Nolan Alexander (Host): Welcome to UK HealthCast, a podcast presented by UK Healthcare. I'm Nolan Alexander. And with me today is Dr. Edward Cantu, the Director of the Lung Service Line and Lung Transplant at UK Healthcare as we talk about lung disease care. Dr. Cantu, how are you today?

Edward Cantu, MD: I am doing well. Thank you.

Host: We're so glad to have you here. And let's get to know you a little bit more. Can you share a bit about your background and what brought you into the field of lung care?

Edward Cantu, MD: Yeah. Well, I joined the University of Pennsylvania in 2010. I just finished fellowship and joined as an assistant professor. My hiring at that point was to advance lung transplantation at the university. I spent 15 years there. And during that time, I was able to help double the clinical volume while maintaining excellent outcomes.

And then, I was able to do several firsts at the University of Pennsylvania. That included the first EVLP lung transplant, the first DCD lung transplant, and the first lobar lung transplant. So, my clinical experience there was phenomenal. I worked with some amazing faculty as well as staff and was able to care for over 500 transplant patients. And overall, the work was very rewarding.

Host: What exactly does comprehensive lung care mean to you?

Edward Cantu, MD: Comprehensive lung care to me means that we're not just technicians. We are focused on the patient experience and the patient's caregivers. So, not only do we want to give high quality care, but we also want to focus on the experience for the family and the patient. So, we want to make sure that we identify their needs early, try to make the transition from being someone who's well, to someone who's ill, as easy for them as possible. And then, take them from that portion of their experience to the clinical experience where we take care of them, and then establish a relationship of care that they will treat us like family.

So, I'm trying to create a situation here at the university that prioritizes the patient experience, so that it makes it easier for patients to entertain entering the health system. So, it can be really scary and very daunting for families and patients to come to Lexington and to face the health state transitions that they're experiencing. And our goal is to make it easier for that transition, easier for them to do well. And when they're several years out from their care, to look back, and think that they had a good experience.

So for me, comprehensive care means not just taking care of the one little thing, but to take care of everything. Experience should be something that's not traumatizing, and that patients and caregivers would then go on and recommend to others.

Host: So under the North Star, the guidance of having the patient first, you help treat a variety of lung conditions from routine to some more complex that you've already talked about. Can you go just a little bit more in depth about what these conditions may look like and how the type of care may differ?

Edward Cantu, MD: Every patient's experience is unique. So, in all aspects of lung care, that patient experience can be something where patients have symptoms, like shortness of breath. They can also have no symptoms and have an incidental finding like solitary pulmonary nodule. Whatever those presentations are, what we are trying to create is a system where we can take care of those patients and educate not only the patients and caregivers but referring providers. That way, we can get optimal care for these patients.

So, the two situations I'm talking about here can lead to two different types of therapies, right? So, let's say someone with a solitary pulmonary nodule. Let's say it's small, and it's not growing, right? And all of that would be assessed within the lung service line. Let's then change that up a little bit. Let's say that nodule is first discovered, it's never been discovered before, and that referral is made to the lung service line. And depending on the size, it can go to an interventionalist, which could be a surgeon or interventional pulmonologist, or it could go to a pulmonologist who will surveil.

And so, what we're trying to do is create a system where whatever the entry point is, the barriers to entry are very low. And we create a collaborative practice with referring providers. So that way, if the care can be done locally, that means they don't have to come to Lexington. We have a large population. I think, one of the percentages I just heard earlier this week is a little under 90% of all patients referred to UK for restrictive lung disease do not live in Lexington. And the average time to get to Lexington is a little over two hours. So, a lot of patients are coming from very far away.

And so, one of the things that we're trying to establish with our collaborating health systems is a way for us to develop collaborative care. So in this patient that I described, that would be identified with a pulmonary nodule that's, say, less than six millimeters, we can help surveil that, but do that maybe through telemedicine or do it in conjunction with the collaborating pulmonologist, just so that way, should there be an advanced therapy that's required, we can get that patient in. But if it's not, we can keep that patient local so they don't have to make a four-hour drive and, you know, come and go back, which may be financially difficult or impossible, because they may not have a car. So, there are a lot of things like that, that we're trying to work through. And entering the health system in a way that makes it easy access for as many patients as possible is one of our goals.

Host: Well, let's talk about that, the near and the far. As you said, 90% outside of Lexington. What are you seeing? What does the landscape of lung disease look like in Kentucky?

Edward Cantu, MD: So, Kentucky has one of the highest rates at the emphysema in the country, and one of the highest rates in the country of coal miners' pneumoconiosis. So, I think, a lot of changes have occurred in potential therapies and clinical trials that make therapies available that are not all interventional, meaning not surgery, not transplant, but maybe medications with clinical trials.

