Multidisciplinary team provides comfort as well as treatment
By Judy Germany
As a pulmonologist (lung disease specialist), Elaine Chen, MD, encourages her patients who smoke to stop — as soon as possible. However, she doesn’t automatically give that same advice to the lung cancer patients she sees at Rush in her other role as palliative care specialist — that is, a caregiver who helps relieve patients’ symptoms due to a major health problem.
“Some patients say smoking is what gets them out of bed in the morning, that it’s the only thing that makes life worth living,” she explains. “If that’s true, I’m not going to pressure them to quit. They know smoking will make their condition worse, but as a palliative care specialist it’s not my job to lecture. My goal is to make their lives better.”
Achieving that goal means everything from managing pain and shortness of breath to helping provide psychosocial support for patients and their families.
In this latter effort, Chen works in partnership with psychosocial oncologists, who are among many specialists with whom she collaborates. At Rush, Chen is far from alone in her concern for how a lung cancer diagnosis can turn lives upside down.
‘We’re treating a person, not just a tumor’
The multidisciplinary team at The Coleman Foundation Comprehensive Lung Cancer Clinic meets weekly to discuss cases and pool their expertise. Chen is part of this group, which includes thoracic surgeons, pulmonologists, medical and radiation oncologists, and those psychosocial oncologists.
They don’t just discuss which treatment will yield the best results. They talk about how to enhance quality of life, whether it’s helping a patient remain mobile so he can visit his first grandchild or how to relieve another patient’s neuropathy so she can keep working and support her family.
“Having all these experts working together, talking to each other in real time, helps us plan and coordinate every aspect of care,” says thoracic surgeon Christopher Seder, MD. “We want to make sure patients are fully supported before, during and after treatment.”
Targeting tumors, not tissue
It helps that the treatments themselves are now designed with quality of life in mind.
For instance, in recent years, conventional external beam radiation therapy — an option for small, localized lung tumors — has given way to techniques that offer accuracy with less discomfort.
They include stereotactic body radiation therapy, which produces beams of carefully targeted radiation focused to match the three-dimensional shape of the tumor, so less surrounding tissue is exposed. The system also detects and corrects for even minuscule movements, ensuring pinpoint precision if the patient isn’t completely still.
Each session takes a scant 5 to 15 minutes — compared to about 45 minutes for traditional radiation therapy — and patients are able to return to normal activities immediately afterward.
In many cases, this treatment can eradicate small tumors with very little harm to healthy lung tissue. It can give hope to patients who are not good candidates for even minimally invasive surgery because they have so many other health issues.
‘Our patients aren’t just alive, they are living’
Lung cancer surgery, too, is trending toward a “less is more” approach.
At Rush, thoracic surgeons are leaders in video-assisted thoracoscopic surgery (VATS), a minimally invasive technique, for lobectomy — the removal of a portion of a lung. Lobectomy is the most effective operation for removing localized lung tumors, but it is an invasive procedure with a long, often painful recovery.
Because of their expertise, thoracic surgeons at Rush are able to use VATS for 74 percent of the lobectomies they perform for stage I tumors. As a result, the average hospital stay after lobectomy for lung cancer at Rush is 4.2 days, nearly half the national average. Other benefits to VATS include less pain and a quicker return to activities of daily living.
No wonder that the Society of Thoracic Surgeons has designated the Rush program its highest rating for lobectomy, placing it among the top 5 percent of thoracic surgery programs in the country.
“We’re seeing patients now who had VATS lobectomies five, six years ago,” Liptay says. “Not only are they cancer-free, but they have a great quality of life. That’s just as important — to them and to us. Our patients aren’t just alive, they are living.”
Making every day count
Of course, the prognosis is not promising for advanced lung cancer. That’s why, for people diagnosed with late-stage disease, early palliative care is recommended to help guide end-of-life decisions and care.
In addition to addressing pain and other symptoms, Chen helps her late-stage lung cancer patients set realistic but personally meaningful goals.
“They may not survive their cancer, but I’ll do my best to get them to their child’s high school graduation or enable them to take their dream vacation,” Chen says. “I want all of my patients to live the rest of their lives as fully as possible — whatever that means for them.”