Key personnel making an impact in the world of lung cancer - 4:
Dr Emily Stone, Consultant Respiratory Physician and Acting Head of Thoracic Medicine, Department of Lung Transplantation and Thoracic Medicine, St Vincent’s Hospital, Sydney.
Dr Stone is a Senior Lecturer at the University of New South Wales and the Chair of the St Vincent’s Hospital Lung Cancer Multidisciplinary Team (MDT). She has developed clinical practice and research interests in the fields of lung cancer, multidisciplinary team care and tobacco control since 2006.
Dr Stone has been a member of the IASLC Tobacco Control and Smoking Cessation Committee since 2013 and is currently Chair of the Committee.
What first motivated you to work in thoracic medicine and lung cancer?
What first drew me to thoracic medicine was its intellectual offering. I focused on lung cancer in my early years of clinical practice: I worked with the lung cancer multidisciplinary team (MDT) and loved the collegiate atmosphere.
I find lung cancer a very rewarding field to work in. There is a crying need for patients with lung cancer to be cared for by people who believe they need respect and the best care, including support with smoking cessation. I used to feel despairing about smokers with lung cancer.
Being on the IASLC Tobacco Control Committee – where I have the opportunity to work with exceptional people (I know everybody says their teams are exceptional, but these people really are) – has educated me and made me a better clinician.
What is different about your role today from when you started your career?
There is much more to offer patients now, due to advances across the spectrum of treatment and care. Advances in imaging, the wider use of PET scans and the introduction of EBUS (endobronchial ultrasound-guided biopsy) mean that our ‘diagnostic toolkit’ is much more sophisticated than it once was, so we can better diagnose lung cancer and identify staging. Use of low-dose CT raises the potential of larger scale screening programmes for lung cancer. I’m presently involved in a trial looking at this.
The development of MDT teams and lung cancer pathways has also been very important. Developing well-validated lung cancer pathways can make a huge difference to advancing care and improving outcomes.
Now a whole team of people, from the GP through to the respiratory physicians, oncologists, surgeons, palliative care physicians, lung cancer nurses and allied health care workers can collaborate to provide the best care for each patient. MDT teams also include imaging specialists and pathologists. There is a lot of expertise that comes together.
With some of the newer therapies including targeted therapies and immunotherapies we are seeing more patients living good quality lives after diagnosis. It is not uncommon now to see people with lung cancer who are active and busy, even after their diagnosis. I often hear about how patients are able to travel or enjoy playing golf, which once seemed unthinkable.
This is not true for everyone, but it seems to be happening more often. Maybe we can turn lung cancer into a more chronic condition.
What do you see as the most significant challenges for advocates?
Lung cancer in non-smokers is very tricky to diagnose early and given that around 15% of lung cancer cases occur in non-smokers we still need to improve early detection.
We will also need to keep driving down smoking levels. There have been big steps on tobacco control. During my medical career smoking rates have halved. We are looking at about 12% in Australia at the moment, but we want to see that pushed down to around 5% in the future, which will be difficult. The use of e-cigarettes also poses a new challenge to our existing models of tobacco control.
In many ways, survivorship is an unexplored field in lung cancer. But there are more and more patients diagnosed at stage IV who are living well. Pathways for survivorship care are well established in other fields, like breast cancer. More work needs to be done on helping patients with lung cancer cope with diagnosis and supporting them to live well on active treatment.
What are you most excited about in your field?
I think developments in the use of biomarkers and genomics have a lot to offer. We have seen the impact on treatment options from markers such as EGFR receptor mutation and EML4-ALK gene rearrangement. I look forward to future markers that may help refine treatments even more, with better outcomes for patients.
What role do you see international collaboration playing in advances in lung cancer treatment?
International collaboration is essential. Different nations and groups have different expertise and working together has been critical in improving lung cancer treatment. For example, some of the high-impact early phase III EGFR TKI trials were carried out across several countries in Asia because the rates of gene mutation are particularly high there.
Tobacco control has to be an international effort because the tobacco industry itself is globalized.
International guidelines, such as those developed by IASLC, are also very important as they often reflect more recent information and clinical trial data and help us optimize the choices for patients.