The Ochsner team in New Orleans is using the latest technology and coordination among physicians and departments to make lung cancer detection and treatment easier for patients in the region.
Last fall, Dr. Susan Gunn, an Ochsner pulmonary critical care specialist, became the first person in Louisiana to use a robotic bronchoscope to examine a patient’s lungs for possible cancer. Thanks to her leadership, Ochsner has since used the device more than 100 times.
The robotic bronchoscope can reach all areas of a patient’s lung while significantly reducing the risk of someone suffering a collapsed lung during the procedure.
“This technology allows us to make a thorough map of a patient’s airways and target nodules that may need to undergo a biopsy,” Dr. Gunn said. “We know that in general, the larger a spot is, the more likely it is than it could be malignant. We consider anything eight millimeters or larger to be actionable.”
If a nodule is determined or suspected to be malignant, Dr. Gunn said Ochsner has moved to a model of single-anesthesia events for treatment as much as possible.
“We have the skill set here at Ochsner to go after the nodule and diagnose it,” she said. “The pathologists are on hand to review it right away while the patient is under the same anesthesia. If it is determined to be cancer, our surgeons can perform a minimally invasive, robotic surgery to remove the cancer. In those situations, the patient goes to sleep worried if they have cancer and wakes up knowing that they have been treated.”
Dr. Brian Pettiford, Ochsner’s thoracic surgical oncologist, said the process allows patients to receive care more quickly and in a more focused manner.
“National guidelines recommending that patients receive definitive treatment within six weeks of finding a cancerous lung nodule,” Dr. Pettiford said. “Once a nodule is identified, they have to see a pulmonologist, then they are usually referred to an interventional radiologist who does a CT scan and perhaps a biopsy. If it is cancer, we have to evaluate the patient and see if they are a candidate for surgery. Imagine rolling all of that into one or two visits and the patient only has to be on the operating table once. It makes a huge difference for them.”
Dr. Gunn added that Ochsner is also unique in that Dr. Pettiford specializes in surgeries related to the lungs, rather than the heart. A second surgeon will join Pettiford in the future. Their specific training and expertise means that they have first-hand, in-depth knowledge of cancer and how it particularly affects the lungs.
“There are a lot of surgeons who are not necessarily cancer-specific or thoracic-specific,” Dr. Gunn said. “Sometimes you might have heart surgeons who perform cancer surgeries, but they might not see the volume of patients to give them that breadth of experience. We’re fortunate in that Dr. Pettiford understands cancer, the treatment process, as well as when it’s not appropriate to operate.”
The Ochsner team has seen and treated lung cancer patients from all ages and demographics. Dr. Gunn noted that new recommendations lung cancer screenings beginning at age 50 for those with significant risk factors, particularly a history of encourage smoking. However, both Dr. Gunn and Dr. Pettiford noted that most of the lung cancer patients that they treat are age 65 and older. They are also seeing lung cancer in non-smokers, some of whom have aggressive forms of cancer that often require chemotherapy but may also readily respond better to a relatively new treatment called immunotherapy.
“We like to catch patients before symptoms appear, so ideally they are identified by their doctor to qualify for a lung cancer screening CT scan,” Dr. Gunn said. “However, they may undergo an X-ray or CT scan for another reason, such as pain in the back, chest or belly. We’ve found a lot of cancers incidentally, meaning they were being seen for an unrelated issue before the cancer was discovered.”
The Ochsner team also recognizes that the prospect of cancer or a diagnosis is overwhelming for patients and their loved ones. To help them navigate the process, Dr. Pettiford said Ochsner has dedicated staff members and nurse navigators who answer all questions, from where to find the right offices in the sprawling Ochsner campus, to scheduling follow-up appointments and sharing resources available to them.
“We’re also proud that we have an oncologic psychiatry program with psychologists on hand to visit with patients and provide counseling and comfort,” he said. “We really help people overcome barriers. If patients come from afar, we have lodging available if they need to stay for an extended period and cannot get a hotel room. We talk to them about financial planning. We’re incorporating more meditation, nutrition management, yoga and acupuncture in our care plans. It’s all about providing the highest standard of care and as much support as we possibly can.”
For more information or to schedule an appointment, visit www.ochsner.org/cancer-care.