Speaker 1 00:00:12 Oops. Okay. Thank you for joining Disability and Progress, but we bring you insights into ideas about, and discussions on disability topics. My name is Sam, I'm the host of the show. Thanks so much for tuning in. Charlene Doll is my research woman. Hello, Charlene
Speaker 0 00:00:29 One.
Speaker 1 00:00:30 There you go. I can hear you now. This is Lung Cancer Awareness Month, and Dr. Manash Manish Patel is here with us to speak about this important topic. Good evening, Dr. Patel.
Speaker 2 00:00:47 Hi.
Speaker 1 00:00:47 Thank you so much for joining us, and I wanna just let everyone know, um, Dr. Patel is an associate, uh, professor of medicine at the University of Minnesota Medical School, and a hematologist slash oncologist oncologist who cares for, um, patients at the University of Minnesota Masonic Cancer Center. Um, so thank you very much for joining us. I really appreciate that. Hopefully I'm pronouncing your, it's Patel,
Speaker 2 00:01:19 Uh, Patel's, my last name. Yeah,
Speaker 1 00:01:21 Minish
Speaker 2 00:01:22 Patel. Pleasure to
Speaker 1 00:01:23 Be here. Thank you. Uh, I wanna start out by asking a little bit from you to give us a little bit of history of why you chose lungs as one of your specialties.
Speaker 2 00:01:37 Um, that's a good question. You know, I guess, uh, I've always been around, uh, lungs in a way, in a long, in many ways. My dad was a, uh, pulmonologist, a lung specialist mm-hmm. <affirmative>, um, so, um, in a rural town in Indiana and so often growing up, um, he would drag me along to the hospital with him. Sometimes I did. I wanted to go and sometimes I didn't <laugh>. Um, but, um, you know, grow, just grew up around a lot of patients with underlying lung disease, not just lung cancer. But, so I guess in some ways, as I started my medical career, I was always sort of drawn towards, um, you know, things that affected the lungs and in particular, um, became interested in cancer as a, uh, as a, uh, subspecialty during medical school. And coincidentally, my first, uh, rotation as a resident was in, um, was in medical oncology. And I was, I've been sort of hooked since then, so. Oh. Um, and so from the very beginning I've been sort of involved in lung cancer and lung cancer research and sort of built upon itself as I started doing, uh, doing work in that area.
Speaker 1 00:02:39 So we will get into more depth of lung cancer, but can you just give me, like, if somebody were to ask you what is lung cancer? Can you give just a bra brief description of what you would tell somebody?
Speaker 2 00:02:52 Yeah, sure. So, you know, lung cancer in a nutshell is, uh, really a type of cancer that, uh, that starts in the lung. Lung, mm-hmm. <affirmative>. Um, and there are a couple of major types of lung cancer. Um, and, you know, the most common one is something called adenocarcinoma of the lung. And it's just a, it's a disease that starts in the lung, has the potential to spread to other parts of the body, but it's really a, a unique, uh, type of cancer that, uh, that really initiates in the lung.
Speaker 1 00:03:19 And are there only two types of lung cancer? It sounds like maybe there's more than two.
Speaker 2 00:03:25 Well, actually there's quite a few types of lung cancer. I think the, there are two major categories which account for probably about 85% of lung cancers as adenocarcinoma, as I mentioned, is the most common. About 25% of patients have what's called squamous cell lung cancer. Ah. Um, and then, um, a much, and then a much smaller proportion, maybe 10 or 15%, uh, have what's called small cell lung cancer. And then there's a smattering of like five or six different other types of lung cancer that we, uh, um, that we know about. Um, but they're, they're pretty rare. So those three subsets are really the, the majority of, uh, patients with lung cancer.
Speaker 1 00:04:03 So Squamish cell, small cell, and, sorry, the other one was
Speaker 2 00:04:07 Non-small cell or a person a carcinoma,
Speaker 1 00:04:10 Small. And so are there different symptoms that show in each one?
Speaker 2 00:04:17 Um, you know, I think the symptoms generally are relatively the same depending on where the cancer is. Um, and I think that's really kind of a, uh, a key message around, you know, lung cancer awareness is that, you know, the vast majority of people when they initially, when they initially have lung cancer, have really no symptoms until it, until it's, you know, starts to advance and cause other problems, um, on other parts of the body. And so, um, sometimes you might be, if you're lucky, you might have some symptoms in the lung like, uh, you know, a cough or maybe you cough up blood or something like that and it shows up very early. Um, and then you can get to a diagnosis early. But for the most part, um, most patients are diagnosed at a later stage after it's already caused a lot of other problems.
Speaker 1 00:05:03 And so give us some example of what some of those other problems might be.
