As the director of the minimally invasive thoracic surgery program at Thomas Jefferson University Hospital, Dr. Nathaniel Evans III specializes in treating lung cancer patients.
The standard treatment for early-stage lung cancer has been to surgically remove the affected lobe of the lung, a procedure that is referred to as a lobectomy. Evans specializes in treating lung cancer patients with a procedure known as VATS, video-assisted thoracic surgery, a minimally invasive procedure to remove tumors from the lung.
The procedure calls for specially designed surgical instruments to be inserted into the chest cavity through small incisions. One of these instruments has a tiny camera that sends pictures to a monitor to provide surgeons with a clear view of the internal organs.
“It’s an exciting time for us in lung cancer because we are finding more and more people with earlier stage cancers and those are the people we can actually cure with surgery,” said Evans, who joined Thomas Jefferson in 2010.
Patients who undergo a traditional lobectomy are left with a surgical incision in their side, are hospitalized for a least a week and experience more postoperative pain.
At Jefferson, about 85 percent of the lobectomies are done using minimally invasive surgery as compared to a national average of 20 percent. Jefferson has done approximately 300 of the procedures thus far.
Patients who undergo the minimally invasive surgery average a two-to-three day hospital stay and shorter recuperation time. Evans said that people with early-stage lung cancer are typically the best candidates for the surgery.
“I think that a lot of the patients who come to see us are scared that they have cancer and they are also scared because they know a family member or a friend who had a lung cancer surgery and didn’t do well and it took months for them to do better. I think that, unfortunately, leads to people not seeking care when they probably should,” Evans said.
According to the Centers for Disease Control, about 200,000 people in the United States are diagnosed with lung cancer every year.
African Americans are more likely to develop lung cancer than any other population in the U.S. The American Lung Association 2010 report titled “Too Many Cases, Too Many Deaths: Lung Cancer in African Americans” found that African Americans are more likely to be diagnosed later, when the cancer is more advanced. The report indicates that African Americans are more likely to wait longer after diagnosis to receive treatment, more likely to refuse treatment, and more likely to die in the hospital after surgery. The report lists various factors that contribute to these health disparities including socioeconomic status, environmental exposure to toxins, access to healthcare, discrimination and social stress.
“Surgery is the best treatment for early-stage lung cancer, and that’s the place where we can really make the best difference in terms of survival - and for whatever reason Black patients are less likely to have surgery,” Evans pointed out.
Evans questions whether or not Black patients with lung cancer are offered surgery as often in the healthcare system.
Evans takes the time to explain to his patients why surgery is considered the best standard of care.
“I think that people often times feel like doctors tell them what they should do just because they feel that’s what needs to be done, and doctors don’t feel the need to explain to patients why they made those recommendations,” says Evans, who is the married father of three children.
“I feel like if we do a better job explaining to people why we made those recommendations, they are much more likely to agree with us or at least feel like they could make the decision themselves.”
After growing up in Moorestown, N.J., Evans obtained his undergraduate degree from Princeton University and his medical degree at Stanford University School of Medicine. He received his postgraduate training in thoracic surgery from Massachusetts General Hospital, University of Pittsburgh Medical Center and Memorial Sloan-Kettering Cancer Center.