Frank C. Detterbeck1, Julia Wang2
1Professor of Thoracic Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, CT, USA; 2JTD Editorial Office, AME Publishing Company.
Editor’s note
We are glad to announce the launch of a new special series named“A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation”in Journal of Thoracic Disease, led by Prof. Frank C. Detterbeck from Yale University School of Medicine.
For an introduction of the special series, we have invited Prof. Frank C. Detterbeck for an interview to share his scientific experience and the stories behind the special series.
Expert introduction
Figure 1 Photo of Prof. Frank C. Detterbeck
Frank C. Detterbeck MD, New Haven, Connecticut, USA
Dr. Frank C. Detterbeck is the Professor & Chief of Thoracic Surgery Yale University, and co-director of the Yale Lung Screening and Nodule Program. He is an Associate Editor of Journal of Thoracic Oncology and is on the Editorial board of the Journal of Thoracic and Cardiovascular Surgery and Chest. He is the Chair for the Lung Cancer Guidelines of the American College of Chest Physicians. He is the former president of the International Thymic Malignancy Interest Group, and has served in leadership positions in most of the major thoracic oncology and thoracic surgery organizations. He has edited several textbooks on lung cancer, mediastinal malignancies and thoracic surgery, and has written more than 250 peer reviewed journal articles and 50 book chapters.
JTD: We are excited to work with you on the series on “A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation”. Could you please share with us what motivates you to lead this series?
Prof. Detterbeck: I am a clinician who is committed to finding the best option for patients. While much has been written about this subject, I felt that we needed to have a summary that was nuanced enough to guide decision-making for individual patients.
JTD: Could you highlight the features of the series?
Prof. Detterbeck: The focus of most comprehensive reviews of a topic is on distilling it down to a single general conclusion – something like “In general, survival is better with treatment A than B”. In clinical care, however, we are always considering multiple outcomes and how they apply to an individual. A general conclusion for an average patient is hard to apply.
The focus of this series is to provide tools that help clinicians with individualized decision-making. We aimed to be as comprehensive as possible, to consider multiple outcomes, and to highlight aspects that increase or diminish the impact for an individual. We developed a tool that highlights the outcomes and characteristics that are most impactful in order to facilitate the decision-making process.
JTD: The majority of your thoracic/chest surgeries are performed using minimally invasive techniques. Could you please tell us about the biggest challenge of using minimally invasive techniques in surgeries? Are there some cases which impress you a lot?
Prof. Detterbeck: I continue to be amazed at how much easier it is for patients to undergo and recover from minimally invasive thoracic surgery compared with the open approach. Even older people do well.
I find the biggest challenge is in anticipating how frail patients will do – often they sail through easily, but sometimes their resilience is less than you expected and takes longer to get back to normal than anticipated.
JTD: You especially emphasize on multidisciplinary teamwork. In this series, how can multidisciplinary teamwork be achieved?
Prof. Detterbeck: There is no question that the thoughtful collective judgment of multiple individuals who each have a slightly different perspective is better than any one person’s judgement. Creating the forum that allows such collective judgment is the key. People need to work together enough that they can read the other person’s level of concern, they need to listen to one another carefully during a discussion, and seek a collaborative decision. When a team achieves this interaction, it is so satisfying that it is easy to perpetuate.
JTD: How would you see the future of the treatment of Stage I NSCL?
Prof. Detterbeck: We have come a long way, but there is still a long way to go. We need to think about early-stage NSCLC not as one entity but a family of diseases. The current focus is on molecular fingerprinting – while this is a huge advance, we need to look beyond this. Identifying different types of early-stage NSCLC will allow us to recognize biologic patterns that will point out the ways to make treatments and outcomes even better. For example, a better understanding of which tumors are prone to remain localized (or not) will refine treatment strategies.
JTD: How can we strengthen the international cooperation in this field?
Prof. Detterbeck: While we already have a lot of international cooperation, we need to take it up a notch. We need to go beyond international meetings and sharing research in journals. These interactions obscure differences in the settings in which we work, the tumors and patients that we see – gaining insight into these differences will allow us to recognize the next layer of complexity – this is what I meant when I talk about recognizing that lung cancer is a family of diseases.
To achieve this insight, I think we need to encourage spending more time observing in each other’s environment. I have learned tremendously from others whenever I can spend a few days in their hospital observing. This sort of “mini-immersion” experience provides insights that an annual society meeting – or worse yet a zoom meeting – doesn’t.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Thoracic Disease for the series “A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation”. The article didn’t undergo external peer review.
Conflicts of interest: Both authors have completed the ICMJE uniform disclosure form. The series “A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation” was commissioned by the editorial office without any funding or sponsorship. FCD served as the unpaid Guest Editor of the series. JW reports that she is a full employee of AME Publishing Company. The authors have no other conflicts of interest to declare.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.