Dr. Leora Horn and Chris Draft remark on types of risk factors, aside from smoking, that potentially play a role in lung cancer, and remark on considerations for connecting patients to appropriate healthcare professionals when monitoring and managing the disease.
PUBLISHED November 06, 2017
Philippa Cheetham, MD: We’ve heard a lot, already, about the biology of these tumors. What are your thoughts now that you know that the outcome still is not going to be good no matter what you do? That some patients do get very aggressive cancers despite prevention strategies, despite early detection, and despite the best treatment in the best center.
Chris Draft: If you say it like that, it sounds like prevention is not good. I say, “My wife took care of herself. She took care of her body.” Absolutely, not smoking is a good thing. But that doesn’t mean that you’re not going to get lung cancer. But that would be great as it relates to prevention. Taking care of yourself is another point. We know obesity, right with smoking, right now, is one of the biggest indicators of smoking. So, exercising, eating better—all of these things are going to help in terms of prevention and giving you the best chance to not get cancer. But it doesn’t mean you’re not going to get it.
Philippa Cheetham, MD: Now, I know that you’re going to come on and describe a little bit more about the specifics of Keasha’s story. Was she treated in a center of academic excellence?
Chris Draft: She was treated at Emory University in Atlanta.
Philippa Cheetham, MD: So, she was treated by experts in lung cancer?
Chris Draft: Yes.
Philippa Cheetham, MD: When you talk to patients about advocacy, how important do you think it is to get to the right doctors at the right time? Do you talk about that as part of your message?
Chris Draft: Absolutely. It’s important that they’re able to get to the right doctors. It’s important to ensure that for whatever is the top-of-the-line treatment, that people can get to that. My wife got her mutation tests. She got her tumor tested. She did that. She was negative for the mutations that would have allowed her to have a targeted therapy. She was tested for all of those things, but she really just didn’t respond. Now, that doesn’t mean that it’s not going to work for somebody else. It doesn’t mean that somebody else shouldn’t do it. It’s just that everybody is not going to respond to it.
Philippa Cheetham, MD: We’re going to come back to talk about the initiatives of Team Draft and what your protocol is to get the message out to people. Dr. Horn, we’ve heard an amazing story of passion, of energy to give back to educate people in the community about lung cancer. It doesn’t necessarily have to only apply to older patients with a smoking history, who may or may not have been screened. How do you feel about the whole message that Chris is trying to get across? As a medical oncologist, you’ve got somebody here who is a huge advocate. What’s your thoughts on all this?
Leora Horn, MD, MSc: I think it’s a really important message, and I think that one of the things that he stressed is, it’s not about prevention. The more we just focus on prevention, we’re going to have that stigma associated with lung cancer. Lung cancer is not just a disease of smokers and, quite frankly, even if you smoked, it’s not like you deserve to get lung cancer. That’s like saying a woman who takes hormone replacement therapy deserves to get breast cancer. No one deserves to get cancer. It is a devastating disease. We need to think about it and get the message out there—that it really can affect everybody. I have patients from age 18 to 94 in my clinic. Cancer doesn’t know race, it doesn’t know ethnicity, it doesn’t know gender, and it doesn’t know how much money you make. It really just devastates whoever gets that disease. The more that we can get that message out there (to advocate for lung cancer), the more money that we can get for research for lung cancer. For every dollar breast cancer gets, lung cancer gets 20 cents. That’s not enough for the number 1 cancer killer in the United States. We need more research. We need more advocacy. We need as much passion as we can get out there in the community to help all these patients and families, and to help us make breakthroughs in science.
Philippa Cheetham, MD: We’ve been hearing about what Chris is doing through Team Draft. Patients that come to you, once they get to you, are already channeled into getting the right care and getting the most up-to-date treatment and analysis of their tumor with molecular testing. How can you, as a medical oncologist specializing in lung cancer, use Chris’s passion, energy, and message to get the right people from outside of your institution to people like you that can give patients the best possible chance to have good outcomes with their disease?
Leora Horn, MD, MSc: I think an important part of it is getting the message out into the community. A year ago, a study was presented at a meeting that showed that 50 percent of patients are still not being tested for the basic mutations. We have oral targeted therapies available that can improve survival and improve quality of life. So, it’s not only getting the message out to the oncologist in the community. It’s getting the message out to the patients, asking the right questions, and using resources to get to the right centers where we can help physicians out in the community think about, “What’s the best way to treat this patient to give them their best chance of survival?”
Philippa Cheetham, MD: Before we bring on Carly Ornstein to talk a little bit more about this whole situation with lung cancer, we’ve already heard that a lot of patients can get lung cancer who have no smoking history at all. Are there other issues that we should be looking at in the environment? If it’s not smoking, what is it? Is lung cancer becoming more common, or is it that we’re just getting better at detecting it?
Leora Horn, MD, MSc: The incidence of lung cancer isn’t necessarily rising, but the incidence of never-smokers with lung cancer is going up. We recently published data with data of Dr. Joan Schiller’s group at the University of Texas Southwestern Medical Center. It definitely is our environment. Radon is one of the most common causes of lung cancer in never-smokers. I often will ask my patients, “Have you tested your house for radon?” We actually recently bought our house and found out the radon level was high. We made them treat it before we moved in.
Philippa Cheetham, MD: Wow.
Leora Horn, MD, MSc: The environment that we live in, look at China as an example, the incidence of lung cancer, there, continues to go up. It definitely has to do with the environment and diet. We don’t know all of the causes of cancer, but the healthier we can be, the better our chances are.
Philippa Cheetham, MD: When you diagnose a patient with lung cancer and they have no smoking history at all, are they shocked by that?
Leora Horn, MD, MSc: They are shocked. We go over all of the different risk factors that could have caused lung cancer. But whether they’ve smoked or not, it’s a devastating diagnosis. I often hear people say, “I had my first kid and I quit smoking.” They’re equally shocked.