers.
3. Challenges for Uninsured PatientsNo routine screening: Uninsured rarely pay for LDCT.
Cost barriers: Even basic visits, X-rays, or CT scans can be unaffordable.
Delayed care-seeking: Often wait until symptoms are severe.
Fragmented care: Urgent-care clinics may treat symptoms but not complete work-up.
Late presentation: By the time CT or biopsy is obtained, disease is often stage III–IV.
Safety-Net Options:
ER provides stabilizing care but not ongoing evaluation.
Federally qualified health centers sometimes arrange imaging at reduced cost.
Medicaid (especially in expansion states) can provide coverage once care is sought.
Hospital charity-care programs may offer diagnostic work-up and treatment for eligible patients.
Outcome: Uninsured patients more often diagnosed late and have worse survival.
4. Weight Loss as a Red-Flag SymptomMechanisms:
Tumor's high energy demands.
Cancer-related inflammation (cytokines) increasing energy use and breaking down muscle/fat.
Reduced appetite.
Physical burden of disease.
Clinical significance:
Unintentional ≥5–10% weight loss in 6–12 months is a red flag.
Often indicates advanced disease.
Should prompt imaging when combined with chest pain, cough, or breathlessness.
In uninsured patients:
Often presents late because early vague weight loss is ignored.
By the time medical help is sought, disease is often advanced.
Early Awareness:
1970s–80s: viewed as isolated incidents.
1991 Harvard Medical Practice Study: adverse events in ~4% of hospitalizations.
Turning Point – 1999 IOM To Err Is Human:
Estimated 44,000–98,000 hospital deaths yearly from preventable errors.
Shifted focus to systemic safety issues.
Later Emphasis:
Diagnostic errors recognized as major source of harm.
2016 BMJ (Makary & Daniel): suggested 250,000 deaths yearly from medical error (method criticized as possibly overstated).
Current View:
Medical error seen as a major contributor to deaths but not a separately certified cause.
Cancer and heart disease remain the top recorded causes.
Lung Cancer Link:
Diagnostic delay (missed or misattributed symptoms) is a common preventable harm.
Still recorded as lung-cancer death.
15–25% of U.S. cases (up to 40% in some Asian countries).
Risk factors: radon, second-hand smoke, air pollution, occupational exposures, genetic predisposition.
Only smokers meet LDCT eligibility → most non-smokers are not screened.
Early symptoms (mild cough, shortness of breath, fatigue, chest/shoulder ache) often attributed to benign conditions.
Adenocarcinoma in non-smokers often peripheral → does not cause early cough.
Rib or chest-wall pain often first serious sign → usually means locally advanced or metastatic disease.
2–4 months from first symptom to confirmed diagnosis (can be longer with misattribution).
Multiple providers and visits before imaging.
Stage IV: spread to distant organs or presence of malignant pleural effusion.
Molecular testing (EGFR, ALK, ROS1, etc.) guides targeted therapy.
Immunotherapy and targeted drugs have improved outcomes; some patients with driver mutations live 3–5 years or more.
For focal symptom relief (bone pain, airway compression, bleeding).
Usually short outpatient courses (1–5 sessions).
Stepwise approach: NSAIDs → opioids → adjuvants (gabapentin, duloxetine, steroids, etc.).
Bone-protective agents reduce fracture risk.
Palliative chemo:
Aims to slow disease and relieve symptoms.
Not expected to eradicate cancer.
Communication Challenges:
30–60% of patients misunderstand its intent.
Some believe it is curative even in advanced disease.
Best Practice:
Clear, repeated conversations; early palliative-care involvement; teach-back method.
ASCO, ESMO, NCCN: discourage cytotoxic chemotherapy in final 2–3 weeks of life.
About 1 in 5 metastatic-cancer patients receive chemotherapy in the last month of life.
About 5–10% receive it in the last two weeks.
Prognostic uncertainty.
Hope for small benefit.
Cultural and emotional factors.
Treatment momentum (next scheduled cycle given before recognizing terminal decline).
Generic IV: $3,000–$7,000 per cycle (including all services).
Targeted / immunotherapy: $15,000–$30,000+ per cycle.
Oral targeted agents: $10,000–$18,000 per month.
In most high-income countries with universal health systems:
Patient pays little or nothing directly.
System cost for generic chemo often in hundreds of dollars per infusion.
Continuing chemo plus hospitalization: $30,000–$50,000 in final two months.
Hospice-centered care: $15,000–$20,000 in final two months.
Hospice often provides better comfort without shortening survival.
U.S. fee-for-service reimburses infusion at a markup above purchase price → creates some incentive to continue therapy.
Most late-life costs come from hospitalizations and ICU care.
Autonomy: patients must be told clearly whether treatment is for cure or comfort.
Non-maleficence: avoid harm from futile therapy.
Justice: address disparities in access, especially for uninsured and never-smokers.
Quality Metrics: proportion receiving chemotherapy in final 14 days used as a marker of appropriate care.
Early Palliative-Care Integration: reduces aggressive late care, improves comfort, may prolong life.
Reduce tobacco use.
Test and mitigate radon in homes.
Improve outdoor air quality.
Maintain workplace protections.
Expand research into screening high-risk non-smokers.
Promote early evaluation of persistent chest or rib pain.
Ensure equitable access to modern therapy and supportive care.
Lung cancer and heart disease remain the top recorded causes of death.
