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UK HealthCare Launches Dedicated Lung Care Service · UK HealthCast

• 0:05
  Nolan (Host): Welcome to UK HealthCast, a podcast presented by UK healthcare.
• 0:10
  I'm Nolan Alexander, and with me today is Dr.
• 0:13
  Edward Cantu, the director of the Lung Service Line and lung
• 0:18
  transplant at UK Healthcare as we talk about lung disease care.
• 0:23
  Dr.
• 0:23
  Cantu, how are you today?
• 0:25
  Edward Cantu, MD: I am doing well.
• 0:25
  Thank you.
• 0:27
  Nolan (Host): We're so glad to have you here and let's get
• 0:29
  to know you a little bit more.
• 0:30
  Can you share a bit about your background And what brought you
• 0:34
  into the field of lung care?
• 0:36
  Edward Cantu, MD: Yeah.
• 0:37
  well I joined the University of Pennsylvania in, 2010.
• 0:41
  I just finished, uh, fellowship and, uh, joined as an assistant professor.
• 0:46
  my hiring at that point was to advance lung transplantation at the university.
• 0:51
  spent 15 years there, and during that time was able to help
• 0:55
  double the clinical volume while, maintaining excellent outcomes.
• 0:59
  And then I was able to do several firsts, at, uh, the University of Pennsylvania.
• 1:04
  That was included, the first EVLP, lung transplant, the first,
• 1:09
  DCD lung transplant, And the first low bar lung transplant.
• 1:12
  So, My clinical experience there was phenomenal.
• 1:16
  I worked with, some amazing, uh, faculty as well as staff and, was able to care
• 1:21
  for over 500 transplant patient's.
• 1:24
  and overall the work was very rewarding.
• 1:27
  Nolan (Host): What exactly does comprehensive lung care mean to you?
• 1:31
  Edward Cantu, MD: Comprehensive, lung care to me, means that we're
• 1:35
  not just, technicians, we are, focused on the patient experience
• 1:39
  And the patient's caregivers.
• 1:41
  So, not only do we want to give high quality care, but we also
• 1:46
  wanna focus on the experience for the family And the, patient.
• 1:50
  So we wanna make sure that, we, identify their needs early.
• 1:55
  Try to make the transition from, being, someone who's well, to someone who's
• 2:00
  ill, as, easy for them as possible.
• 2:03
  And then take them from that, portion of their experience to the, clinical
• 2:08
  experience where we take care of them, And then establish a relationship
• 2:12
  of care that they, will, treat us.
• 2:16
  Like family.
• 2:17
  So, I'm trying to create a situation here at the university that,
• 2:21
  prioritizes the patient experience.
• 2:24
  so that way it makes it easier for patient's, to entertain
• 2:29
  entering the health system.
• 2:30
  So, it can be really scary and very daunting, for families and,
• 2:35
  patient's, to come to Lexington and to.
• 2:38
  face the health state transitions that they're experiencing.
• 2:41
  And, our goal is to make it easier for that transition,
• 2:46
  easier for them to do well.
• 2:48
  And, when they're, several years out from their care, to look back, and
• 2:53
  think that, they had a good experience.
• 2:55
  So for me, comprehensive care means not just taking care of the one little
• 3:00
  thing, but to take care of everything.
• 3:02
  Experience should be something that's not traumatizing, And that
• 3:06
  patient's and caregivers, would then go on and, recommend to other's.
• 3:11
  Nolan (Host): So under the North Star, the guidance right, of having the patient
• 3:15
  first, you help treat a variety of lung conditions from routine to some more
• 3:21
  complex that you've already talked about.
• 3:23
  Can you go just a little bit more in depth about what these conditions may look
• 3:26
  like and how the type of care may differ?
• 3:29
  Edward Cantu, MD: every patient's experience is unique.
• 3:32
  So, in all, aspects of lung care, that patient experience can be
• 3:38
  something where, patient's have symptoms, like shortness of breath.
• 3:42
  they can also have no symptoms and have an incidental finding
• 3:46
  like, solitary pulmonary nodule.
• 3:48
  whatever those, presentations are, what we are trying to create is a system where
• 3:54
  we can take care of those patient's.
• 3:56
  And educate, not only the patient's and caregivers, but referring providers.
• 4:01
  so that way we can get, optimal care for these patient's.
