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“The greatest reward from my involvement in the Lung Cancer Program is being a part of the multidisciplinary approach of providing continuity of care for the patient throughout the process of treatment, connecting them to the available resources and providing ongoing support, both clinically and emotionally.”
Sian David,
Lung Cancer Liaison Nurse, Hoag Cancer Center |
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Lung Cancer
Background
Lung cancer continues to be the number one cause of cancer deaths in both men and women, and is the second most commonly diagnosed and treated cancer at Hoag Hospital. With more than 210 newly diagnosed patients a year, Hoag has one of the largest lung cancer programs in the U.S. Although lung cancer is still the number one cause of cancer deaths among both men and women, the positive news about lung cancer is that new advances in treatment, including the addition of chemotherapy, both before and after surgery, are improving survival rates. And at Hoag, the result is that the 5-year relative survival rate for lung cancer patients diagnosed and/or managed at Hoag Cancer Center is 50% higher than the national figure!
Patient Care
Overview
The dedicated specialists of Hoag Cancer Center provide patients with the highest level of medical care in a healing environment. The Hoag Cancer Center Team provides cancer patients with every diagnostic and therapeutic advantage. In addition, Hoag offers a comprehensive approach including prevention, early detection, the use of standard effective therapies, the use of promising new therapies and participation in laboratory and clinical research.
Hoag Physicians
Hoag physicians from various specialties rank among the most skilled in the world. These specialists will take you from surgery to radiation to chemotherapy. In 1999 215 new lung cancer patients were treated by Hoag physicians, including board certified cardiothoracic surgeons, radiation oncologists, pulmonary specialists and medical oncologists. Each year Hoag surgeons operate on more than 100 newly diagnosed lung cancer patients, and radiation oncology department treats over 150 new lung cancer patients.
Lung Cancer Coordinator
Sian David, Lung Cancer Liaison Nurse and program coordinator, provides information, and emotional support for the patient and family members to help prepare them for the adjustment to living with lung cancer.
Lung Cancer Case Conference
Weekly multidisciplinary case conferences offer thoracic surgeons, pulmonary specialists, medical oncologists, radiation oncologists, pathologists, radiologists and support staff to come together to plan treatment for newly diagnosed lung cancer patients. This unique forum offers the opportunity for members of all disciplines to share information about innovative new therapies which are being implemented in the care of lung cancer patients at Hoag Cancer Center.
Education
Education components include a patient library, 7-CANCER hotline, interactive computer program, hereditary screening pre-surgical education and a six session education and support series designed for the newly diagnosed lung cancer patient.
Hereditary Screening
No specific genetic tests are currently available for lung cancer, and the majority of lung cancers are not thought to be hereditary. However, there are several rare hereditary cancer syndromes in which families can have patterns of lung and other types of cancer. Hoag offers a computer-based program to help determine the likelihood that an individual may have or be at risk for hereditary or familial cancer.
Integrative Complementary Care
Lung cancer patients benefit from the many components of Complementary Care which are available at Hoag. Interventions such as support groups, journaling instruction, aerobic exercise, yoga, visual imagery and meditation are effective additions to the medical plan of care. These programs provide an added dimension of care for the body, mind and spirit of the patient undergoing cancer treatment.
Support Programs
Two specific support groups are available to meet the educational and emotional needs of lung cancer patients.
Educational Support for Newly Diagnosed Lung Cancer Patients — A six week closed ended program that combines education with support and was designed for newly diagnosed patients (up to six months after diagnosis).
Ongoing Support for Lung Cancer Patients — An opportunity to continue to learn about lung cancer and experience support in a group setting.
Prevention
A rare disease at the beginning of the 20th century, lung cancer incidence has reached epidemic proportions. Although other factors may be implicated in the increased incidence, it is estimated that smoking causes 80 to 90% of lung cancer deaths. Therefore, the only proven method for prevention of lung cancer is the elimination of smoking. In order to assist lung cancer patients to stop smoking, and to provide the community with vital information about smoking, numerous educational programs are offered related to smoking cessation and prevention. The Hoag Hospital Pulmonary Medicine Department offers regular "Freedom From Smoking" clinics. (could be underlined indicating that clicking on "Freedom from Smoking" would take you to that section) Nicotine Anonymous, a twelve step support group, meets twice weekly in the hospital. In addition, the Cancer Center provides smoking prevention information to elementary and high schools via classroom presentations.
Early Detection
The best survival in lung cancer is in asymptomatic patients who are found to have small tumors in the lung by radiologic tests. Although there are no screening procedures proven to decrease mortality from lung cancer, for many years Hoag Cancer Center has supported annual chest x-rays in former smokers. However, new developments in computerized tomography (CT) suggest that spiral CT scans are 10 times more sensitive than chest x-rays in detecting lung cancer. The Spiral CT Unit at the Hoag Huntington Beach Health Center became operational in early 2000. Those most likely to benefit from the use of such screening are former smokers, and perhaps active smokers. This test is not currently accepted as a screening tool and insurance reimbursement is generally not provided for that purpose. However, a history of COPD, emphysema, chronic bronchitis, shortness of breath, asbestos exposure or cough will increase the likelihood of reimbursement.
