As many as 226,000 Americans could be diagnosed with lung cancer this year.
At Lourdes Health System (a partner with 21st Century Oncology), while you may have the same type of cancer as another patient, your particular situation — including your overall health, your medical history, even your work and family responsibilities — make your case unique. That is why we develop an individualized cancer treatment plan for every patient; taking not only their disease but also their overall well-being into account.
David Horvick, MD, is here talk about radiation therapy options, and how they offer new ways to manage lung cancer while maintaining quality of life.
Lung Cancer: What Treatments are Available
From the Show: Lourdes Health Talk
Summary:
Air Date: 6/14/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Lourdes carries forth a serious and expanding commitment to the latest in prevention, screening, diagnosis, treatment, and follow-up in cancer care. My guest today is Dr. David Horvick. He's a radiation oncologist with Lourdes Health System. Welcome to the show, Dr. Horvick. Tell us what happens if somebody is diagnosed with lung cancer. That's a very scary diagnosis. What's the first line of defense? What happens next?
Dr. David Horvick (Guest): Once a person is diagnosed, we evaluate the patient with a multi-disciplinary approach. We have tumor conferences where the patient's discussed by a panel of physicians, including surgical specialists, medical oncologists, radiation oncologists, as well as pathologists and diagnostic radiologists. We then come up with a game plan, or treatment plan, based the specific diagnosis, the sub-type of cancer and also the stage of the cancer. If a patient has very early lung cancer, surgery is the treatment of choice. Surgery is considered the gold standard. There are certain patients, even with early lung cancer, who are not surgical candidates because of other medical conditions, and then, we look at other approaches including radiation. For more advanced cases of lung cancer, Stage III, in particular, radiation, has a central role. Chemotherapy is also central to the treatment of many patients with lung cancer.
Melanie: So then, tell us about some of these adjunct services and things--therapies like radiation. People hear that word and they think right away, you know, rays and things and they're not sure what to make of it. Tell us about radiation therapy: what types there are and what can they expect from exposure.
Dr. Horvick: Well, for Stage I lung cancer, if the patient is not a surgical candidate, we have a type of radiation which is called “stereotactic body radiation therapy”. With this type of treatment, we use a very precise beam or series of beams directed precisely at the area of cancer itself. The treatment requires very sophisticated planning and immobilization of the patient. We actually evaluate the movement of the tumor during respirations and do some things to compensate for that. Then, it's a short series of treatments. The patient can be treated with anywhere from one to a maximum of five treatments, done over the course of about a week. The treatments themselves take about a half an hour per day, but they don't hurt; they don't make the patient sick. In general, the way the patient feels when they walk into our department is the way they feel during the treatment and after the treatment. So, for small lung cancers, it's incredibly effective and it's a very easy treatment. For more advanced lung cancer, the standard of care would be radiation in conjunction with chemotherapy. The radiation beam is, again, planned precisely, but because the cancer is more advanced, and because we have to be more careful of the normal tissues because of larger tumors, we use smaller amounts of radiation per day and the radiation is delivered over a longer period of time. So, very typically, patients could have to come to our department daily for six to seven weeks of treatment. Again, the treatment only takes a few minutes a day in that situation. The individual treatments, again, do not hurt. The patients don't get sick. They don't feel any different during or after the treatment than they did beforehand. There could be some cumulative side effects as time goes on with the treatment depending on the location of the tumor. Everybody's problem is a little bit different and everybody's side effects, therefore, are a little bit different. If the tumor is near the esophagus, the food swallowing tube, for example, some of the radiation could affect the esophagus and in the course of treatment, people could have some soreness with swallowing or heartburn. If it's near major airway, they could develop a cough from the treatment. Both of these problems are very manageable. With modern radiation, with the techniques we use, which are most frequently intensity-modulated radiation, or IMRT; the side effects of treatment tend to be quite manageable. Patients do not get sick, they don't get skin burns, there is some fatigue from the treatment, but, overall, the tolerance is very, very good.
Melanie: Dr. Horvick, does any radiation remain in the body during treatment or after treatment's complete?
Dr. Horvick: With this type of radiation, no. That's the difference between beam radiation where the radiation goes into the area being treated during the actual treatment and isotopes, or radiation sources, which can stay in the patient for a longer period of time. Although there are some situations where radioactive implants can be used in lung cancer. In general, most patients with lung cancer receive a form of beam radiation where the radiation is only going into the area of treatment during the treatment. No other area of the body is at risk from the treatment. At the end of treatment, there's no radiation in the person's body and no one around the person is at any risk whatsoever from radiation exposure.
Melanie: Will this affect any other health conditions and can they drive themselves to treatment? What is that like for the patient?
Dr. Horvick: They absolutely can drive themselves. What I tell patients, as far as the radiation itself goes, again, and I mentioned this a little bit earlier, that the way the patient feels when they come into our department is the way they will feel during and after the treatment. Now, that's from the radiation itself. Many of our patients are getting chemotherapy along with the radiation, chemotherapy being drug treatment, and the chemotherapy does go all over the patient's body. So, with the chemotherapy, other symptoms can develop. There can be fatigue caused by chemotherapy as well as from the radiation, so sometimes people can become significantly fatigued which could impair driving. And sometimes, people can become sick from the chemotherapy which would require someone to drive them. But as for the radiation itself, on a daily basis, patients tend to feel quite well.
