New Haven Register (Sunday) (New Haven, CT)
Lung screenings can detect hidden cancer
Georgette Holmes was not surprised to receive a lung cancer diagnosis last year. A lifelong smoker, she figured the day might eventually come. What did surprise her was how secretly the cancer inside her acted. She had no idea she was sick until some blood work came back wonky and her care team sent her for more advanced tests.
“How could I not have known? How could it be so big and I’m still breathing normally?” Holmes said. “It’s my whole left lung
— no cough, no breathing issues, nothing. I was being treated for insomnia.”
Dr. Christopher Iannuzzi is the medical director of radiation oncology at Hartford HealthCare’s Cancer Institute at St. Vincent’s Medical Center. He says it’s important for people to get screened for lung cancer regardless of symptoms, particularly if they’re over the age of 50 and have had a smoking habit throughout their lives.
“If you’re symptomatic, you already have something taking place,” he said. “You want to identify the cancers before they show symptoms, which could be a cough or unexplained weight loss. In Georgette’s case, it was insomnia and left shoulder pain.”
Iannuzzi said the public hasn’t taken to lung cancer screenings as strongly as doctors had hoped, but stressed that early detection is key.
“You can get a CT scan at a low dose, and that can identify nodules in the lung that can be treated effectively before they become too advanced,” he added.
For example, tumors under 2 centimeters are a lot easier to treat, Iannuzzi said. The standard of care is surgery, where doctors remove the lobes of the lung that are affected. But these days surgery is not the only option.
“The advent of stereotactic body radiotherapy, or SBRT, means we can deliver high doses of radiation with pinpoint precision to small areas of the lung,” Iannuzzi said. “Patients get three to five treatments, and the success rate for tumors less than 2 centimeters is more than 90 percent.”
Holmes’ cancer is too advanced for that option, however. She was diagnosed with stage 3B lung cancer and just underwent a round of chemotherapy and radiation.
“I had four rounds of chemo, and the last one kicked my butt,” Holmes said. “Physically my energy level was diminished — I didn’t even know it could go that low. I had no interest in food, and this has lingered. Usually my last day of chemo is a Tuesday; I start feeling not so great on Thursday, but by Sunday it’s livable. This time the symptoms started on Day One and I’m still dragging.”
Holmes lives in Beacon Falls and says it’s quite a trek to get to St. Vincent’s. But she says it has been worth the long drives and long days.
“I really like my doctors. They’re extremely positive, but none of them say just the positive. Dr. Iannuzzi was very clear that the radiation would cause damage to the lungs. It was always a well-rounded, honest story,” she said.
“The nurses were adorable, kind, and nice. I had four or five regular nurses, and even if they weren’t my nurse that day, they’d come in a couple times a day to check on me.”
Holmes drove herself almost an hour to every appointment, which lasted anywhere from four to nine hours depending on the day. Throughout the entire ordeal, the 64-year-old worked full-time.
“I’d go into the cancer center, heat up my breakfast, set up my laptop, and I’d work. Because what else are you going to do?” she said.
Holmes is also a fulltime caretaker.
“I live with my older sister who is physically disabled, and she has a lot of limitations. I do the cooking and cleaning, and I work full-time and go shopping,” she said. “I’m still the milk-getter. It doesn’t matter how sick I am — if we need milk for coffee, I get it.”
Doing all this while sick from chemotherapy and radiation is herculean, but Holmes says it’s better to keep busy, even if it
stretches her to her physical limits.
“This could take you to a very dark place, very easily. It’s a pretty dark situation if you think about it. Massive pain that is never going to go away, and cancer that is never going to go away. It’s in my blood. That’s it. What if I didn’t have a job?” she said. “I’ve had my moments, when I’m up at 3:30 in the morning in pain, making coffee, and I have to get showered and dressed and pack my lunch and work stuff, and I didn’t want to do it. I just didn’t want to do it. But I did.”
Having somewhere to be and something to do keeps the overwhelming nature of the situation at bay, Holmes said.
“For me those moments are short-lived, because I have to jump in the shower and get out the door and get on with my day,” she added. “I think about the people who don’t have to jump in the shower and get on with
it, and how they must get stuck in those moments, and it never ends.”
Iannuzzi said this is not the end of Holmes’ journey. He hopes the treatments shrink her tumors enough for surgery to be an option.
“It’s not clear if she is a surgical candidate yet,” he said. “She has to have a PET scan three months after chemo and radiation because we want all the swelling from treatment to go down first, but my preference is to get her a surgical opinion.”
Iannuzzi says the most important thing for cancer patients is getting holistic care across multiple disciplines.
“One of the most important things for a cancer patient is that their case is presented in a multidisciplinary conference. We have one every week for every part of the cancer team to go through the images, the pathology, the clinical trials, and decide as
a group the best treatment for patients,” he said. “Experts from multiple specialties see the cancer from slightly different perspectives, and this provides a comprehensive treatment plan.”
As for Holmes, she’s determined to live her life to the fullest.
“You plan for the worst and hope for the best,” she said. “You get as much information as you need, and you take it literally one day at a time.”
This is just one example of Hartford HealthCare St. Vincent’s Medical Center bringing more specialists and providers to the community. Tune into Hartford HealthCare St. Vincent’s Medical Center’s Facebook Live discussion, where you can ask questions, on Thursday, Jan. 26, at noon. For more information, visit hartfordhealthcare.org/ cancer or call 855-255-6181.