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Righting a Life Turned Upside Down by Smoking

Fall 2006 – Although Lee Hanson had smoked heavily for nearly 40 years, he still did not associate his dry, nagging cough with lung cancer. Was it bronchitis? Or a benign “smoker’s cough”? Then in May 2004, Hanson, associate vice chancellor and director of development services at Washington University, was sitting at his computer terminal when he suddenly felt ill and lost all feeling in his hands.

Lee HansonThe diagnosis was pneumonia. Hanson discovered that this disease often masks lung cancer and may be caused by the tumor itself. But a chest X-ray showed only the typical signs of pneumonia. After one week of drug therapy, there appeared to be some resolution, so lung cancer was not suspected.

Still, the cough continued. Finally, in July 2004 — nearly seven months after it had started — Hanson had his annual physical exam and mentioned the problem. That afternoon, his physician sent him to the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine for a CT scan, which gives a more accurate, detailed look at the lungs than a conventional X-ray. Hanson was at a planning retreat the next day when his doctor called, asking to see him.

“Ironically, Washington University’s chief fund-raiser for Siteman had that very morning brought blue cancer awareness bracelets to our meeting and handed them out to everybody,” Hanson says. “Little did I know that within 24 hours I would be a patient there, and my life would be turned upside down.”

He had begun smoking in 1965, at a time when the tobacco companies were giving out free cigarette samples to incoming freshmen at his university. “All of the fraternity guys smoked,” he says. “It was the thing to do. Everybody smoked then.”

Soon he was hooked, and through the years, his periodic attempts to quit only ended in a quick relapse. Eventually, he learned that nicotine can be a highly addictive drug, though the tobacco companies long denied it. In 2003, he served on a panel reviewing an educational program that a major tobacco company was developing, and even then they claimed not to have known that smoking was addictive.

When Hanson was under stress, he smoked as much as two packs a day. “At certain times and with certain activities, you always had a cigarette,” he says. “You associated smoking with having a drink, with your first cup of coffee in the morning, after a meal. There were a lot of triggers.”

In addition, he came from a family of smokers, including his father, a World War II veteran who had smoked throughout the war but at last had managed to quit cold turkey. Hanson’s mother smoked until the final hospitalization before her death.

“Eventually, the addiction takes over,” Hanson says. “You are smoking but not for pleasure. There are 100 reasons not to be smoking, yet you still smoke. You wake up in the morning and say, ‘I’m not going to smoke,’ but you find yourself having a cup of coffee and lighting up. So you say, ‘Well, I’ll quit tomorrow.’ It’s typical of an addiction: You rationalize, you justify, you say, ‘It’s not going to happen to me.’”

In his doctor’s office, waiting to hear the results of his scan, he began to fear the worst. The office staff members, usually so cheerful, were suddenly somber. “When my physician came in, he said, ‘You have a tumor in your right lung,’ and I went numb. I drove home and, standing in my driveway, thought to myself, ‘This isn’t the way I wanted it to end.’”

At work, Hanson and his colleagues had just completed the most successful fund-raising campaign in Washington University’s history and were celebrating its triumphant finish. They were looking forward to new challenges. “Then here I was faced with imminent death and apparently no hope,” he says.

But Hanson’s doctor was already at work, asking Washington University surgeons at Siteman and Barnes-Jewish Hospital to evaluate Hanson. That evening Hanson got a phone call telling him to be in the office of Alec Patterson, MD, Joseph C. Bancroft Professor of Surgery and chief of cardiothoracic surgery, first thing the next morning. The thoracic surgery program at Barnes-Jewish Hospital is one of the largest in the United States. The program has an international reputation for its innovative contributions to the surgical management of patients with lung cancer.

“When Dr. Patterson came in, he just exuded confidence,” Hanson says. “He said, ‘I have seen the CT scan. The tumor may be operable, and if so, I can take it out.’ And that was the first good news I had heard in 24 hours.”

From that point on, things moved quickly. Tests determined how far the cancer had advanced. Hanson had a stage IB, non-small cell tumor in his right lung. Fortunately, the cancer had not spread to his lymph nodes, which meant that it was operable — and he had a chance for long-term survival.

Staging cancers accurately is important because it helps determine how patients like Hanson are treated. At Siteman, integrated positron emission tomography-computed tomography imaging (PET-CT) — a new tool that combines the strengths of these two techniques — has given specialists an even more precise way to diagnose and stage lung cancer. “We were the first in St. Louis to offer this advanced technology, and we use it to perform nearly 3,000 studies a year,” says radiologist Barry Siegel, MD, chief of nuclear medicine at Washington University.

Hanson was lucky that his cough drew attention to his disease and prompted this kind of medical investigation, Patterson says. He also is lucky his disease was discovered at a fairly early point, because the presence of symptoms often means advanced, inoperable cancer. “Unfortunately, a lot of these patients present with symptoms such as coughing, coughing up blood, pain in the chest, shortness of breath and so on,” he says.

Hanson quit smoking on July 27, 2004 — the day before his surgery. In the operating room, Patterson says, the surgery was straightforward, a removal of the middle and lower lobes of Hanson’s right lung. Within days, he was in rehabilitation. At the end of his first week home, he was able to walk to the end of his block. “I was so ecstatic, so pleased,” Hanson recalls.

That September, Hanson began chemotherapy under the direction of medical oncologist Ramaswamy Govindan, MD, whom he calls “the nicest human being I’ve ever met, the most compassionate and caring.” The drug combination Hanson took — taxol and carboplatin — first became recommended therapy because of a clinical study sponsored by Cancer and Leukemia Group B, a multi-institutional cooperative group that includes Siteman Cancer Center researchers.

In his current research, Govindan is looking at another key question. “Approximately half of patients with stage I or II lung cancer have a new cancer develop after surgery, while the other half are cured,” he says. “Who are these patients who are cured? It is very critical to find out, and the answer is in their genes.”

To investigate this problem, Govindan and his colleagues are studying outcomes in patients who have had surgery for non-small cell lung cancer to see whether they can identify the genes that predict those outcomes. In another study, Govindan and cancer prevention expert Ming You, MD, PhD, are looking at the role of green tea in preventing lung cancer in patients who have precancerous lesions.

Hanson worked part time for a month before returning to work full time. He was greeted with a “welcome back” party that featured his favorite ice cream and an office full of helium balloons. Hanson hopes he will be among the half who have been cured. Meanwhile, he is grateful for the kindness of all the staff members — from the physicians to the patient transporters — who helped him at Siteman. And he has a thought for other cancer patients. “Hope and fear can’t occupy the same space,” he says. “If you have hope, there’s no room for fear. So never stop hoping. Never give up hope.”