Joan DeFeis, whose entire right lung was removed as part of cancer treatment, pauses during a May 2023 hike through Bryce Canyon National Park in Utah, where she hiked at elevations above 9,000 feet.
Joan DeFeis’ life as a mother, teacher and world traveler took an unexpected turn in 2017 when a seemingly routine gardening incident led to a life-changing diagnosis. While attempting to pull out a large, deeply rooted weed, she felt a pop in her side. Thinking she had broken a rib, she rushed to her local health care center. An X-ray determined there was not a broken rib; she had most likely torn a ligament. However, the X-ray also revealed a shadow on her lung.
The doctor told her not to worry, as shadows are common on X-rays, and recommended a follow-up chest X-ray in one month. Based on that conversation, and a similar one with a physician friend, DeFeis did not perceive the situation as urgent and delayed scheduling her follow-up exam until several months later. By then, not only was the original shadow still there, but further inspection revealed another one in a different lobe. Further tests, including a CT scan and a biopsy, confirmed lung cancer.
DeFeis was shocked. She never smoked and always maintained a healthy lifestyle.
She sought a second opinion at Dana-Farber Brigham Cancer Center, where she was diagnosed with stage III lung adenocarcinoma, a slow-growing cancer that usually starts in the outer areas of the lung, specifically in the mucus-producing cells lining the small airways known as bronchioles.
Trusting Dana-Farber Brigham’s world-renowned expertise, DeFeis began her treatment with a multidisciplinary team, including Daniel Wiener, MD, a thoracic surgeon at Brigham and Women’s Hospital, who specializes in lung cancer surgery.
“Why go somewhere else when you have the best cancer center at your fingertips?” she said.
Soon after, in February 2018, DeFeis underwent a pneumonectomy to remove her entire right lung. This was necessary because the lung contained tumors in the upper and lower lobes that were connected by a string of cancerous cells through the middle lobe.
In a traditional pneumonectomy, surgeons access the lung by making a large incision above the ribcage and spreading open the ribs. Wiener offered DeFeis a minimally invasive alternative called video-assisted thoracoscopic surgery (VATS) to accomplish the same goal. This approach involved three small incisions and avoided the need to spread the ribs, resulting in a quicker and easier recovery.
“Minimally invasive pneumonectomies are rare due to the size and spread of most tumors that require removing the entire right or left lung, but there are exceptions,” said Wiener. “For instance, in Joan’s case, her tumor involved all three lobes but was not particularly large, allowing for a minimally invasive procedure.”
From novel to standard
“I had cancer, but cancer never had me,” says DeFeis, pictured above kayaking through the waters around Antarctica in February 2024.
When DeFeis’ VATS surgery took place in 2018, this method was considered pioneering for a pneumonectomy. While minimally invasive pneumonectomies are still rare, this approach has become common for more standard resections. Today, for example, approximately 60 percent to 80 percent of lung resections are performed using either VATS or robotic methods.
“Since the time of her surgery years ago, I have primarily replaced VATS with robotic surgery, but both are now standard minimally invasive approaches,” said Wiener. “We continuously innovate and refine our surgical methods to ease the patient experience while making sure we are still treating the cancer optimally. We collaborate with colleagues in medical and radiation oncology and provide the best possible surgery as part of a comprehensive treatment plan that often involves multiple specialties. Minimally invasive approaches are always considered for patients with lung cancer, though there might be some cases when this is not possible.”
One day after her surgery, DeFeis was already up and walking around the recovery unit. She ultimately underwent four rounds of chemotherapy to ensure total removal of any lingering cancer cells. She recalls the chemo as the most challenging part of her recovery, leaving her exhausted and barely able to walk. Yet, this rigorous treatment regimen, combined with the successful surgery, has left her cancer-free more than six years later.
Despite losing her right lung, DeFeis has not let it hinder her zest for life and adventure.
“I had cancer, but cancer never had me,” DeFeis said. “I do my best to apply a positive attitude to my life. I truly believe a positive frame of mind helped immensely with my recovery. It encourages me to undertake new challenges with a ‘can-do’ attitude every day.”
DeFeis continues to travel extensively, having recently explored Patagonia, Antarctica, Zion National Park and Bryce Canyon, where she hiked at elevations above 9,000 feet. She has also walked the historic Camino de Santiago in Spain twice, starting from France, a 500-mile journey, and Portugal, a 385-mile pilgrimage.
This fall she plans to embark on the Camino Inglés, a shorter — although still impressive — 75-mile route, and travel to New Zealand this winter, a trip she originally postponed due to her diagnosis.
Amidst travel adventures and volunteer projects, DeFeis is currently working on a children’s book detailing her experience with cancer, aiming to provide hope and understanding to young readers facing similar challenges. She continues to follow up annually with her thoracic surgeon at Brigham and Women’s Hospital for surveillance, where she and Wiener exchange images: reassuring CT scans and photos of her life’s adventures.