Speaker 2 00:05:08 Well, so, you know, generally speaking, and this is true of most cancers, the symptoms of of cancer really, uh, relate to where, where the cancer is and what it might be pressing on, so mm-hmm. <affirmative> in the lungs, you know, if it's, uh, if a tumor is grown, uh, to the point where it's causing you to be short of breath, you know, because it's blocking one of your airways or something like this, you know, it's pretty quite advanced because, you know, there's a, a whole, you know, your lungs take up a lot, a lot of space in your body. And so if you've gotten to a point where a tumor is taking up so much of that space that you can't breathe, it's usually, you know, fairly advanced. Um, likewise, if it's spread to other parts of the bodies, like, you know, it often can spread to the bones and sometimes that can cause pain. Um, it can often spread to the brain, in which case, you know, it might cause some neurologic symptom. And so, you know, those are, are the kind of things that, um, that can be indicative of, uh, you know, of, you know, more advanced cancer. And then, you know, kind of broadly speaking, most patients with cancer spread into other parts of the body can affect things like your appetite, you know, stop eating mm-hmm. <affirmative>, losing weight, um, those kind of things.
Speaker 1 00:06:16 So I'm just curious, if you are fairly active, if a person's fairly active, are they more likely to see symptoms early or does that not really mean anything?
Speaker 2 00:06:27 You know, I don't know that, you know, it's hard to really answer that question because I think in some ways, uh, you know, if you're very active, um, and you know, you may not notice the initial symptoms and, you know, we've heard, you know, doing this, uh, for the last 15 years, you hear all sorts of different stories and sometimes it's like, you know, um, you know, it's a marathon runner who like, suddenly, like their time is like, you know, shorter is longer than what they were used to running a marathon, and they're not really sure why. And then you find out that something like this has happened. And so it's kind of what sometimes these subtle things, but often in those scenarios, you know, if somebody's a marathon runner and they're look, they look very healthy, it's very easy to kind of sort of say, ah, it's probably nothing. Or like, you just tired or maybe a cold or something like this.
Speaker 1 00:07:13 So I feel like when I look up different cancers, I hear like, oh, this is the most, uh, the highest killer cancer killer in the us, blah, blah, blah. But lung cancer really kind of is, isn't it?
Speaker 2 00:07:26 That's right. Uh, we have this, uh, dubious distinction of, uh, being the, uh, the leading cause of, uh, cancer related death worldwide. Um, and, um, though we've made some improvements, it's still, it still remains the, uh, the leading, uh, cause of, uh, cancer related death, um, you know, throughout the world,
Speaker 1 00:07:44 Higher than, uh, breast cancer and some of the big ones out there. Um,
Speaker 2 00:07:50 Yeah, that's right. I mean, I think, uh, you know, uh, both breast and prostate cancer occur more frequently, so we, we see more cases of breast cancer and prostate cancer. But, um, you know, uh, though it's third on the list for, you know, the number of the, the number of cases we see, um, it's still, uh, leads the way in terms of, uh, the, of causing death. Um, and that's largely because we don't pick it up very early. And so curing lung cancer becomes very difficult in the, uh, when it's advanced.
Speaker 1 00:08:23 Do you have statistics like maybe yearly statistics, how many per year you see,
Speaker 2 00:08:29 Um, how many, uh, patients, uh, per year? I think it's, uh, I don't have the exact statistics in front of me. I, I'm sorry. I don't, uh, that's okay. I don't know the exact numbers. Um, but it, you know, there's, uh, certainly, uh, it, it ranges in the millions, uh, a number of deaths per year from, uh, from lung cancer.
Speaker 1 00:08:46 Man, I think when I was young at least, I always thought of lung cancer as the smoker's disease. Um, I know now that that's not necessarily true. Um, having a schoolmate actually who never smoked and died quite young from lung cancer, um, I was horrified to hear when she called me and told me she had it. Um, and since she was so adamant about not smoking. Um, so this isn't always true. So can you talk a little bit about what else can cause this?
Speaker 2 00:09:30 Uh, yeah. You know, you've hit on a really big topic here, um, in the, that's particularly more so recently. You know, we've noticed over the last 40 or 50 years that the total rate of lung cancer has gone down as we've been somewhat as we've been, you know, smoking rates around the world have decreased, but we are seeing an uptick in patients who have never smoked developing lung cancer. And so it's a, it's a big issue. Um, it now is, you know, the seventh most common cause of cancer is, uh, lung cancer and never smokers. Um, so it is a quite a, it is does cause quite a lot of, uh, uh, burden on the healthcare system and on society in general, just even this, you know, lung cancer and never smokers. Um, so we don't know, we don't have a lot of, uh, definitive, um, evidence of sort of what the cause is in patients who have never smoked.
Speaker 2 00:10:27 I think what we are, um, now, uh, notice what we now know is that, uh, that exposure to rate on is a major environ environmental risk for, uh, developing lung cancer. Um, and probably for most, uh, for most people, we think that that's probably the second highest cause around the world of, of developing a lung cancer. We do know in certain populations where, um, you know, there is, uh, exposure to a high degree of, uh, air pollutants, um, particularly like if from, um, uh, lower socioeconomic, uh, uh, areas where they're inhaling, um, you know, in kitchens that don't have adequate ventilation, that inhalation of, uh, fumes from cooking, um, can, uh, be a, a risk factor for developing lung cancer. And of course, secondhand smoke is also a major risk factor, right. For developing, um, lung cancer as well. Um, I just saw earlier today an analysis that was being done looking at the attributed causes of lung cancer across different parts of the world. And, um, you know, certainly even just air pollution related to, um, yeah. Uh, related to industry, uh, has been associated with the higher risk of lung cancer in different parts of the world. Um, so particularly like, uh, in coal burning areas, you know, the industrial fumes that come from that, you know, there's a higher rate of lung cancer in those, in those populations and never smokers.
