NewYork-Presbyterian/Lawrence Hospital in Bronxville and Columbia University have organized a disease-focused, multidisciplinary approach that addresses lung cancer from every angle — from prevention and screening, through treatment and into survivorship.
Each year, lung cancer claims the lives of 9,000 New Yorkers. It is responsible for one of every four lives lost to cancer.
At NewYork-Presbyterian/Lawrence Hospital, the Lung Cancer Program and Thoracic Disease Management Team provide screening, diagnostics, intervention and ongoing support for patients with lung cancer. These services are offered in the comfort and convenience of a community-based setting. In addition, the relationship with the NCI-designated Herbert Irving Comprehensive Cancer Center at Columbia University offers patients access to promising clinical trials.
“We have assembled a comprehensive program of patient services tailored specifically to the short- and long-term needs of those with lung cancer,” says Stephanie Smith-Marrone, MD, a thoracic medical oncologist with NewYork-Presbyterian Medical Group/Westchester and NYP/Lawrence Hospital. “This combination of services is typically found only in large academic centers, and we offer all of these components in a community setting.
“It’s rare to see this, and I’ve been very impressed and glad to be a part of this developing program,” notes Dr. Smith-Marrone, who is also an Assistant Professor of Medicine at Columbia University Medical Center.
Using state-of-the-art imaging, the Lung Cancer Screening Program at NYP/Lawrence Hospital is available for patients at high risk for lung cancer. The hospital was among the first in Westchester County to begin offering low-dose CT scans for lung cancer using an advanced system that limits the amount of radiation needed to perform the test. Low-dose CT scans can detect cancer in early stages among certain high-risk patients, increasing their likelihood of survival, according to findings from the National Lung Screening Trial.
Stephanie Smith-Marrone, MD, a thoracic medical oncologist with NewYork-Presbyterian Medical Group/Westchester and NYP/Lawrence Hospital, explains the risks and benefits of different therapeutic options to a patient at NYP/Lawrence in Bronxville.
NYP/Lawrence Hospital is designated a Lung Cancer Screening Center by the American College of Radiology. The NYP/Lawrence Hospital Radiology Program offers on-site MRI and PET/CT scans, which may also be used to image and stage lung cancer.
Many of the patients referred for screening come from the practice of NewYork-Presbyterian Medical Group/Westchester’s Ralph Binder, MD, a pulmonary disease specialist and member of the Thoracic Disease Management Team at NYP/Lawrence who works closely with patients who have a variety of lung and breathing disorders.
Cancer Program Screening Navigator Ken Granholm, RN, helps ensure the right patients are screened for lung cancer. He coordinates with referring physicians and the NYP/Lawrence Hospital team to guide screened patients through the process, connecting them to the appropriate resources and ensuring follow-up care is provided. Because smoking is thought to be responsible for the majority of lung cancer cases, Granholm also provides information to physicians and the community about tobacco avoidance and smoking cessation.
Teamwork Guides Diagnostics, Treatment
“Identifying the problem is just the first step of patient care,” notes Stephen Reis, MD, an interventional radiologist at NYP/Lawrence Hospital and an Assistant Professor of Interventional Radiology at CUMC. “We offer low-dose CT lung cancer screenings with same-day consultations provided by diagnostic radiologists. That allows us to fast-track referrals for our patients to our pulmonary, oncology, interventional radiology or thoracic surgery programs, depending on the findings.”
Roy Oommen, MD, MBA, a thoracic surgeon with NewYork-Presbyterian Medical Group and NYP/Lawrence Hospital, specializes in minimally invasive lung and esophageal procedures at NYP/Lawrence’s cancer program.
The Thoracic Disease Management Team will promptly review screenings that indicate potential cancer and discuss cases in multidisciplinary tumor board meetings. The team includes fellowship-trained pulmonary disease specialist Dr. Binder, who, as a referring physician, frequently has a longstanding relationship with his patients. Also participating are interventional radiologists, medical and radiation oncologists, thoracic surgeons, and other supportive oncology professionals whose input is vital to the management of lung cancer patients. Complex cases may also be reviewed during thoracic case conferences at NewYork-Presbyterian/Columbia University Medical Center, benefiting from the additional input of experts at this academic center. Working collaboratively allows the team to coordinate appointments and expedite further tests if screenings come back positive.
“Imaging plays an important role in determining whether or not surgery is an appropriate treatment option for a patient who has lung cancer,” says Roy Oommen, MD, MBA, thoracic surgeon with NewYork-Presbyterian Medical Group and NYP/Lawrence Hospital. “It also allows us to plan the surgical approach and then evaluate the results of an operation. I work with the radiology team both before and after procedures with a detailed series of images, and collaborate closely with the medical and radiation oncology teams to ensure patients are receiving the most appropriate care for their particular case. Being part of the NYP/Lawrence Hospital Cancer Center Program makes that possible.”
