Developed with specialists’ expertise and advanced robotic surgery technology as its base, an interdisciplinary lung cancer screening and treatment program at Westchester Medical Center and MidHudson Regional Hospital of Westchester Medical Center is designed to change patient outcomes in the Hudson Valley.
One in 14 Americans faces a lung cancer diagnosis in his or her lifetime, according the American Cancer Society. With cancer remaining the second leading cause of death in the United States, lung cancer takes more lives on an annual basis — approximately 158,000 — than breast, colon and prostate cancers combined. Identifying the community’s need for greater lung cancer awareness to promote early diagnosis and timely treatment, Westchester Medical Center seeks to better serve patients in the region with the formation of a new lung cancer screening and treatment program that deploys the expertise of a multidisciplinary team and the latest innovations in robotic surgery. Also key to the program is its accessibility to all.
“Lung cancer is the leading cause of death among all cancers around the country, and Westchester Medical Center is building a high-quality program to diagnose and treat lung cancer with a multidisciplinary team focused on the goal of advancing patient care in the Hudson Valley.”
— Darren Rohan, MD, FACS, Chief of Surgical Oncology and Medical Director of Minimally Invasive and Robotic Thoracic Surgery, Westchester Medical Center and MidHudson Regional Hospital of Westchester Medical Center
“There is definitely a need for screening among all at-risk patients,” says Darren Rohan, MD, FACS, Chief of Surgical Oncology and Medical Director of Minimally Invasive and Robotic Thoracic Surgery at Westchester Medical Center and MidHudson Regional Hospital. “Access to care can be difficult without health insurance and even for those who have health insurance, so we want to build a program that takes care of patients regardless of their ability to pay.”
Lung Cancer Screenings
Since joining the Westchester Medical Center team last fall, Dr. Rohan, who is board certified in general and cardiothoracic surgery, has initiated a pilot program to provide lung cancer screenings for high-risk patients unable to pay for the low-dose CT scan.
(L–R) Francis Carroll, MD, FACS, a cardiothoracic and vascular surgeon at Westchester Medical Center, and Darren Rohan, MD, FACS, Chief of Surgical Oncology and Medical Director of Minimally Invasive and Robotic Thoracic Surgery at Westchester Medical Center and MidHudson Regional Hospital
“This is a first step in building our lung cancer screening program,” Dr. Rohan says. “It is a complete team effort of pulmonologists, radiologists, oncologists, radiation oncologists, surgeons and administration who work together to make this program a reality. We are all excited that Westchester Medical Center is providing these vital screenings for patients.”
High-risk patients most in need of screenings are those who are between the ages of 55 and 74, smoked at least a pack of cigarettes per day over a 30-year period and are either still smoking or have stopped smoking within the previous 15 years, according to the American Cancer Society. Screenings with the low-dose CT scan can identify cancerous nodules in the lungs in the early stages, despite a lack of symptoms.
A 2011 study published in the Journal of the American Medical Association comparing chest X-ray to CT scan for lung cancer screening found a 20 percent reduction in the mortality rate for lung cancer patients who had the CT, making the CT scan the standard of care for lung cancer screenings.
“Screenings are vitally important because patients may have no symptoms but are at high risk due to their past history of smoking,” Dr. Rohan explains. “Many studies around the country have looked at high-risk patients. Even if they quit smoking 10 years ago, they are still more likely to get lung cancer than those who never smoked.”
Of course, physicians are familiar with the most common symptoms associated with lung cancer: bone and chest pain; coughing up blood; hoarseness; persistent coughing; wheezing and shortness of breath; and unexplained weight loss. However, these symptoms may appear late in the disease process. Even the most cautious primary care provider may not see evidence for suspicion of lung cancer while the disease is in its early stages.
“High-risk patients often don’t have symptoms,” Dr. Rohan adds. “One of the main reasons lung cancer has such a high mortality rate is that by the time patients have symptoms, it has spread to the point that we cannot cure it. Being able to find it earlier, we can diagnose early-stage lung cancer and treat it more effectively.”
The implementation of Westchester Medical Center’s interdisciplinary lung cancer screening and treatment program can increase the number of screenings for high-risk patients in the region and lead to earlier diagnoses, providing Dr. Rohan and the team a greater opportunity to intervene and create more positive patient outcomes.
“A CT scan of the chest is really one of the best ways to see whether there is an abnormality,” Dr. Rohan says. “In order to make a diagnosis, we can perform a biopsy using a variety of modalities, such as CT-guided biopsy, a biopsy with bronchoscopy or endobronchial ultrasound, as well as a newer technique that uses navigational bronchoscopy. Navigational techniques utilize GPS to drive a catheter deeper in the lung with more precision for biopsy.”
Drs. Rohan and Carroll review images from a recent case.
After a patient receives a biopsy, the pathologist determines whether the tissue sample is benign or cancerous and either non-small cell or small-cell lung cancer. Small-cell lung cancer constitutes approximately 15 percent of lung cancer diagnoses and more readily spreads to other areas of the body, but may also respond to chemotherapy treatments. Non-small cell lung cancer accounts for the other 85 percent of lung cancer diagnoses.
“Treatment is dependent on the stage of the lung cancer,” says Dr. Rohan, who focuses primarily on early-stage diagnoses. “The main treatment for early-stage lung cancer is surgical removal.”
Dr. Carroll discusses with OR nurse Nancy Ford, RN, some of the minimally invasive surgical tools that will be used for an upcoming procedure.
Westchester Medical Center’s addition of the innovative da Vinci Xi robotic surgery system further advances lung cancer surgical treatments with its new overhead architecture allowing multi-quadrant surgery to be performed without repositioning the system. Dr. Rohan was the first surgeon in the United States to use the da Vinci Xi technology to perform a robotic lobectomy.