Melanie: And is there any issue with positioning? If someone is uncomfortable in the position you're trying to get them and you want to make sure you're getting to the right area, how does that work?
Dr. Horvick: Well, that's a good question and it's an important issue. Before we start treatment on patients, we do something called a simulation or planning session. It's what patients also call the "marking" or "mapping" session. Because radiation goes in so precisely, the patient has to be in the correct position every day. We have a lot of flexibility in terms of how the patient is positioned but we do need the patient to be in the same position every day. So, I always emphasize to my patients, "Make sure you're comfortable at the time of planning," if something is not working, if you are uncomfortable. We can change arm position. We can elevate the head if the person needs that. We can give different types of supports to make things comfortable. If a person is in a different position from day to day, there's not going to be reproducibility of the radiation. We need the patient to be in the correct position but we have enough modalities, enough devices, to help keep the patient in the position but also allow them to be comfortable.)
Melanie: Dr. Horvick, in just the last few minutes here, give us your best advice for people recently diagnosed with lung cancer, what you tell people every single day about the therapies they can expect.
Dr. Horvick: Well, cancer treatment has advanced dramatically in the course of the last 10 or 15 years. Radiation is much more precise, chemotherapy is better tolerated, there are newer treatments, as well and targeted therapies that are available for appropriate patients. As well, surgical techniques have improved significantly. With this, if the patient is diagnosed with cancer and they go to a center that has all of these modalities where the specialists work as a team to take care of the patient, where things are discussed in collaboration, in general, the treatment will be quite well tolerated and there is a lot that we can do to help patients and frequently cure patients with lung cancer.
Melanie: And now, tell us about your team at Lourdes Health System.
Dr. Horvick: Well, we have a dedicated team for lung cancer. We have excellent thoracic surgeons, medical oncologists, radiation oncologists, pathology, and diagnostic people. We get together constantly to discuss cases in detail so that we can all have the input and come up with the ideal treatment plan. There are national standards of care, we always follow the standards of care and discuss them in relation to the patient, but we also look at the patient as an individual. We involve social services, we involve pastoral care, and we have an excellent nurse navigator and navigation system to help the patients through the process. Being diagnosed with lung cancer is scary and you really need a team to take you through every step of care. At Lourdes, we have that team. It runs through the nurse navigators who are incredible at guiding the patient through the system and through social services, as I said pastoral care, and then the physician team. So, we offer top-quality care, state-of-the-art equipment, and have all modalities to take care of patients with all stages of lung cancer.
Melanie: Thank you so much. It's really great information, so important. Thank you for being with us. You're listening to Lourdes Health Talk, and for more information, you can go to lourdesnet.org. That's lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Lourdes carries forth a serious and expanding commitment to the latest in prevention, screening, diagnosis, treatment, and follow-up in cancer care. My guest today is Dr. David Horvick. He's a radiation oncologist with Lourdes Health System. Welcome to the show, Dr. Horvick. Tell us what happens if somebody is diagnosed with lung cancer. That's a very scary diagnosis. What's the first line of defense? What happens next?
Dr. David Horvick (Guest): Once a person is diagnosed, we evaluate the patient with a multi-disciplinary approach. We have tumor conferences where the patient's discussed by a panel of physicians, including surgical specialists, medical oncologists, radiation oncologists, as well as pathologists and diagnostic radiologists. We then come up with a game plan, or treatment plan, based the specific diagnosis, the sub-type of cancer and also the stage of the cancer. If a patient has very early lung cancer, surgery is the treatment of choice. Surgery is considered the gold standard. There are certain patients, even with early lung cancer, who are not surgical candidates because of other medical conditions, and then, we look at other approaches including radiation. For more advanced cases of lung cancer, Stage III, in particular, radiation, has a central role. Chemotherapy is also central to the treatment of many patients with lung cancer.
Melanie: So then, tell us about some of these adjunct services and things--therapies like radiation. People hear that word and they think right away, you know, rays and things and they're not sure what to make of it. Tell us about radiation therapy: what types there are and what can they expect from exposure.
