How Smilow Doctors Are Saving My Life: A Cancer Survivor’s Story

In the spring of 2024, I began noticing an irritation in my throat, right where my neck meets my chest. At first, I tried to ignore it, figuring it would go away on its own. But it didn’t. Instead, the irritation got worse. I suspected postnasal drip or acid reflux, so, in consultation with my primary care physician, Wayne Warren, MD, I tried all sorts of over-the-counter remedies. The irritation kept getting worse. I coughed all the time.

Dr. Warren referred me to an ear, nose, and throat specialist, who scoped my throat, noticed inflammation around my larynx, and sent me for a barium swallow test. The radiologist who administered the test found nothing amiss with my swallow mechanism but noted a “fullness” in the esophagus that indicated something might be pressing against it.

On further investigation, that “something” turned out to be a 3½-inch-long tumor attached to the upper lobe of my right lung. I had non-small cell lung cancer, which accounts for 85% of all lung cancers and is typically associated with smoking, which I did briefly in the 1970s. My cancer was initially diagnosed as stage III because of the size of the tumor and the fact that it was pressing into my superior mediastinum, which contains the esophagus, the trachea, and important arteries and nerves.

As a journalist, I have been immersed in medical science and health care for nearly a decade. I have interviewed many physicians and patients about horrible diseases. Suddenly, I was the subject rather than the observer. And, ultimately, at age 72, I became what I call a “professional patient.”

I’m telling you my story for three reasons: I want to make you aware of the amazing advances that have been made in lung cancer treatment in recent years. I urge you to see your doctor and get diagnostic tests done as soon as possible when your body starts misbehaving. And I recommend that you get treatment for life-threatening diseases at a major teaching hospital. In my case, I have been treated by Yale Medicine physicians working at Smilow Cancer Hospital within Yale Cancer Center, the only National Cancer Institute-designated comprehensive cancer center in Connecticut. So far, they have saved my life.

One more bit of advice: Be hopeful. It helps.

I have had surgery, chemotherapy, radiation therapy, and immunotherapy—where a patient’s own immune system is harnessed to fight cancer. The treatments were curative; however, the disease recurs for the majority of patients. My chances of surviving for five years are on the order of 40%, according to my oncologist, Scott Gettinger, MD, who is chief of thoracic medical oncology at Smilow.

As my medical oncologist, Dr. Gettinger was and is the “quarterback” for my treatment team. He worked closely with my surgeon, Daniel Boffa, MD, chief of thoracic surgery at Smilow, and my radiation oncologist, Henry Park, MD, chief of thoracic radiotherapy there.

Just a few years ago, advanced lung cancer was a virtual death sentence. While it remains the leading cause of cancer deaths in the United States, the overall survival rate has improved by 26% in the past five years, according to the American Lung Association. Survival rates have even improved for patients with stage IV non-small cell lung cancer—especially for those with EGFR (epidermal growth factor receptor) or ALK (anaplastic lymphoma kinase) genetic mutations.

This remarkable change isn’t due to a single silver bullet. Rather, it can be credited to multiple factors—among them advances in surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy, and also an increase in the use of CT scans to detect tumors earlier. “The percentage of patients we can cure is much higher now. For others we cannot cure, we’re better able to extend life and improve the quality of life,” Dr. Park told me.

After my cancer diagnosis was confirmed, I plunged into anxiety and depression. I feared that I might die in a matter of months. I thought obsessively about death—how it would affect my loved ones and how horrible it would be to be absent from them. However, a week later, during my first meeting with Dr. Gettinger, he told me a bit of good news: Initial indications were that my tumor had not spread to other parts of the lungs or other organs. My mood changed immediately. I began focusing on survival rather than death, and I have been doing so ever since.

Dr. Boffa later told me that studies have found that one of the most important factors in positive outcomes for cancer patients is whether they are hopeful. “Be hopeful! I’m hopeful for you, and you should be hopeful for yourself,” he said.

Even though we know a lot about lung cancer, it remains challenging to assess cancerous activity in an individual patient and choose a course of treatment that’s most effective for that person. In my case, a biopsy found that I had non-small cell lung cancer, with an unusual mix of both adenocarcinoma and squamous cell carcinoma, the two most common subtypes of non-small cell lung cancer. Typically, adenocarcinoma develops from glandular cells in the lung, and squamous cell carcinoma originates in a different kind of cell in the lung airways.