• 4:05
  So, the two situations I'm talking about here, can lead to two
• 4:09
  different types of therapies, right?
• 4:11
  So, let's say someone with a solitary pulmonary nodule.
• 4:15
  Let's say it's small, and it's not, growing right?
• 4:19
  And all of that would be, assessed within the lung service line.
• 4:24
  let's then change that up a little bit.
• 4:26
  Let's say, that nodule is first discovered, it's never been
• 4:30
  discovered before, And that referral is made, to the lung service line.
• 4:34
  and depending on the size, it can go to, interventionalist.
• 4:38
  Which could be a surgeon or interventional pulmonologist, or it could go to
• 4:42
  a pulmonologist, who will surveil.
• 4:45
  And so, what we're trying to do is create a system where, whatever the entry point
• 4:50
  is, the, barriers to entry are very low.
• 4:55
  And, we create a collaborative practice with referring providers.
• 5:00
  So that way, if.
• 5:02
  The care can be done locally.
• 5:04
  That means they don't have to come to Lexington.
• 5:06
  We have a, a large population, I think, one of the, percentages I just
• 5:11
  heard, earlier this week is a little under 90% of all patient's referred
• 5:17
  to UK for, restrictive lung disease.
• 5:21
  Do not live in Lexington.
• 5:23
  And the average time to get to Lexington is, a little over two hours.
• 5:28
  So a lot of patient's are coming from very far away.
• 5:32
  And so, one of the things that we're trying to establish, with our
• 5:37
  collaborating, health systems is a way for us to develop collaborative care.
• 5:42
  So in this patient that I described.
• 5:44
  That would be identified with a pulmonary nodule that say less than six millimeters.
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  We can help, surveil that, but do that maybe through telemedicine
• 5:56
  or, do it in conjunction with the collaborating pulmonologist, just so
• 6:00
  that way, should there be an advanced therapy that's required, we can get
• 6:05
  that patient in, but if it's not.
• 6:08
  We can keep that patient, local so they don't have to make a four hour drive
• 6:13
  and, you know, come and, go back.
• 6:15
  which may be, financially, difficult or, impossible 'cause they may not have a car.
• 6:21
  So, there are a lot of things like that, that we're trying to work through and,
• 6:25
  entering the health system, in a way that, makes it, easy access for as many
• 6:31
  patient's as possible is one of our goals.
• 6:34
  Nolan (Host): Well, let's talk about that, the near And the far as you
• 6:36
  said, 90% outside of Lexington.
• 6:39
  What are you seeing?
• 6:40
  What does the landscape of lung disease look like in Kentucky?
• 6:43
  Edward Cantu, MD: So Kentucky has, one of the highest rates at the
• 6:47
  emphysema in the country, and one of the highest rates in the country
• 6:51
  of coal miners, pneumoconiosis.
• 6:53
  so, I think, A lot of changes have occurred in, potential therapies and
• 6:59
  clinical trials that make, therapies available that are not all interventional,
• 7:03
  meaning not surgery, not transplant, but maybe medications with clinical trials.
• 7:09
  And what we're trying to do is increase the education.
• 7:13
  to our referrings about these therapies so that way we can get patient's these,
• 7:18
  therapies before their disease has progressed so far that they can't,
• 7:22
  qualify for these therapies anymore.
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  And now the only therapy is transplant.
• 7:27
  I myself am a transplant surgeon, but I would love to prevent
• 7:31
  the need of transplant surgery in, in my patient's if I could.
• 7:36
  Even if I could delay it few years, that's still better than transplanting them.
• 7:40
  it seems sort of, counterintuitive, lung transplant has much better outcomes,
• 7:46
  today than in previous decades.
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  but still, there are limitations.
• 7:52
  And so the longer we can delay transplant for patient's, the better they'll
• 7:57
  do long-term in terms of longevity.
• 7:59
  And so, always at the root of our mission is to give the best quality and length
• 8:06
  of life possible for our patient's.
• 8:08
  And sometimes, you know, it's better without surgery.
• 8:11
  hate to say that, but, is true.
• 8:13
  and, I think that, we have a responsibility to our patient's to give.
• 8:20
  the best care possible.
• 8:21
  And to do that, we need to educate Referrings and, our
• 8:25
  community what's out there.
• 8:27
  And that's something we've been doing.
• 8:29
  Nolan (Host): Dr.
• 8:29
  Edward Cantu joining is.