Medical errors contribute to mortality (often through diagnostic delays) but are not counted separately on death certificates.
Non-smokers face a recognized detection gap due to screening rules and lower clinical suspicion.
Rib pain is usually a late symptom—an alarm for prompt imaging.
Late use of chemotherapy often provides little benefit, increases suffering, and doubles end-of-life costs compared with hospice-centered care.
Improving communication, integrating palliative care early, and addressing system barriers are the most effective ways to improve patient outcomes and reduce preventable harm.
Overall Perspective: Lung cancer in non-smokers remains a major public-health challenge because of delayed recognition and gaps in screening. Systemic communication failures—more than deliberate deception—drive continued use of chemotherapy near the end of life. Early recognition, equitable access to care, clear conversations about goals, and early integration of palliative care are essential for improving survival, comfort, and responsible use of health-care resources.
Clear, empathetic communication and integration of palliative care are the best tools to ensure that treatment decisions at the end of life reflect patient goals, avoid unnecessary suffering, and prevent both medical and financial overuse.
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By Dianne Emerson
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Awareness isn't about fear; it's about time. The sooner we see what's hiding in plain sight, the more lives we can save.
Clips Played How Long Can You Survive With Stage 4 Lung Cancer? - Oncology Support Network - YouTube
Music: The Byrds - Turn! Turn! Turn! (To Everything There Is A Season) (Audio)
What happens in every stage of lung cancer? | Cancer: Explained | Macmillan Cancer Support - YouTube
Can a CT Scan Kill You? Know The Risks - Life Extension
CT Scan Drawbacks: Important Risks and Side Effects
Only had back pain: How I Learned I had Stage 4 Lung Cancer - Anne | The Patient Story
Doctors Assured Me It Wasn't Cancer! - Shirley | Stage 4 Lung Cancer | The Patient Story - YouTube
A great channel: 3 Steps to Make Sure Your Medical Wishes Are Followed
My Stage 4 Cancer Symptoms Were DISMISSED! - Leah | Stage 4 Lung Cancer | The Patient Story - YouTube
CT Scans and Cancer: What Are the Risks? | Chris Kresser
Can a CT Scan Kill You? Know The Risks - Life Extension
My Stage 4 LUNG CANCER Symptoms: "It all Happened So Fast!" | The Patient Story
Palliative Chemotherapy: What You Need to Know
Why Doesn't Smoking Weed Give You Lung Cancer Like Cigarettes? | by Tierney Finster | MEL Magazine | Medium
Marijuana & Lung Cancer Risk - Mayo Clinic Health System
Cannabis use among recently treated cancer patients: perceptions and experiences | Supportive Care in Cancer
Is Marijuana a Risk Factor or a Treatment Option for Lung Cancer?
Marijuana and Lung Health | American Lung Association
Over 3.8 million lung cancer deaths prevented in the United States due to smoking decline
Big Banks Found a New Way To Trap You In Medical Debt
Marijuana IS Medicine
Bulk Delta 8 THC Distillate
Delta 8 Shake - Fern Valley Farms
$24.99 No Membership Required: The Wayy Big Hoodie Unisex | Costco
Dryer Rack: Mainstays Oversized Collapsible Steel Laundry Drying Rack, 7 Levels, Silver - Walmart.com
Russia-UK and USA Nuclear Power Plants-First Nuclear Power Plant in RUSSIA -UK and USA ALL lied to public. Nuclear Plants create Dirty Electricity over time as bad or worse than Ionizing Radiation. Directly INTO our homes.
Lifetime risk of dementia after age 55 is double previous estimates – White House and Illegal Drug Use by Musk and Trump. Alzheimer and Dirty Electricity. What is the connection? Tests on RATS confirm how we are getting Alzheimer, no HUMAN studies.
The Romanov Gypsy Takeover -Disguised as Kings, Priests and Generals. They Firebombed Nations, Erased Muslims, and Unleashed the Silent War of Dirty Electricity Eugenics to Destroy Our DNA.
The U.S. Army explored using radioactive poisons to assassinate important individuals such as military or civilian leaders, according to newly declassified docs. Approved at the highest levels of the Army in 1948, the effort was a well-hidden secret….
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Experts Historically Underestimated Radiation Risks
When radiation was first discovered, doctors were wildly enthusiastic about being able to peer inside the body of a living human.
Sadly, radiation killed its early pioneers, who had no idea of its dangers.
Even as knowledge of radiation's lethal properties became apparent, experts consistently underestimated the risks.
One tragic example was an individual named Clarence Dally who intentionally exposed himself multiple times to ionizing radiation from Thomas Edison's "fluoroscope" invention. Within a few months, Dally began suffering debilitating fatigue, body aches, and multiple burn-like lesions on his hands. These lesions turned out to be cancer that rapidly spread throughout his body. Dally lost both his arms to these malignant lesions, and died a painful death in 1904. Thomas Edison was said to be haunted for the rest of his life by Dally's cancer and death, and refused to have anything more to do with ionizing radiation.24
In the 1950s, our federal government routinely conducted above-ground testing of nuclear bombs in the Nevada desert and claimed the radioactive fallout that spread throughout much of the United States was "harmless." In 2002, the federal government admitted that the radiation emitted from these nuclear weapons tests caused 15,000 American cancer deaths.25 Critics claim this number grossly understates the actual number of cancer
"…there is little evidence to support the use of dental X-rays ' in search of occult pathoses in the asymptomatic patient' or 'routine dental radiographs at preset intervals for all patients. Although dental X-rays are an important tool in well-selected patients, efforts to moderate exposure to ionizing radiation to the head is likely to be of benefit to patients and health care providers alike.'"