Treatment
Surgery
Surgery is the mainstay of curative treatment of localized lung cancer. Hoag has a highly qualified staff of board certified cardiothoracic and thoracic surgeons who operate on more than 100 new lung cancers each year with an operative mortality of less than 1%. Surgery may be timed either before or after the patient has been treated with chemotherapy and/or radiation therapy. Thoracic surgeons are assisted in the care of lung cancer patients by the Thoracic Case Manager, Sian David, a nurse with specialized clinical expertise and commitment to the care of this population. Hoag patients with localized disease have a relative 5-year survival rate of 57%, which is 14% higher than the national figure for similar patients.
Radiation Therapy
Radiation therapy is an integral part of treatment for regionally advanced lung cancer. In some cases, radiation therapy is delivered before surgery to shrink a tumor to a more manageable size so that surgery will be more effective. In other situations, radiation therapy will be used after surgery to provide added protection against the cancer returning. With four board-certified radiation oncologists and three state-of –art linear accelerators, Hoag offers the highest quality radiation therapy. In addition, under the direction of Cristopher Duma, the Hoag Gamma Knife program offers the most effective and safest radiation therapy for lung cancer that has metastasized to the brain.
Systemic Therapy
Systemic therapy consists of treatment that is carried to all parts of the body via the bloodstream, and includes chemotherapy and biotherapy agents. Hoag physicians have adopted an aggressive approach to lung cancer treatment in an effort to enhance cure rates. Medical Director Robert O. Dillman was the lead author on landmark publications in the New England Journal of Medicine and Journal of the National Cancer Institute that established a role for chemotherapy in lung cancer. Today at Hoag chemotherapy is routinely used sequentially or concurrently with radiation therapy in patients with regionally advanced disease resulting in a relative 5-year survival rate of 27%, which is 35% higher than the national figure for similar patients. Even in patients with metastatic disease at the time of initial diagnosis, the relative 5-year survival rate for Hoag patients is three times higher than the national figure.
Clinical Trials and Investigational Therapy
Hoag Cancer Center maintains a number of active clinical trials that offer patients access to promising new therapy and to address important questions regarding the management of lung cancer. (At times) the Hoag Cell Biology laboratory offers unique patient-specific approaches utilizing a patient’s own cancer cells as a vaccine, and/or immune cell therapies.
Frequently Asked Questions
I’ve heard that people who get lung cancer don’t survive. Is there any hope?
Yes, there is hope for survival, good quality of life, and, when diagnosed early, cure for patients with lung cancer.
Survival of lung cancer varies stage by stage, but new advances offer hope in every stage. Now, at least one in five patients will be cured. Early stage lung cancers are potentially curable with surgery alone. As the extent of disease progresses from Stage I through Stage III, the cancer does become more difficult to treat successfully. However, research conducted in the last two decades and the availability of new chemotherapy drugs has contributed to improved survival even in later stage disease. The use of chemotherapy prior to surgery is a relatively new approach, which allows some patients to have life preserving surgery when previously these surgeries would not have been possible because the tumors were too large to successfully remove. These changes in the treatment of lung cancer offer more hope for patients with advanced disease. At Hoag, the relative 5-year survival rate for patients with metastatic disease at the time of initial diagnosis is three times higher than the national statistics.
Since I have already developed lung cancer, does it matter that I still smoke?
Yes, it is vitally important that a smoker with lung cancer makes every effort to stop smoking.
There are several reasons why a smoker who develops lung cancer should quit smoking. Recovery from surgery will be faster and general health during treatment will be better if the lungs are no longer exposed to smoke. In addition, the likelihood of developing a second smoking related cancer will be decreased if you quit smoking now.
If lung cancer recurs is there any further treatment?
Yes, although more difficult to treat, there is treatment for recurrent lung cancer.
If cancer recurs, further therapy will depend on the site and extent of the recurrence. Brain metastasis can be treated with gamma knife, a highly specialized radiation therapy technique which delivers a concentrated radiation dose without damaging surrounding tissue. Bone metastasis can be treated with conventional radiation therapy, and other parts of the body can be treated with combinations of radiation, surgery and chemotherapy. As with many other types of cancer, when lung cancer recurs the approach becomes to view the cancer as a chronic disease with attention focused on controlling disease and managing symptoms.
Are there doctors who specialize in the treatment of lung cancer?
Yes, the most effective approach to the treatment of lung cancer involves a multidisciplinary team approach.
Members of the medical team include thoracic surgeons, pulmonary specialists, medical oncologists, and radiation oncologists. It is vitally important that these team members work together to determine the best plan of care for each individual.
Now that I’ve been diagnosed with lung cancer does this mean that members of my family are more likely to get it?
Probably not. No specific genetic tests are currently available for lung cancer .
However, there are several rare hereditary cancer syndromes in which families can have patterns of lung and other types of cancer. The majority of lung cancers are not hereditary. However, if a member of a family has developed a cancer related to smoking, other members of the family may be at risk due to second hand smoke.
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