Cover Asking the right questions can transform a patient’s lung cancer journey (Photo: Getty Images)
Asking the right questions can transform a patient’s lung cancer journey (Photo: Getty Images)
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The 3rd Opinion movement is changing how patients and doctors work together, giving those diagnosed with lung cancer a greater chance at survival and quality of life
In Asia, silence can be deadly. While many of us pride ourselves on being discerning in business, travel and lifestyle choices, when it comes to our health, cultural norms often keep us from asking the right questions—especially in the doctor’s office. Nowhere is this more concerning than in the fight against lung cancer, the region’s deadliest cancer, responsible for 60 per cent of global deaths from the disease. New data paints an urgent picture: cases are rising sharply among younger people, including non-smokers, with the number of new diagnoses in Asia projected to reach 2.1 million by 2040.
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Earlier this month, we celebrated World Lung Cancer Day and it reminded us that awareness is only the first step—empowerment must follow. Yet in Asia-Pacific, up to 77 per cent of patients still leave crucial treatment decisions entirely to their physicians, even though nearly 70 per cent of doctors encourage shared decision-making.
Dr James Yang, Director of the National Taiwan University Cancer Center and a leading advocate for Johnson & Johnson’s ‘The 3rd Opinion’ movement, is on a mission to change that. In this conversation, he shares why asking the right questions can mean better outcomes, more time, and—most importantly—a greater sense of control over one’s health journey.
Above Johnson & Johnson’s 'The 3rd Opinion' movement urges patients to speak up (Photo: Johnson & Johnson)
Johnson & Johnson’s 'The 3rd Opinion' movement urges patients to speak up (Photo: Johnson & Johnson)
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Across Asia, there’s still a cultural hesitation to question medical authority. Why do you think this persists, even among younger, well-educated patients?And what do you say to those who worry that 'speaking up' might be seen as disrespectful or disruptive
Traditionally, doctors in Asia—and families—were hesitant to disclose every detail of a cancer diagnosis, including staging and prognosis. Families worried that if patients knew the truth, they might reject treatment or become too mentally distressed. This was especially true for elderly patients. Younger patients tend to want more control, so the situation has improved over the past 10 to 20 years, but it’s not yet on par with Western societies.
How does patient silence impact treatment outcomes in something as time-sensitive as lung cancer?
One danger is the ‘denial period’ right after diagnosis, especially in stage four cases. Patients or families may delay treatment while seeking alternative therapies—some of which are ineffective or even harmful. This is where second or even third opinions are crucial. Natural approaches like fresh air or light exercise are fine if they don’t delay proper treatment, but misconceptions like starving cancer by avoiding glucose can be dangerous.
You’re a key voice in Johnson & Johnson’s 'The 3rd Opinion' movement, which encourages shared decision-making. What does shared decision-making actually look like in practice—and why is it so powerful in cancer care?
In Taiwan, shared decision-making (SDM) is now a monitored healthcare quality indicator. Patients have access to their health records, test results and treatment options online. This transparency allows them to verify information, research their diagnosis and participate meaningfully in treatment decisions. Our role as doctors has shifted; from being the sole authority to guiding patients in identifying accurate information and navigating choices.
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What are the five most important questions every lung cancer patient—or loved one—should ask during a doctor’s consultation
- What are all my treatment options—and which offers the best chance of survival?
- What are the possible side effects, and how can they be managed?
- Am I eligible for newer therapies, like immunotherapy or targeted drugs?
- Are these treatments reimbursable or will I need to pay out-of-pocket?
- What support systems—medical, psychological, financial—are available to me?
Every patient’s goal should be twofold: improve survival and reduce suffering. We’re fortunate to have many more personalised treatments today, from third-generation tyrosine kinase inhibitors to bispecific antibodies, but each comes with trade-offs that must be discussed in detail.
Above The 3rd Opinion movement empowers patients to shape their cancer journey (Photo: Johnson & Johnson)
The 3rd Opinion movement empowers patients to shape their cancer journey (Photo: Johnson & Johnson)
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What advice would you give to someone who feels overwhelmed during their first diagnosis consultation? How can they advocate for themselves in a calm and effective way?
It’s natural to shut down after hearing the word “cancer.” That’s why we encourage multiple conversations, involving family members and case managers, to revisit information until it’s clear. Pharmacists can explain drug interactions, and the whole care team works to ensure patients understand before starting treatment. The worst thing is to rush into a first treatment without knowing all options—because that first step often has the biggest impact on survival.
There’s growing concern about the rise of lung cancer among younger patients with little or no smoking history. What’s driving this shift—and what should the public be more aware of?
Partly it’s a “stage shift” from more screening—we’re catching cases earlier, even years before they progress. But we are also seeing a real increase. Air pollution, particularly PM2.5, is a major factor. Lifestyle may play a role, but evidence is limited. Interestingly, smoking rates are dropping in many Asian countries, yet non-smoker lung cancer cases are climbing. This underscores the need for awareness, even among people who think they’re not at risk.
Above Lung cancer is rising among young non-smokers in Asia (Photo: Graficon Stuff/Unsplash)
Lung cancer is rising among young non-smokers in Asia (Photo: Graficon Stuff/Unsplash)
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Finally, what message would you like to leave with our readers—especially those who feel healthy and far removed from risk?
The most important step is early detection. For heavy smokers over 50, a low-dose CT scan is the best way to identify lung cancer early. Here in Taiwan, we also recommend screening for non-smokers who have a family history of lung cancer, starting at age 45 for women and 50 for men. If you have one or two relatives with lung cancer, your risk is significantly higher.
It’s true that screening can cause anxiety, especially when small nodules are found. But most of these don’t grow, and guidelines are clear on how often to monitor them. Don’t let fear overwhelm you—follow the schedule and trust that only a very small percentage progress.
Above Shared decision-making empowers patients to weigh survival, side effects and quality of life in their treatment choices (Photo: Esme melike Sezer/Unsplash)
Shared decision-making empowers patients to weigh survival, side effects and quality of life in their treatment choices (Photo: Esme melike Sezer/Unsplash)
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For those already diagnosed, the key is to follow the recommended treatment pathway and participate actively in decisions. If surgery is advised, do it. If additional therapy is needed to reduce recurrence, take it. And if you’re at an advanced stage, explore your options quickly with your doctor.
I also encourage patients to seek a second—or even third—opinion if they’re uncertain. Lung cancer isn’t like a sudden heart attack where treatment must begin the same day, but it is urgent. Ideally, treatment should start within weeks, not months, to give patients the best possible outcome.
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As Senior Lifestyle Writer, Aina writes across the lifestyle vertical, covering wellness, travel, arts and entertainment. Based in Kuala Lumpur, she previously worked at CLEO Malaysia, where she headed the lifestyle, culture and entertainment sections.
