News and Information
Centerpoint Spring 2009 (PDF)
TOP Team Sets the Stage for Best Lung Cancer Treatment
One of the most important steps in securing a good outcome for lung cancer patients happens before treatment ever starts. Accurate determination of the extent of the tumor is crucial for planning the combination of radiation, surgery, or chemotherapy that will be most effective for a patient. The extent of tumor is known as the stage, based on standards that have been adopted worldwide. However, the process of accurately staging is not always straightforward. “Research shows there are widespread inaccuracies in the way that lung cancer patients are staged,” explained Dr. Frank Detterbeck, a thoracic surgeon at Yale Cancer Center. “In fact, recent data shows that better staging has a much greater impact on survival than access to cutting-edge treatments.” A patient who has been staged correctly is on the road to getting optimal treatment. Furthermore, Dr. Detterbeck said, a center that takes great care in staging is likely to maintain high standards throughout treatment, leading to better results.
Dr. Lynn Tanoue and Dr. Detterbeck, co-directors of the Yale Cancer Center Thoracic Oncology Program (TOP), are using the resources of the Cancer Center to raise the quality of staging for all lung cancer patients. Better staging does not always mean more tests for the patient. A variety of imaging technologies, needle biopsies, surgical procedures, and laboratory tests can be used to stage lung cancer. “Choosing the right test is an important step to achieve quick and efficient staging for the patient. Both ordering the right diagnostic tests and correctly interpreting the results require skill and good judgment,” said Dr. Tanoue.
In the Thoracic Oncology Program, a multidisciplinary team participates in staging every lung cancer case using evidence-based, standardized, and detailed protocols. “I can’t possibly know everything there is to know about lung cancer and that is why we work as a team,” Dr. Detterbeck explained. The team is comprised of specialists in medical oncology, nuclear medicine, pathology, pulmonology, radiation oncology, thoracic surgery, and diagnostic imaging, in addition to staff providing support in areas such as nutritional counseling and physical therapy. Each team member’s expertise contributes to developing an accurate diagnosis and staging of the disease and providing the best treatment to each patient.
TOP has invested in several newer technologies that provide less invasive options for diagnosis and staging. These are all part of the newly developed Thoracic Interventional Program. These procedures include advanced bronchoscopic techniques such as electromagnetic navigation, which is like a GPS system to locate small tumors, endobronchial ultrasound, endobronchial laser, and other therapeutic procedures. More extensive staging is available through minimally invasive surgical techniques, such as video assisted mediastinal lymphadenectomy. With all this experience and technology, it is no surprise that the Yale Cancer Center Thoracic Oncology Program has grown rapidly and now cares for more lung cancer patients than any other program in Connecticut.
Dr. Tanoue and Dr. Detterbeck are not only leading efforts to accurately stage patients at YCC, as authors of the chapters on staging in the Lung Cancer Guidelines published by the American College of Chest Physicians they helped “write the book” on accurate and efficient staging. They have published numerous other papers on the appropriate evaluation of patients with lung cancer and how the stage classification can help to predict the biology of an individual patient’s tumor. In addition, they are involved in efforts to improve quality of care of patients with lung cancer nationally. “It is clear that there are vast discrepancies in the staging process and many people are not getting quality care,” said Dr. Detterbeck. “If we are serious about improving outcomes for these patients, we have to address these issues.”
Most patients with lung cancer do not have access to a program as large or specialized as TOP. They may be under the care of excellent physicians and oncologists, but those doctors are often at a disadvantage because they are working in relative isolation without the judgment of a team of specialists whose primary focus is lung cancer. TOP is working hard to counter this problem and to share the team’s input and expertise with others. Their thoracic conference is open to any physician who wishes to discuss a case and the teleconferencing capabilities at Smilow Cancer Hospital at Yale-New Haven will make it easier for TOP physicians to collaborate with other physicians and review cases or participate in tumor boards at distant hospitals.
The major advantage of the Thoracic Oncology Program is that “it brings the whole team’s knowledge to bear on each patient,” said Dr. Detterbeck. “We need to extend this approach to other hospitals by developing an infrastructure and culture of collaboration. This really is an opportunity for all patients to benefit and for everyone to win.”