John Gofman, MD, PhD, was a medical doctor, nuclear chemist, Manhattan Project scientist, co-discoverer of isotopes of uranium and protactinium, the first to separate plutonium in usable quantities, and an early member of the Life Extension Foundation.
Dr. Gofman fought to end policies that allow plutonium and other radioactivity from the nuclear power/weapons fuel chain to be dispersed into the environment. He repeatedly stood up to government pressure to suppress the truth about radiation health dangers.
Dr. Gofman's accomplishments extend to his groundbreaking research in cardiac medicine, which includes the identification and distinguishing of HDL cholesterol and LDL cholesterol. The Journal of Clinical Lipidology named him the "Father of Clinical Lipidology," honoring him for discoveries he made decades ago, which are now part of conventional cardiology.43
His tireless work to reduce unnecessary radiation exposure from medical procedures is finally taking hold with Consumer Reports disseminating data that emanated from work that Dr. Gofman initiated many decades ago.
Dr. Gofman firmly believed there is no safe threshold of ionizing radiation one should needlessly be exposed to. He used a linear no-threshold model of radiation risk and argued that far more cases of cancer and other diseases are caused by unnecessary exposure to medical radiation than what the "authorities" admit.44,45
Not everyone agrees with Dr. Gofman's "linear model of radiation risk" and a debate continues as to whether there is a low level of X-ray exposure that can be accepted as "safe."
Radiation Dose Comparison
Different types of medical diagnostic imaging tests pose varying degrees of risk from ionizing radiation exposure.
A brief list of different medical diagnostic imaging tests that utilize ionizing radiation are provided to better identify scans that generate relatively high exposure in comparison to natural background radiation exposure.
Diagnostic Procedure Typical Effective Dose (mSv)46 Number Of Chest X-rays (PA film) For Equivalent Effective Dose47 Time Period For Equivalent Effective Dose From Natural Background Radiation48 Chest X-ray (PA Film) 0.02 1 2.4 days Skull X-ray 0.1 5 12 days Lumbar Spine 1.5 75 182 days Intravenous (IV) Pyelogram 3 150 1.0 year Upper GI Exam (Barium Swallow) 6 300 2.0 years Lower GI Exam (Barium Enema) 8 400 2.7 years CT Head 2 100 243 days CT Abdomen 8 400 2.7 yearsReferences
CT = Ionizing Radiation
A CT scan uses X-rays, which are ionizing radiation.
The dose is much higher than a plain chest X-ray:
Chest X-ray: about 0.1 mSv (millisievert)
Chest CT: about 5–7 mSv
Abdomen & pelvis CT: 8–10 mSv
A whole-body trauma CT can be 20 mSv or more
For comparison: natural background radiation in the U.S. is about 3 mSv per year.
2. Informed Consent in PracticeEmergency settings:
If the patient is conscious and able, the staff usually give a brief explanation: "We're going to do a CT scan to check for bleeding / clots / injuries. It uses X-rays."
In life-threatening situations (e.g., stroke, major trauma, internal bleeding), the scan is done under implied consent because the benefit of a rapid diagnosis outweighs the small long-term radiation risk.
Outpatient or non-urgent settings:
Patients often sign a general imaging consent that covers CT, X-ray, and similar tests.
Some facilities give a printed information sheet mentioning that CT involves ionizing radiation and noting why it's being ordered.
Usually there is not an extensive discussion of the exact dose, unless the patient asks or is part of a higher-risk group (for example, a child or a pregnant woman).
Studies show that many patients:
Do not realize that CT uses radiation.
Tend to underestimate the dose compared with a plain X-ray.
Are often focused on the immediate health problem rather than the long-term risk.
Clinicians and radiology societies have been trying to improve this by:
Adding plain-language information to consent forms
Posting notices in waiting rooms ("CT uses X-rays")
Training staff to mention radiation risk in routine explanations
The long-term cancer risk from a single diagnostic CT is very small — on the order of 1 in 10,000 to 1 in 1,000 depending on age, body part, and dose.
The immediate benefit — finding a bleed, a clot, a ruptured organ, or a hidden lung mass — is usually far greater than the theoretical risk.
The highest concern is for children and young adults, who are more sensitive to radiation and have more years ahead for a radiation-induced cancer to develop.
You have the right to ask:
Why the CT is needed
Whether an ultrasound or MRI could give the same answer without radiation
How the dose will be kept as low as possible ("ALARA" principle — As Low As Reasonably Achievable)
You can also ask the facility to keep a record of your imaging history so you don't get unnecessary repeat scans.
CT scans in emergencies are often performed very quickly, sometimes without a detailed radiation discussion, because speed can save a life.
In non-emergent cases, patients usually sign a general consent but may not be told the dose unless they ask.
The radiation risk is real but small; the decision to scan is a risk–benefit calculation, generally in favor of scanning when serious disease is suspected.
General Rule
CT scans are avoided during pregnancy whenever possible.
Ultrasound and MRI are preferred because they do not use ionizing radiation.
CT is only used if the information is urgently needed and cannot be obtained by a safer method.