“One of the main reasons I came to Westchester Medical Center was to start a robotic thoracic surgery program,” Dr. Rohan says. “I have been performing the robotic lobectomy to treat lung cancer patients for three years, and we started doing that here last October, as soon as I arrived.”
Dr. Rohan at the controls of the da Vinci Si
Having practiced for more than 10 years as a cardiothoracic surgeon, Dr. Rohan has witnessed and taken part in the evolution of advancing surgical technologies and their enhancements for patient outcomes.
“When I trained, we performed few minimally invasive lung cancer surgeries and instead focused on open surgical techniques that involved spreading the ribs and cutting muscles,” Dr. Rohan recalls. “Patients had much longer recovery periods, so I began doing more minimally invasive, thoracoscopic lung surgeries to treat lung cancer and removing necessary portions of the lung with smaller incisions and muscle-sparing techniques. What we found was that patients had minimal blood loss during surgery, their pain was lessened and their hospital stays were shortened. Patients recovered more quickly and were able to undergo further cancer treatments when necessary.”
As Dr. Rohan developed his expertise in minimally invasive lung surgery, he added robotic surgery to his repertoire as a more effective and innovative to way to better serve lung cancer patients. The accuracy of the da Vinci machine allows surgeons to operate with only a few small incisions, while the visibility of the patient’s anatomy is enhanced via a three-dimensional, high-definition view with real-time imaging.
The da Vinci system can be used for a plethora of surgical treatments including lung surgery, and patients are prepared for surgery in the same manner as traditional surgery.
“Instead of being scrubbed in at the patient’s bedside, we insert small ports into the side of the chest, and then we deploy the robotic arms with a fully-trained surgical assistant beside the patient,” Dr. Rohan says. “Sitting at a console with a screen that provides a three-dimensional, magnified view of the patient’s chest, I control the robotic arms to perform the surgery. This virtually allows for the sensation of having my hands transported inside the patient’s body, so it truly magnifies my ability to perform highly complex surgeries.”
As the leading technology available, the da Vinci surgical system has been used in more than 1.5 million procedures worldwide. A study by the American Association for Thoracic Surgery published in 2012 on the efficacy of the robotic lobectomy tracked results on 325 patients who had the surgery for early-stage lung cancer. Five-year survival rates for the Stage 1 patients ranged from 88–91 percent. The study’s authors concluded that robotic lobectomy can be performed on early-stage lung cancer patients and achieve lower mortality rates.
“The da Vinci robot furthers my abilities to care for patients in a minimally invasive manner and perform a much more precise surgery,” Dr. Rohan says. “It enables me to treat more complicated cases, as well as sicker and older patients. We are at the forefront of this technology that is beginning to spread as one of the preferred approaches to treat lung cancer, and it’s available here for patients in the Hudson Valley.”
Westchester Medical Center’s interdisciplinary lung cancer screening and treatment program relies on a team approach by the many clinicians providing a continuum of care through screening, diagnosis and treatment.
“There is a true collaboration and coordination of care efforts from all the specialties involved in treating lung cancer in addition to our thoracic surgeons,” Dr. Rohan says.
One critical component of the physician collaboration is through multidisciplinary cancer conferences, where specialists can confer on individual patient cases to determine care plans.
“The cancer conference is divided into lung cancer and lung cancer screening conferences,” Dr. Rohan says. “Adding the screening aspect to the cancer conference takes it a step farther than most. We examine any abnormal findings in lung cancer screening results so we can discern and initiate the next steps for patients.”
Changing Lung Cancer Outcomes
The goal of Westchester Medical Center’s interdisciplinary lung cancer screening and treatment program focuses on reaching those high-risk patients in the community and providing them with screenings and early diagnosis so surgical treatments can be more effective. Although the program is in its early stages, Dr. Rohan recognizes its preliminary successes and continued advancements to better serve patients in the region.
Dr. Rohan discusses a robotic procedure with a patient.
“We’ve launched our pilot program for screenings, are employing navigational bronchoscopy for diagnosis, and have added robotic surgery techniques to speed recovery and change the focus back to treatment and cure,” Dr. Rohan says. “In a short amount of time, we have come a long way, and I am optimistic about the program’s continued growth.”
Recent studies of lung cancer screening have shown an increase in survival of as much as 20 percent compared to patients who didn’t get screened, according to Dr. Rohan.
“We’ve already been able to take care of a number of patients who would not have been candidates for traditional surgical treatments,” he says. “Performing surgery and removing their cancer, we were able to treat them more effectively and hopefully cure them.”
Dr. Rohan and the Westchester Medical Center team recognize the importance of reaching high-risk patients and making their new interdisciplinary lung cancer screening and treatment program readily accessible to its community physicians.
OR nurses and certified surgical technicians play an important role in any surgical procedure, including minimally invasive robotic procedures. (L–R) Nancy Ford, RN; Patty Bailey, RN; Melody Fiore, CST; Anastasia Balobanova, CST; Lissy Kaduthanam, RN; and Cathi Ventura, CST
“Clearly for lung cancer screening, it is those high-risk patients whom we are seeking, and we are available to any physician for consultation about a patient,” Dr. Rohan says. “Any patients who might have a lung nodule of unclear etiology or are high risk and asymptomatic — those are the patients who can benefit the most from our program.”
Westchester Medical Center’s ancillary staff can shepherd these patients into the program as quickly as possible for screenings.
“Our goal is to increase lung cancer screenings, and Medicare has approved lung cancer low-dose CT scan of the chest for high-risk patients,” Dr. Rohan says. “We want to raise community awareness and reach primary care physicians to make sure they have the information to counsel appropriate patients who are candidates.”
For more information about Westchester Medical Center’s lung cancer screening program, visit westchestermedicalcenter.com.