Darrin Godin: Welcome back to Talking Hope. I'm your host, Darrin Godin. Today I'm speaking with Dr. Binh Trinh. Dr. Trinh is an accomplished thoracic surgeon whose extensive expertise includes minimally invasive surgery, robotic approaches, lung cancer treatment, lung transplantation, airway and esophageal conditions, and complex thoracic diseases. His research interests include lung cancer, esophageal cancer, mesothelioma, and surgery research. Dr. Trinh practices at City of Hope Orange County Lennar Foundation Cancer Center, located on our 72-acre academic cancer campus in Irvine.
Well, welcome to Talking Hope, Dr. Trinh. We're so glad to have you on the show today. I've been looking forward to having this conversation. Thank you for making time for us.
Binh Trinh: Yes, of course. Hello to you and your audience, Darrin. I'm really happy to be here. And I started about four months ago and it's pretty exciting at the new hospital.
Darrin Godin: It is an exciting time for sure. And I'd like to make sure our audience gets to know our doctors a little bit. So I thought we could start with a question just asking you what drew you or called you to become a physician, and how did you make that decision?
Binh Trinh: I'm a late bloomer, I would say. My family members were in the healthcare and I've always liked the sciences. I built a volcano when I was a kid. I loved the sciences. I was chemistry and math, all that stuff. So it was kind of a natural transition and it was people that I run into. I just think you're affected by people that you meet. And so it just so happens that there were people in the medical field and that drove me there. And the more I found out about it, the more I liked it and it just went from there.
Darrin Godin: I know you did your fellowship at the VA in San Francisco serving veterans. What did you learn about yourself from that experience, and how did it shape the way that you care for patients today?
Binh Trinh: Yeah, I'm from Southern California, so it drove me to come back. So I did a lot of my schoolings at USC, my general surgery, and then I did my fellowship at UCSF. And my first job was actually at UCSF and the VA. It was just one of those things, they needed somebody who was in thoracic surgery. The VA system is kind of a tremendous system to be honest with you. And veterans, a unique population, a lot of men obviously, but a lot of men with real problems. Smoking's very prevalent, heart disease, diabetes, all have basically a very homogeneous group of patients with real problems. And along with that, they have heart disease, lung cancer, and vascular disease. So it was a really good opportunity. And because it's part of the government, there were programs out there designed to a lung cancer screening. And so through that, I was able to learn a lot.
And we actually did our first robotic lung resection at the VA about 10 years ago. And I was part of that. I was really proud and I was just able to get me in touch with pulmonologists and oncologists who were in the field as well.
Darrin Godin: So talk to us about why did you choose to specialize in lung cancer?
Binh Trinh: Yeah, this is dating back. When I was in LA during my training at the time, lung cancer is very prevalent, as you know. A quarter of a million Americans every year have lung cancer, and the vast majority of Americans actually are presenting late, so we can't help them. At the time, there was no screening. And if you go outside of the United States, multiply that number by 10. So that's a lot of people with lung cancer, so 250,000 people every year. And still with lung cancer screening today, we only screen I think 10, 15%. And Southern California is no different. We're actually pretty bad at screening. And screening is completely paid for by your insurance, by the government.
So people should be screening. The data is pretty good, but that was the thing that got me interested. I'm like, "Hey, whoa, there's going to be a lot. This is a big problem. Lung cancer, it's a big disease. It's a major killer, more so than any other disease combined, still so today." So I was like, "This is a really unique opportunity to go in something that's pretty exciting." And I'm glad I did. We can go more into that. But yeah, that was the major rationale for me wanting to go into thoracic surgery.
Darrin Godin: Thank you. So what is it about thoracic surgery that you find most professionally fulfilling?
Binh Trinh: It's high risk, high rewards. It's just exciting. It's cool, but you're able to take care of people who are really sick. I just found it's almost instantaneously gratifying. You know when you're helping somebody and you know when you're not doing something wrong. And I just found that, I mean, it's definitely stressful for sure, but I just love what I do. And just seeing people do well after surgery is gratifying. And the other thing is that surgery has really changed over the last 20 years. It used to be people were like, "I have my chest open, I can't breathe, I'll be incapacitated." That's not true whatsoever. We've gone so, so far to the point where it's almost an outpatient procedure. I mean, it's still a major surgery, there's risk involved, but we've gotten so good and there's a lot of technology involved and multidisciplinary approach, and there's a lot of new opportunities on the horizon that's still growing.
