Lung cancer remains the leading cause of cancer-related mortality worldwide.1 Notably, with advances across all aspects of lung cancer care over the past several decades, the overall five-year survival rate has almost doubled—from 15% to 27%.2 Advances in screening, diagnosis, and treatment have transformed outcomes for many patients and fundamentally changed the population of individuals living after a lung cancer diagnosis.
With these steady gains, one area of lung cancer care warrants our collective attention: cancer survivorship.
What is survivorship?
The 2025 National Comprehensive Cancer Network (NCCN) guidelines define a “cancer survivor” as anyone with a cancer diagnosis—whether they are living with cancer or are disease-free with a history of cancer.3 Similarly, the National Cancer Institute (NCI) defines survivorship as the health and well-being of a person with cancer from the time of diagnosis until the end of life, encompassing physical, psychological, social, and economic needs and experiences.4–5
Survivorship care extends well beyond recurrence surveillance and includes monitoring for long-term and late effects of cancer and its treatment, evaluation for cancer-related syndromes, and coordination of care across specialties. Overall, the concept of survivorship calls for ongoing assessment of a survivor’s physical, mental, financial, and social well-being.
Who are the survivors, and what are they dealing with?
Data from the American Cancer Society and the NCI estimate that 680,450 lung cancer survivors were living in the United States as of January 1, 2025, a number projected to grow to 871,580 by 2035.2 About 82% of lung cancer survivors are 65 years of age or older, and 56% of survivors were diagnosed within the last five years.2
Across cancer types, survivors are living longer than ever before. More than half of US cancer survivors have lived 10 or more years since diagnosis, and nearly 1 in 5 have lived more than 20 years since their cancer diagnosis.6
At the same time, survivorship is increasingly accompanied by functional limitations. Data from the National Health Interview Survey demonstrate a 2.25-fold increase in cancer survivors reporting functional limitations between 1999 and 2018.6 The adjusted prevalence of functional limitations for survivors of lung cancer was 76.5%, second highest of all cancer types and significantly higher than the general population.7 These limitations reflect the cumulative effects of disease, treatment, and comorbid conditions.
Beyond functional impairment, lung cancer survivors often experience a heavy symptom burden, including dyspnea, fatigue, pain, and reduced exercise tolerance, alongside diminished quality of life.8 More than 90% of patients with advanced lung cancer report moderate to severe symptoms during treatment, and many symptoms persist long after therapy ends.8 Baseline pulmonary function frequently influences treatment selection and may further decline following surgery, radiation, chemotherapy, or immunotherapy. Tobacco-related comorbidities (particularly chronic lung disease), older age at diagnosis, and advanced-stage disease at presentation further contribute to ongoing symptom burden.
Survivorship also encompasses less visible but equally impactful concerns. Survivors of lung cancer may experience stigma related to smoking history, including among individuals who have never smoked. Sexual dysfunction affects both men and women and is often underrecognized.2 The psychological and logistical burden of continued cancer surveillance is substantial; current guidelines from the American Society of Clinical Oncology recommend imaging every six months for two years and annually thereafter for patients with curatively treated stage I to III disease.9 Financial strain, employment challenges, and social isolation further shape survivorship experiences, with evidence suggesting that individuals with fewer social and financial supports report higher symptom burden and worse overall well-being.10
What can we do?
Addressing survivorship requires more than periodic imaging to assess for recurrence. We must be vigilant for impairments and for opportunities to improve quality of life. This includes recognizing and managing comorbid conditions such as COPD and depression, addressing persistent symptoms, promoting physical activity and rehabilitation, and supporting wellness.
A central question in survivorship care is who assumes responsibility once active cancer treatment concludes. Too often, survivors find themselves in a care gap in which primary care clinicians may feel uncomfortable addressing lung cancer-specific concerns, while oncologists may step back once cancer treatment ends.
We advocate for pulmonologists to help bridge this gap in survivorship care. With expertise in lung disease, dyspnea, exercise limitation, and long-term pulmonary complications, pulmonologists are well positioned to coordinate surveillance, address functional decline, and partner with primary care and oncology to support survivors longitudinally.
Looking to the future
As lung cancer survival continues to improve, clinicians across disciplines must recognize and address the complex needs of survivors. It is paramount to address survivors’ physical, mental, social, and financial needs to ensure that gains in survival are accompanied by meaningful improvements in health-related quality of life.
It is no longer enough to “survive” lung cancer; our responsibility as pulmonologists is to help survivors persevere beyond it.
References
1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834
2. Wagle NS, Nogueira L, Devasia TP, et al. Cancer treatment and survivorship statistics, 2025. CA Cancer J Clin. 2025;75(4):308-340. doi:10.3322/caac.70011
3. Sanft T, Day AT, Ansbaugh SM, et al. NCCN Guidelines® insights: survivorship, version 2.2025. J Natl Compr Canc Netw. 2025;23(6):208-217. doi:10.6004/jnccn.2025.0028
4. Ha DM, Jacob RA, Bade BC. Survivorship challenges and supportive care in lung cancer. Semin Respir Crit Care Med. 2025;46(5):436-451. doi:10.1055/a-2649-9311
5. Office of Cancer Survivorship. Survivorship terms. National Cancer Institute. https://cancercontrol.cancer.gov/ocs/definitions
6. Tonorezos E, Devasia T, Mariotto AB, et al. Prevalence of cancer survivors in the United States. J Natl Cancer Inst. 2024;116(11):1784-1790. doi:10.1093/jnci/djae135
7. Patel VR, Hussaini SMQ, Blaes AH, et al. Trends in the prevalence of functional limitations among US cancer survivors, 1999-2018. JAMA Oncol. 2023;9(7):1001-1003. doi:10.1001/jamaoncol.2023.1180
8. Tjong MC, Doherty M, Tan H, et al. Province-wide analysis of patient-reported outcomes for stage IV non-small cell lung cancer. Oncologist. 2021;26(10):e1800-e1811. doi:10.1002/onco.13890
9. Schneider BJ, Ismaila N, Aerts J, et al. Lung cancer surveillance after definitive curative-intent therapy: ASCO guideline. J Clin Oncol. 2020;38(7):753-766. doi:10.1200/JCO.19.02748
10. Peng Y, Cheville AL, Zreibe JA, et al. Social determinants of health and patient reported outcomes in lung cancer survivors. J Clin Oncol. 2024; 42(suppl 16; abstr 11118). doi:10.1200/jco.2024.42.16_suppl.11118
