I teamed up with Dr. Ross Camidge from the University of Colorado to write a commentary piece that appeared in this month’s Journal of Thoracic Oncology, covering new challenges that have been borne of our new recognition that lung cancer isn’t one or two big groups but actually many, many subgroups. We also proposed some relatively straightforward and some larger efforts that could be undertaken to adapt to the new world of “molecular oncology” we now find ourselves in.
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Archive for the ‘Ask the Experts’ Category
A Bumpy Road for Lung Cancer Research in a New Molecular Era: Identifying Problems and Solutions
March 9th, 2012 - by Dr. Jack West
Both/And, rather than Either/Or: Expert Panel Recommends Early Integration of Palliative Care into Treatment of Advanced Cancers
March 2nd, 2012 - by Dr. Jack West
The American Society of Clinical Oncology (ASCO) recently convened an expert panel that just published a “provisional clinical opinion” that advises oncologists to initiate a dedicated focus on palliative care right from the time that people with advanced or significantly symptomatic cancers are starting what we would consider “active treatment” for their cancer with things like chemo, targeted therapy, radiation, etc. This is likely to lead to some gradual changes in how palliative care is perceived by both patients and doctors, who have largely considered palliative care to be essentially synonymous with hospice care. Too often, because hospice services in the US have traditionally only been available for patients who are no longer receiving “aggressive” anticancer therapies with a goal of curing cancer or prolonging survival, palliative care and hospice have tended to be afterthoughts that get our attention only very briefly, often in a rushed period when someone with advanced cancer is declining rapidly. Patients in the US receive the benefits of hospice typically for an average of just a few days, despite the fact that these supportive interventions are meant to be available for many months for each patient with a terminal diagnosis. However, if palliative care and hospice are equated with “giving up”, and only available for people after their other treatments are completed, it creates a difficult challenge that deprives patients of the best symptom management and quality of life possible.
Instead, the idea is that palliative care, which is really a focus on open communication, symptom relief/optimal qualify of life, and good discussion of realistic goals of treatment is NOT mutually exclusive with life-prolonging anti-cancer therapy and may even be better than some more aggressive interventions. Palliative care in this framework is actually potentially thought of as its own specialty, with separate practitioners, rather than just something that oncologists offer if time allows and if they think of it. So the idea is that perhaps palliative care should be administered side by side with the treatments oncologists are providing, right from the beginning.
My 5 Take Home Messages from the Santa Monica Targeted Therapies Conference
February 25th, 2012 - by Dr. Jack West
I’m heading back now from the”12th Annual Targeted Therapies in Lung Cancer Conference”, three days crammed with over 150 talks, nearly all lasting just 5 minutes, that introduce a new agent or treatment combination that would be considered a targeted therapy for lung cancer. From this large collection, a few may well prove valuable tools, while the majority won’t meet that bar. It’s obviously not possible to relay news on over 150 agents, each introduced over a few brief slides, but I thought I’d share five leading themes that I came away with.
Should Pre-operative treatment lead to a change in the surgery done? The Balloon Theory vs. The Puddle Theory
February 17th, 2012 - by Dr. Jack West
One of the common scenarios we discuss in our lung cancer tumor boards is like a case we just discussed recently: a patient with a tumor near the middle of the chest and some nearby lymph nodes involved had a collapsed lung lobe; the lung surgeon thinks that because of the location of this cancer, the patient is likely to need the whole lung removed is surgery is going to be a realistic option with curative intent. This patient is a potential candidate for undergoing the rigor of losing his whole lung, based on his breathing tests, but we know that a pneumonectomy (removal of an entire lung) is a major loss, so a less extensive surgery would be attractive if feasible. This leads us to the question of whether, if we give pre-operative chemotherapy specifically with the intent of shrinking a cancer enough, we might be able to do a less extensive, lobectomy surgery (removeing one lobe instead of the whole lung), if an upfront pneumonectomy would otherwise need to be done. A similar question is whether it’s realistic to change someone from a nonsurgical candidate due to local extensive disease into a surgical candidate based on chemotherapy +/- radiation shrinking the extent of disease.
