Stefan Kachala, M.D.: Helping to Change the Future of Lung Cancer

By KIMBERLY Lucey Millen  /  Photography by STAN GODLEWSKI

It wasn’t that long ago that a stage four lung cancer diagnosis often meant a short life expectancy for the patient at hand, oftentimes with just months left to live. “We would tell people to get their affairs in order, estimating they had just three to six more months of life left,” recalls Stefan Kachala, M.D., chief of thoracic surgery at Saint Francis Hospital. No longer is that the case, with some stage four patients now living with lung cancer for more than a decade.

“Over the past 10 years, the treatment of lung cancer has undergone a revolutionary change,” says Dr. Kachala. “Thanks to immunotherapy, a team approach to care and the use of robotics in surgery, we have the tools to take on these highly complex issues, meet the patient where they’re at and get their lives back on track for years to come.”

The Road to the Nutmeg State

Dr. Kachala has been bringing his expertise to the state of Connecticut for eight years, living in Avon with his wife and three boys. He says he was drawn to Saint Francis and Trinity Health Of New England for an opportunity to grow the thoracic program and work alongside polished professionals who embrace a team approach to tackle integrated care for every patient. He grew up in New Jersey, attending Rutgers University for undergraduate and medical school. From there, he went on to complete an internship and residency in general surgery at New York Presbyterian-Weill Cornell, followed by a cardiothoracic surgery residency at the Cleveland Clinic.

Dr. Kachala was a research fellow in the Department of Thoracic Surgery at Memorial Sloan-Kettering Cancer Center. He states his time there working alongside Valerie Rusch, M.D., is what helped mold him into the doctor he has become today. “What struck me most was her bedside manner,” explains Dr. Kachala. “Here was this titan in the field, the head of the department, right there alongside me caring for patients recovering from surgery or coming close to the end of their life. It helped show me as a young physician how you care for these patients. It wasn’t just about being the best surgeon, but being kind, present and walking with them along their journey through cancer care.”

Expanding Screening

Improvements in lung cancer care are seen right from the onset now. More than 220,000 people are still dying of lung cancer every year in the United States, with a high percentage still associated with smoking. Dr. Kachala says experts have watched the significant difference that access to screening made in breast and colon cancer and started modeling lung cancer screenings after the success in those other fields. Now, screening is available for anyone over the age of 50 who has smoked for more than 20 years and quit less than 15 years ago. Despite that, he says outreach is still needed to make sure smokers know about the availability of screenings and get patients to book them. Trinity Health Of New England even takes walk-ins to make sure nobody is turned away from gaining the early diagnosis that could save their life.

“Even though the chances of needing a biopsy after a lung cancer screening are less than 20%, some people are just afraid,” explains Dr. Kachala. “Others don’t know that it’s a covered form of health care. Getting that image, getting the biopsy if needed and getting the knowledge means we can figure out where to start to put your cancer battle in the past.”

Using Robotics for Biopsies

For those 20% of patients who do need a biopsy, he says the method for doing so has also vastly improved, thanks to the advent of robotics. “When robotics came online 10 years ago, people thought it was just another fad,” explains Dr. Kachala. “But we said, wait, there’s something here. Let’s see how we can use this safely and then advance the science to improve outcomes.”

He elaborates that the old way of doing biopsies for lung cancer was akin to getting stabbed in the chest with a long needle: a very daunting and nerve-wracking proposal. Plus, there was a 20% to 30% chance of lung collapse because of the needle piercing the lung. Now, they’re able to perform a robotic-assisted bronchoscopy, where there is no incision, and the patient is asleep. The physician uses a controller to move a small flexible tube through the patient’s air passages in precise ways to reach the lung. While the physician is controlling the robotic system, they’re watching an intricate map of the patient’s lung on a computer screen, basically acting like a road map to guide the physician to get to the nodule that needs to be tested. There is little to no recovery time, and patients can usually go home that same day. The new method allows doctors to even know the stage of cancer when it’s found.