Dr. Oommen, an Instructor in Surgery at CUMC, performs advanced diagnostic procedures, such as minimally invasive endobronchial ultrasound bronchoscopy (EBUS), which uses ultrasound imaging to guide biopsy tools safely through the mouth to the lungs without any external incisions. He also performs mediastinoscopy, a surgical diagnostic procedure. Both procedures are used to collect samples that are processed by the on-site NYP/Lawrence Hospital Pathology laboratory to help stage or potentially rule out cancer. This laboratory is accredited by the College of American Pathologists and is staffed by Columbia University pathologists.
When Surgery Is Indicated
Using the results of imaging, biopsies and other evaluations, the Thoracic Disease Management Team identifies the most appropriate course of intervention, and the team’s recommendations are discussed with the patient and family. For some patients, the treatment plan includes surgical resection of all or part of the affected lobe of the lung. Surgical removal of the tumor is often the best option for achieving a cure and is especially effective as part of a treatment plan in early-stage disease.
Stephen Reis, MD, an interventional radiologist at NYP/Lawrence Hospital and an Assistant Professor of Interventional Radiology at CUMC, works alongside Viris Edwards, special procedures technologist, to perform a therapeutic intervention on a lung cancer patient.
“I work closely with my colleagues to determine when surgical intervention is most appropriate for lung cancer patients,” Dr. Oommen says. “Considerations include tumor size and location, as well as the particular patient’s health, comorbidities and ability to tolerate the surgery, and ultimately, the patient’s decision.”
Dr. Oommen performs surgical resection of lung cancer using minimally invasive options and intraoperative image guidance. This technique, laparoscopic video-assisted thoracic surgery (VATS), allows him to access the lungs using small incisions and without spreading the ribs.
During these procedures, Dr. Oommen advances the scope through the ribcage to the lungs. The video feed helps him navigate the delicate blood vessel structures of the chest and lungs. The state-of-the-art operating rooms opening this fall at NYP/Lawrence Hospital, where Dr. Oommen works, are equipped with high-definition monitors, giving him the best possible setting to help patients who require surgical intervention for lung cancer.
For those who undergo minimally invasive surgery, hospital stays are brief — typically just a few days. Bleeding and pain are minimized and recovery is speedy.
More traditional, open lung cancer surgery may be the better option for patients whose tumors are not accessible using minimally invasive techniques such as VATS or whose tumors are too large to remove using the small incisions made during laparoscopic procedures. Here, too, Dr. Oommen has the experience, technology and team necessary to optimize patient outcomes. Throughout the pre- and postoperative process, Dr. Binder and the pulmonary team remain integral in the care of the patient.
“He’s instrumental in screening and being a strong advocate for patients,” Dr. Oommen says. “He wears many hats and capably manages a wide range of responsibilities.”
Minimally Invasive, Image-guided Interventional Oncology
Patients for whom tumor resection is not optimal may benefit from interventional radiology procedures, such as cryoablation or microwave ablation, offered by Dr. Reis. These procedures may be performed to provide minimally invasive, curative treatment of small tumors or to alleviate symptoms of larger tumors. They may also be appropriate when a patient’s physical condition makes a surgical approach less desirable.
Tackling a patient’s treatment plan at NewYork-Presbyterian/Lawrence Hospital are thoracic surgeon Dr. Oommen, thoracic medical oncologist Dr. Smith-Marrone and Henry J. Lee, MD, PhD, Director of Radiation Oncology at NYP/Lawrence.
During cryoablation, a cryoprobe applies liquid argon gas to a tumor to freeze it, with the goal of destroying cancer cells and their ability to reproduce. Microwave ablation has the same goal, though it is achieved by exposing tumors to intense energy, heating and destroying cancer cells using electromagnetic waves.
Dr. Reis performs both procedures using intraoperative CT imaging to carefully guide the tools necessary to perform the intervention. Additional imaging monitors the effectiveness of such therapies, which may be repeated if necessary.
A Specialized Collaborative Approach
The treatment of lung cancer at NYP/Lawrence Hospital includes radiation therapy as well as medications such as traditional chemotherapy, genetically targeted drugs and newer immunotherapy agents. Access to some of the latest clinical trials in lung cancer is available through the academic partnership with NYP/Columbia University Medical Center in Manhattan.
Ralph Binder, MD, a member of NewYork-Presbyterian Medical Group/Westchester, is one of the members of the Lung Cancer Disease Management team at NYP/Lawrence.
