Cancer Team Follows Through for Golf Pro
Golf coach Tim Nelson is breathing easier today, despite a diagnosis of the asbestos-related cancer mesothelioma almost two years ago. That’s because he sought treatment at the University of Chicago Medicine Comprehensive Cancer Center, a pioneer in researching and treating this rare disease.
Nelson, director of golf at the University of Nebraska Omaha, started having trouble breathing in the fall of 2012, when he was 69. His wife, a registered nurse, thought the problem was bad enough to rate a Saturday trip to the emergency room at a local hospital, where a CT scan showed fluid around his right lung. "They wouldn’t let me go home," he said.
The next day, an exploratory surgery found tumor growth in Nelson’s chest. A biopsy confirmed that it was malignant mesothelioma, an aggressive cancer that attacks the mesothelium, the membrane that covers the chest, abdomen and heart. While Nelson has been a golf pro for most of his life, he did work briefly as a young man at a railroad repair yard, where he was exposed to asbestos. Asbestos exposure accounts for the vast majority of mesothelioma cases, said Hedy Lee Kindler, MD, director of the University of Chicago Medicine Mesothelioma Program. An internationally known expert, Dr. Kindler designs and leads many clinical trials that evaluate novel treatments for malignant mesothelioma.
"The first thing they said was, 'You’ll probably lose your lung,'" Nelson recalls. His physicians in Omaha suggested he pursue further treatment at one of a handful of centers specializing in the disease, and recommended programs in Boston and Chicago. "My wife said, 'I don’t care where we go as long as we get the best,'" Nelson said. He chose the University of Chicago Medicine, making his first visit in December 2012.
There are only about 3,000 new cases of mesothelioma diagnosed each year, and the average oncologist may see one or two at most each year. The University of Chicago Medicine Comprehensive Cancer Center has one of the largest mesothelioma treatment programs in the U.S., drawing patients from throughout the country. About 120 newly diagnosed mesothelioma patients seek treatment at UChicago Medicine each year, allowing clinicians to develop exceptionally broad experience and expertise.
"Our patients have access to doctors who know the subtleties of this disease, which helps us better predict what is going to happen," said Kindler. "Because we see such a large volume of patients, we know all the possible variations."
Once the mesothelioma team identifies the sub-type of disease the patient has, it can recommend the most effective treatments tailored to both the disease and the patient. Not every patient should start with the most aggressive chemotherapy drugs, Kindler said, and many patients will be good candidates for the type of surgery that doesn’t involve removing the lung.
Kindler encourages patients to seek out the program when they’re first diagnosed, so they can have expert guidance throughout the course of their illness. Mesothelioma generally develops 20 to 50 years after asbestos exposure, and many patients will be at an advanced stage when the diagnosis is confirmed.
The tests confirmed that Nelson’s mesothelioma was confined to his right chest cavity. The first major step in his treatment was a surgical procedure called an extended pleurectomy and decortication, to remove the tumor cells from inside of his chest wall and the surface of his lung, including the lining of the sac around the heart and part of his right diaphragm (the breathing muscle that separates the chest cavity from the abdomen). The other surgical option would have been to remove the entire lung along with the tumor instead of 'peeling' it away. The procedure was performed by Wickii Vigneswaran, MD, associate chief of cardiac and thoracic surgery, who operates on 30 to 40 mesothelioma patients each year--many times more than most thoracic surgeons do. He says that while the type of surgery Nelson had is more challenging, it can eradicate 95 to 98 percent of the tumor tissue while allowing the patient to keep both lungs. "When patients are candidates for this surgery, it can not only lengthen their life but improve its quality," he said.
Kindler says that like peeling the pith off an orange, the procedure Nelson received almost always leaves some tumor cells behind. His surgery was followed by a series of chemotherapy treatments, three weeks apart, that he was able to receive in Omaha under her direction. Now he visits Chicago every few months, working around the golf season, for follow-up blood tests and specialized CT scans to check for tumor growth. If it returns, Nelson expects further chemotherapy, potentially as part of a clinical trial.
While Nelson hasn’t thus far been participating in any clinical trials of new treatments, many of these innovative options are available through the University of Chicago program, both for newly diagnosed patients and for those who have already received previous treatments. Kindler says there are several promising avenues, such as immunotherapy (boosting patients' immune response in specific ways that kill cancer cells), and targeted therapy (blocking specific growth pathways associated with mesothelioma).
The program also offers radiation treatment for certain patients, especially those who have had tubes inserted in the chest wall to drain fluid from their lungs.
Nelson is back coaching golf and is doing well. While his tumors haven’t returned, he recognizes that he has an unpredictable disease. "I always thought I felt really good, but I keep feeling better and better since the surgery," he said.