The City of Hope lung cancer team believes in second chances.
When a lung cancer patient recently arrived at City of Hope after being turned down for surgery at other hospitals because she was deemed a surgical risk, physicians took a fresh look at her case.
Yes, she was 72 years old - an immutable fact. But what could be changed were her other risks: poor lung function due to emphysema, and a harmful smoking habit.
The health professionals in the Lung Cancer Program believed that if a special “prehabilitation” program of exercise, oxygen therapy and medication could improve her respiratory health, and a smoking-cessation program could end her tobacco dependence, she would become healthy enough to successfully undergo cancer surgery.
And that is just what happened.
“Surgery has the highest likelihood of cure for lung cancer,” said Kemp Kernstine, M.D., Ph.D., director of the Lung Cancer Program and chief of the Division of Thoracic Surgery. “Not only has the team improved her likelihood for long-term survival, they have also improved her outlook on life.”
Such success stories are growing from the prehabilitation program at City of Hope.
The process starts at the Thursday chest conference, a meeting led by pulmonologist David Horak, M.D., where physicians gather to discuss the needs of thoracic patients.
Patients who may benefit from prehabilitation are then referred to pulmonologist Brian Tiep, M.D. Tiep not only is a City of Hope physician, but also is founder and medical director of the Respiratory Disease Management Institute in Pomona. A respected investigator, medical device inventor and innovator, Tiep conducts an intensive prehabilitation program alongside dedicated pulmonary nurse Mary Barnett, R.N.
Most lung cancer patients have other lung problems, such as COPD (chronic obstructive pulmonary disease), which consists of emphysema and chronic bronchitis. Many also still smoke. But Tiep and Barnett do not let those challenges sway them.
Besides helping patients to quit smoking, they also get them to exercise - primarily walking. “It’s actually not a fight to get them to exercise,” Tiep said. “They have heard it can help get them better.”
Part of the problem for such patients is their constant feeling of being out of breath - a product of lung hyperinflation, which limits their breathing. But exercise training helps ease that, Tiep explained.
During training, patients receive oxygen therapy, which helps improve their endurance and exercise capacity by about 38 percent, Tiep said. He and Barnett also teach a helpful technique for breathing - in through the nose and out through pursed lips - and provide bronchodilating medication (tiotropium bromide, or Spiriva) that improves breathing even further. The team even teaches coughing techniques to keep patients’ lungs clear, and instructs patients how to avoid triggers that can exacerbate lung problems and send patients to the emergency room.
In addition, physical and occupational therapists under Jennifer Brown, O.T.R., director of Rehabilitation Services, have begun seeing patients three times a week for customized strengthening exercises and walking. Joel Boyd, R.R.T., director of Respiratory Therapy, is a partner in the program, as well, and Kernstine noted that Glenda Hale, vice president for Diagnostic & Therapeutic Services, and James Miser, M.D., chief executive officer and chief medical officer, City of Hope National Medical Center, have been instrumental in supporting the effort.
Exercise appears to help patients accept their diagnoses and reduces the likelihood of depression, Kernstine said, and it may also improve tolerance of chemotherapy and radiation therapy.
Within two to four weeks of the prehabilitation program, most patients are well prepared to withstand the surgery.
That was the case for Kernstine’s recent patient, who underwent a robot-assisted right upper and right middle lobectomy to remove two masses. “She required nothing more than a Tylenol the first few days after surgery,” Kernstine said, and she went home on the third day after the procedure.
As Tiep puts it, lung patients are treatable. “A positive therapeutic approach to respiratory illness can be rewarding,” he said. “Patients can live a full life.”