Conversations to Have With Your Oncologist

Recent years have brought exciting advancements for patients with non-small cell lung cancer (NSCLC), particularly when it comes to immunotherapy. However, there are some key discussions that patients must have with their health care team before starting any treatment regimen.

CURE spoke with Gregory J. Riley, M.D., Ph.D., of Memorial Sloan Kettering Cancer Center in New York City, about these new advancements, what kind of questions patients should be asking their doctors and what next steps in the ever-evolving field of lung cancer should be.

CURE: What are some of the key discussions that a patient should have with their health care team when they're first diagnosed?

Riley: I think the key is to figure out what are the goals of care. Our first question is around, “What are we going to be able to do here?” And the patient who has a surgically resectable lung cancer, our goal is cure. We're trying to take this tumor out or give this tumor radiation and have it never come back.

Unfortunately for patients who have metastatic disease, we're often not able to cure those cancers. We're often never able to cure them. But we are able to control them and shrink them and help patients live as long and as well as possible. I think understanding the goal of therapy is really critical.

Once we've decided the goals of therapy, then we figure out what the best therapy is for that given patient with that given tumor. I think we have a lot to learn when we start that conversation with patients. The doctor has a lot to learn about what the patient's priorities are, and the patient has a lot to learn about what the options are for therapy. It's best to understand all those options before you pick the right one.

Immunotherapy is generating a lot of excitement, particularly in lung cancer, but not everyone is a good candidate for it. How do you counsel patients who come in asking about it?

With the advent of advertisements for anti-cancer therapies, we definitely have the conversation more and more in clinic where the patient brings up the name of a drug. I think patients understand that these advertisements often oversell the benefits of therapy. So, this will open the door to the conversation. In that way, those advertisements are helpful because it allows us to talk about things that maybe we wouldn't otherwise talk about.

When I hear from patients about the use of immunotherapy, sometimes they're surprised to know that they're actually receiving the drug that was advertised. They didn't realize it had a different name. Other times, we talk about it and I explain that maybe it's not right for them right now, but it may be right for them down the road.

What are some of the more important aspects to educate patients on?

Whenever we meet with a patient and talk about a new therapy, it's critical to talk about the risks of that therapy, so the patient is informed about what their risks are. I think it's incumbent of doctors and the treatment team, including the chemotherapy administration nurses, that we talk with the patient, and have a lengthy discussion about the side effects that could happen, and in particular about warning signs of what might happen. We give the patients written information with the names of the drugs so that they understand what they're getting, and they have those to refer to if they run into trouble.

Despite all of the exciting advances in lung cancer in recent years, what do you find to still be an unmet need?

We've made dramatic advances on how we treat patients with lung cancer. Median overall survivals have grown significantly, nearly doubling over the past 10 years. But we're still not doing a good job when we treat patients with lung cancer because we're not curing everyone. That's what we have to aim for. We have to aim to cure people. Studies have to be designed to improve the cure rate for patients with metastatic lung cancer. Until we do that, we're nowhere near done.