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TAKE A MOMENT TO MENTION LUNG CANCER SCREENINGS "PRIMARY CARE PHYSICIANS may not have lung cancer screening recommendations at the top of their to-do lists," says Cleveland Lewis Jr., MD, Medical Director of the Lung Cancer Disease Management Team at Orange Regional Medical Center. "For example, there may be some opposition to subjecting indicated patients to annual CT scans. Again, it is tough to suggest a patient receive a screen - ing that will not be reimbursed by insurance or covered by Medicare." However, Dr. Cleveland says, lung cancer screening is important for physicians to keep on their radar, especially as the Centers for Medicare & Medicaid Services may soon issue a final ruling about payment. "I urge physicians to look more deeply into lung cancer screenings," he says. "If they have any doubts, I am more than happy to speak with them. Orange Regional is positioned to be proactive in the community as low-dose CT becomes approved as a major lung cancer screening tool." Physicians should refer patients who: + Are 55 to 80 years old, and + Have smoked for 30 pack years and are either a current smoker or have smoked in the last 15 years, or + Have smoked for 20 pack years and have other risk factors, including family lung cancer history or asbestos exposure and identify the best strategies for medi- cal and ancillary care. During surgical procedures, Dr. Lewis is usually assisted by a skilled physician assistant. Orange Regional follows established, evidence- based protocols for treating lung cancer, as well as offering clinical trials for patients whose cancer does not respond to standard therapy. Cancers treated include small-cell and non-small-cell carcinomas, as well as carcinoid tumors and mesothelioma. The lung cancer management program at Orange Regional Medical Center offers a full range of treatment options. Dr. Lewis says, "At certain stages, patients may receive surgery, chemo- therapy, radiation therapy or some combination of those." He notes that the fashion in which surgeries are performed has changed significantly. Minimally Invasive Surgical Options Orange Regional provides minimally invasive video-assisted thoracic surgery (VATS). This approach offers benefits similar to those of traditional, open sur- gery with greatly reduced postoperative pain, scarring and recovery times. "Making only three small incisions, we insert a video scope to guide the procedure," Dr. Lewis says. "The largest incision is typically two inches long at most. We are able to perform most lung cancer resections through VATS, result- ing in improved outcomes in terms of less pain, quicker lifestyle recovery and minimal scarring." Additionally, radiation oncologists and medical oncologists contribute to patients' ongoing care. Even non-resectable tumors can be treated with chemotherapy and radiation therapy, Dr. Lewis says. "For patients who have late-stage lung cancer or non-resectable tumors, medical and radiation oncologists have modalities that don't include surgery yet can treat tumors with varying degrees of effectiveness," he says. "Some patients can be cured in the late stages with radiation and chemotherapy alone." Dr. Lewis and surgical nurse make postoperative surgical rounds. Dr. Lewis discusses marketing strategies for the Lung Tumor program with a colleague. M D N E W S . CO M ■ MD NEWS Mid Hudson | 9