• 8:31
  Today from UK Healthcare Doctor, what are we doing here at UK
• 8:34
  Healthcare to help improve care for patient's with advanced lung disease?
• 8:39
  Edward Cantu, MD: So we are, doing, state-of-the-art lung transplants.
• 8:43
  So, we do all the transplants that I explained early at the very
• 8:48
  beginning of this, conversation.
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  So we'll do DCD, transplants, EVLP, trans.
• 8:54
  transplants, et cetera.
• 8:56
  So the whole gamut of these, word soup type of, highly technical transplants
• 9:01
  we make available to our patient's.
• 9:04
  And again, the goal is not to do X number of transplants.
• 9:09
  The goal is to do, the number of transplants required, to treat
• 9:14
  our patient's and have them have a good outcome, when patient's
• 9:18
  face the end of advanced lung disease, there are no options.
• 9:22
  the lungs are truly damaged, they're non salvageable.
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  There's really very limited, types of therapies for that, And the transplant
• 9:30
  becomes, preferential treatment.
• 9:33
  Now, survival after lung transplant on average is between five and seven
• 9:38
  years, depending on the patient groups and that's why I said earlier, we
• 9:42
  try to delay it as long as possible because on average, patient's will get
• 9:46
  between five and seven additional years.
• 9:49
  That doesn't mean patient's can't live longer, Those are just averages.
• 9:53
  And I myself have my first patient I transplanted.
• 9:56
  the University of Pennsylvania is, still doing well.
• 9:59
  So, I have at least a 15 year survivor, which, I'm happy to
• 10:04
  report, and happy to see that.
• 10:06
  and I've had patient's that I've treated that, my predecessors had
• 10:10
  transplanted and had lived, 20 plus years.
• 10:13
  So long-term survival is, possible.
• 10:17
  but there are a lot of, Risks and complications associated with the
• 10:21
  treatment, required for lung transplant so patient's become immunocompromised.
• 10:26
  So infections, cancers and rejection become really important.
• 10:31
  risk factors for long-term survival.
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  So, we try to do everything in our power to educate our patient's, and
• 10:37
  give them the best quality care.
• 10:38
  So that way, my goal is.
• 10:41
  15 years from now, I will be talking about, my first, UK
• 10:45
  transplant, who's still doing, well.
• 10:47
  And, I'm happy to say that the, transplants we've done have
• 10:50
  been doing very well and, we're very pleased with, the outcomes.
• 10:54
  And, you know, I think, we have a unique opportunity at UK to
• 10:58
  create something truly remarkable.
• 11:00
  Nolan (Host): what drew you specifically to UK Healthcare from your time there to
• 11:04
  this next chapter here with UK Healthcare?
• 11:07
  Edward Cantu, MD: Well, I think there's a lot of opportunity.
• 11:10
  I think the faculty here And the staff are truly remarkable.
• 11:14
  when I came to visit.
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  I saw the opportunity here, And the impact that we could have on the Commonwealth,
• 11:22
  because, Kentucky has the highest rate of lung disease, in the United States, and
• 11:28
  I saw the opportunity for us to create an infrastructure that not only would help.
• 11:34
  With lung transplant, but could help with all of lung disease.
• 11:38
  I hate to generalize, but everyone I've met has been salt of the earth,
• 11:43
  good human being that, is very grateful for the care that they're given.
• 11:48
  And every, faculty and staff member I've met here at uk, has
• 11:52
  been, unbelievably supportive.
• 11:55
  Unbelievably sympathetic, empathetic with their patient's, and really only want,
• 12:00
  high quality care for their patient's.
• 12:02
  So I think, all of these things made me feel that, coming here would allow me to
• 12:08
  create something that's not everywhere, there are challenges in every health
• 12:12
  system, And what I saw here was only opportunity, opportunity to create
• 12:18
  something special for the commonwealth.
• 12:20
  To create something that I think would leave a lasting legacy for uk.
• 12:24
  So to me this was an easy decision based on, the quality of the
• 12:29
  staff And the faculty and, And the really, the, desperate need of all
• 12:34
  the patient's in the commonwealth.
• 12:36
  Nolan (Host): and you've described it before, UK is a premier program
• 12:38
  and has the potential in your mind to be one of the best in the country.
• 12:43
  With that you're not only joining a new team, but you're
• 12:45
  also building something new.
