Dr. David Wilson
Lung cancer is the leading cause of cancer death in the U.S. and as such presents tremendous challenges.
But the opportunity for improved diagnosis and care is great. With this backdrop of challenges and opportunities, Schneck Medical Center implemented new technology for lung cancer detection and therapy in late 2014. But first, let’s detail the lung cancer experience at Schneck for 2014.
There were 36 cases of lung cancer in 2014. About one in four of those affected people under 60. The sixth decade of life was the most common for incident lung cancer at 41.7 percent. 22.2 percent occurred in the age range of 70-79 and only 11.1 percent greater or equal to the age of 80.
This is similar to the U.S. experience as a whole.
Detection strategies with lung cancer screening should improve earlier disease recognition. Presumably, this would lower the age incidence.
The National Lung Cancer Screening Trial defined a screening benefit with low-dose chest CT scans that promises to aid in early detection of lung cancer. Many insurers and Medicare now cover low-dose chest CT for lung cancer screening.
Stage remains the most important predictive factor in lung cancer outcomes, and 26 patients presented at Stage III and IV disease. This is actually better than national data. Stage III and IV disease at Schneck is at 67 percent, while nationally this number is closer to 85 percent.
Ten cases presented at Stage I and II, which carry a much better prognosis. Lung cancer survival remains at only 15 percent nationally. This is defined as cancer-free status at five years from diagnosis.
Treatment regimens at Schneck were multi-modality, with combinations of surgical, chemotherapeutic and radiation therapy.
No one approach predominated. This is very common and expected given the complex nature of lung cancer. Eleven patients we saw chose no therapy or were beyond the point of tolerating therapy. Again, this is a tragic malignancy, and detection at a late stage often limits therapy options.
Challenging diseases also create enormous opportunities. Schneck embraced opportunities to improve lung cancer detection by investing in the Veran Navigational Bronchoscopy/Percutaneous Biopsy System in late 2014. Combined with transthoracic needle biopsy with CT guidance, it gives Schneck the ability to have three non-surgical methods to detect earlier stage lung cancer.
This has also led to re-thinking the Cancer Nurse Navigator role to include identification of abnormal chest x-rays and chest CTs.
The hope of early detection is promising. Surgery is the most curative therapy. But surgery is best with early-stage disease. Lung cancer surgical case volumes at Schneck began to rise in late 2014, largely due to identifying early-stage disease.
Newer therapy modalities were embraced in 2014 as well. Schneck has implemented the only photodynamic therapy program for lung cancer treatment in the state.
Patients with lung cancer have better therapeutic outcomes if tumors in airways are destroyed.
Many methods exist to eradicate airway tumors, but photodynamic therapy with laser excitation of a cytotoxic photophryn drug is reemerging as a preferred method because it is less traumatic to the patient.
This photodynamic therapy program has treated many patients to improve their ability to undergo chemotherapy and radiation therapy.
The future of lung cancer detection and treatment remains optimistic.
Dr. David Wilson is pulmonologist with Columbus Regional Health with affiliations with other hospitals in the area including Schneck Medical Center. He also is a Fellow of the College of Chest Physicians.