“Today, traditional chemotherapy is only one method of lung cancer treatment. In the past decade, there have been tremendous advances in lung cancer research,” notes Dr. Smith-Marrone. “We now have drugs which target specific mutations in the cancer cells’ DNA and lead to better outcomes for patients, with improved quality of life.”
The affiliation between the Pathology laboratories at NYP/Lawrence and Columbia allows seamless access to testing tissue samples from lung cancer patients for over 400 genes. Depending on those results, Dr. Smith-Marrone can develop personalized treatment plans.
“Likewise, immunotherapy has revolutionized the way we approach lung cancer treatment,” she says. FDA-approved immunotherapy drugs for lung cancer are offered in the Hospital’s infusion room, and fast-track access to new clinical trial options at Columbia is available for patients who may be eligible.
“This is an exciting time for lung cancer research and patient care,” Dr. Smith-Marrone adds. “At NYP/Lawrence, we have the advantage of offering a comprehensive array of sophisticated treatment options within a personalized setting. When patients walk in, they know the team at the desk, and the nurses know them and their stories. And yet, we can offer extremely innovative approaches to lung cancer with a program designed specifically to meet their needs before, during and after treatment.”
Among the top priorities of the new collaboration between NYP/Lawrence and Columbia University Medical Center is bringing radiation therapy to lower Westchester.
“This is a huge benefit to our community because most lung cancer patients require radiation as part of their initial therapy,” says Henry J. Lee, MD, PhD, Director of Radiation Oncology at NYP/Lawrence. “In the past, they all had to travel outside our community to receive weeks of radiation therapy.
“Our top-of-the-line linac system and PET/CT simulator are the newest in the region. They incorporate all the advanced technologies available at Columbia University as well as introducing technologies in the NYP system that are being made available first in Bronxville,” adds Dr. Lee, who is also an Assistant Professor of Radiation Oncology at CUMC. Patients can finally undergo technically complex procedures such as stereotactic radiosurgery that can cure a lung cancer as quickly as a single treatment. “Patients understand the value of a close collaboration between their entire team of oncologists (radiation, surgical, medical and radiological oncologists) and the importance of access to the very best of each type of therapy. And they’re right in feeling that it’s the hallmark of a true cancer center — that is finally coming to lower Westchester.”
The NYP/Lawrence program includes access to a dedicated inpatient oncology unit staffed by an oncology nursing team that understands the needs of cancer patients who require short-term supportive care and management of treatment side effects.
Caring for the Whole Patient
Throughout the screening, diagnosis, treatment and recovery process, specialized cancer nurse navigators assist lung cancer patients. Nurse navigators ensure each aspect of care is clear, answer questions that patients or their loved ones may have, and provide a compassionate touchstone during every step of patients’ care journeys.
The Bronxville hospital offers a comprehensive lung cancer screening program. Gregory T. Sica, MD, Medical Director of Radiology at NYP/Lawrence and Associate Professor of Radiology at Columbia University Medical Center, and Ken Granholm, RN, Screening Navigator, discuss a patient in the screening program.
The NYP/Lawrence Hospital cancer program’s supportive oncology team also includes a full-time social worker, nurse practitioners, a pain and palliative care specialist, dietary and nutritional support, as well as pulmonary rehabilitation. The cancer program is fortunate to have close ties to Jansen Hospice and Palliative Care as well as other community cancer services to assist patients in their own homes.
“Recent research shows that the early use of palliative medicine in the care of patients with lung cancer can actually help them live longer,” Dr. Smith-Marrone says. “That highlights the fact that quality of life is vital to survivorship. Palliative care is not just for patients who are near the end of their lives.”
Life after Lung Cancer
Thanks to the collaborative approach, innovation and dedication of the NYP/Lawrence Hospital team, lung cancer patients can live long, healthy lives. Even with a clean bill of health, however, the aftermath of cancer can drastically affect a person’s life.
With guidance from Dr. Binder, a board-certified pulmonologist, Tina Bellino, CPFT, performs a pulmonary function test on a patient at Dr. Binder’s Eastchester office.
To assist with this, NYP/Lawrence Hospital offers a Cancer Survivorship Program, which includes clinical assessments and post-treatment support group meetings where providers, social workers, spiritual advisers and complementary care providers speak about the physical and emotional concerns of former cancer patients.
“Recovery from lung cancer is an ongoing process,” Dr. Smith-Marrone says. “We understand that follow-up care and access to appropriate services are an essential part of that.”
To learn more about cancer care at NYP/Lawrence Hospital, visit http://www.nyp.org/lawrencecancer/.