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Questions a Lung Cancer Patient Must Ask Their Doctor

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Published on February 17, 2020

Key Takeaways

Lung cancer specialist and researcher Dr. David Waterhouse highlights how some patients are thriving today because of better medicines. Dr. Waterhouse from OHC (Oncology Hematology Care) stresses that many more could benefit by participating in cancer clinical trials, and not as a last resort. Watch as he lists questions anyone with lung cancer should ask their doctor to get personalized, state-of-the-art care and hope.

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Transcript | Questions a Lung Cancer Patient Must Ask Their Doctor

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Andrew Schorr here in Austin, Texas, at a conference, but we're with Dr. David Waterhouse, who is a researcher, a lung cancer specialist from OHC in Cincinnati. Dr. Waterhouse, so much has been changing in lung cancer that gives people hope, but it's really based on research. So, my understanding is maybe the overall cancer death rate is going down, maybe fueled by breakthroughs in lung cancer? 

Dr. Waterhouse:          

Well, yes. In short, yes. If we look at the death rates due to cancer in the United States, they are finally starting to drop, and they've been dropping since around 2014 to 2015. Well, lung cancer is the number one cause of cancer death, men and women. And we're seeing a disproportionate drop in lung cancer, and it's fueled by a few things. One, men are not smoking at the rates they used to. Two, women were actually increasing smoking; now, they're decreasing. So, the prevalence is going down a little bit.

But we've also had really paradigm changes in how we treat lung cancer. So, on one hand, you have the immunotherapies, which are targeting large swaths of populations and resulting in long-term survivals that we've never seen before. I just got back from overseas reporting on the five-year survival in patients who were treated with a drug called nivolumab (Opdivo), for example.

And there are others. If you look at the opposite end, so those are wide swaths of people, but we also know there's lots of needles in haystacks—these small populations of people with very targetable genetic mutations. And so, we now know that by doing what's called next-gen sequencing looking for these targeted mutations, and then directing therapies that go right at that specific mutation, or the by-product of that mutation, we're getting outcomes that are way different. 

So, you're seeing people living longer and also living better, so that it's not just, they're not just surviving, they're thriving. They're doing well. That said, there are still a ton of people dying of lung cancer. It's heartbreaking. And so, I'm a giant fan of clinical research.

Andrew Schorr:

Let's talk about that. So, the benefit has been happening with research that has already been underway or related to approved drugs. Is research continuing in lung cancer so that those people who haven't been helped, if only they would consider trials, might give them more hope?

Dr. Waterhouse:          

Sure. So, in my opinion, the best treatment for any patient is a clinical trial. Historically, people thought of clinical trials like a Hail Mary pass. "I'll do it if nothing else works." And I think that's a mistake. I think that participation in a trial is actually their best hope. And so, we strongly try to search out those patients and match them to the trials. If we don't have a trial, we try to help find them one elsewhere.

Sadly, in the United States right now, only about 3 percent of patients are going on these trials. There are more drugs than there are patients right now. And so, we need to be able to drive people into these trials. And we need to let them know, and we need to let their providers know, this is important work. Every drug we take came through a clinical trials process, and it's not a Hail Mary pass. For that individual, it might be, but it's the best care they can get.

Andrew Schorr:

All right. Let me ask you, for our audience, so there may be people watching where themselves or Mom or Dad, or Grandma or Grandpa has been diagnosed with this all too prevalent lung cancer, and they're terrified. Since you're a research director, what questions should they be asking their doctor, or even going beyond that to see does research apply to them?

Dr. Waterhouse:          

Sure. I think that there are several questions. First of all, not all cancers are equal, and not all cancers are the same nor are they managed the same. We lump lung cancer, but it is not a single cancer. There's a whole bunch of cancers.

Andrew Schorr:

So, you need to be tested.

Dr. Waterhouse:          

So, what type of cancer do I have? Have you done genetic testing on my cancer? Have you done next-gen sequencing on my cancer? Can you tell me more about the characteristics? So, in the same way that we think of a woman with breast cancer, is it estrogen receptor-positive or not, I'm thinking about a lung cancer. Is it a small cell? A non-small cell? If it's non-small, is it squamous or adeno? Does it have a ROS mutation or an ALK mutation or a BRAF mutation? Does it have an EGFR mutation? I want to know all of those characteristics.

I want to know the stage of my cancer. Is it localized, or has it spread? Because we will manage those differently. And then, yes, finally the answer to all of that will then be is there a clinical trial that would be appropriate for me either at your institution or elsewhere? I don't have a problem with people getting second opinions in my clinic. I think doctors who don't like second opinions are either insecure, don't know their business or both. I don't want that doctor, and I don't want my patients to think of me that way.

So, we're lucky at OHC to actually present all of our patients with lung cancer at Multidisciplinary Tumor Boards. So, we have, sitting in the room we'll have the surgeon, the pathologist, the radiologist, radiation, medical oncology all looking at the same case, and they’re trying to apply that communal knowledge to the care. And I'm proud. OHC founded most of those Tumor Boards in Cincinnati.

Andrew Schorr:

Good for you. Well, I'm glad you're so passionate about it. And as you were saying, there's been real progress. I noticed some 10-year lung cancer survivors that used to never happen based on research and people getting the benefit of that. But as you are well aware, there are so many people who are left out now. 

Dr. Waterhouse:          

We're powered by those stories. I have those patients. One of my favorite patients in the clinic was on one of our very earliest immune therapy trials. He's now celebrating six years of progression-free survival. He saw his daughter married. He hiked the Grand Canyon. He has done so many things, and he's so grateful. He's a volunteer in the clinic. So, I now have lung cancer patients talking our breast cancer patients off the ledge. Who would have ever imagined?

But just as you're powered by those survivors, you're equally, if not more powered by the ones we didn't get taken care of, or couldn't fix. And those are the ones that are driving the thing now. We're not going to stop until we're done with it. I can tell you OHC Research isn't quitting.

Andrew Schorr:

Oh, good. Good for you and your peers in the lung cancer research  lung cancer research community around the world. Thank you so much, Dr. Waterhouse, for what you do.

Dr. Waterhouse:          

Thank you for having me here, and thank you for supporting this meeting. This is an important meeting. 

Andrew Schorr:

Thank you, thank you. All right. So, if you or someone you love is affected by lung cancer, just to recap a couple of things. What are you dealing with? Genomic testing, staging, whatever can be known with the latest testing about that person's lung cancer, and then what are the options, whether it's at that clinic that you're going to or anywhere. You need to know all of your options so you can make an informed decision, and it can make a difference. Did I get it right? 

Dr. Waterhouse:          

Absolutely got it right. And if you are dealing with this, I'm awful sorry what you're going through.

Andrew Schorr:

Amen. But there is hope. Andrew Schorr with Dr. David Waterhouse from OHC. Remember, knowledge and checking into clinical trials can be the best medicine of all.

Dr. Waterhouse:          

Absolutely.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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