Brett Bade, MD, is a pulmonologist at Yale University and the West Haven Veterans Affairs Medical Center. He has board certifications in Internal Medicine, Pulmonology, and Critical Care, and he specializes in the care of patients with chronic lung disease and lung cancer. Dr. Bade's research focuses are to better understand quality of life impairments for patients with lung cancer and implementation of techniques to relieve their symptoms.
In a few sentences, can you explain the role of a pulmonologist?
Pulmonologists focus on treating patients with lung disease and who feel short of breath. In a multi-disciplinary lung cancer clinic, pulmonologists have several roles. Our most common role is treating lung diseases that are common in patients with lung cancer, especially chronic obstructive pulmonary disease. We also commonly evaluate spots on the lung (i.e., “lung nodules”) to distinguish cancerous from non-cancerous nodules and diagnose lung cancer via several types of procedures. Finally, pulmonologists help manage patients whose cancer treatment injures their lungs.
Is your role patient-facing? [how much/often do you interact with patients]
Yes. Pulmonologists spend most of their time seeing patients face-to-face in the clinic.
Why is it important for someone affected by lung cancer to have a pulmonologist on their medical team?
Patients with lung cancer often have a lot to deal with: stress, shortness of breath, fear, and uncertainty. To ensure care is comprehensive, lung cancer is best managed by teams with multiple providers focusing on the patient’s needs and providing their expertise. Since pulmonologists specialize in disease of the lungs, they contribute greatly to several aspects of lung cancer care. I will provide 3 frequent questions that I’m able to help answer:
“Can I undergo surgery?”Pulmonologists can help determine how much risk is associated with a procedure or surgery based on how well your lungs function and how active you are.
“Why am I short of breath?”Most patients with lung cancer struggle with shortness of breath, and the pulmonologist can identify why and provide treatment options.
“Is there a less invasive test that can help me?”Pulmonologists have developed several tools that allow some patients to avoid more invasive procedures.Most frequently, pulmonologists use bronchoscopes (a small scope that evaluates the lungs) to help diagnose your cancer and determine if lymph nodes are involved.Some pulmonologists (called Interventional Pulmonologists) spend most of their time performing these procedures.
What are challenges you face as a pulmonologist in working in lung cancer?
Probably the biggest challenge any pulmonologist faces is education around active exposure (smoking) and trying to help their patients quit. Most patients with lung cancer are current or former smokers. Though quitting smoking at ANY point in your treatment will help, it’s a often hard habit to overcome. Second, patients often meet pulmonologists at a critical point in their lives. Specifically, in the same day patients might learn that they have permanent lung disease and lung cancer. Helping patients overcome the emotions and stress of this news is hard for everyone. Finally, improving quality of life in patients with lung cancer is a daily struggle. My particular interest is in quality and life and physical activity, and both of these are often impaired in patients with lung disease and lung cancer. Developing strategies to improve quality of life and physical activity during and after lung cancer treatment is a huge challenge for patients and physicians.
What’s the most common misconception patients have about pulmonologists and what they do?
I think most patients are surprised that pulmonologists can (and should) be involved in their lung cancer care. While the lung cancer team is led by the Oncologist, today’s multi-disciplinary approach ensures that all aspects of a patient’s care are addressed, including the cancer, associated symptoms, lifestyle changes, and treatment-related stressors.
Also, many people think that the lung disease and symptoms they have are permanent. I often hear the line, “There’s nothing I can do.” While it’s true that some lung diseases cause irreversible damage, the pulmonologist can provide multiple options to improve lung function, maintain lung function, and improve how you feel.
What are some tips you have for patients and caregivers to help them work better with their pulmonologist or healthcare provider in general?
Communication is key. During lung cancer treatment, patients meet multiple healthcare providers. It’s intimidating and can be scary. I think one of the most stressful parts of lung cancer treatment is the uncertainty: What’s next? How am I going to feel? Can I keep living my life like I’m used to? Are there other options? My main advice for patients and caregivers is to ask questions. You (the patient) are the most important part of the treatment team, and it’s our job to help you understand what’s happening and what your options are. If you don’t know what someone is talking about in a visit, you should ask them. Taking notes is a great strategy. The lung cancer team is designed to have multiple people to help you answer questions and make decisions.
What do you find most rewarding about your job?
Feeling short of breath is debilitating. I never get tired of helping someone feel less short of breath or developing strategies to help them carry out their life before, during, and after cancer treatment.
What is one piece of advice you would give to someone newly diagnosed with lung cancer?
Make sure your treatment team is multi-disciplinary and has expertise in lung cancer. Lung cancer treatment has changed dramatically in the last 20 years. Lung cancer teams should include a combination of your primary doctor, a Medical Oncologist, a Radiation Oncologist, a Thoracic Surgeon, a Thoracic Radiologist, a Pulmonologist, a Pathologist, a Palliative care provider, and a Cancer Care Coordinator. While not every patient needs to see every team member, multi-disciplinary teams help ensure that all aspects of lung cancer are addressed.
What gives you hope for people living with lung cancer?
In short, we are getting better at treating lung cancer. In the last 20 years, the number of treatment options for patients with lung cancer has expanded greatly. As a result, we are finding lung cancer earlier, and patients with lung cancer are living longer and living better. I think that trend is going to continue in the years to come.
Meet Your Medical Team blog series gives lung cancer patients insight into the role and importance of each medical specialist that they encounter through their diagnosis and treatment. These interviews are intended to help patients communicate better with their healthcare providers and become better advocates in their own care.
Learn more about the different types of medical experts that make up your medical team in the Lung Cancer 101 section of LUNGevity’s website.