Nearly 50 years after the War on Cancer and two decades into a new century with targeted therapies, doctors have discovered a deceptively simple method of helping people with lung cancer live longer: Provide a team approach to treatment and copious doses of tender loving care.
For decades, lung cancer has been shrouded in dismal statistics and poor expectations driven mostly by late detection and advanced disease. The five-year survival rate for people with lung cancer in the United States is only 17 percent.
But patients treated at Stony Brook Cancer Center are living substantially longer than the national average — and not because of a newly approved medication or an experimental drug. These patients — all comers — are gaining added years of life because they are treated by a multidisciplinary team, doctors have found.
Stony Brook doctors are the first in the country to statistically demonstrate that a multidisciplinary approach to care can add years to the lives of patients treated for lung cancer. Their proof is based on more than a decade of data — patients treated from 2002 to 2016.
Dr. Thomas Bilfinger, director of the Lung Cancer Evaluation Center, a division of the cancer center, said the greater medical community had expressed “universal interest in deploying a multidisciplinary model” for lung cancer. But scientific documentation that proved a team approach imparts a longevity benefit was unavailable until now.
“At the end of the day, there is no one person in charge of the patient,” said Bilfinger, who founded the Lung Cancer Evaluation Center in 2000. “Here we have something that I would describe as a hub approach.”
In the hub are medical, surgical and radiation oncologists, pathologists, imaging specialists, pulmonary specialists, nurse practitioners, nutritionists and a patient navigator, the professional who serves as each patient’s go-to person. The navigator helps with insurance issues, doles out hugs and provides pats on the back as needed.
Such TLC goes a long way to allay fears and help patients look forward to a healthy outcome, Bilfinger and his colleagues said.
Hospitals nationwide rely on a standard treatment model for lung cancer, Bilfinger explained, which encompasses multiple services, such as surgical, radiation oncology, medical oncology and imaging, such as X-rays and CT scans. The responsibility of care, he underscored, typically falls on the patient with communication and coordination among doctors often becoming fragmented and delayed.
Centralizing care in a team approach, he said, eliminates delays and expedites treatment.
Bilfinger and his team of medical investigators analyzed more than 4,000 lung cancer patients treated over a 14-year period, comparing 1,956 patients participating in the Stony Brook multidisciplinary care model to 2,315 receiving traditional care.
For patients diagnosed with Stage 1 disease, the one-year survival rate is 92.4 percent with the Stony Brook multidisciplinary model, compared with 79.2 percent with standard care. The 13.2 percentage-point difference is statistically significant, Bilfinger said.
Likewise, the five-year survival rate for Stage 1 lung cancer patients treated under the Stony Brook team method is 52.5 percent, compared with 32.5 percent for standard care patients. More advanced forms of the cancer treated through the team approach have equally impressive higher survival rates.
After adjusting their data for biases, Bilfinger and his team found the multidisciplinary model had a 30 percent survival advantage over standard care, calculating survival out 10 years.
In Massapequa Park, Denise Gerschenson, a patient at the Lung Cancer Evaluation Center, said the program has given her a strong dose of hope. Her cancer was revealed in 2015 via the lung cancer screening program at Mercy Medical Center in Rockville Centre. She said she transferred to Stony Brook because of the treatment program.
Patients such as Gerschenson remain in the evaluation center’s program for five years, then loop back into Stony Brook’s screening program.
Gerschenson said she has no doubt how she developed lung cancer, having been a smoker for many years. She said she is grateful the tumor was detected at an early stage.
“I grew up in a house with smoking, so it was not that surprising that I would take it up as well,” the 64-year-old retiree said, noting both of her parents developed lung cancer. Although her father had the disease, he died of a heart condition. Her mother’s lung tumor was advanced by the time it was discovered, Gerschenson said.
“I had surgery and they removed about a third of my lung to make sure the area around it was clear, but I didn’t have chemo or radiation, so I guess finding it early was the key factor,” she said.
As for her future, Gerschenson described her outlook as positive and bright.
Bilfinger’s discovery that a team approach changes the survival odds arrives at a time when experts at the National Cancer Institute, the American Cancer Society and American Society of Clinical Oncology are encouraging cancer researchers to find ways to improve survival for lethal forms of cancer.
Lung cancer remains the leading cause of cancer death not only in the United States, but globally, according to the World Health Organization. It’s a disease fraught with recurrences, metastases, and as a result, high mortality. An ugly stigma has been cast over the cancer by an unyielding public convinced that patients bring the disease on themselves.
The new care model can help turn an important statistical corner for lung cancer — if it gains wider acceptance, the Stony Brook team hopes.
Barbara Nemesure, one of Bilfinger's collaborators, calls the care method a "one-stop shop" and attributes patients' emotional boost to the navigator who helps ease them into the care model.
“This is someone who will hold the patient’s hand if they need that or give them a hug or provide a shoulder to cry on,” Nemesure said.
The navigator also helps patients fill out the daunting paperwork that often accompanies a cancer diagnosis. Even though the navigator is on hand for TLC, no one team member is more prominent than the others, Nemesure said.
“I think it’s the combination of everything,” Nemesure said. “The fact that you as a patient have all these great minds in the room at the same time is really helpful.
“We talk about survival in this program. We like to talk to our patients about the fact that they are going to live, and they are not going to die.”
Other forms of cancer already have shown a survival benefit from the multidisciplinary approach.
Breast cancer programs at Memorial Sloan Kettering Cancer Center in Manhattan and M.D. Cancer Center in Houston were in the vanguard of advancing the model in the 1990s. The approach long since has been the norm.
Dr. Diane M. Simeone, director of the Pancreatic Cancer Center at NYU’s Perlmutter Cancer Center, told Newsday last fall that multidisciplinary care will help dramatically improve outcomes for patients with that malignancy, considered one of the most lethal cancers.