Situations where CT is sometimes chosen even in pregnancy include:
Life-threatening emergencies for the mother:
Suspected pulmonary embolism (blood clot in the lungs)
Severe trauma (e.g., after a car accident)
Suspected internal bleeding in the chest or abdomen
Stroke, brain bleeding
If the mother's life is at risk, doctors will prioritize her diagnosis and treatment, as this also benefits the fetus.
Radiation risk depends on:
Stage of pregnancy: The first trimester (especially weeks 2–15) is most sensitive.
Body area scanned:
Head or chest CT: The fetus is not in the primary beam; the dose to the fetus is very low (often
Abdominal or pelvic CT: The fetus is in the beam; typical dose is 10–25 mGy.
For context: – Risk of birth defects rises noticeably above about 100 mGy. – A single CT of the abdomen or pelvis is well below that threshold, but is associated with a small increase in lifetime cancer risk for the child.
4. Risk EstimatesThe baseline risk of a child developing cancer is about 1 in 500.
A fetal exposure of 10–20 mGy (typical for one abdominal CT) may increase that risk by about 1 in 1,000–2,000.
There is no evidence of birth defects from typical diagnostic CT doses.
The main concern is the small increase in lifetime cancer risk.
Doctors weigh the immediate danger to the mother against the small, delayed risk to the fetus.
Stabilizing or saving the mother's life is the best protection for the fetus.
Modern CT scanners use dose-reduction protocols for pregnant patients:
Limiting scan area
Lowering exposure settings
Using shielding when it does not interfere with imaging
Patients should be told that CT uses X-rays and that every effort is made to minimize fetal exposure.
If the scan is of the head or chest, patients can be reassured the radiation to the fetus is negligible.
If the scan is of the abdomen/pelvis, the decision should involve:
The treating physician
A radiologist
Sometimes a maternal–fetal medicine specialist
Ultrasound and MRI are first choice for imaging in pregnancy.
CT is only used when truly needed and with precautions to reduce dose.
For most CT exams not involving the belly/pelvis, fetal radiation exposure is extremely low.
Even when the pelvis is scanned, the absolute risk increase is small, and the mother's health remains the top priority.
Maternal Mortality in the U.S.
According to the CDC:
In 2021, the U.S. maternal-mortality rate was about 33 deaths per 100,000 live births.
This is 2–3 times higher than in Canada, the U.K., or most of western Europe.
The risk is much higher for Black women — in some years 2–3 times the rate of white women.
Many deaths occur after delivery, often from:
Hemorrhage
Hypertensive disorders (like pre-eclampsia/eclampsia)
Infections
Cardiovascular disease
Countries such as Norway, Germany, Japan, Australia report fewer than 10 deaths per 100,000 live births.
Some lower-income nations have improved dramatically through:
More accessible prenatal care
Skilled birth attendants
Rapid emergency response for complications
The U.S. rate is therefore high not because modern care isn't available, but because it's not equally accessible or consistently delivered.
Access and inequality:
Many women, especially in rural areas or without insurance, have limited access to prenatal care.
Chronic health conditions:
Higher rates of obesity, diabetes, hypertension.
Fragmented health-care system:
Gaps in coordination between prenatal, delivery, and postpartum care.
Systemic racism and implicit bias:
Documented in research as contributing to delays in recognition and response to complications in Black women.
Under-prioritizing postpartum care:
A large share of deaths occur in the weeks to months after birth, when follow-up may be inadequate.
In an acute emergency (e.g., suspected pulmonary embolism or internal bleeding), physicians generally do prioritize saving the mother's life first, because the fetus cannot survive if the mother dies.
The concern you raise reflects a broader systemic problem: many women in the U.S. do not get timely preventive or emergency care in the first place.
The U.S. has advanced medical technology, but maternal health outcomes lag behind many peer nations because of access, inequality, and system failures, not because clinicians deliberately disregard mothers' lives.
In emergencies requiring CT scans or other interventions, the ethical standard is to prioritize maternal survival, which in turn is usually the best chance for the baby.
Improving maternal survival overall depends on:
Early and continuous prenatal care
Rapid recognition of complications
Equitable access to quality care before, during, and after delivery
Information and Support Gaps
Historically stigmatized: for decades lung cancer was thought of as a "smoker's disease." Many cancer centers built their educational materials and support programs first for breast, prostate, colon and childhood cancers.
Result: people who never smoked often find no brochures, few support groups, and a focus on smoking cessation rather than on the needs of those already diagnosed.
Patient impact: many describe feeling as if they had to learn a new medical vocabulary, navigate insurance and treatment options alone, and explain repeatedly that they never smoked.
Targeted therapy pills (like EGFR or ALK inhibitors) can cost tens of thousands of dollars per month in the U.S. without insurance or assistance.
Even in countries with public health care (like Canada), patients sometimes face delays in confirming coverage or accessing newer targeted drugs.
Many people start chemotherapy first simply because it is more immediately accessible, then transition to targeted pills when coverage or drug supply is arranged.
The experience you quoted reflects a fairly typical modern pattern for EGFR- or ALK-positive lung cancer:
Initial chemotherapy (if pill not yet available or coverage uncertain)
First targeted pill → good response, often for 1–2 years
Progression → switch to a newer targeted pill
Repeat until there is no longer an effective targeted option
Sometimes radiation or clinical trials added for local progression
Patients often describe:
Rapid symptom relief (cough, breathlessness) within days or weeks after starting an effective pill
Cycles of hope and setback each time a drug eventually stops working
Regular imaging (CT every 3–4 months, sometimes PET or brain MRI) to monitor for progression
Lung cancer, especially adenocarcinoma, can progress without obvious new symptoms. Routine scans often detect changes before the patient feels them.
