Can I Get Social Security Disability Benefits for Lung Cancer?
- About Lung Cancer and Disability
- How to Get Disability Benefits for Lung Cancer by Meeting a Listing
- Residual Functional Capacity Assessment for Lung Cancer
- Getting Your Doctor’s Medical Opinion About What You Can Still Do
If you have lung cancer, Social Security disability benefits may be available. To determine whether you are disabled by your lung cancer, the Social Security Administration first considers whether it is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See How to Get Disability Benefits for Lung Cancer by Meeting a Listing. If you meet or equal a listing because of your lung cancer, you are considered disabled. If your lung cancer is not severe enough to equal or meet a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite the lung cancer), to determine whether you qualify for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process.
More than 100,000 men and 50,000 women develop lung cancer yearly in the U.S. The overall cure rate for lung cancer in general is only about 10%. Most people with lung cancer (88%) will die within 5 years. There is no question that the major cause of lung cancer is cigarette smoking, although there are other much less prominent risk factors contributing to occurrence, including chemicals, metals, asbestos, and passive exposure to cigarette smoke. Concerning many forms of cancer, earlier detection leads to a better chance of cure. Unfortunately, there is no evidence that screening tests for early lung cancer decrease the number of people dying from that disorder. In fact, it is relevant to Social Security disability determination that CT chest scanning is unreliable in detecting early cancer and adjudicators should not assume that “suspicious” nodules in the lungs are likely to be cancer. For example, in one study, 500 smokers and former smokers were given CT chest scans and 70% has suspicious masses of unknown nature. Only 1.4% of these nodules were cancer. See Residual Functional Capacity Assessment for Lung Cancer.
Lobe of a lung from a person with a history of smoking and asbestos exposure: Figure 18-13 (Medical Evidence by Quinn, Quinn, and Quinn)
Symptoms of Lung Cancer
Symptoms of lung cancer may include chest pain, cough, coughing up blood, shortness of breath, hoarseness, and difficulty swallowing. Less than 10% are asymptomatic at diagnosis. Lung cancer may be associated with a number of possible related syndromes. For example, nearly a third of cases will suffer loss of appetite and weight loss. More than 10% will have endocrine abnormalities, caused by tumor secretion of hormones. Others may have neurological, ocular, skin, renal, or skeletal problems. Even if a claimant does not meet this listing, the adjudicator should carefully weigh the effect of any related syndrome that may be present. For instance, a claimant with sufficient weight loss from cancer could be allowed under listing 5.08 (see How to Get Disability Benefits for Weight Loss by Meeting a Listing). Also, claimants with lung cancer frequently have chronic obstructive pulmonary disease (COPD) induced by cigarette smoking, and this can be the source of substantial functional loss. Claimants with lung cancer who also have evidence of COPD should be evaluated with pulmonary function studies, if they are not an allowance under the lung cancer listing.
TNM Classification System of Lung Cancer Staging
The TMN classification system may be used in reporting the severity of a lung cancer. T0-T4 relates to the severity of the primary tumor. T0 means no evidence of a tumor. T1 is a small tumor. T4 is a large tumor extending outside of the lung, and perhaps involving other organs in the vicinity such as the heart. T2-T3 tumors are intermediate in severity.
The degree of lymph node involvement is denoted by N0-N3. N0 means no spread of cancer to the lymph nodes. N3 is advanced involvement of regional lymph nodes. N1-N2 are intermediate in severity. M0 and M1 stand for the absence or presence respectively of distant metastasis (spread of cancer to distant organs or lymph nodes).
Staging is from 0-IV. Stage 0 is for carcinoma in situ, which means the earliest possible cancer is confined to its cell layer of origin without any extension into surrounding tissues. Stages I and II involve early (T1 or T2) cancers with no or early spread of cancer to the lymph nodes (N0 or N1). Stage III implies various combinations of T and N that correspond to more advanced cancers. Stage IV means distant metastasis. Various studies show only a 5 – 6% survival at 5 years for inoperable lung cancer.
Small Cell Carcinoma
Small cell (oat cell) carcinoma is the most deadly of lung cancers with a post-resection survival at 5 years of about 0 – 1%, even for Stage I cancers. Over 90% will be dead within 2 years. Unlike most other lung cancers, small cell carcinoma is sensitive to radiation. However, more than two-thirds of cases have distant metastasis at diagnosis and such widespread cancer is not amenable to radiation. Chemotherapy is needed to provide what little increase in lifespan that is achievable. Without treatment small cell carcinoma is usually lethal in 2 – 3 months, or even earlier. The median survival time with currently available therapy is only 6 to 12 months and long-term survival is rare.