Speaker 1 00:11:53 It makes me think of like India and China, and I always wonder if
Speaker 2 00:11:57 For sure, and think those two places in particular, uh, have had a, a, a much higher, uh, growth of, of lung cancer, and particularly patients who've never smoked.
Speaker 1 00:12:11 I wanna talk a minute about, um, genetics, cuz I believe, if I've done my reading right, that that does play somewhat of a role in lung cancer. So you'll have to correct me if I'm wrong, but how do genetics, what role does genetics play in this?
Speaker 2 00:12:29 Yeah, so, um, that's a good question. You know, we don't really think of lung cancer as being a hereditary disease. Um, uh, at least not typically. Um, you know, there's not like these, um, large genetic syndromes that are associated with a single mutation that, you know, causes, that leads to a higher risk of developing lung cancer. Like we have for a lot of other, um, like, you know, for breast cancer, they have the b c A one gene that, you know, puts, it, puts you at high risk. We don't really have that in lung cancer. Um, we do know that there are families in which, uh, they might be at a higher risk. And I don't think we'd really have the final word on this, but my, um, opinion or hypothesis has always been that there's probably some, uh, genetic, uh, defect in the way we metabolize, uh, pollutants or inhalants, ah, uh, that might put us at higher risk than the general population.
Speaker 2 00:13:23 But we haven't really put our finger on that exactly at this point. Um, certainly the genetics of the cancer has become very important and, you know, since during the time that I've been in, um, in practice, you know, are, um, we've become much more, you know, I told you about the sort of the three major kinds of cancer, uh, but within that there are a lot of different, uh, cancers that are based on the genetics of the, the actual tumor, not necessarily the genes that you pass on to your, to your family member, but the DNA of the tumor itself mm-hmm. <affirmative>, um, that define different subsets of, of cancer that can be, um, can be treated very differently
Speaker 1 00:14:00 There. They talk about a five year survival rate. Um, does this vary depending on the type of lung cancer you get?
Speaker 2 00:14:12 Uh, for sure there is a lot of variability around those statistics. Um, and, um, you know, I think it varies depending on the type of lung cancer you get. It really also varies on, you know, I mentioned earlier about the genetics of the tumor, and that really plays a big role in sort of determining, you know, the outlook for many patients. Um, you know, I think the other major thing that, you know, uh, that plays a role in the overall survival is the stage of the cancer, um, such that, you know, if it's fairly limited to just the lung, we often have a much higher rate of overall of long term survival, you know, people get cured of the, of the cancer. Um, I think the big problem with lung cancer is, as I mentioned from the outset, is that, you know, well many, most patients are diagnosed at a fairly advanced stage where it's harder, harder to cure.
Speaker 2 00:15:02 Um, and so, um, you know, if they have stage four lung cancer, then that's a much, the outlook is much more grim, um, than, uh, than if it's earlier stage. I think the, uh, one thing that is, uh, uh, on a very optimistic note is that we're doing better. And there are some, you know, when I started my career, uh, the expected lung survival for a patient with metastatic lung cancer, advanced lung cancer, um, you know, was, um, on average about nine months. And, um, you know, only about 5% of patients would be alive at five years. Um, today, uh, we've made a substantial improvement upon that to the point where in some subsets of lung cancer, the me the average survival is now almost like three years, and there are about 15 or 20% of patients that are alive, um, you know, more than five years. And I think, you know, some patients in my clinic now are 10, 11 years out with metastatic lung cancer that are surviving. Well,
Speaker 1 00:16:05 And when we talk about metastatic, we're talking about cancer that has started in lungs and gone elsewhere,
Speaker 2 00:16:12 Correct? Yep. Stage four, uh, lung cancer that has spread from the lungs to other parts of the body.
Speaker 1 00:16:19 When you do by chance get somebody in the earlier stages of lung cancer that hasn't gone somewhere, can you actually cure or is it just still a prolonged time that, yeah,
Speaker 2 00:16:33 So if a patient gets, uh, diagnosed in as a stage one, uh, non-small cell lung or stage one lung cancer, we often can cure those patients. So probably better than 80% of the time we do a surgery. Um, and depending on the characteristics of the tumor, we may or may not, um, offer them, um, some kind of treatment afterwards. But with that, with the surgery and, um, you know, and, and, uh, with the treatment afterwards, sometimes, you know, 75, 80% of those patients might be cured.
Speaker 1 00:17:02 Can you tell me a little bit about why, um, lung cancer cells are less sensitive, um, to available chemotherapy drugs?
Speaker 2 00:17:12 Um, I would say, um, well, I mean, I think it really is, um, very much about the biology of the cancer. And so, you know, when, um, it's not necessarily that they're more resistant to chemotherapy, but I think as we've started to learn a little bit more about the biology of the cancer, we're starting to recognize that, um, you know, chemotherapy may not be the best, you know, the best treatment for this disease and that we're, you know, now increasingly, um, are using things like immunotherapy or trying to, you know, get the immune system to, uh, kill the cancer or depending on the tumor genetics, if we know that the the tumor has a particular vulnerability, we can target it more specifically. And those treatments usually work a lot better. So they're much more effective at killing the cancer, and they're also a lot less toxic than chemotherapy. So that's been a really major development in, in sort of lung cancer treatment these, these days.