This fuels the sense that it is a "sneaky" disease and underscores why routine surveillance is standard once a diagnosis is made.
Patients often report that the most difficult period is at diagnosis — telling children and family, learning new terminology, trying to understand treatment choices.
Peer support (in person or online) and well-informed friends or neighbors often become essential for:
child care
transportation to appointments
cooking and daily household tasks
Where a cancer center lacks disease-specific materials or navigators, patients may feel as if they're "on their own."
The scarcity of lung-cancer-specific support and educational materials is being recognized as a barrier to care.
Modern advocacy groups (e.g., GO2 for Lung Cancer in the U.S., Lung Cancer Canada) now push for:
better patient navigation services
financial-access programs for targeted therapies
updated educational resources that reflect the needs of never-smokers and the role of targeted drugs
These efforts are gradually reducing the informational void that patients like the one you quoted have faced.
The confusion and sense of abandonment you noted are unfortunately common among lung-cancer patients, especially never-smokers.
Lack of early detection programs and of visible, disease-specific support resources has contributed to late diagnoses and unnecessary suffering.
Treatment advances (targeted therapies, immunotherapy, palliative radiation) now mean that timely diagnosis and good care coordination can prolong life for years, but navigating the system remains a major challenge.
Especially worrisome is the fact that some physicians have a financial investment in the very medical diagnostic imaging centers to which patients are referred.
Consumer Reports magazine now urges patients to ask if their doctor has a financial interest in a diagnostic imaging center. It should not come as a surprise that when physicians invest in a CT scanner or other radiology equipment, they then have a financial incentive to refer more of their patients for CT scans and other imaging tests.
Consumer Reports urges all patients to question their doctor when a CT scan or X-ray is ordered, as some problems can be managed without powerful doses of radiation.8
Widespread Ignorance Of The DangersConsumer Reports conducted a survey and found that only 4% of patients prescribed a CT scan had the knowledge to say "no" to their doctor.1 This prompted one enlightened doctor to state that patients need to take the lead in questioning whether a CT scan or X-ray is necessary.
A 2012 study was done of medical personnel who worked with patients undergoing abdominal CT scans (which often emit the most radiation). This study found that less than 50% understood that these scans could cause cancer.9
Another study revealed only 9% of emergency room physicians said they knew that CT scans increased cancer risk.10
This widespread ignorance amongst professionals on the front lines of medical care is alarming.
Until doctors get up to speed on the risks posted by radiation-emitting imaging devices, patients need to assert control and not capitulate to the exaggerated fears doctors instill to persuade patients to undergo unnecessary CT scans, X-rays, or other diagnostic imaging procedures involving ionizing radiation.
Defending Against LawsuitsA study presented at the 2011 meeting of the American Academy of Orthopedic Surgeons provided clear evidence of why CT scans and other medical diagnostic imaging tests are being so over utilized.
It turns out that 35% of imaging tests are being done by doctors out of fear of lawsuits.1,11-13 In other words, if sued by a patient (and zealous personal injury attorney) for malpractice, doctors need hard evidence showing the patient was aggressively diagnosed, as well as treated.
What Radon Is
Radon is a naturally occurring radioactive gas produced by the decay of uranium in soil and rock.
It seeps into houses through basements, crawl spaces, cracks, and sump pits.
Outdoors it is diluted and harmless; the risk comes from sustained indoor exposure over years.
The U.S. Environmental Protection Agency (EPA) sets an "action level" of 4 picocuries per liter (pCi/L) of air. Long-term exposure above this level is associated with a higher lifetime risk of lung cancer.
The World Health Organization recommends a slightly lower reference level: 2.7 pCi/L (100 Bq/m³).
Nationwide average: about 1.3 pCi/L.
EPA surveys:
Roughly 1 in 15 U.S. homes (~7%) test above the EPA action level of 4 pCi/L.
Higher rates occur in some regions:
Upper Midwest and Northern Plains (Iowa, North Dakota, South Dakota, Minnesota, parts of Wisconsin, Colorado, Pennsylvania): 30–40% or more of homes may test above 4 pCi/L.
Coastal regions and much of the Southeast: Usually
Newer well-sealed, energy-efficient homes can sometimes have higher radon levels because they trap soil gases indoors.
Areas with uranium-rich bedrock (parts of Canada, Czech Republic, Finland, Iran, China) also have higher radon in homes.
In many countries, 5–10% of homes exceed the national action level.
The absolute risk is still small on an individual level but important on a population level:
EPA estimates that radon exposure contributes to about 21,000 lung-cancer deaths per year in the U.S.
The risk is much higher in smokers, but even for never-smokers, long-term high exposure increases lifetime risk.
Radon is not rare, but it is not ubiquitous either:
In most U.S. regions only a minority of homes (about 7%) exceed the action level.
In certain high-radon regions, testing is strongly recommended for every home.
Testing is inexpensive and simple (home test kits or professional testers). If a problem is found, mitigation (ventilation or sub-slab depressurization) usually lowers levels below 2 pCi/L.