Gene mutations—small changes in a cell’s DNA—can trigger uncontrolled cell growth. A blood test that identifies circulating mutant DNA released from dead cancer cells identified a MET gene mutation driving my cancer cell replication. That was rare for my kind of cancer, occurring in only 3% to 4% of non-small cell lung cancers.

Early on, my doctors hoped to first use chemotherapy and immunotherapy to shrink my tumor, so it would pull away from my esophagus and trachea—and make it easier to perform surgery. However, with all the genetic evidence in hand, they recommended that I have surgery first.

Which I did. The morning before surgery, on Aug. 15, 2024, when Dr. Boffa visited me, I asked to see his hands, and I was greatly relieved to see that they were relatively small, and his fingers were thin. This was good news because within two hours, after spreading the ribs in my back and side to gain access, he would be reaching into my chest to remove the tumor. Many lung cancer patients benefit from minimally invasive and robotic surgery techniques, which lessen trauma and recovery times, but those more advanced techniques weren’t appropriate for me.

The surgery took six and a half hours, mainly because Dr. Boffa had to carefully, with his fingers, separate the tumor from my esophagus, trachea, and the blood vessels and nerves around them. He later told me that the tumor was sticky, and he had to be exceedingly careful not to puncture any of these vital organs. “Think of a pad of paper where the first 50 sheets are different from the sheets underneath. You try to find the exact spot where the change happens and pull to create a separation, then cut. You don’t want to make a hole. There’s just a tiny margin of error,” Dr. Boffa explained to me.

Surgery knocked me on my rear end. I was so weak afterward that I could barely walk a half-dozen steps at the end of the first day. The good news was that the tumor was gone (along with my upper right lung lobe), and no cancer was found in the lymph nodes that Dr. Boffa had removed along with the tumor and lobe.

But I wasn’t safe yet. The tumor had been pressed against my esophagus and trachea for months, and post-surgery biopsies showed that some cancer cells had been left behind—“tentacles,” Dr. Boffa called them.

To kill those cells, Drs. Gettinger and Park recommended an intensive course of treatment combining chemotherapy with radiation therapy. This would involve 33 radiation treatments and 12 chemo infusions over the course of six and a half weeks. The idea here was to use the chemo treatments to kill cancer cells—or at least to weaken them to make it easier for radiation to kill them.

Cancer cells have a more difficult time repairing themselves than normal cells do after they’re damaged by radiation. The trick was to find just the right amount of chemo and radiation to do this work without harming the rest of my body too much. “We customize the treatment as much as possible to maximize the benefits and minimize the risks,” Dr. Park told me.

One of the most important advances in radiation therapy for lung cancer is the ability to more precisely target the area of concern—and not harm parts of the body where no cancer exists. For me, Dr. Park used intensity-modulated radiation therapy (IMRT), customizing the X-ray beams to target the 6-inch crescent shape of the superior mediastinum and lung where cancer cells had been found. Dr. Park is one of the pioneers in using another radiation therapy technology called SCINTIX® Biology-Guided Radiotherapy, which uses live signals produced by a patient’s tumor to precisely direct radiation beams. While I was not a candidate for SCINTIX since my tumor was already removed and the radiation field was too large, IMRT was thought to be the optimal technique for treating any cancerous cells that remained.

I took an elevator into the basement of Smilow each weekday to get my five-minute dose of radiation. I felt nothing during the treatment, but over time, my skin got sensitive, like sunburn, all around my chest, underarms, and back. Also, by the end of each week, when I took a sip of water it felt like I was swallowing a golf ball.

Chemo was interspersed with radiation—a one-two punch. As with every aspect of my treatment, I chose the most aggressive option. With chemo, that meant I got six days of high-intensity infusions overlapping with the first radiation treatments and six more days of infusions near the end. That included four days of cisplatin and 12 days of etoposide, two commonly used chemotherapy drugs. Between the two courses of chemo, I had three weeks to recover. I needed every bit of that time because I suffered from intense fatigue, nausea, and constipation. I will spare you the details. The chemo also affected my kidneys and decreased the number of neutrophils (a kind of white blood cell) available to fight infections.

I soothed my mind over those six weeks by visualizing what the chemo and radiation were doing inside my body. The chemo was attacking the nuclei of the cancer cells the way a chef scrambles a raw egg yolk with a whisk, I imagined. The radiation was blasting cancer cells the way a microwave oven cooks scrambled eggs.

