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Lung Cancer: New Reason for Hope

Earlier detection and newer treatments are giving lung cancer patients better odds.

Lung cancer wasn’t on the agenda when a West Orange woman accompanied her husband to his routine annual checkup at Saint Barnabas Medical Center (SBMC) in the fall of 2018. “But his doctor asked if we had previously smoked, and we said yes,” Carol says. “We had smoked a lot, starting in our late teens and smoking two or three packs a day for decades before quitting.”

The doctor invited them to participate in an SBMC program linked to a study for people at high risk of lung cancer. The couple agreed and went for low-dose CT scans, a screening test that can detect lung cancer at an early stage. “My husband’s scan was clear,” Carol says. “But mine came back showing something.”

The lesion in Carol’s lung was surgically removed by Subroto Paul, MD, MPH, Director of Thoracic Surgical Services at RWJBarnabas Health, Section Chief of Thoracic Surgery at SBMC and a member of the Barnabas Health Medical Group. The pathology showed it was a stage 1 tumor that had not metastasized. Carol’s lung cancer had been caught early, before she even had symptoms.

“Dr. Paul could not have been more reassuring, and the surgery was very easy. Now I’m cancer-free,” Carol says. “Dr. Paul and Dr. Kristin Fless were absolutely wonderful and I was able to have excellent treatment at Saint Barnabas Medical Center, close to home.

“Without this program, I would not have known I had cancer. It saved my life.”

CATCHING IT EARLY

Lung cancer can be an insidious disease, generally not causing symptoms until its later stage, when treatment is more difficult. “It kills more people than breast, colon and prostate cancer combined,” says medical oncologist Andrew Brown, MD, Co-Director of SBMC’s Lung Cancer Screening Program. “Yet because of new, innovative treatments and advances in diagnosis, I’m more optimistic when treating lung cancer now than I have ever been in my career.”

Early detection is an important factor. “There’s evidence of up to a 90 percent survival rate at five years among people who detect lung cancer early,” says Dr. Paul.

That’s why SBMC is participating in a large study on the benefits of screening among smokers and others at high risk of lung cancer, even those who have no symptoms. In conjunction with the study, called the International Early Lung Cancer Action Program (I-ELCAP), SBMC provides three free yearly lung cancer screening scans to eligible patients.

The SBMC program has screened more than 1,600 high-risk patients to date, and the majority of cancers found have been low-stage growths amenable to treatment. Many scans also detect lung growths called nodules that must be assessed to determine if they’re cancerous or benign. Noncancerous nodules are tracked over time for changes that may indicate cancer.

SBMC is also implementing ways to identify patients at high risk of lung cancer who are in the hospital for reasons unrelated to lung disease.

COMPREHENSIVE CARE

“We’re a multidisciplinary team at every level. That leads to better coordinated care, quicker diagnosis and treatment, and improved outcomes,” says Kristin Fless, MD, Director of Interventional Pulmonology at SBMC and a member of the Barnabas Health Medical Group.

The medical center provides a continuum of care to accommodate any stage of lung cancer. “Thanks to technology advances, there’s been a lot of progress in diagnosing lung disease,” says Dr. Fless. These include minimally invasive electromagnetic navigation bronchoscopy, which uses GPS-like technology to guide a diagnostic probe that can reach small lesions deep in the lungs, and endobronchial ultrasound imaging.

The comprehensive program at SBMC provides whatever lung cancer patients need, whether those services are from a pulmonologist, radiation oncologist, medical oncologist or thoracic surgeon. When people who needed additional follow-up are ultimately found to have low-stage cancer, they express gratitude and relief for having participated in the program, program administrators say.

An added benefit is free smoking cessation support with a Certified Tobacco Treatment Specialist. One-on- one counseling, education about treatments and consistent follow-up have led to a 40 percent success rate—double the national average.

INDIVIDUALIZED OPTIONS

Patients diagnosed with lung cancer have more options than ever before.

“Many patients benefit from minimally invasive surgery for the lung, often done using robotic surgery,” Dr. Paul says. “These small, articulated instruments can do everything a hand can do—and more—on a miniaturized scale that allows very precise movements and smaller incisions.”

At SBMC, radiation therapy can be delivered using advanced methods such as the CyberKnife radiation delivery system, which automatically adjusts the radiation beam as a tumor moves with the patient’s breath.

“In addition, there’s been an explosion of targeted therapies and immunotherapies that are leading to more personalized treatment,” says Dr. Brown. “We are using deeper genetics and the biologic activity of tumors to make more informed treatment decisions. We are also using medicines and therapies to target specific mutations and address cancers at a deeper, cellular level that is more specific to each individual.”

SBMC specialists are even collaborating with researchers to study the role that bacteria in the lungs—the lung microbiome—may play in fostering or preventing cancer.

“This may help us explain why some people who have never smoked still get lung cancer,” Dr. Paul says. “It’s another way Saint Barnabas Medical Center is at the forefront of lung cancer care.”

To learn more about lung cancer screening, quit-smoking programs and lung cancer treatments at Saint Barnabas Medical Center, call 973.322.6644 or visit www.rwjbh.org/sbmclung.