Speaker 1 00:18:12 Is there a difference between targeted therapy and immunotherapy?
Speaker 2 00:18:17 Um, I, we generally think of them differently, although I guess I would say that targeted therapy is just using, so I mean, I guess it, the distinction between targeted therapy and chemotherapy is that chemotherapy is a little bit like using a sledgehammer. Um, whereas, you know, we're with a targeted therapy, it's more of a fine finer tuned instrument. Mm. Um, and, um, so, uh, you know, when we are using targeted therapy, whether it be immunotherapy or, um, uh, or a, uh, molecularly targeted agents, it's just more precise. So it's hitting the tumor where it hurts, um, and not affecting the rest of the, you know, not having so much of the collateral damage.
Speaker 1 00:19:00 And do you feel like the targeted therapies are working much better than what you used to do?
Speaker 2 00:19:09 Absolutely. Uh, there's no question about it. I mean, I think, uh, you know, um, it, it really is no longer the case that, you know, chemotherapy does not form the backbone of our therapy these days. Um, so while we might still use chemotherapy, it's more, it's not the main, uh, player in determining sort of the outcomes. So it's either immunotherapy or, um, the, you know, molecularly targeted agents against a particular vulnerability that the tumor might have.
Speaker 1 00:19:43 Well, you hear a lot about organ transplants. And can you not do lung transplants?
Speaker 2 00:19:49 Uh, no, you can't. Uh, you know, I think, uh, for most cancers, for most, um, transplants, you know, um, you know, not even considering lung cancer. You know, when you have an organ transplant, there is a lot of immune suppression that goes along with that so that the body can accept that transplant and that immune suppression can often lead to, uh, disease progression or
Speaker 1 00:20:13 Well cancer. Oh. Cause, and
Speaker 2 00:20:16 So for most patients with lung cancer, even though it might be confined to the lung, you know, doing a lung transplant's a huge whack. Um, and, uh, so it's, uh, not something that we think that, and it really doesn't result in cures. And so, you know, putting somebody through a lung transplant and the recovery that's, uh, associated with it doesn't really improve their outcome. And in fact, it may make it worse.
Speaker 1 00:20:40 How much, if any of your lung can you lose and still lead a normal life?
Speaker 2 00:20:46 Yeah, I mean, I think, uh, that's a good question. You know, I think, um, we have done in some patients, you know, removed an entire lung. Um, and, uh, one, uh, unique thing that most people, most of the listeners may not, uh, appreciate is that the right lung actually has much more of the lung volume than the left lung. Ah. And so, um, you know, if you do a left, uh, if you remove the left lung, that's often a lot more easier to tolerate than removing the right lung. Um, I will say though that I have, uh, a couple patients in my clinic who have had a total resection of the right lung even and have still been able to function and do things, uh, you know, so in the right patient with he otherwise healthy lungs, um, you know, this person has been climbing up in the a Alps and, um, you know, oh, my doing, doing world, world travel on one left lung.
Speaker 2 00:21:38 So, um, you know, and now I think he's now eight or nine years from his cancer surgery. So, um, so it is possible in the right patient. Um, unfortunately many of our patients that we see are elderly, um, they might already have under underlying lung disease. And so for those people, you know, you always have to take a, uh, uh, a little bit of a, uh, so there's a very, you know, um, uh, in depth sort of evaluation of what kind of lung surgery a patient can tolerate. Mm-hmm. <affirmative>, um, and, you know, we would only really offer those, uh, to remove the lung cancer if we think they could tolerate the surgery.
Speaker 1 00:22:14 And presumably if you do that, can the other lung learn to adapt? Can it actually the capacity of the lung actually grow
Speaker 2 00:22:26 Still? Yeah, it absolutely does. Absolutely does. So when you take out one lung, the oth the other remaining lung does sort of expand a little bit more. Um, you know, it doesn't completely replace the one that's, that's been removed, but, uh, but people can adapt. People can adapt to that. Um, it sometimes does take a fairly long time of like, you know, rehabilitation to recover from that, but, but any patients can, uh, recover quite well
Speaker 1 00:22:52 When they talk about testing. I saw something like, uh, PDL one. What is that? Mm-hmm. <affirmative>?
Speaker 2 00:23:00 Yeah, good question. So PDL one is a, it's called program death one, and it's a protein that's expressed, um, it's made by, um, your, uh, uh, immune system, um, and then P PD one, and then it binds to this protein PDL one. Um, and what that does in nature is, you know, dampens your immune system so that, you know, sort of helps prevent your body from your, your immune system from attacking part of your body. And tumors, uh, have become somewhat smart in that they know that if they, they express this protein PDL one, that it can shield themselves from the immune system because your immune system wants to get rid of cancers. Um, and so if it makes this protein, it makes it very hard for the immune system to, uh, to recognize that that's a cancer needs to be taken care of. Um, and so what the, so the reason that we, we look at that is that the many of the drugs and we refer to as immunotherapy, are really targeting that protein, the PDL one on the tumor. So now if it, if this, if we block that PDL one, now the immune system can see the cancer and then learn to attack it.
