Approaching Stage IV Lung Cancer - Episode 4
Philippa Cheetham, MD: Dr. Martin, I’m going to bring you in here. Nance’s already told us that she was diagnosed with stage 4 cancer of the lung, and yet despite having a lesion that had spread from the lung to the spine, she was out on the golf course totally unaware that she had a spinal lesion, no symptoms at all. We often hear about patients who had lung cancer years ago who had severe weight loss and chronic cough, sometimes even coughing up blood. How difficult is it to get a patient to understand that they have a serious disease and the fact that it’s quite advanced and having conversations about advanced cancer when you have absolutely no symptoms whatsoever?
Sara F. Martin, MD: Well, I think it’s probably not terribly difficult to get patients to understand that. Especially in today’s medical world, you can show them the imaging so they can see what you’re seeing. And in general, patients hear the word “cancer” and regardless of whether they have symptoms or not, that does affect their being and how they think about things. So, just like Nance wanted to pursue treatment, I think most patients, once they hear that word, want to know what the next steps are for their treatment to hopefully have a good outcome like Nance had.
Philippa Cheetham, MD: You specialize in palliative care. How common is it for somebody to present like this, with a secondary lesion, and to have no symptoms? Is that a fairly common situation?
Sara F. Martin, MD: I would defer to Dr. Horn on that, but I don’t know that that’s necessarily terribly common for them to present with no symptoms.
Leora Horn, MD, MSc: Most patients will have some symptoms. A lesion in the spine, as we mentioned, could cause back pain or spot in the liver can often lead to fatigue, nausea, and weight loss. So, it really depends on where that other cancer may be.
Philippa Cheetham, MD: And when you meet a patient like Nance, there’s obviously a lot of issues to discuss with the shock of initial diagnosis and many potential treatment options of both the primary lesion and secondary lesions. Just give us some idea about how an initial conversation would go when you meet somebody like Nance? What are the kind of issues that you discuss with the patient?
Sara F. Martin, MD: So, normally, we talk about what palliative care actually is. That’s a relatively new term for most patients, family, and some medical providers as well. We’ll go through what those words actually mean and what they mean in the context of their care. And then in an initial consultation, depending on how the patient is doing, we spend a lot of time talking about them, what’s important to them, what do they like to do, what do we need to know about them to make their care tailored to them to ensure that we’re honoring their values, and what’s important to them as we go through the treatment process.
Philippa Cheetham, MD: Many patients have heard the words “palliative care,” which often for many implies that this is not a curative disease, that it may involve further treatments in controlling symptoms but not necessarily cure. When patients hear the words “palliative care,” is that a frightening concept to patients that their disease is probably not curable? And is that what it means?
Sara F. Martin, MD: I’ll define it for you and maybe that will help, but palliative care is specialized medical care living with a serious illness. That’s the simplest definition. And the focus of care is to help relieve symptoms, pain, and stress of living with a serious illness and hopefully increase the quality of life for the patient and the family. So, you heard me say serious illness quite a bit. Palliative care does not imply end-of-life care. We care for patients who will hopefully be cured or who have just a chronic medical condition and not just a terminal medical condition.
Philippa Cheetham, MD: And who refers patients to you, is it from the hospital, is it from experts like Dr. Horn? You actually work in the community as well.
Sara F. Martin, MD: Yes. We get referrals, and I can only speak to Vanderbilt in particular, from all specialties. So, we have a team in the hospital and we get referrals from inpatient medical physicians there. They actually work in the cancer clinic, so we get referrals from cancer doctors in the cancer clinic, including Dr. Horn. And then we have our own free-standing palliative care clinic as well and get referrals from the community physicians.
Philippa Cheetham, MD: So, people are fleeing into your services from many different avenues.
Sara F. Martin, MD: Correct.
Transcript Edited for Clarity