And right now we're at a very exponential growth really on our abilities. And so I don't see it stopping anytime soon. It's very, very exciting and we're just able to offer this and patient are, I think, reaping the rewards as well.
Darrin Godin: Say more about that. Why have we seen such a change in the past 20 years? Is it new technology? Is it new ways of doing surgery? Say more.
Binh Trinh: Yeah, I think we understand oncology a lot better. It's not just smoking, but we understand the genetics behind lung cancer. We are able to identify targeted lesions that are amendable to pills and non-chemotherapy drugs that can actually fight the cancer. These have side effects, but the side effects profile are much, much less. So that's number one.
Number two, we're able to offer medical therapy and surgical therapy combined along with other disciplines like radiation oncology, local therapies. So there's a lot of people involved and together we're able to treat people with really advanced cancer. So it's no longer a situation where if you have advanced cancer, that's it. I've actually met somebody today. She's very young, in her 40s, not a smoker, and stage four lung cancer. And she had these things that I just talked about. She had the EGFR mutation, Stage IV, but she's actually, she's working, she's on maintenance medication and we're talking about surgery for her to remove the residual spots.
But if we look back at her original scans, it was everywhere. And I'm not only seeing it for lung cancer, I'm seeing it for colorectal cancer. I saw a patient last week and she had innumerable liver metastasis. And I was looking at her, wow, that was two years ago, but now you're here and she's doing good. She's active and again, really young. So that's the paradigm change.
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Binh Trinh: Again, really young. So that's the paradigm change. So that's number two. Number three is that the surgery has gotten a lot better. We've gone from an open incision decades ago to a small incision with [inaudible 00:09:16] by bedside. And we moved towards robotic approach where the incisions are multiple but smaller. And then now we're moving towards a single incision. So traditionally incisions are made to operate on someone with lung cancer or other surgeries in the chest or other cancer in the chest. You have to go between the ribs. And there are a lot of nerves in their ribs, that hurts. No matter how big the incisions are, they hurt. Yes, your recovery is much, much faster, but it hurts still. It's self-limited, but it's still a problem. So we're moving away from that slowly. And I think there's very recent, very exciting data showing that when we try to operate outside the chest, outside the rib cage, that we're able to do just a good enough job, but the pain is much better.
Potentially cosmetic may also be better as well. So that's really exciting. The technology has really helped us. And the other thing is that we can get them out really quick. I did a case on Tuesday, she had a 10 centimeter mass, and I took it out, and she went home the next day. So there's a lot of excitement to be had.
Darrin Godin: Yeah. Yeah, I could see that. And as you talk about those different things, I have many different questions now I want to go down. So let's start with this one. You mentioned the younger patient. We all know that unfortunately that is becoming more of a trend. We're seeing what we've been calling the younger face of cancer show up in our clinic. So sounds like you're seeing that as well. Are there other trends you're seeing in lung cancer specifically as well?
Binh Trinh: Yeah. So not just younger patient, we're able to offer treatment to a more diverse patient population. So younger and also much older and much older with other comorbidities because we're able to do it with less side effects. And come with less side effects, they recover quicker, and they can get other treatments for other issues. So that's the trend. The complication that we used to see or the adverse effects that we used to see for lung cancer surgery like atrial fibrillation, bleeding, arrhythmias, pain, recovery, that's all gone down. It's significantly down to the point that I'm barely doing anything. We're not checking labs after surgery. We're hardly ever checking x-rays. Once the surgery's done, we can ascertain if there's an issue within about six hours. And then all we ask them to do is just get on their feet. They need to walk. Walking help prevents clots, pneumonias.
And once they can walk, and they're eating almost right away, so that's how we know, and then they go home. So we're not doing very much after the surgery, you're just doing normal things after surgery.
Darrin Godin: Wow. What about smoking? Often, people just associate lung cancer is because people smoke. That's not necessarily true. What are you seeing in your clinics and the patients that you're treating?
Binh Trinh: Yeah, no, they're active smokers for sure. And we need to do a better job screening for smokers, I think, we're just not good enough. So we need to screen better. It's just because oftentimes the screeners are not really us, they're the frontline primary medical care, family practitioner. But there are other risk factors like radon exposure, your environmental exposures. If you have prior lung disease like interstitial lung disease, that can be a problem. Obviously, family history is a major thing. Non-smoking, of Asian descent, or just non-smoking in general, there's more a higher prevalence of them having these special mutations that can be amenable to these drugs. We're [inaudible 00:13:35] out more and more every year. And people with other cancers that are not lung cancer can also be at risk for lung cancer, like people with head and neck cancers or maybe breast cancer. They can be at risk for lung cancer as well.
