Lung cancer specialists pool their resources to develop a unique treatment plan for every patient, to cure when possible and care at every step of the way.

By Kathleen Yount

When Pat Hansen describes the day she and her husband, Erik, learned that Erik had advanced lung cancer, she doesn’t mince words. “When the love of your life is diagnosed with a horrible case of cancer,” she says, “the world as you know it changes, and it’s not the same ever again.”

“It was quite a shock,” agrees Erik, who has never smoked. But he also says his treatment team at Duke, including medical oncologist Frank Dunphy, MD, and nurse clinician Karen Dukelow, RN, never let him and his wife feel alone in the struggle. “Between all four of us we’d come up with a plan to move forward. We really worked together as a team.”

Patients with lung cancers like Erik’s face steep odds -- most advanced cancers prove fatal within a year of diagnosis. So Duke assembles a crew of experienced specialists to rally for each lung-cancer patient. The players run the gamut, from medical and radiation oncologists to surgeons to pathologists, but they are all focused on bringing hope to those battling what remains the greatest cancer killer in the United States.

Plans of Attack

One of the reasons lung cancer is so deadly is that it often lurks undetected at its earliest and most treatable stages -- by the time a patient develops symptoms, the cancer has usually spread beyond the lung. But as diagnostic and imaging technologies improve, the odds may begin to tip in patients’ favor.

Duke is a world leader in PET scanning for lung cancer -- a highly sensitive technique that allows physicians to distinguish between benign and malignant tumors and better determine whether the cancer has spread in the body.

Imaging technology also helps radiation oncologists such as Lawrence Marks, MD, and Nicole Larrier, MD, treat these tough cases. They and other Duke researchers are working to better understand how normal tissue reacts to the radiation, so they can optimize delivery of therapy. “We want to determine exactly how much radiation is safe,” Marks says.

Before any sort of radiation therapy or chemotherapy, most patients will undergo surgery to remove their lung tumors. Duke is home to four thoracic surgeons who focus exclusively on lung and chest surgery -- enabling them to develop special expertise in effective but technically challenging procedures.

In fact, Duke surgeons -- including Thomas D’Amico, MD, William Burfeind Jr., MD, David Harpole Jr., MD, and Eric Toloza, MD, PhD -- are national leaders in minimally invasive surgical procedures such as thoracoscopic lobectomy. In this procedure, surgeons remove the cancerous lobe of the lung through an incision roughly two inches long.

Traditional lung surgery involves a long incision around the chest and spreading the patient’s ribs. This new procedure does neither, leaving patients in less postoperative pain and with a shorter overall recovery time. D’Amico says that shorter recovery times also allow patients to start chemotherapy earlier, which can be critical in some instances.

Healing for the Whole Person

When chemotherapy is warranted, oncologists prepare an arsenal of both the best drugs to destroy cancer cells and strategies to minimize the harsh side effects. Duke’s thoracic medical oncologists care exclusively for lung cancer patients -- in fact, they helped develop the guidelines now used nationally by oncologists for medical management of the complications from lung cancer and its treatment.

Jeffrey Crawford, MD, chief of medical oncology at Duke, says that more patients are receiving chemotherapy at earlier stages. “As we’re developing less toxic drugs, more patients can receive them,” he says, noting that research is also helping physicians determine which drugs their patients will respond to best.

Oncologist Jennifer Garst, MD, says that a focal point of any treatment plan is not only killing cancer cells, but also maintaining the patient’s quality of life. Duke care teams give special attention to pain, appetite and taste alterations, and support of physical mobility and psychological well-being.

“The anxiety associated with cancer can be every bit as painful as physical pain, and we work hard to help people manage that, whether through medications, meditation, or gentle exercise,” says Garst.

“Lung cancer is a deadly disease, and there are many situations in which we can’t cure our patients,” she says. “But we can still care for them. That means supporting them, supporting their family, and giving them the best quality of life we can, for as long as we can.”