how cigarette smoking affect chemo
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[Take Better Care of Yourself] Small Cell Lung Cancer (SCLC) - Conservatively estimated annual treatment costs reach 1.5-2 million HKD. Even a normal physical examination may not prevent late-stage lung cancer – exorbitant treatment costs make the right choice crucial.
A friend, a long-time smoker, underwent a physical examination in 2023, including a chest X-ray, cancer markers, and a CT scan, all of which were normal.
However, one night in July 2025, he suddenly experienced severe abdominal pain and was taken to a public emergency room at 5 AM. Due to the triage system, there was a long wait, during which only basic X-rays were performed, failing to identify the cause or effectively manage the pain.
As the pain persisted, my friend decided to transfer to a private hospital. Upon arrival, an abdominal CT scan was quickly arranged, revealing a tumor, followed immediately by a PET-CT scan and biopsy. He was diagnosed with stage IV small cell lung cancer with liver and bone metastases. A week of hospitalization cost approximately HKD 110,000.
First-line treatment: Chemotherapy + Immunotherapy (starting August 2025)
After diagnosis, my friend needed to start first-line treatment immediately. The hospital arranged a standard lung cancer treatment plan:
✔️ Chemotherapy (EP regimen)
• Cisplatin
• Etoposide
Combined with commonly used supportive medications for chemotherapy:
• Dexamethasone
• Granisetron / Akynzeo (antiemetics)
• Magnesium sulfate
• Potassium chloride
• Sodium chloride / Osmofundin (infusion to protect kidney function)
✔️ Immunotherapy (Atezolizumab / Tecentriq)
• Cost per treatment: Approximately $37,706
✔️ Total cost per chemotherapy cycle
• Chemotherapy + Immunotherapy + Doctor's fees: Approximately $65,000/cycle
My friend received 4 treatments per cycle, but the effect was mediocre; the CEA index remained high, and tumor activity did not decrease effectively.
Facing the Dilemma of Cost and Treatment Schedule
Treatment of advanced lung cancer requires saving time, but:
• Private hospitals are expensive
• Public hospitals have long waiting times (possibly a month, then another month before treatment can begin)
Patients often have to make difficult choices between cost, waiting time, and treatment effectiveness.
Choosing Government Private Treatment: Receiving Private-Level Treatment in a Public Hospital
A friend ultimately chose the "private treatment" option at a public hospital. Although daily hospitalization costs are charged at the private rate, it offers:
• Better room environment
• Higher privacy
• Comprehensive medical support
• Lower cost than private hospitals
• Immediate treatment start time, without long waiting times
For patients undergoing long-term treatment, this is a more reassuring option.
Second-Line Treatment: Dual Immunotherapy (from November 2025)
After the limited effectiveness of first-line treatment, doctors arrange second-line immunotherapy.
✔️ Dual Immunotherapy Combination
• Atezolizumab (Tecentriq)
• Tarlatamab (DLL3 inhibitor)
Both have:
• Completed Phase III clinical trials
• FDA approved
• Registered in Hong Kong
However, they are not included in the government's drug list, therefore they are ineligible for subsidies and must be paid out of pocket.
✔️ Monthly Treatment Costs (including hospitalization)
• Approximately $167,000/month (including approximately $160,000 for Atezolizumab + Tarlatamab)
Treatment Efficacy: Decreased CEA, Tumor Shrinkage
Fortunately, the second-line immunotherapy is gradually showing effects:
• CEA index from 7.3 → 5.3 (normal 4.6)
• Shrinkage of liver and bone tumors
• Disease under control
Giving my friend renewed hope and allowing him to spend more time with family.
She said, "I didn't know if I could make it through this, so I chose to be kind to myself. Even in a government hospital, I opted for private treatment, staying in a private second-class room to receive treatment in the most comfortable environment." Treatment Costs for Late-Stage Lung Cancer
1. Private Hospital Testing (CT, PET-CT, Biopsy)
• Approximately $110,000
2. First-Line Treatment: Chemotherapy + Immunotherapy (Atezolizumab)
• Approximately $65,000/month
3. Second-Line Treatment: Dual Immunotherapy (Atezolizumab + Tarlatamab)
• Approximately $167,000/month
Summary
Small cell lung cancer (SCLC) is a rapidly proliferating type of lung cancer. The tumor cells divide much faster than other cancers, and early-stage SCLC often presents no obvious symptoms. Even with physical examinations such as chest X-rays, CT scans, and tumor marker tests, the tumor may go undetected in its early stages due to its small size and hidden location. This is why many SCLC patients are diagnosed at an advanced stage—not because it's ignored, but because the disease itself is extremely difficult to detect in its early stages.
Another characteristic of small cell lung cancer (SCLC) is its high rate of metastasis. Tumor cells can spread to the liver, bones, lymphatic system, and even the brain in a short period, leading to rapid changes in the disease's progression. Although SCLC is highly sensitive to chemotherapy, and initial treatment can usually shrink the tumor quickly, it is also prone to recurrence, requiring continuous monitoring and follow-up treatment. This is why immunotherapy, dual immunotherapy combinations, and novel targeted drugs are gradually becoming important options for advanced SCLC.
Throughout the treatment process, my friend frankly admitted that the side effects were not the most difficult part; the real challenges were the long treatment course, the daily psychological pressure of facing the unknown, and the heavy medical expenses. Fortunately, advancements in medicine have allowed many patients with advanced small cell lung cancer to extend their survival and coexist with the disease. When drug resistance develops, second-line, third-line, and even fourth-line treatments can still be chosen, giving patients more opportunities to buy time.
My friend is still working hard on treatment and cherishes every day spent with family. Her story reminds us:
"When illness strikes, the most important thing is still having a choice—to receive the most reassuring and reliable treatment." I wish my friend a smooth treatment process and a speedy recovery.
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