Multidisciplinary Team Diagnoses Patient With Two Separate Lung Cancers

Barbara Sowder, 65, says that in the fall of 2014 she had a cough that she just couldn't shake, but she attributed it to pesky allergies.

"Finally my husband and sons insisted that I go to the doctor," she says, adding that she scheduled an appointment with Melissa Erickson, MD, UC Health primary care physician in Florence, Kentucky.

Erickson ordered a chest X-ray done the day of the appointment and then a follow-up CT scan, and as Sowder simply states, the results were "not good."

"They saw two nodules in the lungs—one in the left lower lung and one in the right lower lung—and an enlarged lymph node on the right side," she says. A bladder cancer survivor, Sowder decided to see her former oncologist for advice. Since he is associated with another group not under Sowder's insurance coverage, he highly recommended Sandra Starnes, MD, and personally called her office to get her in for an appointment. 

"He told me I would be in great hands with the lung cancer multidisciplinary team at UC Health."

A few days later, Sowder saw Starnes, a thoracic surgeon with the UC Cancer Institute and the John B. Flege Jr. Chair in Cardiothoracic Surgery at the UC College of Medicine, who immediately ordered a PET scan and an MRI of the head.  

She also referred Sowder to Sadia Benzaquen, MD, faculty member at the UC College of Medicine and the area's only board certified interventional pulmonologist, who performed a bronchoscopy and biopsy that confirmed the left lung nodule was cancer. "He had such a positive attitude," Sowder says. "He kept telling me that we would fight this and I would be alright. I had been so down, but he really lifted my spirits."

Sowder was then referred to John Morris, MD, PhD, professor in the Division of Hematology Oncology at the UC College of Medicine and oncologist, and Bradley Huth, MD, assistant professor and radiation oncologist, who along with Starnes meet weekly to determine the best care for each individual patient under their care. Sowder was diagnosed with Stage IIIA cancer in her right lung and Stage I cancer in her left lung.  

"It was a huge relief that I was not diagnosed with Stage IV lung cancer which would dictate only chemotherapy as treatment," she says, "but because the team viewed my lung cancer as two primary cancers, which is much less common, the treatment was directed towards a total cure of the cancer."  

Sowder was scheduled for surgery to have her right lower lobe removed; however, prior to removing the lobe, Starnes checked the lymph nodes along Sowder's windpipe, and found traces of cancer. Instead of removing the lower lobe, she put a port in for chemotherapy access.  

Sowder received two three-week sessions of chemotherapy along with radiation five days a week for one month. On the Mondays when she received chemotherapy, she would spend 10 or more hours at the Barrett Center.  

"I became very fatigued and just emotionally drained but overall managed to do well with my treatment plan. I received wonderful encouragement from my family, friends and my care team. I can't say enough about how nice everyone is at the Barrett Center," she says.

After a few months, the team determined Sowder was healthy enough for surgery, and in July 2015, Starnes was able to remove the lower right lobe of her lung along with the cancer.  

"Recovery was tough—learning to deal with less breathing capacity—although I'm told full recovery could take up to a year," she says "I wasn't able to pick up and cuddle my grandchildren for the longest time because I was weak and short of breath, but now I can again hug and play with them."

After recovering from surgery, Sowder again had two more rounds of chemotherapy to help ensure that the cancer wouldn't come back. Surgery for the left lung tumor would likely have required removal of the entire lower lobe; therefore, the team also gave her the option of undergoing stereotactic radiotherapy with Huth instead. Stereotactic radiotherapy is a way of targeting radiotherapy very precisely at the tumor. 

"They gave me options, which I appreciated, and because I didn't want to have another surgery, I chose the stereotactic radiotherapy of which I had in three treatments in November," she says. "I had a follow up CT scan in January 2016 and everything looks fine so far. While I still become short of breath, and probably always will, my energy level is coming back. I really feel like I couldn't have received this level of care anywhere else. The doctors and everyone at the UC Cancer Institute has been fantastic."

Starnes says it's this team approach that really gives patients like Sowder an advantage.  

"Our combined expertise puts us at a better position to treat patients with more complicated tumors and personalize our care to the individual," she says.

Morris agrees.  

"In most other institutions or practices, Ms. Sowder's care would have been palliative and not curative, as we did," he says.

Likewise, Sowder said that her and her family's opinion of her care underwent a complete 180 degree shift compared to prior entering treatment at UC.  

"I really didn't know about the expertise available here," she says. "I have to admit, before actually getting treatment at the UC Cancer Institute, I wouldn't have chosen it, but now I wouldn't choose anywhere else. I believe it is one of the top cancer hospitals anywhere, and I'm so thankful for the wonderful physicians and staff at UC Health who continue to help me on this journey."