Bottom line: Radon is common enough that public-health agencies recommend testing every home at least once, especially in high-radon states, but the majority of U.S. homes are below the action level.
Palliative Chemotherapy – Communication, Practice, and Costs 1. Historical ContextChemotherapy in the 20th century: Originally developed as a curative tool for certain cancers (leukemia, lymphoma, germ-cell tumors).
Shift in solid tumors: For metastatic solid tumors such as lung and colorectal cancer, most regimens have palliative intent because cure is rarely possible once the disease has spread.
Integration with palliative care: Over the last two decades, randomized trials (notably Temel et al., 2010 in metastatic non–small cell lung cancer) showed that early palliative-care involvement improves quality of life and sometimes modestly prolongs survival.
Guideline development: ASCO, ESMO, and NCCN have formalized recommendations to limit aggressive therapy near the end of life and to prioritize comfort and shared decision-making.
Goal: Not to cure, but to:
slow disease progression,
reduce symptoms such as pain, cough, dyspnea,
sometimes extend life by weeks to months.
Typical use: Stage IV or otherwise inoperable cancer.
Contrast with Curative Chemotherapy:
Curative regimens aim to eradicate disease (e.g., early-stage lymphomas, germ-cell tumors).
Palliative regimens accept ongoing disease and prioritize comfort and modest life prolongation.
Informed Consent: International guidelines require that clinicians explain:
The goal of treatment (control vs. cure),
The expected benefits and risks,
The prognosis with and without therapy.
Palliative-Care Team Role: Often brought in early to reinforce communication, manage symptoms, and support decision-making.
Legal/Ethical Foundation: Respect for patient autonomy requires truthful, comprehensible disclosure.
Language
"Palliative" derives from Latin palliare ("to cloak, to ease") – not widely understood as meaning non-curative.
Patients often interpret "chemotherapy" as inherently curative, reinforced by cultural depictions.
Hope vs. Acceptance
Patients may equate continuing therapy with "not giving up."
Clinicians sometimes soften or delay explicit statements about incurability to preserve morale.
Cultural and Family Influences
In some cultures, families request that prognosis not be disclosed directly to the patient.
Health Literacy and Timing
Complex terms (progression-free survival, response rate) can obscure intent.
Initial treatment discussions often occur during periods of emotional distress, reducing information retention.
NEJM (Weeks et al., 2012):
1,193 patients with newly diagnosed stage IV lung or colorectal cancer.
69% of lung-cancer patients and 81% of colorectal-cancer patients believed chemotherapy might cure them.
Subsequent studies: Across multiple countries, 30–60% of patients receiving palliative chemo believed it was intended to cure their disease.
Overestimation of Benefit: Many believe treatment will extend life by years, when median benefit is typically measured in weeks or a few months.
Implication: Misunderstanding is common even in well-resourced health systems.
Plain Language: e.g., "This treatment cannot remove the cancer. It may help you feel better and may help you live a little longer, but the illness will continue to grow."
Teach-Back Technique: Ask patients to repeat in their own words what they have understood.
Decision Aids: Charts, videos, and pamphlets showing expected benefits and side-effects in simple terms.
Repeated Conversations: Re-address prognosis as the disease progresses or as goals shift.
Early Palliative-Care Integration: Shown to improve understanding, reduce aggressive care near end of life, improve quality of life, and sometimes extend survival.
In the final weeks or months, oncologists must decide whether to offer further chemotherapy or focus solely on comfort.
ASCO, ESMO, NCCN: Recommend against cytotoxic chemotherapy in the final 2–3 weeks of life, as the likelihood of benefit is extremely low and the risk of harm is high.
Usually consists of one additional cycle or infusion, sometimes given because of hope for a reprieve or because a scheduled cycle was delivered before recognizing imminent decline.
Most regimens take weeks to show effect; little chance of meaningful benefit in final days.
Adverse effects (infection, fatigue, nausea) can worsen quality of life and sometimes shorten survival.
No evidence of systematic deception: Studies of recorded oncologist–patient conversations rarely find explicit false claims.
Common issues: Vague wording, euphemisms ("treatment to help"), lack of repeated clarification, patient hopeful interpretation.
Cross-national phenomenon: High misunderstanding rates also found in countries without financial incentives for infusion-based care.
Guidelines and Quality Metrics: Developed to counteract overuse, not to enable it.
Generic IV palliative regimens:
Drug cost: $100–$1,000
Total visit including infusion, labs, staff: $3,000–$7,000
New targeted / immunotherapies:
Drug cost: $10,000–$25,000+ per infusion
Total cycle including administration: $15,000–$30,000+
Oral targeted agents: $10,000–$18,000 per month
Patient's out-of-pocket cost depends on insurance, co-pays, deductibles, and financial-assistance programs.
In high-income countries with national health systems (e.g., Canada, UK, most EU states, Japan, Australia), patients usually pay little or nothing directly.
For common generic regimens, system costs are often hundreds of dollars per infusion.
Prices for branded targeted drugs remain high worldwide but are typically lower than in the U.S. due to negotiated purchasing.
In the U.S. fee-for-service system, infusion centers typically receive reimbursement above the drug's purchase price, producing a modest margin.
This margin, together with cultural and clinical factors, can encourage continued use of infusion therapies.
Major late-life spending, however, also arises from hospitalizations, ICU stays, and emergency care.
*Includes hospital, emergency, hospice, imaging, lab, and systemic therapy.