I'm treating someone right now who was actually diagnosed with breast cancer, and that's how she got diagnosed, but she got scanned and she was also diagnosed with lung cancer at the same time. So it's just vigilance and yeah, no, for sure. It's continue to surprise us.
Darrin Godin: One of the other things you mentioned earlier is how things have changed over the last decades. Our understanding. I think I heard you say our understanding of the disease and the progression and so forth, which makes me think of research. So can you talk about some of the research that you've been involved in and why it's important in surgical oncology, and specifically maybe even to lung cancer?
Binh Trinh: Yeah, no, I think that's why the City of Hope is really great because I came from a big hospital system, but City of Hope just works on cancer. And so with that, it's very streamlined. I think there's a lot of benefit to that. From a research perspective, there's two things that I'm interested in. One is, I'm really interested in getting patients through the process fast, as fast as possible, as safe as possible. They come in with a problem, and they don't come in with step A. It doesn't happen like that. It's not A, B, C, D. It's not synchronous. The way the patient come to you is asynchronous, meaning they could be stage one, they could be stage four, they can be stage three. And I'm glad I'm in my position because I'm interfacing with oncology, radio oncology, GI, pulmonologist. So it's great for me because I can actually deliver, I can point them in the right direction.
So I'm actually a great initial starting point. I'll just tell them, look, you're not ready for surgery, but here's the plan. And so because of that, I want to go through that process as quickly as possible. And so how you do that? You do that because we have minimally invasive surgery that's really expanding. We can get them through the surgery much quicker. The chest tube is a problem still, and that holds them in the hospital. And I think there are ways of getting chest tubes out faster and earlier, had some ideas on my collaboration with other people, but the chest tube [inaudible 00:16:22] in the hospital.
Sometimes we're not sure it's cancer, you have a nodule in the lung. And so there are ways of figuring out if this is a high degree chance of having a cancer. Traditionally, we want to know what we're getting into. So you need a biopsy, so like a pathologic biopsy. And so without that, many physicians won't send a patient until they know that, but that process takes a long time. That's an Achilles heel of lung cancer because it can take months. I kid you not, it can take months. I've seen people took six months, and then the cancer can actually progress. So we really want to shorten that period. And so I think that's a nice area of research that I want to be involved in.
There's going to be a day, I think, that we don't require a pathologic diagnosis. We're already doing that, but you can be wrong a fraction of the time, like 10% of the time. You don't want to be wrong most of the time, but there'll come a day, I think, the technology is good enough, probably imaging or molecular imaging, where we can say with a high degree of certainty that this is a cancer without putting a needle into a tumor. So the standard of care is still requiring a pathologic diagnosis. You got to get tissue.
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Binh Trinh: ...but I think there'll come a time where we can actually, as long as the cancer's early, there'll come a time where we can actually proceed without absolutely needing a diagnosis like that.
Darrin Godin: You're new to our organization, but we are just celebrating that we've opened Orange County's only cancer specialty hospital right here in Irvine. What does having that inpatient hospital allow you to do in your area of expertise that maybe if we didn't have the hospital, we wouldn't be able to offer our patients?
Binh Trinh: No, I think it's really important because we need to be able to take care of patients. It's a place for us to congregate. It's not just a hospital, but it's really an academic center. And I find it funny because City of Hope is an academic center. Yes, there are no residents, but we're teaching each other and I'm learning every day from other cancer doctors as well. So I think it's a place for education.
We often discuss cases amongst each other and we get a lot of pointers and it's a place for patient to heal. It's a bridge to healing. So it's extremely possible. Also, it's a stake in the ground. Orange County doesn't have a former cancer hospital. So that's one of the reasons I came because I'm from here and this is really the first time there's a cancer center NCI designated in Orange County. And so it's an opportunity that I couldn't really turn down. So I'm really happy to be here.
Darrin Godin: Well, as you know, Orange County is very diverse. How important is it for patients with cancer to receive care in keeping with their own language, their background, their preferences, and how do you practice that sort of patient-centered approach?
