'What cool new toys will they come up with': RWJ Barnabas's director of thoracic surgery on the future of cancer tech

There are two things in oncology that excite Joanna Sesti, MD: using new robotic technology and building lasting relationships with her patients.

As director of thoracic surgery at West Orange, N.J.-based RWJ Barnabas Health and chief of thoracic surgery and director of robotic thoracic surgery at Livingston, N.J.-based Cooperman Barnabas Medical Center, Dr. Sesti is constantly on the lookout for new technology and treatments that make cancer care easier for patients, families and clinicians.

Question: What drew you to oncology?

Dr. Joanna Sesti: A lot of things. I unfortunately lost my dad to cancer. So that was a big driver for me to get more involved in cancer care because of his experience and our experiences of family. But beyond that, I think that one of the things that I really appreciate about oncology care, especially surface surgical oncology care, is the long-standing relationship that you develop with your patients. For a lot of patients with benign disease that we treat in thoracic surgery, it's a one time situation. The patient comes in, you evaluate new surgery and you really don't see them again ever. But the oncology patients are with us forever. I personally follow all of my oncology patients. I see them every six months for two years and then once a year after that for basically forever. It's a nice relationship that you develop with them over time, and you see how they surpass probably one of the biggest adversities in their lifetime. I find that very rewarding.

Q: What cancer study, technology or innovation are you most excited about right now?

JS: One of the things that drew me to thoracic surgery is technological advances, especially in the last 10 to 15 years. The major advancement I'm excited about is the introduction of the robotic surgical system and the adaptation to thoracic surgery. With each interaction it's become better and better until it's become mainstream in thoracic surgery. Before the robotic system was introduced, the adaptation of minimally invasive techniques in lung cancer surgery was pretty dismal across the country. But with the introduction of this robotic surgical system, the adaptation to minimally invasive techniques has really rocketed, which is at the end of the day better for the patients. So certainly any further iterations of the robotic system is an exciting thing to look forward to. 

I know a lot of other companies are looking to roll out robotic platforms. So what cool toys will they come up with? I guess we'll see. 

The introduction of immunotherapeutics has been really just groundbreaking. I actually just saw a patient yesterday that had pretty advanced lung cancer. They were treated with chemotherapy and immunotherapy as induction prior to surgery. And when we rescan them, there wasn't even any evidence that there was any cancer left. Hopefully there will be more agents that are discovered that are targeted to certain mutations. So that's all very exciting as well.

Q: What aspect of your work or the field keeps you up at night?

JS: I think the fact that especially for lung cancer, even in early-stage disease, we still have a fair amount of patients that die of cancer. There are still a lot of patients out there that have recurrence and eventually die of lung cancer. So that obviously is bothersome to anybody who treats cancer because what you want to be able to tell your patient is, "Listen, we caught this early. Thank goodness we treated it. You're safe." But that's difficult to say right now. I think it's only a matter of time before these immunotherapeutics are adapted from more advanced diseases to potentially early diseases. And the hope is that it will change the history of lung cancer. 

When it comes to esophageal cancer, I don't think we have a great treatment unfortunately, even with immunotherapeutics and chemotherapy and advances in the surgical treatment. I think we're still lagging in helping patients. My hope is that eventually some sort of immunotherapeutic will be discovered that'll make a significant difference in esophageal cancer as it has in lung cancer.

Q: What's one thing your hospital/system is doing in cancer care that you're most proud of?

JS: I think that the commitment to adopting the latest technologies is really great. Our hospitals have the latest iteration of the DaVinci robotic system and at least two hospitals have access to one of the robotic bronchoscopy systems. And because we're affiliated with Rutgers Cancer Institute of New Jersey, which is the only NCI-designated cancer center in New Jersey, we're able to help patients access millions of clinical trials throughout cancer care. Before, they had to travel to Manhattan or elsewhere to enroll in trials. Our system is really pushing to make that a thing of the past for the state of New Jersey.

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