And what we're trying to do is increase the education to our referrings about these therapies, so that we can get patients these therapies before their disease has progressed so far that they can't qualify for these therapies anymore, and now the only therapy is transplant. I myself am a transplant surgeon, but I would love to prevent the need of transplant surgery in my patients if I could. Even if I could delay it a few years, that's still better than transplanting them.

It seems sort of counterintuitive. Lung transplant has much better outcomes today than in previous decades. But still, there are limitations. And so, the longer we can delay transplant for patients, the better they'll do long-term in terms of longevity. And so, always at the root of our mission is to give the best quality and length of life possible for our patients. And sometimes, you know, it's better without surgery. I hate to say that, but it's is true. And I think that we have a responsibility to our patients to give the best care possible. And to do that, we need to educate referrings and our community what's out there. And that's something we've been doing.

Host: Dr. Edward Cantu joining is today from UK Healthcare. Doctor, what are we doing here at UK Healthcare to help improve care for patients with advanced lung disease?

Edward Cantu, MD: So, we are doing state-of-the-art lung transplants. So, we do all the transplants that I explained early at the very beginning of this conversation. So, we'll do DCD transplants, EVLP transplants, NRP transplants, et cetera. So, the whole gamut of these word soup type of highly technical transplants we make available to our patients.

And again, the goal is not to do X number of transplants. The goal is to do the number of transplants required to treat our patients and have them have a good outcome. When patients face the end of advanced lung disease, there are no options. The lungs are truly damaged, they're non-salvageable. There's really very limited types of therapies for that. And the transplant becomes preferential treatment.

Now, survival after lung transplant on average is between five and seven years, depending on the patient groups. And that's why I said earlier, we try to delay it as long as possible. Because on average, patients will get between five and seven additional years. That doesn't mean patients can't live longer, those are just averages. And I myself, my first patient I transplanted at the University of Pennsylvania is still doing well. So, I have at least a 15-year survivor, which I'm happy to report, and happy to see that. And I've had patients that I've treated that my predecessors had transplanted and had lived 20 plus years.

So, long-term survival is possible. But there are a lot of risks and complications associated with the treatment required for lung transplant. So, patients become immunocompromised, so infections, cancers and rejection become really important risk factors for long-term survival. So, we try to do everything in our power to educate our patients, and give them the best quality of care. So that way, my goal is 15 years from now, I will be talking about my first UK transplant who's still doing well. And I'm happy to say that the transplants we've done have been doing very well and we're very pleased with the outcomes. And, you know, I think, we have a unique opportunity at UK to create something truly remarkable.

Host: What drew you specifically to UK Healthcare from your time there to this next chapter here with UK Healthcare?

Edward Cantu, MD: Well, I think there's a lot of opportunity. I think the faculty here and the staff are truly remarkable. When I came to visit and I saw the opportunity here, and the impact that we could have on the Commonwealth, because Kentucky has the highest rate of lung disease in the United States, and I saw the opportunity for us to create an infrastructure that not only would help with lung transplant, but could help with all of lung disease.

I hate to generalize, but everyone I've met has been salt of the earth, good human being that is very grateful for the care that they're given. And every faculty and staff member I've met here at UK has been unbelievably supportive, unbelievably sympathetic, empathetic with their patients, and really only want high quality care for their patients. So, I think, all of these things made me feel that coming here would allow me to create something that's not everywhere. There are challenges in every health system. And what I saw here was only opportunity, opportunity to create something special for the commonwealth and to create something that I think would leave a lasting legacy for UK. So to me, this was an easy decision based on the quality of the staff and the faculty and really the desperate need of all the patients in the commonwealth.

Host: And you've described it before, UK is a premier program and has the potential, in your mind, to be one of the best in the country. And with that, you're not only joining a new team, but you're also building something new. Can you tell us about the lung service line and future lung center that you're hoping to establish?

Edward Cantu, MD: Absolutely. So right now, the lung service line, we're focusing on solitary pulmonary nodules and lung transplant. And that's just the short term, right? But we're also doing in-depth analysis to find out where the needs are within the service line that we haven't identified. So, sleep studies, asthma, CF, et cetera, et cetera.

And so, our goal is to be a comprehensive lung center that covers everything lung-related. You mentioned our tagline earlier, our goal ultimately is better breathing, better quality of life through innovation, education, and clinical excellence. So for us, what we want to do is be able to create something that not only makes it advantageous for patients within the commonwealth, but makes it the central focus for education. So, we'll have people who want to train at UK for research, so researchers to come here because all the critical infrastructures are in place for us to do high quality, high impact, disease-changing research, and for us to have clinical excellence that is really unmatched.

