Newly appointed Christiana Care Chief of Thoracic Surgery Charles Mulligan Jr., M.D., surveys the state of the science as he takes on the leadership of the Thoracic/Esophageal Cancer Multidisciplinary Clinic at the Helen F. Graham Cancer Center & Research Institute.
Dr. Mulligan is board-certified in general and thoracic surgery with special interest in lung cancer, esophageal cancer, mesothelioma and mediastinal tumors. He first joined the Thoracic Surgery Service at the Graham Cancer Center in 2008 after retiring from active duty with the U.S. Army. His 21 years of federal service included serving as chief of Thoracic Surgery and chairman of the Thoracic Tumor Board at Walter Reed Army Hospital. During the War on Terror, Dr. Mulligan served as chief of Thoracic Surgery with the 28th Combat Support Hospital in Iraq from 2003-2004 and as chief of General and Thoracic Surgery in Iraq from 2006-2007. He returns to Christiana Care after being recruited in 2012 to build the Thoracic Surgical Oncology Service at Centra Health and Pearson Cancer Center in Lynchburg, Va., which he completed in November 2014.
Q: How are we changing cancer care in Delaware?
A: Our multidisciplinary cancer team, under the direction of Bank of America Endowed Medical Director Nicholas J. Petrelli, M.D., has created a national model for the diagnosis, prevention and treatment of lung and esophageal cancers.
The Thoracic/Esophageal MDC meets every Tuesday afternoon at the Graham Cancer Center. That is where our patients and their family members sit down with an entire team of specialists and their own nurse navigator.
This scenario was unheard of just 10 years ago, but it has proven to be highly effective in facilitating the most comprehensive treatment plan for the patient’s particular disease process.
Q: What are your priorities as MDC leader?
A: Understanding our patients and taking care of their medical needs is our first priority. Our mission, launched more than a decade ago, is still our mission today:
- Grow our cancer care program.
- Lead with cutting-edge technologies.
- Accelerate enrollment in clinical trials.
- Advance the science of thoracic/ esophageal cancer care to benefit patients everywhere.
Q: You recently rejoined the Graham Cancer Center after leaving in 2012 to launch a similar program out of state. Has the experience honed your perspective moving forward?
A: Key to our success here at the Graham Cancer Center is the patient-centric focus of the MDC, a model I used to build a similar thoracic program from the ground up in Virginia.
Graham Cancer Center patients need not travel elsewhere to get top-notch, quality care with all the latest technologies in the hands of experienced specialists. Another big plus is the “down home” feeling you get when you walk through our doors. That signals a level of personalized care you might not find at a larger institution. The parking is not bad, either!
I want to continue to reach out and to strengthen relationships with primary-care physicians and specialists in the community. No question or concern is too small for us to answer. We want to ensure the resources and capabilities at the Graham Cancer Center are familiar and accessible to everyone in our region.
Q: Scientifically, how do we measure up?
A: The Graham Cancer Center is one of the original National Cancer Institute selected Community Cancer Center sites and a leader in NCI’s Community Oncology Research Program. We have one of the top clinical trial enrollment ratios in the country.
The thoracic/esophageal program is very active in clinical research, with opportunities for patients to access the most promising new treatments that impact not only quality of life but improve survival rates. We also have a burgeoning Translational Cancer Research Program that pairs scientists with clinicians to move discoveries closer to everyday medicine.
Q: What research are you currently most excited about?
A: We’ve just launched a new initiative with scientists at The Wistar Institute in Philadelphia to identify a potential biomarker in the blood that could signal the presence of lung cancer. This is a very important study, similar to one we worked on previously, that could eventually produce a blood test to identify lung cancer early, detect recurrence and help us distinguish between benign and malignant nodules found through screening.
This is just one example among several studies where physician investigators are collaborating with academic institutions and bio-pharma companies around the country.
Q: As a thoracic surgeon you specialize in the latest minimally invasive surgical techniques. What are some of the advanced technologies the Graham Center has to offer?
A: Thoracic surgeon Brian Nam, M.D., and I are experienced in minimally invasive surgical techniques that allow us to treat and to stage lung and esophageal tumors with only a few small incisions. There are cases where conventional surgery is necessary, but when appropriate, techniques such as video-assisted thoracic surgery (VATS) and and minimally invasive esophagectomy allow patients to experience shorter hospital stays with less pain and quicker recovery.
Also, Dr. Nam and I, along with interventional pulmonologist Tuhina Raman, M.D, specialize in endobronchial ultrasound and the latest navigational bronchoscopy techniques, offered at few other centers in the region. These technologies are used to diagnose and stage cancer, facilitate pre-operative treatment planning and to manage symptoms that may restrict breathing or cause pain.
Of course, our patients can access advanced radiation oncology and chemotherapy protocols as well, and the most innovative biologics and “personalized” therapies that target specific cancer genes, for example, to block the growth and spread of the cancer.
Q: Lung cancer continues to be a major contributor to the overall cancer burden in our state. Tell us about efforts to control this disease.
A: We are poised to make a measurable impact on lung cancer cure rates in our state. Right now only about 15 in 100 patients survive five years from their diagnosis of lung cancer, and the mortality rate for lung cancer exceeds that of breast, colon and prostate cancers combined. Early detection can change these numbers.
An important part of our mission is leveraging our expertise in support of the Christiana Care Medical Group and the state of Delaware to make low-dose CT scan screening for lung cancer accessible to those at risk, according to national guidelines. But no screening program is complete without counseling and help to quit smoking, essential services that are embedded in our Graham Cancer Center programs targeting lung cancer.