Binh Trinh: Yeah, no, that's really important. Obviously I don't speak all the languages. I speak Vietnamese and Spanglish, but I think one example of how we try to accommodate for that would be, let's say we have a lung cancer screening for sure, a flyer. So I think it's important to have the information be in different languages.
We all have phones now, and so I think there are easy ways to get the information onto someone's phone, like a QR code, for example. We definitely need translation help, but I think more so, I think what could really connect us beyond the language is just time. I think regardless of where people come from, I think time is really what's important. So you have to sit down there and give time for the patient to speak their mind and let them tell you what they need. So I think just time, that will solve most things.
I know that doctors work hard and oftentimes we can seem like we're rushing through the meeting. It's because we do work hard, but I think we constantly have to remember that patient needs a time to spend with them and allow them to ask their question because there could be cultural things that we don't understand. And I'll admit that I don't know everything. Sometimes we're just ignorant, we don't know. But with time, I think we can recognize that and I think it's important that we offer time to patients.
Darrin Godin: Say a little bit more about that and how does that look when you have a patient in front of you? What does that mean to give them more time?
Binh Trinh: I think a lot of patients don't necessarily understand what's going on. So they come in for the first time. Someone might have told them something, but it doesn't make sense. So I think it's important to explain to patients in simple terms what is going on, what it means.
"We think this is lung cancer. We know this is lung cancer. This is the stage. Yes, you're at a further stage, but here's the plan. So here are your options. Surgery, chemotherapy, chemotherapy for surgery, maybe not surgery, but maybe radiation, but maybe surgery upfront and then we'll try to figure out what's going on. But these are the options you have. These are the benefits that you should expect. There's no guarantees, but these are the options. You should watch out for this. These are the potential side effects that you might see. Oh, by the way, you have this other medical problem. Your kidneys are pretty weak, so maybe chemotherapy may not be the best for you, so we'll have to talk to your oncologist about changing your regimen so that you have the appropriate drugs that doesn't hurt your kidneys."
So options are important, make them understand it's important. Covering timelines and expectation. And then lastly, I usually say, and I usually do it more than once, which can be like, "Do you have any questions? Do you have any questions? Do you have any questions?" So I think allowing them an opportunity. And not just them, but their family, because ultimately patients with cancer will need help at one point or later. So I think the family needs to also be part of it. I know the patient makes the decision, but I think family needs to be involved as well. And culturally, in some culture, families are extremely important, sometimes the most important. Right? Yeah. So I give time. I just try to explain things out and give them a roadmap. I draw pictures. I draw pictures. So yeah.
Darrin Godin: Well, thank you for that. I think it's so important and I believe it's a hallmark of City of Hope Orange County that we have the considerations of our different cultural differences that we have here in our county. And we've hired physicians and staff that resemble and look like and understand the community that we serve. And so I think that's a huge benefit that we have.
And I love when you talk about giving patients time that you talked about options, and certainly all of our research and our clinical trials that we have going on are some of those options that we offer our patients that are very different than what they may be able to receive from another community hospital.
I want to go back to something that I was going to ask you earlier and I kind of went away from, but I understand that you spend a lot of your time still collaborating with physicians in organizations specifically in Vietnam. Can you tell us more about that and what's that all about?
Binh Trinh: Oh yeah, this call came from my time at UCSF. This is the prior job that I was doing as late as last year and I left, came back home here. I spent half my time doing lung transplants, and then my other half would be oncology, in lung oncology. And this is before the pandemic. Our program has really grown and actually was becoming really well renowned in terms of quality. And it's all based on ... Because lung transplant, basically you're creating one thing for another. These patients are literally on the last breath, I kid you not. If you have to choose what is a miracle, this is pretty close to a miracle. They're basically on their deathbed and on a ventilator, and then they come out with new lungs and they're walking the next day. It's pretty amazing.
Anyway, we were getting pretty good, and then it just so happened that Vietnam had already been working on patients. There's a huge population of TB in Vietnam. TB is very endemic to the area, and we had a program, a tuberculosis program there and they were collaborating already. And so they were interested in doing lung transplants. Because it's such an investment they weren't sure how to do it. There were some prior experience, but their outcomes were not great. And so a bunch of their physician came and visited us and we just walked them through the process. It took several years.
The other thing that I'm really proud about is, so COVID came and so that shifted entire ...