Late chemotherapy:
A cycle of standard generic IV adds $3,000–$7,000.
A cycle of immunotherapy/targeted therapy adds $10,000–$25,000+.
When given, accounts for 10–20% of spending in final month.
Hospice / Palliative-only approach:
Typically $5,000–$10,000 in last month, with better comfort and often no loss of survival.
Net difference:
Continuing active treatment plus hospital stays: $30,000–$50,000 in last two months
Hospice-centered approach: ≈ $15,000–$20,000
ASCO & NCCN: Emphasize avoiding cytotoxic chemotherapy in final 2–3 weeks of life.
Quality Metric: Proportion of patients receiving chemotherapy in last 14 days of life – lower rates seen as sign of better quality.
Early Palliative-Care Integration: Demonstrated to improve patient experience and reduce unnecessary late chemotherapy.
Value-based and bundled payment models: Being tested to lessen the incentive for infusion-based care.
Autonomy: Requires honest, comprehensible information so patients can choose in line with their goals.
Non-maleficence: Avoiding harm includes avoiding side-effects of futile late therapy.
Justice: Equitable access to hospice and palliative care is often lacking, particularly for uninsured patients.
Transparency: Health-care systems must recognize that both cultural and financial factors can distort decisions.
Palliative chemotherapy usually signals non-curative intent, yet one-third to two-thirds of patients misunderstand its purpose.
About one in five metastatic-cancer patients receive chemotherapy in the last month of life; 5–10% in the last two weeks, despite guidelines.
Misunderstanding is largely due to communication gaps, cultural expectations, and prognostic uncertainty, not deliberate deception.
In the U.S., late-life care with continued chemotherapy typically costs twice as much as hospice-centered care in the final two months.
Reducing unwanted late chemotherapy requires:
Honest, repeated, plain-language discussions of goals of care,
Early integration of palliative care,
Monitoring of late chemotherapy as a quality measure,
Policy alignment to reduce perverse financial incentives.
Overall Message:
Public Health, Lung Cancer in Non-Smokers, and Systemic Barriers 1. "Killer Inside the House" as a Public-Health MetaphorSmoking (1980s–1990s): Public-health campaigns shifted focus from smoking as a personal habit to the harm caused inside homes by second-hand smoke.
Messages included: "You're bringing the danger home," "The smoke inside your home harms your kids."
Highlighted that the most dangerous air could be indoors, not outdoors.
Environmental Hazards:
Lead paint, asbestos, mold, pesticides: dangers literally in the walls, pipes, carpets.
Often framed as "hidden danger in your own home."
Infectious Diseases:
COVID-19 emphasized that most transmission occurs in households and workplaces.
Messaging stressed indoor precautions: ventilation, testing, masking when a family member is ill.
Metaphorical Uses:
Applied to health-care system failures: preventable hospital infections, medication overuse, opioid over-prescribing, marketing of ultra-processed foods.
Implies the threat originates within systems meant to protect us.
Tone:
The phrase is powerful but used sparingly in formal campaigns because of its horror-story connotation.
Public agencies prefer terms such as "hidden danger in the home" or "the risk is already indoors."
Bottom line: Many serious health threats—smoke, radon, lead, infections, even some unsafe medical practices—come from our own environments or health-care systems.
2. Screening and Diagnostic Coverage in the U.S.Screening (USPSTF 2021):
Annual low-dose CT (LDCT) for adults 50–80 years with ≥20 pack-years smoking history and current smoker or quit within 15 years.
Under the Affordable Care Act, private plans and Medicare cover LDCT without co-pay for those meeting criteria.
Medicaid varies by state but usually follows USPSTF guidelines.
Gap: Never-smokers not eligible → no routine LDCT coverage.
Diagnostic Imaging for Symptomatic Patients:
If symptoms present, imaging is diagnostic and usually covered.
Chest X-ray and CT generally reimbursed by Medicare, Medicaid, and private insurance if physician documents "medical necessity."
Prior authorization sometimes required.
PET-CT, bronchoscopy, biopsy also typically covered with documentation.
Barriers:
Delays due to authorization processes.
Stepwise approach (X-ray before CT) may miss peripheral tumors.
Patient factors: co-pays, transport, misunderstanding of urgency.
State-by-state Medicaid differences.
Key point: For symptomatic patients, including never-smokers, diagnostic CT is usually covered with proper documentation. The main gap lies in screening of asymptomatic never-smokers.
3. Challenges for Uninsured PatientsNo routine screening: Uninsured rarely pay for LDCT.
Cost barriers: Even basic visits, X-rays, or CT scans can be unaffordable.
Delayed care-seeking: Often wait until symptoms are severe.
Fragmented care: Urgent-care clinics may treat symptoms but not complete work-up.
Late presentation: By the time CT or biopsy is obtained, disease is often stage III–IV.
Safety-Net Options:
ER provides stabilizing care but not ongoing evaluation.
Federally qualified health centers sometimes arrange imaging at reduced cost.
Medicaid (especially in expansion states) can provide coverage once care is sought.
Hospital charity-care programs may offer diagnostic work-up and treatment for eligible patients.
Outcome: Uninsured patients more often diagnosed late and have worse survival.
4. Weight Loss as a Red-Flag SymptomMechanisms:
Tumor's high energy demands.
Cancer-related inflammation (cytokines) increasing energy use and breaking down muscle/fat.
Reduced appetite.
Physical burden of disease.
