Interdisciplinary Team Benefits Lung Cancer Patients
An otherwise healthy patient with a persistent cough reluctantly visits her primary care physician. After two weeks of antibiotics, the cough persists. The doctor orders a chest x-ray and discovers a suspicious looking grey shadow.
A healthy man is planning to have knee surgery and receives a chest x-ray, as part of the pre-op screening. A small, irregular looking grey mass is detected.
A middle-aged woman notices a slight swelling in her neck and face. She’s fatigued and has lost her appetite. A routine physical shows nothing out of the ordinary, but a chest x-ray reveals a grey shadow in her lungs.
Unfortunately, this scene will be played out by 3,200 people in Maryland this year who will be diagnosed with lung or chest cancer. Anne Arundel Medical Center (AAMC) is poised to help make the outcomes of those patients more positive. Thoracic surgeon Karl Holschuh, M.D., and 15 other specialists at AAMC have taken a proactive approach in the battle with lung cancer by establishing the Thoracic Oncology Program (TOP), an interdisciplinary approach to patients suffering from benign and malignant chest tumors. The team, made up of board certified specialists in oncology, pathology, pulmonology, thoracic surgery and radiology, meets weekly to discuss patients—like the three above—who have been referred after a diagnosis of lung cancer.
Lung cancer is the number one killer among cancers in men and women. According to the American Cancer Society, one third of the people who die of cancer this year in the United States will have lung cancer. This statistic is significant because fewer cases of lung cancer are reported each year than prostate and breast cancer, but more people die from it.
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Dr. Holschuh says it’s no mystery that lung cancer kills so many people. “We’ve educated the public about breast, prostate, and colon cancer. There’s a public awareness with those cancers, and we’re beginning to catch them earlier now, when they are more easily treated.” Lung cancer hasn’t received the same publicity, although it should. Of the 556,500 estimated cancer deaths in 2003, 157,200 deaths will be from lung cancer; colon cancer ranks second, but far behind, at 57,100.
Dr. Holschuh said, “The prospect of cancer is frightening for any patient, especially when it involves the chest or lungs because these cancers have a propensity to grow and spread quickly.” With the Thoracic Oncology Program, modeled after similar programs in university settings, a single phone call by the patient or the referring physician is all it takes to put the team to work immediately. The goal is to work closely with the primary care physician or referring physician to build a collaborative, efficient system of treating lung cancer patients.
Every Tuesday at noon they gather to discuss their cases, bringing x-rays and other diagnostic tests before the team. Together they discuss options and treatment plans and lay the ground work for treating patients who may need some combination of surgery, radiation and chemotherapy.
When people learn they have cancer, they want it removed immediately and treatment to begin. However, pathologists first must determine what kind of lung cancer it is. Some cancers are treated successfully with surgery and radiation; others require surgery, radiation and the addition of chemotherapy.
In the past, patients could become frustrated by shuffling from an oncologist, to a surgeon, to a pulmonologist. What TOP does is put 15 experts together in one room, rather than the patient having to make appointments with each of them. It’s a much more efficient way to develop a treatment plan.
Patients are scheduled to see specialists their cases warrant, but the visits will be coordinated through TOP and the patient’s primary care physician. “This expedites the process and gives a level of comfort to the patients,” Ruff said. “In addition, when the patient visits one of the specialists, he or she is already familiar with the case because it was discussed in one of the weekly meetings. Our team’s goal is to keep the primary care or referring physician intimately involved from the beginning.”
Dr. Holschuh, who completed a fellowship at Yale in thoracic surgery, said it’s unusual, especially in this day, for physicians in a non-teaching hospital to meet weekly to discuss patients. “Everyone is so busy that in most hospitals you’re lucky to catch a colleague in the hallway to discuss a patient. Now we’re able to look at all the options together and collectively form the best treatment plan for our patients. And fifteen heads are better than one.”
“To have an interdisciplinary approach and plan in place before treatment and surgery is absolutely unique in a regional health organization like Anne Arundel Medical Center,” said Dr. Sjoerd Beck, pulmonary specialist. “As technology moves forward and specialization increases, patients definitely benefit from the expertise of several specialists, coordinating their observations and treatment recommendations into a collective treatment plan.”
In addition to having the benefit of highly qualified team of specialists, patients also have access to the complete range of advanced diagnostic capabilities at AAMC, including onsite CT, MRI and PET/CT Fusion screening, video-assisted thoracoscopy, bronchoscopy and pulmonary function testing.
The hospital also is involved in six clinical trials; four for non-small cell tumors, one for small cell tumors, and more recently, a new study to help prevent recurrence of lung cancer in post-surgical patients. “Participating in national clinical trials is a real advantage to our patients,” said Dr. Holschuh, “as well as helping to unlock the door to cancer cures.”
Dr. Holschuh said the key to reducing the number of lung cancer deaths is early detection. “There will be a cure for lung cancer some day,” he said. “We know many of the causes of lung cancer and we’re making advancements in gene therapy, chemotherapy and technology.”