- 2 years ago
Kristen Hermann interviews Dr. Matthew Puc
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00:00Hi, and thank you for joining us. I am Kristen Herman, and with me virtually is Dr. Matthew
00:05Poots. He is a board-certified general thoracic surgeon who specializes in thoracic oncology.
00:11He's also the chief of thoracic surgery at Virtual Health and the director of Virtual
00:15Lung Cancer's screening program. Hi, Dr. Poots. Howdy. How are you? Nice to meet you.
00:21Great. How are you doing? I'm doing fabulous. Wonderful. Well,
00:25thank you for coming on. November is Lung Cancer Awareness Month, and while I am aware of the
00:31existence of lung cancer, I don't know a whole lot about it, and I know I'm probably not alone.
00:36What are some symptoms of lung cancer? What should we be looking out for, and how does it differ from
00:41something like a common cold or like allergies or something like that? Correct. Those are all great
00:46questions and very relevant when we talk about lung cancer, because one of the tricky things about lung
00:52cancer is in its early stages when we actually want to find it, there are no symptoms, and that's some
00:58of the difficulties that we deal with on a daily basis. Most, and unfortunately, most patients, when
01:05they do present with symptoms of lung cancer, it's usually at more advanced stages, and that's some
01:11of the difficulties that we have, and those symptoms can be very varied and unfortunately very
01:17nonspecific. You know, people can have a cough that can linger, and typically what I tell folks,
01:23you know, if you have a cough that lingers for more than a couple months and it just is not going away,
01:29you know, I would seek medical attention or medical advice at that time from your primary or specialist.
01:37You know, if you develop kind of troubled breathing or shortness of breath that's kind of out of the
01:43norm for, you know, an individual might be a sign that, hey, maybe something more is going on.
01:51People can have kind of nonspecific chest pains, you know, more on a chronic basis that just,
01:57again, seem to linger and not get better. Some of those things, you know, again, it's very
02:02nonspecific, and this is some of the difficulty about diagnosing lung cancer, but those are sometimes
02:09little triggers that people can use to say, hey, maybe, you know, when these symptoms are hanging
02:14around for a while, you know, seek medical attention. Again, it could be a variety of things,
02:20but that's how lung cancer can present, but the caveat to that is, you know, we want to find lung
02:25cancer at its earliest stage because then it's the most treatable, and at that point, there really
02:32aren't any symptoms yet, and that's what we struggle with on a daily basis.
02:35I know if I, you know, have, if you have a cough or if you have any kind of symptom and you go
02:40online, it's just like a million things, including cancer, but it's really hard to tell, and especially
02:46with new things being introduced like COVID and long COVID and all of this stuff, but those all sound
02:52like things that, you know, if you've had a cough for that many months, you should be seeing a doctor
02:55anyway, and hopefully they can find it, and are there differences in the symptoms between lung disease
03:00and lung cancer? Yeah, not necessarily, and that's a good point because there's a lot of overlap there.
03:08Again, you know, if you have, let's say, the common lung disease with smokers is like emphysemas,
03:15COPD, a lot of those folks can have chronic coughs, can have shortness of breath, and so those,
03:23you know, those symptoms should trigger an evaluation or a medical evaluation, and usually
03:30in the process, they'll look at things and, you know, things like lung tumors, lung nodules,
03:36those are things that come up and should be evaluated in the course of the overall treatment
03:41for those symptoms, and kind of what we say is lung cancer is always a differential, especially
03:47in these high-risk individuals, such as, you know, current smokers or former smokers, but again, yeah,
03:54it's difficult because the symptoms, there are no specific symptoms for lung cancer. They're vague,
04:00and they can, you know, mix and match with other lung diseases. You know, even people with, you know,
04:05chronic allergies, for example, may have seasonal allergies, and sometimes that's a trigger if you
04:10just have it in the spring, let's say, or just in the fall, and then it goes away. Likely, that's more
04:15of an allergic thing, but again, if you have something that spans seasons and is persistent,
04:21then that should really trigger an evaluation. And speaking of the evaluation of getting screened,
04:27how do you know if you are high risk for lung cancer? Like, who should be screened? Is it something
04:33everybody does, or is it something that only if you have particular background? Yeah, and that's a very
04:40point in question because it's different than for, you know, breast cancer screening and colon
04:46screening, because for lung cancer, we do target a very high-risk group of individuals,
04:52and we know that based on very good clinical trials now over the years that have determined,
05:00you know, who should be screened. And currently, where we're at in terms of lung cancer screening,
05:06it's anyone who's 50 years or older, current smoker, former smoker, and what we call a 20 or greater
05:16pack year history. And what pack years really means is, for example, the way you calculate that is how
05:24many packs per day you smoke for how many years, times how many years. So if you smoked one pack a day
05:31for 20 years, one times 20 is a 20 pack year history. So then you would qualify, you know,
05:39anything greater than 20 pack years would qualify you for a lung screening study. And what that entails
05:47is a what we call a low dose CT scan of the chest, where you go in, it's a very quick scan, there's no
05:55IVs, there's no contrast, they just put you through the CT scanner. And the scanner, I can tell you is not a
06:04closed tube, like an MRI, this is an open kind of donut shaped. So if you're claustrophobic, people usually do
06:12okay with this type of scan. But it's a pretty quick scan, it's five, 10 minutes, they just run you through and that
