A Tale of Two Patients: Sam and Simon
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Same cancer. Different countries.
Very different outcomes.
When Sam and Simon both received the same devastating diagnosis in 2026, their prognoses should have been identical. Same age. Same cancer. Same stage. But Sam lives in Dallas and Simon lives in Liverpool. And when it comes to access to the best treatments for small cell lung cancer (SCLC), that distinction makes a world of difference.
Sam
68 years old
Dallas, Texas
Sam had a brain scan performed, and it revealed lung cancer that had already spread, including two small spots on his brain. The type of cancer he has is called small cell lung cancer (SCLC).
Sam is covered by Medicare.
Simon
68 years old
Liverpool, England
Simon went to his general practitioner (GP), who referred him urgently for a brain scan. The scans confirmed the same diagnosis as Sam: small cell lung cancer that had spread with two spots on the brain.
Simon is a National Health Service (NHS) patient.
Small cell lung cancer (SCLC) is one of the most aggressive forms of lung cancer, known for its rapid growth and early spread to other parts of the body, most often including the brain, liver, and bones. Thirty to thirty-five thousand people in the US are diagnosed with SCLC every year. Once the cancer has metastasized, a cure is no longer possible. Treatment shifts entirely to slowing the disease's progression and managing symptoms. Standard approaches include platinum-based chemotherapy, radiation therapy, and immunotherapy, though SCLC almost always develops resistance to treatment within months.
A lack of targetable genetic mutations and the cancer's ability to quickly combat therapy has slowed medical progress. The prognosis remains devastating—fewer than 5 in 100 patients survive five years after diagnosis, with patients for whom the cancer has spread extensively facing a five-year survival rate of just 2–3%.
Getting a Diagnosis
Both Sam and Simon noticed their symptoms at roughly the same time. Here is how long it took each of them to get a diagnosis confirmed and start treatment:
Sam
Simon
Week 1
Saw his doctor and had a chest X-ray and urgent CT scan and was referred to a lung specialist within 1 week.
Weeks 1–2
Saw his GP, who referred him urgently to a specialist. Had a CT scan, but the NHS has a shortage of radiologists who read scans. This caused delays in getting his results reported.
Weeks 2–3
Had a biopsy to confirm the cancer type and received his diagnosis. He underwent a full-body scan (PET-CT) and brain MRI. All his results were back within 10 days.
Weeks 5–7
Simon gets in to see a specialist who orders biopsy and staging scans after CT scan results and diagnoses him with SCLC. Simon meets NHS target of 21 days between specialist visit and diagnosis for SCLC, but many NHS patients do not.
Week 4
Sam met his cancer team, discussed his options, and started treatment.
Total: About one month from first appointment to diagnosis and starting treatment.
Total: : 11+ weeks, more than a month after Sam.
NHS Disease Targets:
-
28-day maximum from referral to diagnosis (<80% of patients meeting this target across all cancers)
-
62-days referral to first treatment (<75% of patients meet this target)
-
31-days to start treatment after diagnosis and treatment plan agreed upon.
However, these targets are routinely missed.
Why does it matter?
SCLC is one of the fastest-growing cancers. A patient's physical ability to withstand treatment can decline significantly within weeks. If a patient becomes too sick before treatment starts, they may no longer be fit enough to receive the strongest and most effective treatments. Every week of delay in care narrows their options and outcomes.
Treatment: Where the Paths Split
Sam and Simon receive exactly the same chemotherapy at first. But when the cancer comes back, as this type of cancer almost always does, only Sam has access to the best available treatment.
Starting Treatment
(First-line Therapy)
Sam
He receives a combination of three drugs—two types of chemotherapy plus an immunotherapy drug called atezolizumab. For brain metastases, Sam's team offers a precise, targeted form of brain radiation called stereotactic radiosurgery. Sam has the option to receive an FDA-approved maintenance drug called lurbinectedin after chemotherapy finishes prolonging remission.
Simon
He receives the same first-line three-drug combination as Sam. However, for his brain metastases, Simon is more likely to receive whole-brain radiation rather than the more targeted treatment Sam gets, because the precise technique varies in availability across NHS hospitals.
Lurbinectedin availability in the UK is likely at least a year away due to regulatory review and government pricing.
When the Cancer Returns
SCLC typically comes back after initial treatment and advances. This is where Sam and Simon's paths diverge the most.
Sam receives tarlatamab, FDA approved in 2024. The therapy trains his immune system to attack the tumors. Patients who received tarlatamab lived an average of 13.6 months after their cancer returned, compared to 8.3 months for those on chemotherapy. Treatment with tarlatamab could extend Sam’s life by more than a year.
Tarlatamab also has milder side effects than chemotherapy. It does not typically cause the severe blood problems that make patients so ill, allowing Sam a better quality of life during treatment.
Simon receives a chemotherapy drug called topotecan, the standard NHS option for relapsed SCLC. However, the NHS also limits coverage based on a rating of the patient’s health status and frailty. In the UK, topotecan is typically only accessible to those with the least serious disability due to illness.
Topotecan works for some patients but causes serious side effects. The average survival from relapse is about 8 months.
The UK’s medicine approval body, the Medicines and Healthcare Regulatory Agency (MHRA), has not yet assessed tarlatamab and NHS’s regulatory body has not assessed it for pricing and coverage. As a result, Simon will not likely live long enough to access tarlatamab.
When topotecan stops working for Simon, there is no further NHS-funded treatment available for his cancer. He would be referred to palliative care to manage symptoms and quality of life rather than fighting the disease. Sam, by contrast, still has several treatment options available.
What Does This Mean for Sam and Simon?
Sam and Simon are fictional, but the gaps in treatment access and outcomes they represent are real. In the U.S., more than 30% of lung cancer patients survive one year after diagnosis. In England, that figure is less than 20%. Several factors contribute to this difference: faster access to diagnosis and treatment, a wider range of treatment options, no restrictions based on disability status, and the expanded use of low-dose CT screening for high-risk patients in the U.S.
More information on what "Most Favored Nation" drug pricing means for the U.S.
Sources
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