Research

Lung cancer care during COVID-19: Q&A with Shanda Blackmon, M.D., M.P.H.

Shanda Blackmon, M.D., M.P.H., is a thoracic surgeon and professor of surgery at Mayo Clinic in Rochester, Minnesota.

How has coronavirus disease 2019 (COVID-19) affected lung cancer treatment?

Unfortunately, COVID-19 has severely affected individuals diagnosed with lung cancer. Those who have experienced delayed lung cancer screenings, diagnosis and treatment because of the pandemic may now be facing advanced disease.

Are patients with lung cancer more severely affected by COVID-19?

Regrettably, during the COVID-19 pandemic, there have been significant delays in getting patients with a diagnosis of lung cancer to treatment.

Patients who get COVID-19 while they're immunocompromised due to lung cancer treatment are increasingly susceptible to having a worse survival rate.

Patients with lung cancer might remain immunocompromised even after cancer treatment is complete and have difficulty recovering. They may not have regular access to care due to the pandemic and can feel isolated and forgotten. The effects of isolation while having cancer can have a tremendous mental impact. These patients may need additional physical and emotional support.

What should patients with lung cancer know at this time?

Patients with lung cancer need to know that delays in care can affect their survival. Delays in care can lead to tumors spreading to lymph nodes or metastasizing. If people think they are at risk of lung cancer, they should be screened, especially if they are between the ages of 55 and 80, are a current smoker or have quit within the past 15 years, and have a history of smoking at least 30 packs a year. Patients who have already been diagnosed should get treatment as quickly as possible.

Our teams offer lung cancer screening, expert diagnosis and advice, and comprehensive treatment options for lung cancer. In addition to direct care, patients have access to multidisciplinary tumor board reviews, when needed, and our educational materials. We can also help coordinate treatment close to home for patients, when appropriate.

What should patients undergoing lung cancer treatment know about COVID-19 risks?

Immunocompromised patients undergoing lung cancer treatment should take strict quarantine measures. They should avoid going out into public, keep a social distance of 6 feet, wear a mask where appropriate, and make sure they limit contact with other family members who are at high risk of contracting COVID-19. This includes being around children who might not be quarantined and who are especially prone to asymptomatic spread of the disease. Until antibody testing and tracking is available, we recommend immunocompromised patients with cancer continue to quarantine and protect themselves, even from exposed family members.

Which patients should be referred to Mayo Clinic at this time? Are there any changes?

Currently, there are no restrictions on patients with lung cancer being referred to Mayo Clinic. Patients who qualify for lung cancer screening can self-refer to Mayo Clinic to be screened and diagnosed at an earlier stage of disease when the lung cancer is most curable. Mayo Clinic is continuing to safely treat patients with lung cancer, and we want to make sure that there are no delays in assessing patients with lung cancer, getting them diagnosed, staged and treated.

What steps has Mayo Clinic taken to ensure safety?

Mayo Clinic has taken several steps to ensure the safety of both patients and staff. When patients come into one of our facilities, they are carefully screened to make sure they do not have signs or symptoms of COVID-19. We are also requiring that all patients, staff and visitors on Mayo Clinic campuses follow current Centers for Disease Control and Prevention masking guidelines.

We continue to explore and implement additional measures for patient and staff safety. Throughout patients' entire hospitalization, we're doing everything we can to limit exposure to COVID-19. In Minnesota, specifically, a much smaller COVID-19peak is expected, so hospital and ICU bed capacity is no longer a concern for our campuses. We anticipate that by the careful measures implemented by our state and Mayo Clinic, we will all benefit and help protect both our patients and our staff.

Past Funded Project: Longitudinal Healthy Lungs Research Project

In coordination with Bruce Johnson, Ph.D., of Mayo Clinic, the Wortman Foundation helped develop a Lung Health Study that will be rolled out in several phases.

The purpose of the studyis to engage communities and participants of all ages in order to enhance education about lung health, lung cancer, and pulmonary research — while investigating, in a fun and educational way, the influence of genetics and environment on the change in lung function as we age.

The healthy lungs research study project will use some of the devices we wore in the Kili Heart Climb, plus a growing list of new and developing technologies such as the MyBreath app by Breath Research (see column on the right).

Anyone can participatevirtually or in person, at a Running Lungs 5k or 10K Walk Run Or Climb held across the U.S. 

Wortman Lung Cancer Foundationis a 501(c)(3) nonprofitfocused on sponsoring Running Lungs races and events to build lung health awareness.

Read the April 2018 Longitudinal Healthy Lungs Research Project update here.

Why is a public lung research project so important?

Linda and Jerry run to fight the unfair stigma associated with lung cancer. Everyone knows people shouldn’t smoke, but any blame or stigma attached to lung cancer needs to disappear. Shockingly, Linda was required to attend Nicotine Rehab, even though she never smoked. Her life insurance was cancelled and was told “You should be dead!” 

As oncologists and funders point out, low funding levels for lung cancer research create a negative cycle that leads to fewer scientist getting on the case. This must be changed!

We approached Dr. Bruce Johnson to provide a research arm to Running Lungs events, providing a unique opportunity to create a database of participants from various locations, ages, backgrounds, and lifestyles to better understand lung health and lung cancer.

Gene is linked to lung cancer development in never smokers

A five-center collaborative study that scanned the genomes of thousands of "never smokers" diagnosed with lung cancer as well as healthy never smokers has found a gene they say could be responsible for a significant number of those cancers. 

In the March 22 online issue of Lancet Oncology, the researchers reported that about 30 percent of patients who never smoked and who developed lung cancer had the same uncommon variant, or allele, residing in a gene known as GPC5. The research was co-led by scientists at the Mayo Clinic campus in Minnesota, Harvard University, University of California at Los Angeles (UCLA), and MD Anderson Cancer Center. Researchers found in laboratory studies that this allele leads to greatly reduced GPC5 expression, compared to normal lung tissue. The finding suggests that the gene has an important tumor suppressor-like function and that insufficient function can promote lung cancer development. 

"This is the first gene that has been found that is specifically associated with lung cancer in people who have never smoked," says the study's lead investigator, Ping Yang, M.D., Ph.D., Mayo Clinic genetic epidemiologist. 

"What's more, our findings suggest GPC5 may be a critical gene in lung cancer development, and genetic variations of this gene may significantly contribute to increased risk of lung cancer," she says. "This is very exciting." 

In this video, Dr. Yang discusses the study and its findings.

Mayo Clinic researchers are focusing on desperately needed Lung Cancer funding and research.

RESEARCH

Medtronic, LUNG HEALTH SOLUTIONS BULLETIN, JUNE 2018

Demmy, T. MD, et al.  ONCOLOGIC EQUIVALENCE OF MINIMALLY INVASIVE LOBECTOMY: THE SCIENTIFIC AND PRACTICAL.ARGUMENTS; Annals of Thoracic Surgery, June 2018
DOI: https://doi.org/10.1016/j.athoracsur.2018.02.089

Hurt, R, et al. Open Doorway to Truth: Legacy of the Minnesota Tobacco Trial, May 2009; 84(5):446-456, 
http://www.mayoclinicproceedings.org/

Hurt, Richard, MD; Robertson, Channing, PhD. Prying Open the Door to the Tobacco Industry's Secrets About Nicotine: The Minnesota Tobacco Trial, JAMA, October 7, 1998, Vol. 280.