• 12:48
  Can you tell us about the lung service line and future lung center
• 12:52
  that you're hoping to establish?
• 12:54
  Edward Cantu, MD: Absolutely.
• 12:55
  so right now the lung service line, we're focusing on solitary pulmonary
• 13:01
  nodules and lung transplant.
• 13:03
  That's just the short term, right?
• 13:06
  but we're also doing in-depth analysis to find out where the needs are within the
• 13:11
  service line that we haven't identified.
• 13:14
  So sleep studies, asthma, cf, et cetera, et cetera.
• 13:19
  And so our goal is to be a comprehensive lung center that covers everything.
• 13:26
  Related.
• 13:27
  you mentioned our tagline, earlier our goal ultimately is better breathing,
• 13:32
  better quality of life through innovation, education and clinical excellence.
• 13:37
  So for us, what we wanna do is be able to create something that, not
• 13:42
  only makes it, advantageous for patient's within the commonwealth,
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  but makes it the central focus.
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  For education.
• 13:51
  So we'll have, people who want to train at uk, for research, so researchers to
• 13:56
  come here because, all the critical infrastructures in place for us to do high
• 14:00
  quality, high impact, disease changing research, And for us to have clinical
• 14:06
  excellence that, is really unmatched.
• 14:08
  And I think, like I said earlier, there's a lot of, Work that was
• 14:12
  done before I, I, I came here.
• 14:14
  It's not like I'm starting from scratch.
• 14:16
  and I'm hoping to, to stand on the shoulders of those who came
• 14:20
  before me, to be able to create something really, truly amazing.
• 14:23
  And again, if we can do it, we'd like to see every single patient,
• 14:28
  having more hope and feeling better.
• 14:30
  so that way they, do not suffer from a lung disease and silence and alone.
• 14:35
  Nolan (Host): What a great vision to have.
• 14:37
  I love it.
• 14:37
  Dr.
• 14:38
  Cantu.
• 14:38
  I, I think That is so special.
• 14:40
  And also I'm, I'm curious, why is it unique for a surgeon to be leading
• 14:44
  this type of service line, And what advantages does that bring to patient's?
• 14:49
  Edward Cantu, MD: most service lines are generally run by,
• 14:51
  physicians, not surgeons.
• 14:53
  and in my previous, position at the University of Pennsylvania, I ran the.
• 14:58
  ILD service line, which gave me, some understanding of how, the sausage is
• 15:04
  made and I've taken, uh, that experience here So, it's just, surgeons are, are
• 15:10
  generally in the operating room and they're really, really is no extra
• 15:14
  time, for, administrative roles.
• 15:17
  And here at uk, I've been given, some time to have an administrative role.
• 15:23
  And so, that's why it's unique 'cause it's, as a surgeon, the more I
• 15:28
  operate, the more patient's I can help.
• 15:31
  And UK has, resourced, lung transplant here in a way that I don't
• 15:36
  need to do every lung transplant.
• 15:38
  There was a time at the University of Pennsylvania when I was doing almost
• 15:42
  every single lung transplant, and, that was, challenging but not sustainable.
• 15:47
  So I think this model works much better.
• 15:50
  And I think, being able to, have, collaboration through, surgical
• 15:54
  partners, And the medical faculty has been outstanding and, that's made it possible
• 16:00
  for a surgeon to lead, a service line.
• 16:02
  you know, from my perspective, understanding how, the ORs work, how,
• 16:08
  surgeons think is beneficial to a service line because, it adds a compliment
• 16:14
  to the general, medical leadership.
• 16:17
  So that way there's a balance.
• 16:18
  And I think, I'm one of the, few people to say that, surgeons know better 'cause
• 16:23
  we don't, we like to think we do.
• 16:25
  Like the, uh, saying goes, never in doubt.
• 16:28
  seldom wrong.
• 16:30
  Nolan (Host): Dr.
• 16:31
  Cantu, you're full of humility and I love that.
• 16:33
  As a leader, I think That is truly important.
• 16:36
  I want you to look ahead of the future.
• 16:38
  What are your hopes for lung care at UK over the next five to 10 years?
• 16:42
  Edward Cantu, MD: over the next five to 10 years, we're gonna see
• 16:44
  a complete, uh, expansion in our research and education enterprise.
• 16:48
  So again, physicians want to train here.
• 16:51
  Physicians wanna work here.
• 16:53
  students want to train here.
