Heather Wakelee, M.D., spends a lot of time talking with her lung cancer patients about what to do after surgery, about the option of adjuvant systemic therapy that usually includes three months of physically-taxing chemotherapy.
At the Stanford Cancer Center, she knows that each individual patient has individual needs. She doesn’t give them any easy, cookie-cutter answers. She only provides them with options.
I try not to ever answer a question when a patient asks me, ‘What would you do?’ because I’m looking at it from the context of me, and having young kids. I don’t know what it’s like to be 70 years old, and having some other health issues, and trying to make that decision.
Wakelee is an assistant professor of medicine at Stanford University in the Division of Oncology, co-leader of the Lung Cancer Disease Management Group. She has studied, written and spoken extensively on non-small cell lung cancer; on why female lung cancer patients survive longer; on sex differences in susceptibility, biology and therapeutic responses to lung cancer; and novel cytotoxic agents in lung cancer.
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Since coming to Stanford University in 1997, first as an intern, then a resident and then a fellow, she has made lung cancer her clinical focus. She was appointed staff physician in 2003, carving a distinct niche at one of America’s premier medical institutions. She fit perfectly.
“When I talk with [patients] about what we can do to improve cure rates, the only thing that we know that has an impact is chemotherapy, and it’s not an easy chemotherapy,” she said. “Most people can get through it, but it’s challenging.”
Fast Fact After undergraduate work at Princeton and med school at Johns Hopkins, Dr. Wakelee returned to her West Coast roots.
Wakelee usually tells her patients that chemotherapy is not for everyone, but that undergoing it usually improves chance of avoiding cancer again by 5-10 percent. The risk with lung cancer, as with most cancers, is that there can be small tumor cells that have escaped the targeted area, and chemotherapy can eliminate those.
“We talk about the fact that there’s a more than likely chance that they’ve already been cured [with surgery], and there’s a percentage of people even if we give them treatment, who will not be cured,” she said. “Sometimes, it’s hard to continue thinking about therapy when you understand that everything that was visible is gone.”
Wakelee understands the commitment of a three-month chemotherapy regimen. It can be draining, especially after a major surgery, and it often slows the return to normalcy for both patient and family. Most of the treatments are once every three weeks, at least one full day of treatment and a couple days of recovery each time.
For many people, they’d really like to just get the whole cancer thought behind them [after surgery], and that can be an issue as you’re thinking about ongoing treatment. That certainly plays a role [in a decision whether to do chemotherapy]. People’s responses are quite varied.
With the developmental therapeutics group at Stanford, Wakelee is involved in Phase I trials of several new drugs. She has a particular interest in anti-angiogenesis agents.
She is the principal investigator of the ongoing International Lung Cancer Intergroup exploring the use of bevacizumab as part of the adjuvant chemotherapy routine for resected early-stage non-small cell lung cancer.
She has a particular interest in studying lung cancer in non-smokers, pushing it as a public health issue in need of much-more exploration, and particularly why females are being treated for it now more than ever before.
“Further exploration of its incidence patterns, etiology and biology is needed,” she said.
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