Non-Small Cell Lung Cancer
There are at least 3 distinct types of non-small cell lung cancer, including the following:
- Epidermoid carcinoma – Epidermoid (also known as squamous cell) carcinoma is the most frequent primary lung cancer, accounting for about a third of cases. About a third of post-resection cases overall will survive for 5 years. A little more than half of post-resection Stage I cases will survive 5 years, and about a third of Stage II cases. About 10 – 20% of Stage III cases will live 5 years. Most Stage IV cases will not survive a year.
- Adenocarcinoma– Adenocarcinoma accounts for about 25% of lung cancers. Approximately a fourth of post-resection cases overall will survive for 5 years. About half of post-resection Stage I cases will survive 5 years. Survival decreases markedly for more advanced cancers—as low as 2% for some Stage III cancers at 5 years. Most Stage IV cases will not survive a year. This category includes bronchoalveolar carcinoma (which has about a 50% 5-year post-resection survival rate).
- Large cell carcinoma– At 5 years post-resection, large cell carcinoma has survival rates similar to those for adenocarcinoma, and accounts for about 15% of lung cancer cases.
Treatment – Non-Small Cell Lung Cancer
Stage 0 non-small cell lung cancer (NSCLC) is the same as carcinoma in situ of the lung. Because these tumors are by definition noninvasive and incapable of spreading elsewhere, they should be curable with surgical resection; however, there is a high incidence of second primary cancers, many of which are unresectable. Surgical resection may be done using the least extensive technique possible (segmentectomy or wedge resection) to preserve maximum normal pulmonary tissue, since these patients are at high risk for second lung cancers.
Stages I and II
Surgery is the treatment of choice for patients with Stage I or Stage II non-small cell lung cancer (NSCLC). Careful preoperative assessment of the patient’s overall medical condition, especially the patient’s pulmonary reserve, is critical in considering the benefits of surgery. The immediate postoperative mortality rate is age-related, but 3% to 5% with lobectomy can be expected. Patients with impaired pulmonary function may be considered for segmental or wedge resection of the primary tumor.
Patients with inoperable Stage I or Stage II disease and with sufficient pulmonary reserve may be considered for radiation therapy with curative intent.
Depending on clinical circumstances, the principal forms of treatment that are considered for patients with stage IIIA non-small cell lung cancer (NSCLC) are radiation therapy, chemotherapy, surgery, and combinations of these treatments. Although the majority of these patients do not achieve a complete response to radiation therapy, there is a reproducible long-term survival benefit in 5% to 10% of patients treated with standard radiotherapy, and significant palliation often results.
Patients with Stage IIIB non-small cell lung cancer (NSCLC) do not benefit from surgery alone and are best managed by initial chemotherapy, chemotherapy plus radiation therapy, or radiation therapy alone, depending on sites of tumor involvement and performance status. Most patients with excellent performance status should be considered for combined modality therapy. However, patients with malignant pleural effusion are rarely candidates for radiation therapy, and should generally be treated similarly to Stage IV patients.
Palliative chemotherapy with a regimen based on cisplatin or carboplatin (both platinum-containing anti-cancer drugs) has been associated with objective and subjective responses for patients with non-small cell lung cancer that has spread elsewhere. Randomized trials have shown that cisplatin-based chemotherapy produces modest benefits in short-term survival compared to supportive care alone in patients with inoperable Stage IIIB or IV disease. Although toxic effects may vary, outcomes are similar with most platinum-containing regimens.
Despite studies supporting further evaluation of chemotherapeutic approaches for both metastatic and locally advanced non-small cell lung cancer (NSCLC), efficacy of current platinum-based chemotherapy combinations is such that no specific regimen can be regarded as standard therapy. Appropriate patients should be encouraged to participate in clinical trials evaluating the role of platinum-based and non-platinum-based chemotherapy. Outside of a clinical trial setting, chemotherapy should be given only to patients with good performance status and evaluable tumor lesions who desire such treatment after being fully informed of its anticipated risks and limited benefits.
Many patients with recurrent non-small cell lung cancer (NSCLC) are eligible for clinical trials. Radiation therapy may provide excellent alleviation of symptoms from a localized tumor mass. Laser therapy may also be used for accessible endobronchial tumors.