Lung cancer is believed to cause more mortality among women in the United States than breast, ovarian, and uterine cancers combined, according to a review published in the journal Seminars in Oncology Nursing.

Although mortality rates had declined for lung/bronchus, colon/rectum, breast, and prostate cancers between 1995 and 2002, the incidence of lung cancer in women had gone up by 0.3% per year. In this review, the authors described the impact of lung cancer on women and the role of nurses in caring for women with the disease.

Among subtypes of non-small cell lung cancer, adenocarcinoma is more common in female smokers, whereas squamous cell carcinoma more common in their male counterparts. Other sex differences exist with regard to subtype of adenocarcinoma and incidence of small cell lung cancer.


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Exposures to cigarette smoke and/or chemicals such as radon gas, uranium, air pollution, and other chemicals can contribute to lung cancer risks. However, the authors pointed out that sex-associated differences in susceptibility to lung cancer carcinogens are unclear. Some differences appear to make prognosis better for female patients than for male patients.

Possible sex-associated differences in lung cancer risks involve hormones, genetics, and other molecular influences, the authors explained. Among patients with lung cancer, women show a higher propensity to develop smoking-related carcinogens in structures called DNA adducts than do men. The authors also suggested that women may be more vulnerable to smoking-related molecular alterations, such as alterations to the tumor suppressor gene p53.

Regarding possible hormonal associations, estrogen receptors alpha and beta may be linked to sex-related lung cancer differences. Additionally, sex-associated differences in the expression of certain genes have also been found among people who smoke.

Despite the risks of lung cancer, many women continue to smoke. “There is increasing evidence that nurses play an important role in smoking cessation,” the authors wrote. However, in a US survey of oncology nurses, those who were more likely to be smokers themselves tended to perceive more barriers to providing patients with smoking cessation interventions.

Younger nurses, those without an advanced degree, nurse practitioners, and nurses with an administrative role also were more likely to perceive a greater number of barriers to smoking cessation interventions, according to survey responses. The authors stressed the importance of including smoking cessation interventions in undergraduate nursing education, as well as in continuing education programs.

Nurse assessment of anxiety and depression, as well as caregiving capacity, in caregivers of women with lung cancer are important to the care of these patients, explained the authors. “[R]esearch that focuses specifically on quality of life and women with lung cancer and their caregivers shows the importance of including this in the nursing assessment for this population,” they concluded in their report.

Reference

O’Keeffe P, Patel J. Women and lung cancer. Semin Oncol Nurs. 2008;24(1):3-8. doi:10.1016/j.soncn.2007.11.014