PANAGIS GALIATSATOS, MD, MHS
Associate Professor of Medicine, Division of Pulmonary & Critical Care medicine, Sidney Kimmel Comprehensive Cancer Center, Health Equity Faculty Lead, Office of Diversity, Inclusion, & Health Equity, Associate Director, Hereditary Hemorrhagic Telangiectasia Center of Clinical Excellence, Director, Tobacco Treatment & Cancer Screening Clinic
«True health needs to take into account all things that impact health. If I provide an inhaler for asthma, but my patient constantly breathes in secondhand smoke, the inhaler will not work. If my patient has advanced diabetes, no insulin will help if all they can afford is unhealthy food. These social factors impact health outcomes all the time. My strongest research shows that if you live in poverty, you are ten times more likely to develop sepsis versus someone of your same age and gender living in more affluent regions».
Συνέντευξη: Κοσμάς Ζακυνθινός
Mr Galiatsatos, lung cancer remains the leading cause of cancer death in the United States. What has changed in recent years, what recent advances have been made in targeted therapy and immunotherapy?
It does. It is due to the inability to screen efficiently in the most at-risk patients (those who smoke cigarettes) and the lack of screening for the general population. Therefore, lung cancer tends to be identified late in its stage, resulting in a difficult to manage disease. Targeted therapy directed to the genetics of the cancer have made breakthroughs in the recent years. However, this only is able to reach a small portion of those with lung cancer. More research is needed.
Despite scientific and technological advances, the number of people currently screened for lung cancer remains low. What needs to change in the philosophy of Health Systems and citizens?
First, assuring evidence based medicine towards tobacco dependence and cigarette used is practiced by all clinicians. Helping those who smoke stop smoking, approached with counseling with or without pharmacotherapy is vital to help patients stop smoking permanently. In the United States, physicians are poorly trained in how to help their patients stop smoking.
In addition, more efforts need to occur to stop the promotion of tobacco overall. In several regions of the United States, tobacco farmers were provided with financial incentives to change into producing grapes for wine.
Overall, recognizing this preventable cause of lung cancer (smoking) should be addressed more aggressively for both prevention and management.
What are the early symptoms of lung cancer and how does early detection affect patient survival rates?
The earliest symptom of lung cancer is: no symptoms. Lung cancer can grow and grow before it results in the first symptom. That symptom is often a cough, due to the fact it stimulates cough receptors in the lung tissue and the airways. Also, chest discomfort may also be evident as well. This is why it is vital to discuss with your doctor if you should be screened for lung cancer. When symptoms occur, it often means the cancer has grown and spread, making it harder to treat. Finding early cancer before it develops symptoms gives one close to a 100% chance of survival. If you smoke or have a family history of lung cancer, and are 50 or older, talk to your doctor about being screened now.
The American Cancer Society recently expanded its diagnostic recommendations to say that all people ages 50 to 80 should be screened for lung cancer. What has changed in lung cancer guidelines?
The biggest change is around smoking. In the earlier recommendations, it was said that if you had stopped smoking more than 10 years prior, than you were not a risk. Now, it is evident that regardless of when you stopped, even if it is 20 years ago, if you have smoked a considerable amount of cigarettes, that risk stays with you for life. However, stopping smoking gives you the best chance that if a cancer still develops, you can defeat it. Stopping smoking assures the treatments for lung cancer are effective.
Practically, what does lung cancer screening mean in years of life for patients but also in savings for health systems?
If properly screened for, this will save millions of lives. If caught at stage I, millions of lives will be saved. More investment should go into current screening of lung cancer. I am also the principal investigator on a biomarker for lung cancer, where I’m hoping in the next 5 years, lung cancer screening will occur through a simple blood test.
The second leading cause of lung cancer is exposure to radon, a colorless, odorless radioactive gas that is naturally released from soil, water and rocks. How often do we encounter it in our daily lives?
Radon is a byproduct of the natural decay of certain elements found in the soil. We are exposed to it if our homes are built on such decay. In the United States, you can receive a free in-home radon detector. If found, proper efforts can be taken place to upgrade the home.
The best way to prevent cancer is to stop smoking. Are there any changes in the incidence of the disease, given changes in citizens’ smoking habits, such as heated and vaping products?