Clinical significance:
Unintentional ≥5–10% weight loss in 6–12 months is a red flag.
Often indicates advanced disease.
Should prompt imaging when combined with chest pain, cough, or breathlessness.
In uninsured patients:
Often presents late because early vague weight loss is ignored.
By the time medical help is sought, disease is often advanced.
Early Awareness:
1970s–80s: viewed as isolated incidents.
1991 Harvard Medical Practice Study: adverse events in ~4% of hospitalizations.
Turning Point – 1999 IOM To Err Is Human:
Estimated 44,000–98,000 hospital deaths yearly from preventable errors.
Shifted focus to systemic safety issues.
Later Emphasis:
Diagnostic errors recognized as major source of harm.
2016 BMJ (Makary & Daniel): suggested 250,000 deaths yearly from medical error (method criticized as possibly overstated).
Current View:
Medical error seen as a major contributor to deaths but not a separately certified cause.
Cancer and heart disease remain the top recorded causes.
Lung Cancer Link:
Diagnostic delay (missed or misattributed symptoms) is a common preventable harm.
Still recorded as lung-cancer death.
15–25% of U.S. cases (up to 40% in some Asian countries).
Risk factors: radon, second-hand smoke, air pollution, occupational exposures, genetic predisposition.
Only smokers meet LDCT eligibility → most non-smokers are not screened.
Early symptoms (mild cough, shortness of breath, fatigue, chest/shoulder ache) often attributed to benign conditions.
Adenocarcinoma in non-smokers often peripheral → does not cause early cough.
Rib or chest-wall pain often first serious sign → usually means locally advanced or metastatic disease.
2–4 months from first symptom to confirmed diagnosis (can be longer with misattribution).
Multiple providers and visits before imaging.
Stage IV: spread to distant organs or presence of malignant pleural effusion.
Molecular testing (EGFR, ALK, ROS1, etc.) guides targeted therapy.
Immunotherapy and targeted drugs have improved outcomes; some patients with driver mutations live 3–5 years or more.
For focal symptom relief (bone pain, airway compression, bleeding).
Usually short outpatient courses (1–5 sessions).
Stepwise approach: NSAIDs → opioids → adjuvants (gabapentin, duloxetine, steroids, etc.).
Bone-protective agents reduce fracture risk.
Palliative chemo:
Aims to slow disease and relieve symptoms.
Not expected to eradicate cancer.
Communication Challenges:
30–60% of patients misunderstand its intent.
Some believe it is curative even in advanced disease.
Best Practice:
Clear, repeated conversations; early palliative-care involvement; teach-back method.
ASCO, ESMO, NCCN: discourage cytotoxic chemotherapy in final 2–3 weeks of life.
About 1 in 5 metastatic-cancer patients receive chemotherapy in the last month of life.
About 5–10% receive it in the last two weeks.
Prognostic uncertainty.
Hope for small benefit.
Cultural and emotional factors.
Treatment momentum (next scheduled cycle given before recognizing terminal decline).
Generic IV: $3,000–$7,000 per cycle (including all services).
Targeted / immunotherapy: $15,000–$30,000+ per cycle.
Oral targeted agents: $10,000–$18,000 per month.
In most high-income countries with universal health systems:
Patient pays little or nothing directly.
System cost for generic chemo often in hundreds of dollars per infusion.
Continuing chemo plus hospitalization: $30,000–$50,000 in final two months.
Hospice-centered care: $15,000–$20,000 in final two months.
Hospice often provides better comfort without shortening survival.
U.S. fee-for-service reimburses infusion at a markup above purchase price → creates some incentive to continue therapy.
Most late-life costs come from hospitalizations and ICU care.
Autonomy: patients must be told clearly whether treatment is for cure or comfort.
Non-maleficence: avoid harm from futile therapy.
Justice: address disparities in access, especially for uninsured and never-smokers.
Quality Metrics: proportion receiving chemotherapy in final 14 days used as a marker of appropriate care.
Early Palliative-Care Integration: reduces aggressive late care, improves comfort, may prolong life.
Reduce tobacco use.
Test and mitigate radon in homes.
Improve outdoor air quality.
Maintain workplace protections.
Expand research into screening high-risk non-smokers.
Promote early evaluation of persistent chest or rib pain.
Ensure equitable access to modern therapy and supportive care.
Lung cancer and heart disease remain the top recorded causes of death.
Medical errors contribute to mortality (often through diagnostic delays) but are not counted separately on death certificates.
Non-smokers face a recognized detection gap due to screening rules and lower clinical suspicion.
Rib pain is usually a late symptom—an alarm for prompt imaging.
Late use of chemotherapy often provides little benefit, increases suffering, and doubles end-of-life costs compared with hospice-centered care.
Improving communication, integrating palliative care early, and addressing system barriers are the most effective ways to improve patient outcomes and reduce preventable harm.
Overall Perspective: Lung cancer in non-smokers remains a major public-health challenge because of delayed recognition and gaps in screening. Systemic communication failures—more than deliberate deception—drive continued use of chemotherapy near the end of life. Early recognition, equitable access to care, clear conversations about goals, and early integration of palliative care are essential for improving survival, comfort, and responsible use of health-care resources.
Clear, empathetic communication and integration of palliative care are the best tools to ensure that treatment decisions at the end of life reflect patient goals, avoid unnecessary suffering, and prevent both medical and financial overuse.
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