For many people, fracturing your hip is a painful inconvenience. For 73-year-old Bessie Sexton, it may have saved her life.
When patients get X-rays in the hospital, sometimes doctors find things they weren’t even looking for. During Bessie’s recovery from hip surgery, she had additional scans, including a chest computerized tomography (CT) scan – a special type of X-ray imaging. The CT scan suggested that she had a concerning lung nodule that was potentially cancerous.
It happens more often than you’d think. About 20-30% of patients who have chest X-rays, will have at least one nodule in their lungs. Studies estimate that about 500,000 patients across the U.S. have lung nodules detected each year. For 10% of these patients, the lung nodule is worrisome – at risk for cancer – and requires further investigation. Follow-up is needed to ensure that patients get the proper care for their nodules.
However, for about 50% of patients with lung nodules, there isn’t a formal process in place to manage their care. Patients may not be told about their nodules, or they may forget about them when they return home from the hospital. They may not receive the right evaluation of their worrisome nodules, or their primary care doctor may order too many follow-up tests, studies or biopsies.
Fortunately for Bessie, a longtime seamstress and breast cancer survivor, Atrium Health had an Incidental Lung Nodule Program in place when her lung cancer was detected at an early stage.
On the day she was to be discharged following her hip surgery, Bessie’s case was reviewed at the weekly lung nodule conference, where she was referred to Dr. Jeffrey Hagen chief of thoracic surgery at Atrium Health Sanger Heart & Vascular Institute and director of thoracic surgical oncology at Atrium Health Levine Cancer Institute. Bessie needed surgery to remove the lung tumor.
“When I met Bessie, she was in pretty good shape; her lung nodule wasn’t causing any symptoms,” explains Hagen. “For lung cancer, if it’s been there long enough to cause symptoms, the prognosis is much worse.”
According to Hagen, Bessie’s outcome was positive for two reasons: the timely evaluation and management of her incidental lung nodule and the availability of minimally invasive robotic lung surgery.
Multidisciplinary care
The Incidental Lung Nodule Program uses software to scan all CT scan reports from patients. It flags any predefined keywords, such as nodule, mass, lesion and lung, to help identify any patients with potential lung nodules. Medical assistants and nurse navigators review the compiled nodule report and ensure that doctors follow up on any concerning nodules.
Lung nodule navigators bring the list of patients with lung nodules to the weekly lung nodule conference. Each week, the multidisciplinary team of surgeons, pulmonologists and radiologists reviews 20-30 patients, taking time to examine the imaging for each patient.
Then, the team develops a plan that could include recommendations for additional CT scans, a biopsy or a consult with pulmonary medicine. The lung nodule navigator communicates the plan to the patient and their primary doctor.
“The navigator is the point person to ensure that the patient doesn’t fall through the cracks,” explains Hagen. “Atrium Health lung nodule navigators lead patients from detection to diagnosis, ensuring that patients get to the appropriate next level of care.”
If a nodule is determined to be cancer, lung cancer navigators help guide patients through the cancer treatment process and coordinate care.
Minimally invasive lung surgery
Atrium Health now offers one of the largest robotic lung surgery programs in the Southeast region. Since 2018, Atrium Health surgeons have performed more than 750 robotic lung procedures.
Traditional lung surgery using thoracotomy involves a large, painful incision that requires three to four months of recovery. Minimally invasive lung surgery using video-assisted thoracic surgery (VATS) offers several improvements. For example, patients have a shorter hospital stay with less pain and fewer complications.
“When you’re doing complicated lung cancer surgery, some tumors are difficult to access,” Hagen notes. “For 10-20% of patients, you have to change the surgical plan from minimally invasive to open surgery in order to complete the procedure.”
Compared with other minimally invasive techniques, robotic lung surgery carries less than half the risk of needing to convert to open surgery, with only 5-10% of patients requiring the conversion. At Atrium Health, less than 3% of patients need to be converted to open surgery.
“Having an experienced robotic lung cancer team like ours gives patients a much higher chance of achieving minimally invasive surgery with the best possible outcome,” adds Hagen.
In addition, robotic lung surgery may offer a better method of cancer control. When doing a VATS lobectomy (a minimally invasive procedure to remove a lobe in the lung), there are limitations involving the surgical instruments, which can make it difficult to remove lymph nodes during surgery.
Hagen explains, “The robot overcomes these limitations, allowing the surgeon to complete the lymph node removal, which is better for the patient and better for controlling the cancer.”
Open communication, commitment to improving outcomes
Bessie appreciated the open communication and kindness provided by her health care team prior to her lung surgery.
“I loved my doctors and nurses; they explained everything and gave me all the information I needed,” she says. “They treated me like I was their mama. Everything went well and I had no complications.”
Following the surgery, Bessie was back to her usual activities within about three weeks. The best news, according to Hagen, is that the procedure confirmed her lung tumor to be stage I, which means she’s likely cured and won’t need further treatment.
Bessie recommends Atrium Health to other patients like her. “I had excellent care without any problems,” she says. “They’re number one for me. The service was really good. You can’t go wrong dealing with them.”
Hagen sees Bessie’s case as a testament to the commitment of his team’s efforts to improve lung cancer outcomes.
“You need a coordinated, well-organized program to treat patients like Bessie,” he says. “Combining multidisciplinary care with robotic lung surgery in a screening environment is the key to improving patient outcomes. If you find it early and treat it well, you’ll see great results.”
How does he feel about helping lung cancer patients? “We want to provide superior care to as many patients as possible – and hopefully deliver a cure,” he says. “There’s nothing better than being able to tell a patient that their cancer was caught early and they’re likely cured. It happens often, and it’s quite rewarding.”
Atrium Health’s Lung Cancer Screening Program and Incidental Lung Nodule Program are the only programs of their kind in the Charlotte region. Our team of experts is passionate about finding lung cancer early, when it’s easiest to treat. That’s why we developed these programs focused on early detection. Atrium Health’s Lung Cancer Screening Program includes preventative screening for patients who are at high risk for lung cancer. Atrium Health’s Incidental Lung Nodule Program ensure patients with a lung nodule get appropriate follow up care when a nodule is found by accident when a patient is receiving care for another reason. Both programs provide advanced, comprehensive care for patients with lung nodules.
