Lung Cancer Without Treatment

Considerations When Weighing Quality of Life vs. Survival

If you have been diagnosed with lung cancer, the first two questions you may have is how long you are likely to live and whether you will be able to tolerate treatment. In some cases, the cancer may be advanced and the treatment so impactful that it may compromise the quality of your life in a way that you find acceptable—so much so that you consider moving forward without lung cancer treatment.

If you decide to forego it, you will want to know "what's next" so that you can make plans for yourself and your loved ones. Although your doctor can give you some idea of how the disease is likely to progress, each case is different and the answers you seek may not always be so straightforward.

How Long Do I Have to Live?

It's a reasonable question but one that oncologists are generally hard-pressed to answer, particularly in the earlier stages of the disease. Even though the stage and grade of your cancer can help doctors predict the likely outcome (known as the prognosis), there are few doctors who will give you a precise amount of time because, in all fairness, the "likely outcome" may not be your outcome.

Among the factors that can predict survival times in people with lung cancer:

  • Cancer stage, classified by the characteristics of the tumor, whether lymph nodes are involved, and whether the cancer has spread (metastasized)
  • Cancer grade, which describes the characteristics of the cancer cell, whether it is likely to spread, and how fast
  • Your age, particularly if you are in your senior years
  • Your current health, including your general health, wellness, and the chronic illnesses you have
  • Your performance status, a term that describes your ability to carry on ordinary daily activities while living with cancer

The one factor that almost invariably affects survival time is whether you seek treatment or not. Even among senior patients with advanced cancer, some form of chemotherapy has been shown to increase survival times significantly.

If caught early enough, lung cancer may even be fully curable. If you are older and present with metastatic lung cancer, you can be still be treated and increase your chance of living at least one year by no less than 40%.

But, for some people, survival is not their primary goal, particularly if they already have poor performance status. If advanced cancer is involved, their ability to tolerate chemotherapy may be poor. If this is you, it is fair and reasonable to ask how long you have to live if you do not opt to seek treatment.

Given that around 80% of all lung cancer cases are diagnosed when the disease is advanced (stage 3 or stage 4), this is a concern and decision point that many people share.

If left untreated, people with non-small cell lung cancer, the most common form of the disease, might live anywhere five to 12 months, depending on the stage. In contrast, people with small cell lung cancer generally survive three to 15 months without treatment (based on the stage).

Survival Benefits vs. Quality of Life

Sometimes the survival benefits of cancer treatment may be small. For example, if a doctor feels that a particular chemotherapy regimen can extend your life by a few weeks but may cause potentially debilitating side effects, you may decide that the consequences of treatment outweigh the benefits. And that's a perfectly reasonable and fair choice.

But it is also important to understand that there are many myths about lung cancer that may be skewing your perspective. One is that people reach a certain age when they are "too old" for lung cancer treatment. In actuality, older people often do well with treatments, particularly newer immunotherapy drugs called checkpoint inhibitors that may be more tolerable than traditional chemotherapy drugs.

Similarly, targeted therapies, which directly target cancer cells and leave normal cells untouched, generally have milder effects than some chemotherapy drugs.

It is also important to acknowledge that chemotherapy regimens used today are nowhere near as problematic as those of the past. For example, they cause less treatment-induced nausea, vomiting, and fatigue.

Other Reasons Some Forego Treatment

There are many reasons why people may decide not to pursue lung cancer treatment. Beyond your quality of life or fear of treatment side effects, other issues may influence this decision—whether you are immediately aware of them or not.

Religious Beliefs

Some people choose to pass on cancer treatment due to religious beliefs. These include people who are Christian Scientists, Jehovah's Witnesses, Amish, or Scientologists. For them, their faith and belief will often direct what is the "right" thing to do.

On the other hand, some people may turn to religion for curative purposes, believing that prayer or other practices can rid them of their cancer. There is little if any evidence of this ever working.

While faith is important in dealing with any disease (and can make a difference in how well you cope with the disease), it is important to keep an open mind about the benefits and risks of cancer treatment if your faith does not bar medical interventions.

If in doubt or crisis, speak with a spiritual advisor of your faith, such as pastor or rabbi, to work through any fears or struggles you are experiencing. Doing so can help you make a more informed decision.

Financial Concerns

People sometimes choose to forego treatment for financial reasons. They may not want to drain what limited savings they have and that their family depends on. Or, they may lack insurance or think that certain treatments are unattainable to them because they either make too little or too much money.

There are resources for those who are uninsured or underinsured, as well as financial assistance programs that aid in the cost of treatment, transport, home care, family services, and other common concerns.

Before avoiding treatment you think you cannot afford, speak with a social worker at your cancer treatment center who can help you navigate the services and programs available to you.