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Binh Trinh: COVID came and so that shifted entirely to a virtual kind of thing. They were doing surgeries and I was watching them virtually doing a surgery and advising them from 15 hours away. It's interesting because that country doesn't have a donation system. As you realize when you register for a car, they ask you, "Do you want to be a donor?" That process doesn't happen in very many countries. In that country, when your loved one dies, your body belongs to the family basically. You can't ask the patient before, "Can we give your body away for transplant?" Because when they die, it doesn't matter, the family decides. There was no process.
They're slowly figuring out how to do that. Since then they've done, I want to say about a dozen cases, 15 cases. I have to say, their outcomes are very good. With limited resources, outcomes are really good. Along with that, they do a lot of lung cancer. Smoking in Vietnam is very prevalent. They do many more lung cancer surgeries than we do. They do many, many more. They do probably 10, 15 cases a day. We probably do that much in a couple weeks. We learn a lot from them. With that, I think there's opportunity to collaborate from a scientific standpoint.
I think it's been a really good way to learn. Because of resource constraints, we're learning how to not use a lot of resources to get what we need to get done. So efficiency, for example, that's been really nice. Then it's just collaboration with other people from other countries, any countries to be sure, because people have different ways to do things and I think that's a good way to learn.
Darrin Godin: Yeah. Thanks for sharing that. I want to ask you a question. What does hope or the concept of hope mean to you, Dr. Trinh?
Binh Trinh: Yeah, I think hope is... I suspect cancer treatment's going to change. Well, maybe it's obvious already, I'm not sure, but it's like HIV. I think you don't really cure cancer, but you're living with cancer. Ultimately, what's important is we want to get people back to their families. We want to maintain their quality of life and minimize the side effects of the treatment that we're giving them. Then doing it in a way that's efficient, that doesn't interrupt their lives.
Because I've seen some examples, actually many examples now, more so than what I'm used to seeing, where I'm looking at them like there's no way this person is going to be around, and somehow they're doing great. I'm constantly challenged and surprised by how far we've gone. I believe we're going to come to a situation where we're not curing cancer. I know that term is what people want to hear, but maybe we should go away from the term curing cancer and managing cancer.
Like HIV, where it's not a death sentence, you're really living with a situation, live a long time with quality of life. Then we're just maintaining you in a way that it's a compromise, but I think we're going to come to a point where that's going to happen. I think we're already seeing some of that. It's just that we don't know enough yet in 2026. We know a lot more than 2000, but I think in about 2050 or 2030, I think it may come to... The other thing is, I have an example yesterday, I saw a patient on Wednesday. He came in and he had a cancer in his esophagus.
It was completely blocking him and no one had seen him yet. He saw a GI doctor at endoscopy, but he literally couldn't eat. I just admitted him in the clinic and I put a stent in him. He went from not eating, cannot tolerate any fluids, his blood sugar was low and he was spitting up and just miserable. A month before that, he was normal, working, everything. It's hitting him really fast. We were able to open up the blockage. Now he's going to see an oncologist to initiate treatment and hopefully he can become a surgical patient as well.
He's going to go home today and tomorrow, so that's actually what I'm seeing now. I think giving patients their lives back is really important.
Darrin Godin: I agree. I agree. Giving patients their life back, that is probably nothing better than that that we can do. Dr. Trinh, before we close here, I would like to have you just look into the camera and tell us, what is your message for someone facing cancer surgery? What do they need to know from a cancer surgeon like yourself?
Binh Trinh: Yeah, I think you need to know that you're not alone, that we've seen this many times. You're not alone. There are people just like you. Because we've seen it many times, we know how to treat it. Yes, we don't know everything, but we're along the way with you. We're going to help address your questions and concerns. We're along with you to help you get back to your life.
Darrin Godin: Well, thank you so much, Dr. Trinh, for spending your time with us this afternoon. We're glad to have you on the podcast, and thank you for all you're doing to take care of our patients here in Orange County.
Binh Trinh: Darrin, happy Friday. Thank you for inviting me. Hope you have a safe future. Thank you for inviting me. Thank you.
Darrin Godin: Well, I hope you enjoyed that conversation today with Dr. Binh Trinh. It is an exciting time to be here at City of Hope as we bring the full continuum of advanced cancer care to Orange County and beyond on our 72 acre academic research campus, solely focused on cancer prevention, treatment, and cures.
To make an appointment or learn more about City of Hope Orange County, visit us at cityofhope.org/oc or call (877) 541-4673. Again, I'm Darrin Godin. Thank you for joining us on Talking Hope, and we'll see you on the next episode.