Rex Chin-Wei Yung, MD, Assistant Professor of Medicine, Assistant Professor of Oncology, The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, discusses the challenges that forming a multidisciplinary team can create, particularly the introduction of the pulmonologist for treating lung cancer.

The inclusion of any new person into a group can be disruptive. There needs to be a clear reason why the new individual is an asset to the team. This needs to be clear both to the existing group and the person being added. Time is the most valuable asset and it is important that no one feels as if his or her time is being wasted.

The pulmonologist in a multimodality group needs to know they are providing a useful service to the patient. Establishing a routine and constant flow of patients can help the pulmonologist gain interest as a member.

In many groups there is a zero-sum gain feeling. If a surgeon recommends a procedure to a pulmonologist he may feel that he is missing out on an opportunity but this is not the case. In multimodality therapy there is a higher chance an issue will be detected and treated, which can result in more surgery. The end result is better treatment; surgery can be given or prevented more accurately. The primary focus should be on the welfare of the patient.

Videos

Dr. Rex Yung from Sidney Kimmel Comprehensive Cancer Center Discusses Forming a Multidisciplinary Team

Dr. Yung Discusses Forming a Multidisciplinary Team

Rex Chin-Wei Yung, MD, Assistant Professor of Medicine, Assistant Professor of Oncology, The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, discusses the paradigm shift in lung cancer treatment from a very broad diagnosis from a few hundred cells to more complex molecular based panel.

In the early years of lung cancer a broad diagnosis was used because it was believed there was no difference in the subtypes of cancer. As further knowledge about the different subtypes was gained more adequate tissue staging was needed to ascertain response to medications. Some drugs are only effective in select subtypes of lung cancer; pemetrexed and bevacizumab, for example, do not perform well in squamous cell lung cancer.

Tissue-staging practices have advanced beyond diagnosing the cell type alone into completing biomarker panels in order to pair a predictive marker with an effective targeted therapy, such as tyrosine-kinase inhibitor (TKI) treatments that require a mutation in the epidermal growth factor receptor (EGFR).

Yung concludes by stating that lung cancer is shifting towards more thorough tissue staging. Enough tissue needs to be gathered to characterize not only the cell type but also for molecular panels. Possessing a fuller knowledge of the cancer will guide therapy and create a personalized approach that will create better outcomes for the patients.

Dr. Rex Yung from Sidney Kimmel Comprehensive Cancer Center on a Paradigm Shift in Lung Cancer Treatment

Dr. Yung on a Paradigm Shift in Lung Cancer Treatment

Rex Chin-Wei Yung, MD, Assistant Professor of Medicine, Assistant Professor of Oncology, The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, explains the role of the pulmonologist has broadened as the desire to develop a multidisciplinary approach to treat lung cancer increases.

Lung cancer is behind other tumor types for realizing the benefit of a multidisciplinary approach. The treatment of patients with breast cancer can be viewed as a paradigm of how lung cancer treatment should be. This paradigm makes it clear that diagnosis guidelines and standards need to be solidified in lung cancer therapy, especially in regards to staging lymph nodes.

Pulmonologists aid the treatment process by helping with clinical staging using imaging, CT scans, PET scans, and new metabolic, nuclear type imaging, and molecular imaging. Yung adds that in many cases clinical staging is inadequate and the need to educate about the importance of tissue staging needs to be further stressed.

Dr. Rex Yung from Sidney Kimmel Comprehensive Cancer Center Discusses the Evolving Role of the Pulmonologist

Rex Chin-Wei Yung, MD

Articles

Dr. Yung Discusses Forming a Multidisciplinary Team

Dr. Yung on a Paradigm Shift in Lung Cancer Treatment

Dr. Yung on the Evolving Role of the Pulmonologist