Dr. Horvick: Well, for Stage I lung cancer, if the patient is not a surgical candidate, we have a type of radiation which is called “stereotactic body radiation therapy”. With this type of treatment, we use a very precise beam or series of beams directed precisely at the area of cancer itself. The treatment requires very sophisticated planning and immobilization of the patient. We actually evaluate the movement of the tumor during respirations and do some things to compensate for that. Then, it's a short series of treatments. The patient can be treated with anywhere from one to a maximum of five treatments, done over the course of about a week. The treatments themselves take about a half an hour per day, but they don't hurt; they don't make the patient sick. In general, the way the patient feels when they walk into our department is the way they feel during the treatment and after the treatment. So, for small lung cancers, it's incredibly effective and it's a very easy treatment. For more advanced lung cancer, the standard of care would be radiation in conjunction with chemotherapy. The radiation beam is, again, planned precisely, but because the cancer is more advanced, and because we have to be more careful of the normal tissues because of larger tumors, we use smaller amounts of radiation per day and the radiation is delivered over a longer period of time. So, very typically, patients could have to come to our department daily for six to seven weeks of treatment. Again, the treatment only takes a few minutes a day in that situation. The individual treatments, again, do not hurt. The patients don't get sick. They don't feel any different during or after the treatment than they did beforehand. There could be some cumulative side effects as time goes on with the treatment depending on the location of the tumor. Everybody's problem is a little bit different and everybody's side effects, therefore, are a little bit different. If the tumor is near the esophagus, the food swallowing tube, for example, some of the radiation could affect the esophagus and in the course of treatment, people could have some soreness with swallowing or heartburn. If it's near major airway, they could develop a cough from the treatment. Both of these problems are very manageable. With modern radiation, with the techniques we use, which are most frequently intensity-modulated radiation, or IMRT; the side effects of treatment tend to be quite manageable. Patients do not get sick, they don't get skin burns, there is some fatigue from the treatment, but, overall, the tolerance is very, very good.
Melanie: Dr. Horvick, does any radiation remain in the body during treatment or after treatment's complete?
Dr. Horvick: With this type of radiation, no. That's the difference between beam radiation where the radiation goes into the area being treated during the actual treatment and isotopes, or radiation sources, which can stay in the patient for a longer period of time. Although there are some situations where radioactive implants can be used in lung cancer. In general, most patients with lung cancer receive a form of beam radiation where the radiation is only going into the area of treatment during the treatment. No other area of the body is at risk from the treatment. At the end of treatment, there's no radiation in the person's body and no one around the person is at any risk whatsoever from radiation exposure.
Melanie: Will this affect any other health conditions and can they drive themselves to treatment? What is that like for the patient?
Dr. Horvick: They absolutely can drive themselves. What I tell patients, as far as the radiation itself goes, again, and I mentioned this a little bit earlier, that the way the patient feels when they come into our department is the way they will feel during and after the treatment. Now, that's from the radiation itself. Many of our patients are getting chemotherapy along with the radiation, chemotherapy being drug treatment, and the chemotherapy does go all over the patient's body. So, with the chemotherapy, other symptoms can develop. There can be fatigue caused by chemotherapy as well as from the radiation, so sometimes people can become significantly fatigued which could impair driving. And sometimes, people can become sick from the chemotherapy which would require someone to drive them. But as for the radiation itself, on a daily basis, patients tend to feel quite well.
Melanie: And is there any issue with positioning? If someone is uncomfortable in the position you're trying to get them and you want to make sure you're getting to the right area, how does that work?
Dr. Horvick: Well, that's a good question and it's an important issue. Before we start treatment on patients, we do something called a simulation or planning session. It's what patients also call the "marking" or "mapping" session. Because radiation goes in so precisely, the patient has to be in the correct position every day. We have a lot of flexibility in terms of how the patient is positioned but we do need the patient to be in the same position every day. So, I always emphasize to my patients, "Make sure you're comfortable at the time of planning," if something is not working, if you are uncomfortable. We can change arm position. We can elevate the head if the person needs that. We can give different types of supports to make things comfortable. If a person is in a different position from day to day, there's not going to be reproducibility of the radiation. We need the patient to be in the correct position but we have enough modalities, enough devices, to help keep the patient in the position but also allow them to be comfortable.)
Melanie: Dr. Horvick, in just the last few minutes here, give us your best advice for people recently diagnosed with lung cancer, what you tell people every single day about the therapies they can expect.
Dr. Horvick: Well, cancer treatment has advanced dramatically in the course of the last 10 or 15 years. Radiation is much more precise, chemotherapy is better tolerated, there are newer treatments, as well and targeted therapies that are available for appropriate patients. As well, surgical techniques have improved significantly. With this, if the patient is diagnosed with cancer and they go to a center that has all of these modalities where the specialists work as a team to take care of the patient, where things are discussed in collaboration, in general, the treatment will be quite well tolerated and there is a lot that we can do to help patients and frequently cure patients with lung cancer.
Melanie: And now, tell us about your team at Lourdes Health System.
Dr. Horvick: Well, we have a dedicated team for lung cancer. We have excellent thoracic surgeons, medical oncologists, radiation oncologists, pathology, and diagnostic people. We get together constantly to discuss cases in detail so that we can all have the input and come up with the ideal treatment plan. There are national standards of care, we always follow the standards of care and discuss them in relation to the patient, but we also look at the patient as an individual. We involve social services, we involve pastoral care, and we have an excellent nurse navigator and navigation system to help the patients through the process. Being diagnosed with lung cancer is scary and you really need a team to take you through every step of care. At Lourdes, we have that team. It runs through the nurse navigators who are incredible at guiding the patient through the system and through social services, as I said pastoral care, and then the physician team. So, we offer top-quality care, state-of-the-art equipment, and have all modalities to take care of patients with all stages of lung cancer.
Melanie: Thank you so much. It's really great information, so important. Thank you for being with us. You're listening to Lourdes Health Talk, and for more information, you can go to lourdesnet.org. That's lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