The main reduction would be to not breathe in any toxins at all. Even with vaping products, the harm reduction would not be as a great as completely stopping inhaled toxins. The focus should be on proper management of cigarette usage and helping patients come off all inhaled products permanently. Harm reduction is not harm elimination.
Studies link e-cigarettes and asthma in adolescents; What has changed in its habits and frequency?
E-cigarettes are growing in the use in adolescents. They see it as a safe alternative to traditional cigarettes. However, in the adolescents, when their lungs are actively growing, any inhaled toxin is going to impact their lungs. We are seeing a rise in challenging to manage asthma, chronic bronchitis, and chronic infections in adolescents who vape. We must do more to protect the youth from vaping or inhaling any toxins into their developing lungs.
Hereditary hemorrhagic telangiectasia is a rare condition, and the intensity of symptoms may vary significantly between patients. What are the epidemiological data and the latest therapeutic developments on this front?
While it is a rare disease, about one in 3.000 persons, it is becoming more and more common. In fact, in Greece, there has been a surge of patients with HHT, as evident by the number of patients coming to our clinic who are Greek. The treatment relies on screening and intervening with surgery. If surgery cannot help, we use anti-angiogenic treatments. I am one of the research investigators for pazopanib, an oral medication for HHT. Currently, the current treatment outside of surgery to fix the vascular malformation is an intravenous medications (bevacizumab), which is received 6 to 12 times a year and is costly and time consuming. However, helping patients with HHT has helped me currently create a treatment that may also help lung cancer! More on that in the near future!
In recent years you have travelled an impressive research course. What does your research show in terms of understanding socioeconomic variables and how they affect healthcare?
First, as physicians, we need to understand we practice medicine. True health needs to take into account all things that impact health. If I provide an inhaler for asthma, but my patient constantly breathes in secondhand smoke, the inhaler will not work. If my patient has advanced diabetes, no insulin will help if all they can afford is unhealthy food. These social factors impact health outcomes all the time. My strongest research shows that if you live in poverty, you are ten times more likely to develop sepsis versus someone of your same age and gender living in more affluent regions. These socioeconomic variables will truly result in death of our population unless we as a health system can work with other government agencies to assure the population has access to health, not just health care.
The development of telemedicine whether it will improve the provision of services to health systems. What is the situation in America and the corresponding picture in the EU?
Telemedicine is a vital tool. I see patients from all over the world, and for many rare diseases. While I may need a clinic visit once or twice a year in person, the other times can be achieved by virtual visits. This allows my patients to balance the disease management with their lives, which they appreciate. It makes medical care more effective and more compliant. We need to embrace telemedicine.
In closing, we would like to comment on the state of the NHS and private hospitals in our country. As an observer from a technologically advanced country, what are the «dark» spots identified, as well as the prospects for improving health systems?
For me, it’s the ability for health systems to operate in a manner to promote health and not simply react to disease. More of an emphasis on health screenings, discuss what people can do to prevent disease, such as cancer, is vital. It will mean doctors need to take their wisdom and their technology out into the community. Medicine is a public trust; if it stays isolated and only reacts to disease, it will never be able to truly promote health and health equity.
WHO IS WHO
Panagis Galiatsatos, M.D., MHS completed his undergraduate studies at Temple University and his medical degree at the University of Maryland School of Medicine. He completed his residency at the Johns Hopkins Bayview Medical Center in internal medicine, where he also served as an assistant chief of service. Then, he went into pulmonary and critical care training at the National Institutes of Health in Bethesda and at the Johns Hopkins Hospital in Baltimore City. He also earned a masters in health sciences degree from Duke University School of Medicine and a masters as a tobacco treatment specialist from the University of Pennsylvania.
He is an Assistant Professor at the Johns Hopkins School of Medicine where he currently co-directs Medicine for the Greater Good (MGG) and is the community engagement co-director for the Baltimore Breathe Center. Through his work in Baltimore City, he has been able to tackle community health needs through collaborations and partnerships, implementing population health strategies, and creating educational programs for healthcare professionals to become physician citizens. His projects have impacted over 7,000 Baltimore City persons and over 150 healthcare professional learners.
Currently, his research interests are in chronic obstructive pulmonary disease, asthma, tobacco dependence, and health equity. He co-authored a book, «Building Healthy Community Partnerships Through Medical Religious Partnerships» that captures much of the projects he has implemented and overseen. He is the son of Greek immigrant parents and was born and raised in Baltimore.