06:18gives us a full picture of your lungs, from top to bottom, and we're looking for anything suspicious, such as a lung
06:25nodule, that might suggest, you know, a lung cancer. With that being said, a lot of people have benign lung
06:35nodules, or just random lung nodules, that's very common, you know, probably a third or more of the population has a
06:43lung nodule, but you know, only a few percentage of those are actually malignancies. But in this high risk group, very
06:50effective. I mean, we've had many clinical trials now, you know, in the US and internationally that have
06:58shown a decreased mortality in folks who are high risk for lung cancer who get a low dose CT scan on an
07:07annual basis. So that's really kind of changed the conversation in terms of lung cancer screening,
07:15because as I mentioned earlier, most lung cancers develop or present at later stages, when they're not
07:22curable. If we can screen folks and find them at stage one, those have a much higher risk of being
07:29actually curable and treatable. So that's where we kind of have to move the needle. And it's important
07:36to kind of this month, obviously, lung awareness month, lung cancer awareness month, is the sooner we can
07:44find these nodules and the cancers, the better off. The problem is, when you look nationally,
07:51we're only screening of all the eligible patients who are eligible for lung cancer screening now,
07:57we're probably only screening less than still less than 10% of that population. So, so as opposed to,
08:04for example, breast cancer screening is probably over 80% of the population we're getting to,
08:10same with kind of colon cancer and prostate, much better. We're, you know, we're still in the single
08:16digits. And a lot of that is just education. You know, lung cancer screening has not been around for
08:22a long time. So, you know, Medicare and private payers only started paying for screening back in 2015.
08:30So in relative terms, right, we're only kind of five or six years into this. So we're still kind
08:37of in the infancy. But, you know, as the years go by, I'm seeing more and more scans being done. And,
08:43and that's the, that's the caveat here is to get more people screened so we can find these cancers
08:48at an earlier stage, and really improve on that, on that survival rate for lung cancer patients.
08:55So unlike a colonoscopy or, or a mammogram where, you know, everybody, once you get to a certain age,
09:01you know, you, you go and look at the test and you get them every year and it becomes something
09:04that's kind of a habit. So this is something that it's high risk individuals only for now.
09:10Is it something that we hope to see opened up to the entire population? Like would it hurt
09:15if Medicare and those places?
09:17Yeah, that's a fabulous question. And I can tell you that. So in the U S the, what we call the United
09:25States Preventative Services Task Force, the agency that determines, you know, who should be
09:31screened for what cancer at what age and all those specifics. Other organizations such as the Society
09:38of Thoracic Surgeons, the, the Nance, the National Cancer Associations really want to take it as that
09:48approach. I mean, they, they, they want to, to your point is, is get more people into that screening
09:54protocols. Uh, and I, and I think it's a process. It's going to take some time for us to get there.
10:01Um, it may not be everybody, um, cause we really have to show kind of efficacy in screening everybody
10:09right now. We've just kind of shown it in these high risk select high risk groups. Uh, and I think if
10:15we can start there, I think with time, you know, hopefully, yeah, we can roll back the age, uh, less
10:21smoking history, things like that. And I think with time, we might get there. I think with the smoking
10:28history too, a lot of times people are like, you know, I'm not a pack a day, you know, I do it socially
10:33or at the bar or whatever. And, and it is actually when you said a 20 pack year or more history, like to
10:39me, that's way more cigarettes than I would have assumed could cause lung cancer or would be likely to
10:44cause lung cancer. That's really interesting. I hope that everyone will eventually be able
10:48to be tested for everything. I'm happy to do it, you know? Correct. Correct. No, I agree. So it's a
10:54work in progress. And for lung cancer screening, say you are screened and they're, you know, heaven
11:01forbid there's a positive result. What are your next steps within the virtual cancer program? Correct.
11:07Correct. So, you know, at Virtua, we have this Penn Medicine virtual cancer, uh, program, uh,
11:14where we affiliate with Penn Medicine, um, to provide some of the, you know, cutting edge cancer
11:21care in the region. Um, but if you are identified on a lung screen to have a nodule, then generally
11:29you get kind of put into our, um, nodule surveillance program that we have in place. So anyone who's
11:35within Virtua, who's kind of identified either through screening, um, or incidental nodules, um,
11:43or found to have an incidental nodule on a screen for a different reason, let's say you kind of
11:48enter our nodule surveillance program. Um, and in that program, we very quickly determine your level
11:55of concern with whatever we found. Um, you know, cause we find a lot of nodules that just need
12:00surveillance, let's say, you know, every six months or three months or something determined timeframe,
12:05other nodules that are found to be more, to be larger or more significant or concerning. And they
12:12immediately kind of enter the pipeline where they meet our pulmonologists, uh, they meet our cancer
12:19team essentially. Um, and a decision is made how to proceed. Does that patient need a biopsy? Do they
12:25just need to go to surgery? Most of them need some more imaging studies to further stage, uh, and figure
12:33out what we're dealing with within that particular patient. So there's a lot of kind of personalized
12:38care that happens at that point, because it really determines, you know, that patient's risk factors,
12:45age, other comorbidities, um, and that level of concern that we have for that individual.