These may include:

  • Medicaid: Available to those with low income as well as people with excessive medical expenses who are medically needy
  • Social Security benefits: Available to those with limited income to help pay for medical care and enroll in Medicare if needed
  • 2-1-1 services: Provides referrals to medical providers, mental health resources, transportation, food banks, financial assistance programs, health insurance, childcare, and other services (available in most states)
  • Hospital care assistance programs: Mandated by federal and state law to provide low-income or uninsured people with free or low-cost medical care
  • American Cancer Society: Offers programs that help individuals and families navigate treatment decisions and emotional challenges
  • CancerCare: A national non-profit that offers free support, information, and financial assistance to people with cancer
  • Patient Advocate Foundation: A national non-profit that can direct you to financial assistance programs and also offers copay assistance to those who meet eligibility criteria
  • Patient Assistance Programs (PAPs): Offered by many pharmaceutical manufacturers to help pay for medications or cover copay costs

Do not decide against cancer treatment for financial reasons without first meeting with a social worker experienced in cancer or a patient navigator offered by many hospitals and cancer treatment centers.

Lung Cancer Stigma

Some people decide against treatment because of the stigma of lung cancer. For current or former smokers, "smoker's guilt" can get the best of them and lead one to believe that they somehow "deserve" the disease because they made a conscious choice to light up.

Nobody deserves cancer, and lung cancer occurs in smokers and non-smokers alike. As with any potentially life-threatening disease, lung cancer is treated with care and compassion regardless of its possible causes.

If you have problems coping with your diagnosis, ask your doctor for a referral to a psychiatrist or psychologist who can help. Support groups are also available to put you in touch with others who understand what you are going through firsthand.

Making Your Decision

If you are thinking about foregoing cancer treatment, you need to ensure that you make an informed choice based on a full and complete understanding of your illness and possible outcomes. Moreover, the information must be provided in a language you understand without undue influence or coercion.

Understanding cancer can be difficult. Sometimes there is miscommunication. Medical terms may be hard to understand, and treatments can get easily confused and muddled.

If you are struggling to make a decision about whether or not to continue on without lung cancer treatment, there are four things you should do:

  • Always take your time and avoid rushing to judgment.
  • Seek a second, third, or even fourth opinion if needed—whatever it takes to help you reach a decision you're as confident in as possible.
  • Ask as many questions as you need. Do not allow providers to dismiss or minimize your concerns. Be your own advocate or find a patient advocate.
  • Work not only with your doctor but with therapists and counselors who can help you work through emotional concerns.

You are ultimately in control of your own medical decisions. Try to walk this road by keeping an open mind, taking the time to listen and educate yourself before closing the door on treatment. If you do decide to skip treatment, it can be helpful to clarify why not only to your loved ones and doctor but to yourself. Own your decision. But remember, too, that you can change your mind.

If a Loved One Declines Treatment

If a loved one decides to forego lung cancer treatment, it can be a difficult, heart-wrenching thing to hear. You may not be able to fully comprehend it at first. In such instances, let your loved one know that you hear them and love them, but that you need a day or two to process the news.

If you do decide you need more information, ask compassionately. Avoid judgmental questions starting with "why," and give your loved one time to express themselves fully without interruption or displays of panic or disapproval.

In the end, there will come a time when you need to respect your loved one's decision, however hard that may be. Acceptance will ultimately make you a better caregiver and prepare you emotionally for when your loved one is no longer with you.

A Word From Verywell

There are four approaches to medical treatment: preventative, curative, management, and palliative. It is important to remember this when diagnosed with lung cancer. Just because you decide not to undergo chemotherapy does not mean that there are no options available to you.

Even if your lung cancer is not curable, you can still benefit greatly from palliative treatments that can reduce pain and symptoms as the cancer progresses. This not only helps maintain the quality of your life but may, in some cases, extend survival time without undue suffering or stress—particularly when started earlier.

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  1. Prigerson HG, Bao Y, Shah MA, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol. 2015;1(6):778-84. doi:10.1001/jamaoncol.2015.2378

  2. Davidoff A, Tang M, Seal B, Edelman M. Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2191-7. doi:10.1200/JCO.2009.25.4052 

  3. Blandin Knight S, Crosbie PA, Balata H, Chudziak J, Hussell T, Dive C. Progress and prospects of early detection in lung cancer. Open Biol. 2017;7(9):170070. doi:10.1098/rsob.170070

  4. Wao H, Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B. Survival of patients with non-small cell lung cancer without treatment: a systematic review and meta-analysis. Syst Rev. 2013;2:10. doi:10.1186/2046-4053-2-10

  5. Wallace AS, Arya M, Frazier SR, Westgate S, Wang Z, Doll D. Combined small-cell lung carcinoma: An institutional experience. Thorac Cancer. 2014;5(1):57-62. doi:10.1111/1759-7714.12059

  6. Casaluce F, Sgambato A, Maione P, Spagnuolo A, Gridelli C. Lung cancer, elderly and immune checkpoint inhibitors. J Thorac Dis. 2018;10(Suppl 13):S1474-S1481. doi:10.21037/jtd.2018.05.90

  7. American Cancer Society. What's new in non-small cell lung cancer research? May 16, 2016

  8. Ambroggi M, Biasini C, Toscani I, et al. Can early palliative care with anticancer treatment improve overall survival and patient-related outcomes in advanced lung cancer patients? A review of the literature. Support Care Cancer. 2018;26(9):2945-53. doi:10.1007/s00520-018-4184-3