The statistics are unsettling: Almost 1 in 4 cancer deaths are due to lung cancer, making it the leading cause of cancer death among both men and women. More people die each year of lung cancer than of colon, breast, and prostate cancers combined. In 2020, the American Cancer Society estimates there will be about 135,720 deaths from lung cancer.
For Dr. Arthur Oliver Romero, a UNLV Medicine pulmonologist, better treatment of patients with the disease has become a hallmark of a career focused on diagnosing and treating disorders of the respiratory system.
His intense interest in caring for those with the disease began during a combined 3-year post-graduate pulmonary critical care fellowship — 2007-10 — at the University of California, San Francisco (UCSF), Fresno.
“A lot of these patients are diagnosed with advanced-stage lung cancer and have very little hope,” said Romero, an assistant professor of pulmonary and critical care medicine at the UNLV School of Medicine. “I’ve always felt that my role is to help them breathe better and give them the best quality of life possible in the time they have left.”
The SPOTS Program
In 2015, Romero put together a team of doctors and nurses, all involved in cancer care, and started the SPOTS (Screening for Pulmonary Oncologic Tumor Services) program at UMC.
“In the beginning,” he said, “it was a lung cancer screening program, but it evolved into a multispecialty group, which included a thoracic surgeon, medical and radiation oncologists, pathologists, an oncology nurse navigator, and myself as the pulmonologist. We saw the patients in our respective offices but met every two weeks in a Thoracic Tumor Board to discuss and coordinate the care of our patients. It was as if the patient was seeing all the specialists at once and we would just send the patient, after formulating a consensus treatment, to whomever is next in the management plan. We made sure there was no lag in their care.”
As time went on, Romero acquired new skills using special bronchoscopes and computer navigation systems for the lung. He was the first in Nevada, for example, to use electromagnetic navigation bronchoscopy for biopsy of previously unreachable lung nodules.
Still, as the cases became more complex, he found that he wanted to do more. He decided to pursue a year-long advanced fellowship in interventional pulmonology at UCSF beginning in July 2019. A relatively new field, interventional pulmonology focuses on minimally invasive procedures to help patients with lung cancer. Not only did Romero become familiar with those procedures, he also learned novel therapies to offer patients with severe COPD, refractory pleural effusions, and interstitial lung disease. Armed with these new skills from his fellowship, he can now help patients who would previously have had to go out of state just to seek treatment.
“My goal was to set up the UNLV interventional pulmonology program, which would be the first and only such program in Nevada,” he said.
The Disruption of COVID
But a new disease — COVID-19 — came along in March, and Romero, who returned from his training four months ago in July, was called on to help and spend more time in the ICU. He is still building his program, but like other pulmonologists, he now spends much of his time on the frontlines with COVID patients.
“I want to do all I can to help people overcome COVID-19. Other work initiatives are currently on the back burner,” he said, pointing out that UMC is now seeing a spike in COVID cases, with the critically ill on life support needing ventilators to breathe.
With no effective medication to treat the underlying COVID infection and vaccines still on the horizon, Romero said physicians just have to do what they can to support and help patients recover, usually with a regimen of convalescent plasma, the drug Remdesivir and a course of high-dose steroids. “We also keep patients on specialized nasal breathing devices or pressurized face masks as long as they can tolerate these. We like to keep them breathing on their own as long as possible.”
“Often you feel stuck because you watch and support patients day-by-day but you can’t rush them. The patients will tell you when they are ready to get better,” he said. ”At times it can get pretty frustrating…still, I have to give credit to our nurses, respiratory therapists, and other staff, as well as our trainees, the UNLV residents and fellows, who are with us every single moment caring for these patients. We couldn’t do it without them.”
Patients on ventilators – especially the sickest — need to be positioned daily, having to alternate between lying on their backs and stomachs. About three to four medical professionals are needed to turn the patient over each time. The practice helps open up lungs that may have been compressed in one position and decrease the patients’ oxygen requirements.
During his recent fellowship, Romero says he was trained to perform a percutaneous tracheostomy, which sometimes must be used with COVID patients who cannot come off the ventilator. The procedure, which is often done in the operating room, places a breathing tube through the patient’s neck. “I’m able to do it at the bedside to minimize the use of ORs and keep these available for other procedures,” he explained.
A graduate of the University of the Philippines College of Medicine, Romero did postgraduate work and earned his master’s degree in medical informatics from Erasmus University Rotterdam in the Netherlands prior to traveling to UCSF Fresno for postgraduate medical training.
While understanding that the virulence of COVID-19 keeps hospital officials from allowing families to see their hospitalized loved ones, the doctor says the “no visitor” policy makes it more difficult for both families and medical practitioners alike.
“In the pre-COVID era, we always had families involved in the care of our ICU patients. They were always there at bedside spending time with their loved ones and helping them recover more quickly. This allowed for a constant flow of communication and, in effect, allowed us to take care of the family, too. Given the current high risk of transmission, no visitors are allowed except during end-of-life scenarios. So this has clearly been very difficult for family members and adds to the complexity of caring for the COVID patient. It has become part of our routine to call and update family members daily.”
Romero, who still works with lung cancer patients, knows that he cannot completely give up this aspect of his practice and put these lung cancer procedures on hold.
“The day will come when we will get past COVID,” he said, “and lung cancer will still be there. In fact, it is here now and will not go away. Making someone’s life better — that’s why I got into medicine. It is a privilege I have now, and one that I‘ll continue to have in the future. Right now though, we’ve got an emergency in our country that must be handled.”