Evaluating Surgical Options With Decision-Making in Early-Stage Lung Cancer - Episode 2

‘Time is of the Essence’ in Decision-Making for Early-Stage Lung Cancer

As part of its “Speaking Out” video series, Dr. Peter Baik, on behalf of Cancer Treatment Centers of America, discussed the importance of timing and decision-making of treatment in early-stage lung cancer.


This video series featured, Dr. Peter Baik, who is a thoracic surgeon at Cancer Treatment Centers of America® (CTCA) in Phoenix and Chicago, and was moderated by Kristie L. Kahl.

Kahl: To start, why is it important for patients to have an active voice in their diagnosis and treatment options – especially when it comes to things like quality of life?

Baik: With lung cancer treatment, especially early-stage, the first thing that we think of is surgery; but now there's radiation, there's other new therapies coming up. So, quality of life, we have to take that into consideration. What do you like to do? Do you like to run the marathon and you can't do without running the marathon? Then surgery may not be the best option. (Another example is if you’re a long-time smoker and do not want to carry an oxygen bottle around), … I have to make sure that they understand the potential complications. (Another example is) being in the hospital for two to three days, sometimes five days (after surgery), you're going to be debilitated. Who's going to help you after surgery? (Will you) have the right support, both physically, emotionally and mentally? That's the other important thing that we have to consider is, can family support you? And so talking about all those things is paramount.

But, of course, the most important thing is for you to understand exactly what you're dealing with. You're told that you have stage 1 lung cancer, you have a small nodule, you could just take it out surgically. What does that mean? What I try to do is share images with a patient. I show them the (combined positive score [the ratio of the number of all PD-L1-expressing cells]). I may even draw it out for them or whatever I have to do so the patients can understand it's shared decision making.

Kahl: We’ve come a long way, but can you discuss some of the benefits to minimally invasive surgery?

Baik: (The difference between minimally invasive and invasive is) a big cut versus small cut. For example, there are a lot of patients who love to golf. And when you swing, the big back muscle, the wing muscles, your swings can be really affected. But if you do (minimally invasive surgery), you don't have to do all those things (with invasive surgery). For example, I had a patient who came in with a nodule that needed to be (removed) and they were planning on doing an open procedure. If he had the (open) procedure, he would not be able to go back to golf for at least six weeks. And it was kind of interesting, because I did the (minimally invasive surgery and he) got discharged the next day. Two weeks later, I saw him in clinic, he asked me, “Hey, when can I play golf?” And knowing him (personally), I asked him, “You haven't played yet?”

It's all about the pain and being able to recover. The wound heals (better) when it's smaller. If you have a big (wound), it's going to take longer; you've got big muscle groups that are cut and it has to heal, and it’s never actually going to be the same.

Kahl: How can patients learn more about what their surgical options are and what might be best for them?

Baik: So that's the good thing about Dr. Google, but you have to be careful to make sure that you go to reputable resources. There are sites that try to give you a lot of different options for surgery. But the most important thing is, if you have any doubts or questions, you could always ask for a second opinion. (When patient get a) second opinion, (it’s to help) if they don't understand (their options) or they just don't feel comfortable. It doesn't hurt me if patients don’t feel comfortable with me. That's fine. As long as the patient understands what are the options, the best options, and they get the best treatment. That's the most important thing. If they don't feel comfortable, it doesn't hurt my feelings. Why? Because with the patient, there has to be a trust, there has to be confidence. And all those things play (a role) when it comes to healing.

Kahl: What is your biggest piece of advice for a newly diagnosed patient with lung cancer weighing their treatment options?

Baik: The important thing is that you want to make sure that things are progressing. You don't want to wait two months, three months to get things done or getting the staging done. Anytime you have a lung nodule, and it's diagnosed as lung cancer, you have a chance for those microscopic cancer cells to (spread) somewhere else, because that's what they like to do. And once lung cancer (spreads) into the lymph nodes further away, or you have metastasis, your five-year survival decreases dramatically. And so you want to make sure that you get the proper treatments, workup, in an expeditious time. (Of note), it's not possible to get the stage tomorrow and then get the surgery. But if you have to wait a month for an appointment, another month for a procedure, then another month to see someone else, time is of the essence.

Transcription edited for clarity and conciseness.

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