Can Lung Cancer Patients Be Surgically Downstaged?

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What is the role of a thoracic surgeon in lung cancer?  Lung cancer patient and advocate, Janet Freeman-Daily, interviews Dr. David Odell from Lurie Comprehensive Cancer Center in this informative video.  Dr. Odell shares insight on why a thoracic surgeon may be part of your team, as well as explaining “downstaging.”  Dr. Odell explains, “A surgeon’s role is not just cutting cancer out.  It’s about helping make the decisions from diagnostic to end of therapeutics.”

This in-person town meeting was sponsored by the Patient Empowerment Network through educational grants from Helsinn, Genentech and Novartis, with additional funding from LUNGevity Foundation through an educational grant from Pfizer. It was produced by Patient Power in partnership with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and LUNGevity.  

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Transcript

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. 

Janet Freeman-Daily:

 I'm Janet Freeman-Daily, a lung cancer patient and activist, and I'm here with Dr. David Odell.  He's an assistant professor of thoracic surgery at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University.  Welcome. 

Dr. Odell:

Thank you, Janet.

Janet Freeman-Daily:

What would you say is the importance of having an experienced thoracic surgeon?

Dr. Odell:

Well, I think the role the surgeon in the care of patients with lung cancer has oftentimes been thought of as just the person who is resecting disease, but I think a very important component of care for patients is having a multidisciplinary conversation about the approach to treatment.  So I think having a thoracic surgeon on board to have that perspective about what can and cannot be dealt with surgically, whether it comes to resection or even at earlier stages in terms of getting tissue for diagnostic purposes to establish treatment plans is very important. 

Having a thoracic surgeon on board really is key from the standpoint of outcomes too, when it comes to surgery. Still, about 40 percent of lung cancer surgery in the United States is done by general surgeons, and we're starting to see as techniques surgically, the technology that we bring to bear in the operating room becomes more and more specific and focused on the care of lung cancer patients that there is a difference when it comes to experience levels.  So having—as a cancer patient being a discerning consumer become really becomes important. 

Janet Freeman-Daily:

I would think also in this era of target the therapies that the surgeon has a role to play in deciding whether or not perhaps surgery would be useful in getting a sizable tissue sample.

Dr. Odell:

You know, that's a conversation that we have almost on a daily basis with our medical oncology colleagues, what's the best way to get the tissue that they need to determine whether or not a patient is a candidate for targeted therapy.  And, as you know, we have multiple opportunities and avenues with which to get tissue sampling, some of which are much less invasive than others, and being able to have someone with expertise weigh in on the appropriate way to get that tissue that has the least impact to the patient really can be very valuable.

Janet Freeman-Daily:

So I've heard that some patients might be surgically downstaged.  Can you tell me about that?   

Dr. Odell:

Yes, that's true.  You know, we think about our approach to treatment in patients that are potentially resectable as really what can we do to minimize the extent of the operation that we need to do.  So when we talk about surgically downstaging patients, much of this has to do with combined multimodality treatments such that we try to minimize the bulk of tumor with adjuvant therapies, neo-adjuvant therapies.

Janet Freeman-Daily:

And that means taking chemo before surgery?

Dr. Odell:

Which meaning taking chemo before surgery. So we try to shrink the tumors down so that, for example, rather than having to take out the entire right lung we are able to remove only one lobe of the lung, preserving as much of the patient's pulmonary function as possible afterwards. 

Janet Freeman-Daily:

So in some cases, patients who tame chemo find that later they can have surgery. 

Dr. Odell:

And oftentimes those are situations that are discussed at length beforehand, because in some of those cases we'll actually determine that, yes, surgery is something that we should do as the first step. If we are planning surgery as a second step after chemotherapy or sometimes even after chemotherapy and radiation treatments, it does very much change the way that those first steps in treatment are approached by the medical oncologists and our radiation oncology colleagues.

I'd like every patient to know that our role in the treatment of this disease is not just cutting it out. It's helping to make the decision all the way from the diagnostics through the end of therapeutics. 

And I think that having a surgical voice in those discussions as you try to determine a treatment plan really is in the patient's best interest, both in terms of how do we appropriately stage and diagnose the cancer and how do we treat it ultimately. 

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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Page last updated on July 17, 2017