Speaker 1 00:24:15 So let's talk about testing. How is it done?
Speaker 2 00:24:18 So the testing for PDL one is, um, is just done on a biopsy specimen. Um, so if they, if we put a needle into the tumor and take a little piece of it and send it to the lab, they will actually, um, stain it using an antibody to see if it makes that protein or not. Um, there is additional testing that gets done, uh, which is a DNA test that I mentioned before. And so they will, what they will do actually do is take the DNA directly from the tumor and then do a, uh, do sequencing of different genes, um, to see if there are mutations, uh, that we can target. Specifically
Speaker 1 00:24:56 If you stain test, will it still show up if it's not, even if it's not in that part of the lung?
Speaker 2 00:25:05 Like if it's in one question. Part is, is it in the whole, that's one of the problems with that testing is that, uh, you know, it's really dependent on where you get that biopsy from. Um, and so it's very possible that if we get a very small piece of the tumor, that we might miss it. Um, you know, obviously, or maybe not obvious, but it's sometimes hard to get really big chunks of tumors, um, to look at under the microscope. And so, um, it's one of the, uh, one of the things that we're trying to, um, you know, on the research side of things, trying to figure out how do we better predict, uh, patients who might respond better to immunotherapy, particularly given that, you know, this test is, is not perfect.
Speaker 1 00:25:45 How do you find the tumor in the lung?
Speaker 2 00:25:49 Yeah. So usually with a CT scan, a CAT scan or a PET scan, um, you know, these are sort of, uh, um, you know, in most cases, if it's something that's been, um, diagnosed early, it's because somebody got a CT scan, um, for some other reason. Or, you know, with, you know, brings up another topic, which is, you know, screening for lung cancer, uh, with the CT scan, which is now, you know, something that should be done, um, for most patients at high risk of lung for developing lung cancer.
Speaker 1 00:26:19 So if you're doing a DNA test of the specimen, is that a better test than the stain test?
Speaker 2 00:26:27 Um, there are complimentary. I think, uh, you know, so, uh, usually, um, we would, uh, do on any new patient diagnosed with lung cancer, we do test the stain test for PDL one. Uh, but then we also do test the DNA because, um, you know, all of those things, um, we have to put together, uh, you know, what's the best therapy for that patient. And so when we get all of that information, we can really make the best kind of decisions.
Speaker 1 00:26:57 What kind of things, or, I mean, let's say somebody is worried they have a cough, they've had it for a long time, but, and you know, they don't really have any other things, but they'd like to be checked for lung issues. What do they do? Can they,
Speaker 2 00:27:17 Yeah, that's, uh, that's a good question. I mean, I think, um, you know, and you know, one thing that I think is important is that as a, as a patient, as a person, um, you know, what I would tell patients is to really advocate for yourself mm-hmm. <affirmative>, um, in the sense that, uh, you know, I think we don't want to create sort of like this mass hysteria that everybody that is has a cough, you know, needs to get a CT scan. Uh, but, you know, uh, if, you know, talk to your physician, um, you know, things aren't right, you know, um, I've already been on a course of antibiotics and things really aren't getting better, let's maybe not just assume that it's, you know, lingering cough. Maybe it's worthwhile getting a CT scan to check because you don't, you know, things aren't going the way that you expect.
Speaker 1 00:28:03 What is normal cough and what is abnormal cough?
Speaker 2 00:28:06 I don't think we know <laugh>. I mean, I think that's the problem, you know, that's kind of the problem, you know, so, you know, you, you know, if somebody has a cough, uh, you know, that has, uh, you know, I have, I have chronic asthma, and so I cough me too, you know, after I get a cold, I
Speaker 1 00:28:20 Cough and I cough all the time,
Speaker 2 00:28:21 A cough, and it takes me like a month before I get, you know, get better or more. And so, um, you know, that's kind of been my routine now, and I've had a CT scan, so I'm kind of not like, as worried about it anymore. But, you know, in these kind of things where it's sort of like, well, things aren't getting better and you've been prescribed the medicines to get it better, but it's not getting better. These are the ones where we say like, maybe we should, you know, get a CT scan and take a look. And in fact, my, my mother was diagnosed with lung cancer, this in exactly this way. Oh, she had a really bad flu, uh, flu case, and, uh, she was just like, sick for a long time, just wasn't getting better. And she talked to her physician and they, they decided to together that they would just get a CT scan just to make sure that there was nothing else there. And by the time she had actually got the CT scan, she felt a whole lot better. Um, but she went ahead and did it. And there they found this, you know, mass in her lung and, you know, thankfully she's doing, and she, you know, they caught it early. She had it cut out and, uh, you know, she, we brought her up here to the university to get it taken out, and, um, and she's, she's doing great
Speaker 1 00:29:29 Now. What a great story,
Speaker 2 00:29:31 <laugh>. So it happens.