Another factor that helped me get through treatment was the kindness and care of the team at Smilow—including doctors, residents, nurses, X-ray technicians, phlebotomists, schedulers, receptionists, valet parkers, and snack ladies. With few exceptions, Smilow people went out of their way to help me feel better. At the end of chemo treatment, nurses gathered around me in the hallway while I rang a celebratory bell. In radiation, an even larger group cheered when I sounded their gong. It made me tear up.

I would be remiss if I didn’t credit my family and friends for the incredible amount of moral and practical support they have provided through my cancer journey. My wife, Lisa, is a kind and tireless caregiver. My siblings visit and call on the phone. Many friends have joined me on long walks during recovery. Some drive all the way from Manhattan to have lunch with me and, figuratively, hold my hand.

The next step in my treatment plan after radiation was immunotherapy. The goal with immunotherapy is to unleash the immune system so it attacks and kills any remaining cancer cells. I was treated with a monoclonal antibody, durvalumab, a relatively new type of cancer drug with a unique way of attacking cancer cells. It’s called an immune check-point inhibitor. Here’s how the drug works: Some of my cancer cells had PD-L1 proteins (called checkpoints) on their external surfaces, which signaled to the immune system’s white blood cells not to attack them. Durvalumab inhibits the PD-L1 checkpoint, essentially freeing the white blood cells to attack the cancer cells.

Dr. Gettinger recommended durvalumab to me because it was effective for stage III non-small cell lung cancer patients in a large study published in 2017 in The New England Journal of Medicine, which paved the way for the U.S. Food and Drug Administration to approve the drug for use in patients. The median progression-free survival rate for patients who received durvalumab was nearly three times longer than that for patients who received a placebo. “The survival advantage with durvalumab in this setting was unprecedented,” Dr. Gettinger told me.

Immunotherapy has been a game changer—and not just for earlier-stage cancer patients. Some patients who had stage IV cancers have remained disease free for 10 years or more after treatment of metastatic lung cancer to the liver, bones, and brain. One of the newest approaches is modifying a patient’s own immune cells to better attack cancer.

Unfortunately, I had autoimmune reactions to durvalumab. My jazzed-up immune system attacked healthy cells in my liver and left lung—the good one. As a result, I had to stop immunotherapy after five treatments. I also got pneumonia, which often happens to lung cancer surgery patients, and which sent me to the hospital.

Because a nerve called the recurrent laryngeal nerve, which moves in the chest but can impact a person’s voice, was apparently damaged by my radiation therapy, I’m getting physical therapy to improve my speech. I’m also getting PT to help me recover from pneumonia.

These days, my life has settled into a rhythm. Every four months, I get a CT scan to see if new tumors have appeared in my chest or abdomen. Even though I seem to be cured, I live always with the cloud of cancer above me. I try to ignore it. I hike, bike, do yoga, work on a novel I’m writing, attend classes at Southern Connecticut State University, watch sports on TV, and enjoy life with my friends and family.

If my cancer returns, my team will switch gears and begin treating me with the goal of extending my life rather than necessarily curing me. The main tool they will use will be targeted therapy, a newer category of drugs that specifically focus on the genetic anomalies found in tumors, disrupting their growth. At that point, the chances that I will be cured again will be small, but, of course, I will hope for the best.

While I fight my personal battle against cancer, my doctors and others in the medical community face their own challenges. U.S. National Cancer Institute funding for research has been hit by federal budget cuts—and the future will likely bring further decreases in funding. Some insurers are balking at paying for increasingly complex and expensive treatments. And a shortage of medical oncologists nationally is expected to get worse in the coming years—further exacerbating existing disparities in access to high-quality health care.

Still, one major factor that keeps hope alive for lung cancer patients like me is the rapid pace of breakthroughs in medical research. The way Dr. Boffa sees things, many of the advances in recent years have come because of “connecting two dots that are close together.” Going forward, he believes, many advances will come as researchers deepen their understanding of how the body—and cancers—work on a more fundamental level. That way, we will be able to disrupt the pathways of disease and identify treatments that work best for individual patients. “It’s a transformation of the way we deal with lung cancer. We’re thinking differently. The impact could be enormous,” he told me.

One of the great attributes of modern medicine is things can change quickly. Amazing new theories and therapies appear all the time. For patients, so long as you’re alive, you can hope.

Before each of my office visits with Dr. Gettinger, a nurse takes my blood pressure and asks me a bunch of questions, among them, “Do you know who you are and where you are?” I tell her, “Yes.” To myself I say: “I’m a lung cancer survivor, and I’m in the place that’s saving my life.”