And I think, like I said earlier, there's a lot of work that was done before I came here. It's not like I'm starting from scratch. And I'm hoping to stand on the shoulders of those who came before me, to be able to create something really, truly amazing. And again, if we can do it, we'd like to see every single patient, having more hope and feeling better, so that they do not suffer from a lung disease in silence and alone.

Host: What a great vision to have. I love it, Dr. Cantu. I think that is so special. And also, I'm curious, why is it unique for a surgeon to be leading this type of service line? And what advantages does that bring to patients?

Edward Cantu, MD: Most service lines are generally run by physicians, not surgeons. And in my previous position at the University of Pennsylvania, I ran the ILD service line, which gave me some understanding of how the sausage is made. And I've taken that experience here. So, it's just surgeons are generally in the operating room, and there really is no extra time for administrative roles.

And here at UK, I've been given some time to have an administrative role. And so, that's why it's unique. Because as a surgeon, the more I operate, the more patients I can help. And UK has resourced lung transplant here in a way that I don't need to do every lung transplant. There was a time at the University of Pennsylvania when I was doing almost every single lung transplant. And that was challenging but not sustainable. So, I think this model works much better. And I think being able to have collaboration through surgical partners. And the medical faculty has been outstanding and that's made it possible for a surgeon to lead a service line.

You know, from my perspective, understanding how the ORs work, how surgeons think is beneficial to a service line because it adds a complement to the general medical leadership, so that there's a balance. And I think I'm one of the few people to say that surgeons know better because we don't. We like to think we do, like the saying goes, "Never in doubt. Seldom wrong."

Host: Dr. Cantu, you're full of humility, and I love that as a leader. I think that is truly important. I want you to look ahead of the future. What are your hopes for lung care at UK over the next five to ten years?

Edward Cantu, MD: Over the next five to ten years, we're going to see a complete expansion in our research and education enterprise. So again, physicians want to train here. Physicians want to work here. Students want to train here. I think that's going to be one thing you're going to see. You're going to see an expansion in the research enterprise, such that the number of grants here at the university within the service line and affiliated collaborating secondary service lines will increase.

And I definitely will say that the number of patients receiving appropriate care for advanced lung disease will go up. So, there'll be more lung transplants for sure. We will be a much larger group. So, because of all this, we'll need increased volume, we'll need increased capacity. So, I will see that our faculty will increase. And we will be one of the places in the United States where industry will want to partner, right? So, we want to set up the infrastructure correctly, so that we can partner with our industry sponsors. So that way, we can do cutting-edge clinical trials. We can use the latest devices to make sure we are giving the best quality care for our patients and give opportunity for patients who may have no other options. So five to ten years, I see this program being such that it'll be the premier program in the country where everyone wants to come, whether you're patient, faculty, or staff.

Host: If someone thinks they or a loved one may need advanced lung care right now, what's the best way for them to begin that journey?

Edward Cantu, MD: So, it depends where they are. So if they're outside of the UK Health system, they can talk to their provider, whether that's a primary care provider, whether it's their pulmonologist, to let them know that they would like a referral. Once they've received that referral, that they understand we're going to have a collaborative practice with their referring provider and we're going to set the bar for high level communication, so that the referring providers not only get to read our notes, but we'll contact them, tell them what we think is going on, how we think we can care for that patient. And if that patient can be cared for locally with our referring provider, we can help them with that. So that way, they don't have to drive to Lexington, make that two-hour or more drive.

And then, we will then make available to referring providers advanced therapies that they may not be able to provide. That way, patients get the best of both worlds, they get high quality care locally, but they get outstanding advanced therapies access here at UK. So, it will work well for the health system, but it also works well for the patient. And again, our focus is making the patient experience as easy as possible with the goal of making them, not have to jump through hoops if we can get the high quality care locally. And so, those are the things that I would look forward to and expect.

Host: And Dr. Cantu, you've given us so much today. Is there anything else that you'd like to add?

Edward Cantu, MD: The main things I want to make sure that everyone knows is we're here to help. We want to collaboratively work to make sure that every patient does well. And so, if anyone has any problems accessing our system, please reach out to me and I'm happy to iron out those details and make sure that the next referral is more smooth or the next patient visit is communicated back to our referring providers. Because again, we can't give high quality care if we don't have good communication and good teamwork for our patients. And so, that's, ultimately, I think, the take-home message, that we want to collaborate with everyone, so that every single patient gets the highest quality care and we don't fumble any balls.

Host: Dr. Cantu, thank you so much for sharing knowledge and your vision with us today.

Edward Cantu, MD: It's my pleasure. Thank you so much, Nolan.

Host: That was Dr. Edward Cantu. For more information, go to ukhealthcare.uky.edu. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. Thanks for listening to UK HealthCast, a podcast from UK Healthcare.