Speaker 1 00:29:33 So it's interesting, sometimes I think that doctors go into their profession because they know of someone or have a personal, you know, exposure to something. But you, yours obviously must have come after, I presume. That's right. That's right. And now you've, you've been exposed like majorly to this, and so you really know what it's like dealing with something like that. Are there negatives to being a more of a, an aggressive checker for lung issues? I suppose the cost
Speaker 2 00:30:05 On insurance. I mean, I think there are downsides to doing scans because sometimes we find things that we don't need to know about <laugh>. Um, you know, um, and you know, for me, I think, um, the lung nodule is, is a very challenging thing to deal with because lung nodules are very common, particularly the Midwest. There's a lot of fungi in the soils. And so people inhale these fungi and, um, they don't cause any problem, but they co they show up on a scan as a nodule. And so we have to be a little bit careful about how we interpret some of these things. And we don't want to go and biopsy or cut out every nodule that we see. Um, you know, and I think at the university in many large, uh, medical centers, you know, we're fortunate in the twin cities that we have, you know, really, uh, advanced, uh, healthcare systems that have been designed to sort of deal with these kind of issues.
Speaker 2 00:30:55 So if we have, you know, at the university, if we have a patient with a lung nodule, um, that is, uh, that could be cancer, but it's, you know, not sort of indeterminate, they have a, uh, conference that every once a week where they, uh, have a team of specialists, um, surgeons, uh, uh, radiologists, uh, to look at the scan and determine a plan of how they're gonna follow that. So then it might be if it's, you know, very small and not very worrisome, uh, by, based on the imaging criteria, then they might say, let's do another scan in three months. And then there's a nodule conference, there's a nodule clinic where they'll see the patient, give them the results of the scan, tell them what the plan is for following it, and, um, and then follow out that plan so that we're not necessarily just blindly, um, cutting out or putting needles into people's lungs unnecessarily.
Speaker 1 00:31:52 Obviously, when someone gets diagnosed with young cancer, in the case of my friend, she had two fairly young children. Well, that was really devastating. Um, what, what do you usually suggest that they do to get support?
Speaker 2 00:32:13 Well, I think it's, you know, first of all, those cases are, are heartbreaking. Um, you know, it's really difficult. Um, I think, uh, you know, it's hard to really, uh, say that there is one right answer in terms of how to support them in that way. Um, you know, I think we do try to put them in touch with, uh, with other people who have gone through this. Uh, there are several organizations around around town that can help. Um, I, we happen to be, um, involved with a a, an organization called A Breath of Hope Lung Foundation. Um, and they are a, uh, they're an organization I've been involved with for probably the last 10 years. Uh, and they do a phenomenal job of supporting patients, uh, with lung cancer, uh, providing, um, uh, support. Um, when we, you know, in our clinic, when we have patients like that with young, young children, uh, we do get them involved with our, um, you know, social workers so they can help with sort of how to have those conversations, uh, with the children that you know, that, you know, mom or dad has a very difficult diagnosis and how they, how to deal with that.
Speaker 2 00:33:22 Um, you know, I think we also spend a lot of time with the patients focusing on, you know, what are, you know, trying to establish what are the goals of treatment and for patients who have, uh, young kids, you know, often it's sort of like, um, you know, we often have really difficult conversations about, well, how are we gonna maximize your time with your family? Right. You know, and try to avoid making you too sick with treatment, but also trying to give you the best treatment to let you live, um, as best you can and for as long as you can with your, uh, with your young ones and your, you know, your loved ones.
Speaker 1 00:33:58 What's the youngest you've ever seen?
Speaker 2 00:34:02 26, I believe.
Speaker 1 00:34:04 Oh my.
Speaker 2 00:34:05 Yeah.
Speaker 1 00:34:08 Uh, is there a preference, a gender preference for lung cancer?
Speaker 2 00:34:14 Um, not really. Um, you know, I think, uh, as the, uh, the advertisement that I've often heard, so if you've got lungs, you can get lung cancer, it really doesn't discriminate, uh, particularly, uh, in, in that way.
Speaker 1 00:34:29 So is there a ethnicity preference?
Speaker 2 00:34:34 Um, not really. Again, uh, you know, I think it is, uh, very common amongst, uh, amongst, you know, many different ethnicities. Um, you know, I would say that in the never smoking subset, it may be more common in Asian population and in young women, um, we don't fully understand that. Exactly. Uh, as far as why that might be,
Speaker 1 00:34:57 I remember
Speaker 2 00:34:59 It is, uh, you know, the younger, younger patients more often are women. Um, and, uh, the, um, and, and also in, uh, the Asian population as well,
Speaker 1 00:35:10 I felt like, um, many years ago, I, I went to Japan and I, I was like amazed. It felt like everyone smoked there. I was like, what? <laugh>? But it, I, I think it was just maybe where I was, but it, there was, it felt like there was a large amount of smoking.
Speaker 2 00:35:28 Well, certainly globally, there's a lot, there's a lot more cigarette smoking across the world than there is in the US for sure. Um, and around the, around the globe in particular, and particularly sort of the lower socioeconomic, uh, countries, there's a really high rate of smoking still. So it's a big worldwide problem. Uh, and you know, thankfully we don't have as much cigarette smoking here. And it, and it's partly the, you know, I think we talked a lot about sort of the improvements in treatments and whatnot, but I think a lot of the reason why the lung cancer incidents has been getting, getting better is because we are, and, and the mortality from lung cancer is getting lower is because we're, um, you know, there, there's a lot less smoking around.