“Because of this new method, a lot of times we’re now finding cancer when it’s at stage one,” says Dr. Kachala. “Now we can focus on making the cancer a distant memory, not a death sentence. Instead of talking about end-of-life care, we’re talking about long-term plans and trips with grandchildren.”

Reducing Recovery Time After Surgery

For patients who do need surgery to remove a part of their lung in a lobectomy, that same robotics technology is making recovery time far more manageable. Dr. Kachala states surgeries that used to require three to seven days in the hospital are now seeing patients return home the next day.

“Robotics are allowing us to do better surgeries with less blood loss now,” says Dr. Kachala. “By using the Da Vinci Robotics Platform, we can make five small incisions instead of one large one. Robotics enable us to effectively control their pain, helping patients be more mobile and active. This results in a quicker recovery because mobility and movement are the real medicine for recovery. When patients do their part and prepare for surgery with smoking cessation, optimized nutrition and daily physical activity, we’re just the final step in helping them get back to the life they had before.”

Along with the reduced recovery time, he says the quick process from diagnosis to operating room is also a big change, realizing that, in many cases, waiting to get the cancer out is the hardest part. “As recently as five years ago, a study came out that showed it could be three to six months between getting the initial CT scan to getting into the operating room,” adds Dr. Kachala. “Now, we’re down to about 30 days.”

The Showstopper

The biggest breakthrough in lung cancer treatment is coming in the form of immunotherapy. Dr. Kachala says that, at first, they were reserving the treatment for patients who couldn’t have surgery; they then realized many of their outcomes were outperforming the others. Now, medical oncologists are working on trials to determine just how many different cancers immunotherapy can be effective in treating. Dr. Kachala uses a party metaphor about cancer being like an uninvited guest to explain how it works. It sneaks in and hides from your immune system, so your body’s natural defenses don’t destroy it. The immunotherapy is like the Scooby-Doo detective ripping off the disguise so the authorities can find the uninvited guest and kick them out of your body.

“It helps your own body recognize that the cancer cells are foreign invaders that should not be there,” states Dr. Kachala. “Your own body is very effective at policing itself. We just have to give it the tools to do so.” He emphasizes that immunotherapy is still a very serious therapy with side effects. Some patients who have an autoimmune disease like rheumatoid arthritis or who even may be prone to rashes can’t use the treatment. But for those who are eligible, Dr. Kachala says immunotherapy can be a game-changer. “It’s a potent drug that continues to develop our understanding of how we can use the body to treat lung cancer.”

Where the Road Leads Next

“Every patient who comes into my office is having a tough day,” says Dr. Kachala. “My job is to bring a servant’s heart and show the patient they can be in control of their diagnosis, to empower them.” He has made it his goal over the past eight years to focus on continually improving, learning from each case ways to make his care even better for the next patient.

“I do this thousands of times, but it’s the first, and hopefully only time, each patient will be facing this.” Dr. Kachala is applying robotic methods to permit the resection of larger tumors with minimally invasive techniques. The multidisciplinary thoracic oncology team at Saint Francis is working toward a future where cancer is 100% curable. They even foresee a future of curing cancer with pills and no longer needing to perform surgeries at all, using AI technologies to help make sure nothing slips through the cracks for any patient facing a medical crisis.

“You don’t want to face this by yourself, and you don’t have to,” concludes Dr. Kachala. “Together, we’re going to attack this from every angle to empower you to fight every day. Patients should have confidence that Saint Francis and Trinity Health Of New England can handle your diagnoses; together, we’ll start that incremental process now, so you can breathe deeply again.”

Kimberly Lucey Millen is a freelance journalist with more than two decades of experience in both print and broadcast media. She lives in New England with her husband and son, exploring all that each of the four seasons has to offer.

Stan Godlewski is an editorial, corporate and healthcare photographer based in Connecticut and working primarily between Boston and New York City.