Alexander Whitley, MD, PhD, FACRO, Owner and Vice President, Central Alabama Radiation Oncology

Please share your name, title, and a brief overview of your professional history.

Alexander Whitley, MD, PhD, FACRO: My name is Alexander Whitley, MD, PhD, FACRO. I’m the owner and vice president of Central Alabama Radiation Oncology. 

Can you discuss the role of multidisciplinary team care coordination in the diagnosis and treatment of early-stage NSCLC?

Dr Whitley: Multidisciplinary care is integral to starting a patient on an appropriate best first curative approach for early-stage lung cancer.  It is multifaceted in the most appropriate modality for accurate staging, appropriate histologic and sequencing assessment of the pathology, assessing operability of the patient, resectability of the cancer, assessing the patients desires and wishes, combating nihilism of historical outcomes of lung cancer, etc.

When you have different options for the management of early-stage lung cancer, the coordination with different specialists is required to ensure the best approach. All specialties have their inherent biases. It is important to step aside, evaluate the randomized data together, and ultimately recommend the best approach for an individual patient.

How does collaboration among different health care professionals impact the management of patients with NSCLC?

Dr Whitley: It is integral to obtaining the best oncologic outcomes and the best functional outcomes for a patient.  The entire team from pathology, thoracic surgery, pulmonology, medical oncology, radiation oncology, advanced practitioners, dietitians, palliative care, pharmacists, etc. is essential.  The entire team’s goal is to get the patient the best outcome with the least impact on their quality of life along with the least financial cost to the patient and the system. In different health care environments, this can be dramatically different. But collaboration is required and necessary to find the best approach for the patient and their family.

Often, we opt for a shared decision model with the patient. For example, surgery and radiation are different tools in the toolbox with different courses of therapy and side effects and patients often have varying opinions about what they will and will not do for themselves.

What are some key differences encountered in coordinating care for patients with Stage II and Stage III NSCLC cases?

Dr Whitley: Stage II patients, depending on operability, have lots of options. This ranges between neoadjuvant chemoimmunotherapy, adjuvant therapy, radiation therapy, and more.  Stage III disease is a wide spectrum of disease and careful upfront complete staging is required to help inform patients of treatment options.  These options often can be slightly different depending on experience of the thoracic surgeon as well.  Not that stage II disease is not multidisciplinary, because it clearly is, but stage III disease is that much more so a multidisciplinary approach and I would submit requires input of all specialties to coordinate the best care for the patient and the disease.

What have been the benefits of utilizing a multidisciplinary team in the care of NSCLC patients?

Dr Whitley: The multidisciplinary team coming together not only provides the patient with the best information to make an informed decision about the initial approach, but entire teams allow continual evaluation of the patient as they progress through therapy to continue to adapt and adjust recommendations, manage toxicities, and ultimately obtain the best oncologic outcomes and quality of life outcomes for the patient.

Were there any key messages you hope your session audience at AVAHO 2024 walked away with?

Dr Whitley: Understand that stage II and stage III lung cancer care is complex with a multitude of options that requires a multidisciplinary team.  Coordination of care is critical.  Understanding your own medical environment as a practitioner and working to limit delays in diagnosis, staging, multidisciplinary discussion, and management through the process is critical to make the changes necessary to benefit your patients, neighbors, and friends.