Speaker 1 00:36:07 Are there any new treatments you guys are actually looking at but aren't being used yet?
Speaker 2 00:36:13 Uh, well, there's a lot for sure. Um, you know, I think one of the really exciting things, um, that we are, uh, work, there's a couple of, uh, exciting things that we are working on in particular at the university. Uh, one is, um, is using cell immune cells as a therapy for lung cancer. So I talked to you a little bit about using immune therapy to block PDL one mm-hmm. <affirmative>. And that's really the tip of the iceberg really in terms of, uh, immunotherapy. And, you know, we have been very much interested in using, um, immune cells that are either, um, engineered in the lab to be, uh, much more, uh, focused cancer killers. Um, and so we've got a couple of clinical trials that are, um, going to be starting very soon at the university using, um, cells. So one of them will be taking, you know, taking a specimen from a patient and, you know, the, the tumors themselves will have, um, immune cells that are within the cancer that are trying to kill the cancer, but they just can't do it.
Speaker 2 00:37:18 And so, um, you know, one of the really exciting clinical trials that has cut that's been done recently was to actually taking those immune cells from the patient, growing them in the lab, and then giving them back to the patient. Um, and those are really particularly effectively seeing some really dramatic responses with patients with lung cancer. And so we're doing the next generation of that kind of a trial where we're taking the T cells out of the tumor, modifying them in the clinic to make them even more active and then putting them back in the patient. Wow. And that's gonna be starting hopefully early next year. And then likewise, uh, you know, we're using a different type of immune cell called natural killer cells that are targeted against a particular target. Um, and so that's another exciting trial that we've got, uh, starting up here pretty soon.
Speaker 2 00:38:06 Um, and then one other kind of, uh, interesting thing that is we've, uh, that has, uh, been, um, that we've been working on as well, is trying to understand, um, the way the gut microbiome can influence, um, cancer therapy. And so we have a clinical trial using a, um, uh, actually a bacteria pill, uh, that's meant to sort of improve the, uh, the, the gut microbiome, the bacteria in the gut to help improve the response to treatment. And so that's a trial that's, um, starting, uh, actually gonna be opening up, uh, next week for, uh, for patients with new diagnosis of lung cancer.
Speaker 1 00:38:50 Sometimes looking at the studies for people who have cancer, it feels like you have to be at a specific stage or a specific, you know, whatever, to get into the study. Is lung cancer that same way, or is it kind of, if you've got it, you can get into a study pretty easily?
Speaker 2 00:39:09 Well, I think, you know, I tell patients all the time that if they're seeing, and they're seeing an oncologist or you know, doctor about their cancer treatment to ask about clinical trials mm-hmm. <affirmative>. So just, you know, and there, there are, every trial has a specific inclusion exclusion criteria. Um, and, um, you know, it may or may not be right for a patient given wherever, wherever they are in their treatment. Um, the, a particular trial may not be the right, right thing for them at that time. Uh, but, um, you know, I think you, it's really hard to know what the right answer is unless you ask about it. And, um, you know, if they don't have, you know, if we don't have clinical trials at our site, we'll often say, well, let's take a look and see what they've got down, you know, at Mayo or somewhere else in town. Um, you know, because there might be a trial that might fit for them, uh, around there. And I think, you know, it's really important that we do these trials, uh, because that's how we, that's how we get these advancements in treatment is really by participating in clinical trials and, um, um, getting, gaining that knowledge that helps us sort of get the next treatment. That,
Speaker 1 00:40:16 Where can people go to find more about lung cancer?
Speaker 2 00:40:21 Uh, yeah. So I, you know, I think, um, there are, uh, many sources. Um, I think, uh, I mentioned already a Breath of Hope Lung Foundation. Um, they have a, uh, patient portal, uh, that is loaded with a lot of, uh, really, uh, great, uh, educational resources about lung cancer. They have like an animated, uh, display that talks about, uh, different stages of lung cancer, different treatments for lung cancer. Um, certainly on the University of Minnesota website, uh, you know, the cancer, uh, uh, cancer.umn.edu um, has a list of, uh, clinical trials that are open and available for patients with lung cancer. Um, and, you know, I think if, just as I was saying before, you know, if you've got, uh, lung cancer and you're meeting with your oncologist, I think it would be, uh, useful to sort of say, you know, tell that person, you know, uh, am I eligible for a clinical trial? Or is, is there a trial that's right for me? Because I think it's important that we, uh, we do these things
Speaker 1 00:41:24 Sometimes, um, when you're <laugh>, I, I hate to use it, but sometimes it feels like you can shop for doctors. You know, there's a lot of different doctors around and different specialties. What would you say to look for if you have been diagnosed with lung cancer that you wanna make sure you're in a good place? What's the best things to look for?
