Philippa Cheetham, MD: You’re working at Vanderbilt and you’re specializing in lung cancer. Dr. Martin also has an expertise in managing the palliative care issues. But many patients don’t have access to tertiary referral centers of excellence and academic centers that may not necessarily be as specialized as both of you. What’s the outlook for patients who may be diagnosed like Nance but managed in the local community, potentially not in areas that are so specialized in being able to offer not just the latest and greatest medical breakthroughs but the whole multidisciplinary team that you are so expertly able to offer patients at Vanderbilt?
Leora Horn, MD, MSc: So, I think it’s a lot harder especially to be a community oncologist today and to keep up with all the different drugs, diseases, and breakthroughs that are coming through. And I often think that my job is a lot easier because all I have to know about is what’s going on in lung cancer. But there are more treatments. So, for patients who can’t necessarily get to an academic medical center, there are so many more FDA-approved therapies and options for patients out in the community. And when patients come to see us for a second opinion, if we don’t put them on a clinical trial, I actually send them back to their doctor and let them know what FDA-approved therapies they can get closer to home. When you’re treating a patient, you’re treating a whole family, and sometimes it’s not easy for the whole family to take that day off of work to get to the cancer center. And so, we try to keep people at home in their communities getting treatments closer to home. But if we have something new or a clinical trial or something different to offer, those are the patients we recommend should stay here. Of course, there are patients who live in Nashville and so Vanderbilt becomes their center of choice. But for patients who are traveling two or three hours to come to us, we try and make things as easy for them at home as possible.
Philippa Cheetham, MD: Dr. Martin, Dr. Horn, I’m going to ask both of you, for patients who are watching this segment who may have been diagnosed with lung cancer themselves or have a loved one in this situation, you guys know what services should be offered to patients and what’s out there. But patients and their caregivers often don’t know what questions to ask or even what services are available. Are there any top tips or points that you could bring up to help patients and their caregivers ask the right questions about where to get the support they need with palliative care of diagnosis? How do you zone in to know this is the place that they need to go to, or these are the questions they should be asking, or even any specific resources that you may be able to offer? How do you help educate patients to get to the right center of excellence, the right doctor, the right palliative care team? Any words of wisdom for patients watching this segment?
Sara F. Martin, MD: Well, in terms of palliative care, I think you can just ask, “Do you have a palliative care team that I could see or be referred to if the time is right or if I feel like I need that?”
Philippa Cheetham, MD: And if we’re giving that kind of advice to ask for palliative care, what are the services that would make you think that patient is best plugged into palliative care?
Sara F. Martin, MD: Palliative care, again, is an additional layer for support for anyone trying to live with a serious or chronic illness, and there have been multiple studies now that have shown that in patients with advanced lung cancer in particular but in other serious illnesses, having earlier palliative care, patients actually feel and do better. So, I think for all patients and families, if you have palliative care available, it could be a useful resource to that patient and their family as they go through their treatment process. Palliative care is best provided in a team, so usually there’s a whole interdisciplinary team, not just myself seeing these patients—so a chaplain, a social worker, a nurse. There are resources within that clinic setting that can be provided that you might not otherwise access.
Philippa Cheetham, MD: And Nance has already mentioned how important it was for her son to have the support. A lot of the burden of cancer falls on the family, the caregivers, the loved ones. How do we bring them into the equation to make sure that they get the support that they need?
Sara F. Martin, MD: Right. Certainly, I would ask in your cancer center as well, and Dr. Horn can speak to this, but there are support groups that I think can be very helpful for family members. Most cancer centers likely have a social worker. If you don’t have palliative care available, which can be very helpful, there are resources in the community, including travel, lodging, medications, as well as support groups that might be available. Nashville is a big city, so we have a large Gilda's Club, which is a national cancer support group with a lot of resources and support for patients and caregivers as well.
Philippa Cheetham, MD: Before I come on to you, Dr. Horn, Nance, has your son been with you to most of your appointments?
Nance Neshanian: Yes.
Philippa Cheetham, MD: So, he’s very aware of all the results of tests and how you’re doing?
Nance Neshanian: Yes.
Philippa Cheetham, MD: And I guess that’s a huge support to you to have somebody there to support you.
Nance Neshanian: It really is, yes. Because several times, I’ve been a little sicker and he was there to recognize that I needed to go to the hospital, not for the cancer but for a couple of other things. I had a heart attack and had he not been there, I would have been dead.
Philippa Cheetham, MD: How are you doing now? What stage are you at now?