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 -- 2007-2010 -- 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,” says Dr. 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.”
In 2015, Dr. 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 says, “ it was a lung cancer screening program, but it evolved into a multi-specialty 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, Dr. 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 of 2019. A relatively new field, Interventional Pulmonology focuses on minimally invasive procedures to help patients with lung cancer. Not only did Dr. 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, Dr. Romero 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,” Dr. Romero says.
But a new disease -- COVID-19 -- came along in March, and Dr. 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 focused on 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 says, 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, Dr. Romero says 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,” Dr. Romero 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.”