• 16:55
  I think that's gonna be one thing you're gonna see.
• 16:56
  You're gonna see, an expansion in the, in the research enterprise, such
• 17:00
  that, the number of grants here at the university, within the service
• 17:04
  line and, affiliated collaborating, secondary service lines will increase.
• 17:09
  and I definitely will, say that.
• 17:13
  The number of patient's receiving appropriate care for advanced
• 17:16
  lung disease will go up.
• 17:17
  So there'll be more lung transplants for sure.
• 17:20
  will be a much larger, group.
• 17:22
  So, because of all this we'll need increased volume, we'll
• 17:26
  need increased capacity, so.
• 17:28
  I will see that our faculty will increase And we will be one of the
• 17:32
  places where in the United States where, industry will wanna partner, right?
• 17:37
  So, we wanna set up the infrastructure correctly so that way we can partner
• 17:41
  with our, industry, sponsors, so that way we can do cutting-edge clinical trials.
• 17:47
  We can, use, the latest devices to make sure, We are giving the best
• 17:52
  quality, care for our patient's and give opportunity for patient's
• 17:57
  who may have no other options.
• 17:59
  So five to 10 years, I see this program, being such that, it'll be
• 18:05
  the premier program in the country where everyone wants to come, whether
• 18:08
  you're patient, faculty or staff.
• 18:11
  Nolan (Host): If someone thinks they or a loved one may need advanced
• 18:14
  lung care right now, what's the best way for them to begin that journey?
• 18:19
  Edward Cantu, MD: So, it depends where they are.
• 18:21
  So if they're outside of, the UK health system, they can talk to their provider,
• 18:26
  whether that's a primary care provider, whether it's their pulmonologist, to let
• 18:31
  them know that they would like a referral.
• 18:33
  once they've received that referral that they understand we're gonna
• 18:37
  have a collaborative practice, with their referring provider.
• 18:41
  And we're going to set the, bar for, high level communication.
• 18:46
  So.
• 18:46
  That way, the referring providers not only get to read our notes, but we'll contact
• 18:51
  them, tell them what we think is going on, how we think we can care for that patient.
• 18:57
  And if that patient can be cared for locally with our referring
• 19:00
  provider, we can help them with that.
• 19:02
  so that way they don't have to drive to Lexington, make that two hour or more.
• 19:07
  And then, we will then, make available to referring providers advanced therapies
• 19:13
  that they may not be able to provide.
• 19:15
  So that way, patient's get the, both of bo, both worlds.
• 19:18
  They get high quality care locally, but they get, outstanding
• 19:22
  advanced therapies, access.
• 19:24
  Here at UK So, it will work well for the health system, but it
• 19:28
  also works well for the patient.
• 19:30
  And again, our focus is making, the patient experience, as easy as possible,
• 19:36
  with the goal of making them, not have to jump through hoops if we can
• 19:39
  get the high quality care locally.
• 19:42
  And so Those are the things that I would look forward to and, and expect.
• 19:46
  Nolan (Host): And Dr.
• 19:46
  Cantu, you've given us so much today.
• 19:48
  Is there anything else that you'd like to add?
• 19:51
  Edward Cantu, MD: the main things I wanna make sure that everyone
• 19:53
  knows is, we're here to help.
• 19:56
  We wanna collaboratively work to make sure that every patient does well.
• 20:00
  And so if anyone has any problems, accessing our system, please, reach out
• 20:06
  to me and I'm happy to, to iron out those details and make sure that, the next
• 20:10
  referral is more smooth or the next.
• 20:13
  Uh, patient visit, is communicated, back to our referring providers because
• 20:18
  again, we can't give high quality care if we don't have good communication
• 20:22
  and, good teamwork, for our patient's.
• 20:24
  And so that's, ultimately I think the, take-home message that we
• 20:28
  want to collaborate with everyone so that way every single patient
• 20:31
  gets the highest quality care And we don't fumble any balls.
• 20:36
  Nolan (Host): Dr.
• 20:36
  Cantu, thank you so much for sharing knowledge and your vision with us today.
• 20:40
  Edward Cantu, MD: It's my pleasure.
• 20:41
  Thank you so much, Noah.
• 20:43
  Nolan (Host): That was Dr.
• 20:44
  Edward Cantu.
• 20:44
  For more information, go to UK healthcare.uk.edu.
• 20:51
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• 20:55
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• 21:00
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