Speaker 2 00:41:46 Yeah, like I said before, I think we're fortunate that, you know, here in the Twin Cities, uh, we have several very good places around the Twin Cities. And I would say all of the major, major health systems around here, um, have really good people doing, uh, lung cancer care. I think really the main issue with, well, for lung cancer, I mean, I think it's really important for patients to advocate for themselves mm-hmm. <affirmative>, that we need to have these, uh, genetic tests that are being done on the tumor. We need to have PDL one testing. So, you know, depending on who you're seeing, you know, most people are aware of this, but you know, if they, if it's not there, at least you gotta ask about it and, and get it, get it done. Um, and then I'd say, you know, mainly I think the, the other thing that is important is that, you know, um, this is a life and life and death kind of a thing.
Speaker 2 00:42:38 Uh, you know, I think the main thing is that you want to feel very comfortable with the person that's in front of you, that you can have a good conversation with you. They feel like they've, they've listened to you, um, because, um, you know, you don't get a lot of other op you know, you don't get a lot of second chances at this when you're diagnosed with lung cancer. You gotta get it right from the beginning. And, um, you know, uh, there's really, um, it's enough of a, it's enough of a battle to have lung cancer to then have to also battle with the physician that you're seeing that you don't, you're not really clicking with. So, you know, if things aren't working out right, you know, seek a second opinion or, you know, even a third opinion sometimes, um, to get that person that's the right fit.
Speaker 1 00:43:22 Is there anything that you would like to see happen in this field, um, coming
Speaker 2 00:43:29 Up? I think a big thing, and one where we don't do very well right now is screening for lung cancer. Um, it's a very big problem, right. You know, screening for lung cancer has been approved by the, uh, United States Preventative Task force for probably, almost, almost a decade now. I think 2014 is when it first was approved by the U S P tf, but probably only about 50% at 40% of, uh, patients who, uh, can be screened are actually screened. Um, and screening is not perfect. It's not, uh, it's not, uh, the end all and be all, but we know we can decrease lung cancer mortality by, by screening and detecting it early. We have a test that can be done that's safe and, um, relatively easy to do, um, that can pick up, uh, uh, pick up lung cancers early at a stage where we can cure it. And I think if we were able to screen, uh, more people, uh, we would certainly do, uh, as much good, uh, without as, without as much harm as we do with all of this, you know, the great advances we've made. And I'm one of the, you know, I mean, I think I'm very excited about the treatments that we have to offer and all those things, but I would much rather not have to, not have to do it because we just don't have that much, uh, that much cancer around.
Speaker 1 00:44:47 Are there many false positives with the, is just a matter of seeing, knowing what the numbers are? There are
Speaker 2 00:44:52 For sure false positives. You know, like I said, on our part, we have to do a good job of like managing those things and making sure that we're not, um, overreacting to some of these things. But I think, um, you know, as we've had many discussions about this, you know, um, if, you know, anybody would rather know that they had it, um, and
Speaker 1 00:45:14 Right
Speaker 2 00:45:15 Know that there's something there that we can, we can address rather than finding out too late that there's, that there's nothing there. And we have a test that can do that, and there are problems with it, no question. There are false positives, and we may be, you know, um, doing more scans as a result of that. But you know, then we, we know we can keep people safe that way.
Speaker 1 00:45:35 Dr. Patel, thank you. I really appreciate your time coming on. Is there anything you'd like to leave us with?
Speaker 2 00:45:42 Um, no, I think, uh, you know, you've covered, uh, covered a lot of ground. I mean, uh, I think, uh, the key thing for Lung Cancer Awareness Month is that, uh, you know, we're, um, as a, as a group of people, we're aware that this can happen. Is it not just a smoker's disease as you kind of pointed out? Um, and so, um, you know, I think we want to, uh, I think that's a, a message that we want to get out, that this is an important problem for all of us. And if you live long enough, um, just like I have, you know, you somebody, somebody close to you is gonna be affected by this disease. And so I think it's an important problem for all of us to deal with. Um, so I hope, uh, going forward that we'll, we'll, uh, get a little bit more, get more support for doing the research that we do and trying to, uh, you know, trying to end this problem for future generations.
Speaker 1 00:46:31 Thank you very much for your time.
Speaker 2 00:46:33 Thanks so much.
Speaker 1 00:46:37 We'll be right back after this message. This has been Disability and Progress. The views express on this show are not necessarily those of kfi or it's board of directors. My name is Sam, I'm the host of this show, Charlene Dolls, my research lady. We've been speaking to Dr. Pat, uh, Manish Patel. Uh, Dr. Patel was talking about Cancer Awareness Month, and Dr. Patel is, um,
Speaker 1 00:47:18 Is an associate, uh, professor of medicine at the University of Minnesota Medical School. And he's also a hematologist slash oncologist who cares for adults with patients, uh, for patients at the Medical University Minnesota Masonic Cancer Center. And he is also a lead, uh, physician scientist researching oncotic virus of, uh, lung cancer. So thank you, Dr. Patel. I really appreciate you being on tonight. And I wanna remind people that we have a lot of podcasts, so if you have not yet checked them out, please do. And, um, we are archived. Every show is on the archives for two weeks, but then it goes to podcast and our trustee podcaster Erin, will make sure it's there forever. And if you would like to be on our email list, you can email us at Disability and
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Speaker 0 00:48:28 Work.