12:51Uh, and we also have a multidisciplinary thoracic conference that meets on a weekly basis for that
12:58exact reason. So these patients can be kind of quickly vetted and determined where they need to
13:04go next, um, for the most efficient care, because obviously when you're identified with a potential
13:10lung cancer, right, you want that dealt with, you know, yesterday. Uh, and that's kind of how we
13:15approach these things. We, we kind of get these folks in the pipeline as quickly as possible and
13:20through it, um, and through the process to get them kind of diagnosed, uh, and then treated.
13:26And I see that there are some other programs too, you know, not related to these, you know,
13:30a high risk individuals or a screening for lung cancer, um, pulmonary fitness and nutritional
13:36what is. So, so there's a whole, yeah, an umbrella term, you know, the virtual comprehensive lung
13:44program, which incorporates all those facets, uh, which you just noted, but, you know, within that
13:50umbrella, as we talked extensively about already as lung cancer screening, um, and the,
13:56kind of this lung nodule program, um, pulmonary fitness is incredibly important, especially for
14:03folks, uh, with emphysema and COPD, uh, nutritional support in that same kind of vein is very important
14:11for their overall health, um, and pulmonary health in particular. Um, you know, the other
14:17very important thing is smoking cessation program, uh, and having a robust program, because as I say,
14:25lung cancer screening only identifies cancers that have already developed, um, smoking cessation is
14:31preventative, uh, and that's just as important, if not more important, um, because obviously with
14:38smoking cessation, we're helping, you know, prevent lung cancers, but we're also kind of preventing
14:44overall improved health in general that impacts patients on multiple different organ systems,
14:51which is important. So, so at Virtua, we have, you know, a combination of, uh, uh, available, um,
14:59smoking cessation specialists who are specifically trained in helping folks get off tobacco. Uh, we have
15:06group sessions, um, that happen on a monthly basis to help folks. And we also have individual
15:12counseling, um, that can also happen, you know, for example, through my thoracic surgery office,
15:19I have a PA who's a, who's specialty training, smoking cessation, who can help folks through the
15:25process on an individual basis. Because the one thing that we do know is, you know, we have a lot of
15:31nicotine replacement aids, we have medications that we can give folks, but those alone aren't as
15:37effective as, you know, the psychological component and having someone to talk to and talk through the
15:44process, that's just equally important. And those two things together really improve, uh, a person's,
15:51uh, ability to get off tobacco ultimately, which is the goal. Um, and so we have a very robust program
15:58in that regards, uh, we have clinical trials ongoing and that we can put people into who are trying to
16:05quit tobacco to see, you know, what works and what doesn't. So, so we're pretty aggressive from that
16:10end to really help folks on multiple levels, um, within that kind of lung cancer care or lung care
16:18in general and virtually. And I've seen articles about this and, you know, even if you've smoked for
16:24years, you know, I think some people like think, oh, well, I've smoked all my life, you know, like
16:28it's never too late because actually if you quit, like you can dramatically decrease,
16:32decrease your, your, your lung cancer risk and also increase your life expectancy.
16:38Correct. People don't realize that. Yeah. Just the moment you stop smoking, your body starts to heal
16:45and you actually start to feel better. So on multiple levels, yeah, it's like you said, it's never too late
16:51to, to start, um, or, or stop however you want to look at it, um, to get off tobacco because yeah,
17:00you you'll start to heal. Your lungs will actually start to feel better. You actually, most people
17:05start breathing better, just getting off tobacco, regardless of any medications or anything else. So,
17:11so there are a lot of health benefits, correct, on multiple levels, um, to start whenever, whenever
17:17you can.
17:18There's nothing like knowing someone and especially loving someone that you just want them to be
17:23healthy. You want them to live forever. You know that they smoke and it's, it's frustrating. And I'm sure
17:28it's frustrating to be a smoker and not be able to stop. And I love that you have all of these programs
17:32helping people to do that.
17:35Correct. Correct. Cause it is an addiction. People, like you said, people want to be off,
17:39um, and the folks that are trying are trying hard and it's not easy. And that's why I tell folks never
17:44give up. Uh, there's no such thing as failure. It's just keep trying. Uh, and eventually, you know,
17:50uh, it will happen, but it is a struggle for these folks and it's, and it's, and it's difficult. Um,
17:57and so, yeah, we try to do everything we can for them from that regard. So maybe use Lung Cancer
18:03Awareness Month as the, as the catalyst to, to quit smoking or to get yourself checked out or screened
18:08if you're one of those high-risk individuals. And if you'd like more information about Virtua's
18:12comprehensive lung program, you can visit virtua.org slash lung. Talk to amazing people like Dr.
18:18Boots. Thank you so much for all that you do in healthcare and for talking with us and giving
18:22us this life-saving information. Well, thank you for giving me the opportunity and having me on the
18:28air today. Thank you. Thank you.