Interviewer: What does a physician want their lung cancer patient to know after a positive diagnosis? We'll find out next on The Scope.
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Interviewer: Dr. Wallace Akerly is at Huntsman Cancer Institute. He's a lung cancer expert and I want to have a brief conversation. After you have a patient that has a lung cancer diagnosis, what are typically some of the things that you would tell them? Because at the time, it's probably a little overwhelming so this might give that patient opportunity to hear that information again?
Dr. Wallace: So the first thing we talk about with a patient is typically explaining what's happened is in the past and every patient has to know what the cancer is and where it has spread. So the test they may or may not understand, but the what part is a biopsy and they've probably already had that before they come to see me. We look at it under the microscope and explain or look at these cancer cells and see that these were once normal cells that are behaving very differently. And they can see that under the microscope that the cell that's supposed to be contained to the lung has somehow figured out a way to grow right through basement membranes. So the biopsy says that this cell is not behaving correctly, it's a cancer.
The second part is where has it spread. And the patient has typically gone through a CT scan or a PET scan and draw out a picture that says these are the places where your cancer is present. Knowing where the cancer has gone and that it is a cancer helps the patient explain in their own mind or understand what their symptoms are and why they're feeling the way they're feeling. It may be cancer-related or it may not be. But as we then start to treat these symptoms, it gives the patient the understanding to say, "I can treat this as an arthritis or I can treat this with my as-needed medications they have at home as a cancer."
Interviewer: What else do you try to explain to a patient?
Dr. Wallace: So the next thing is to understand what made the cancer the cancer and so the old world, we looked at a biopsy and said, "This is what the cancer cell looks like." The new world is taking it one step further and we are now doing gene studies. Genes of the cancer that tell the cancer what to do and we can find which of these genes is responsible in very many cases for making the cancer the cancer. So a cancer is our normal cells, except that one part of our normal function has been hijacked and is damaged. If I can understand what step it is that's causing that, well, then we can talk about drugs to block that pathway or at least try to blunt it if I can't correct the pathway.
Alternately, I can pick out a pathway and potentially prescribe them a targeted therapy or a specific therapy that makes the cancer the cancer. Surprisingly, these therapies can be much more well tolerated and more active. So everything is a balance of how well does it work, how many side effects does it cause. And these targeted therapies could easily be a pill that one takes at home and can have the side effects of almost taking an antibiotic, something so different than the chemotherapy that we've been giving for 20 or 30 years.
Interviewer: What's the importance of family members in this whole process?
Dr. Wallace: Family is so, so important. It's sometimes harder on the family than it is on the patient. The family tends to have to keep stiff upper lip and say they'll be strong for the patient so matter what. And yes, it's hard for the patient, but the family suffers with this too so I think it's very important to have family members there. They hear the same background information that the patient hears and their role is to listen and try to understand it as well as the patient because the patient, very commonly, is just overwhelmed by this information.
And even though I write this down and I hand out printed information, people can't always remember it. They sometimes just totally get stuck on the word "cancer." Sometimes they're surprised, but very common they go home that evening and say, "I didn't remember anything that they said," and they look at these handwritten notes we pass out and they say, "Jeez. This note says this," and they can then remember with that trigger what it was that we talked about.
We typically talk about standard treatments. "We'll do this and see how it goes," but everything is simple in cancer. We measure something, we give a treatment, we measure it again. If the cancer has gotten smaller, we're doing the right thing. If the cancer hasn't gotten smaller, we need a new plan. And so we will list the number of potential treatments we have and we usually end off with where do we think the world is going because the first thing the family does and the patient does when they get home is they get on the internet and they look around.
Dr. Wallace: So it's important they understand, "This is where I am. This is how I'm going to cope with it. This is how my nurses and social workers and physician are going to support me as I get through this. This is my team that will educate my family members so they will help support me," and we'll run through these therapies as appropriate. We'll balance the benefit versus the side effects. And if possible, we'll try to get them involved with therapies that might be available in two to three years.
Interviewer: So it sounds like it's not just a diagnosis of a physical ailment, there is also treatment for the mental and the spiritual and there is a lot of supporting roles involved other than just you telling somebody, "I'm sorry. You have lung cancer. Let's go do this treatment."
Dr. Wallace: That's so correct. We treat as a team. No one person stands alone. We have many expertises. We have surgeons, radiation therapists and pathologists and so on in the physician group that is interested in the cancer. But we care about so much more than that. It's important to have social workers in the cancer wellness center and the cancer learning center and all of these other things to give the patient the strength to be able to get through this. It's a terrible diagnosis, but there is hope and there are many new therapies. In the last couple of years, there have been a number of drugs approved. In my disease, for lung cancer, there have been two new therapies approved that work by completely different mechanisms. Very, very promising.
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