Combating Cancer - Advances in treatment offer hope for a longer better life

Advances in treatment offer hope for a longer, better life.

Learning that you or a loved one has cancer turns your life upside down. But advances in prevention, early detection, alternatives to surgery and fully integrative care are helping to cushion the blow and offering many patients both longer lives and better quality of life.

Prevention and Early Detection
“One of the things that a lot of physicians are really excited about is the HPV vaccine,” says Leeanne Dalton, administrative director for Oncology Services, Bon Secours Hampton Roads. “If all eligible girls and women were to receive the vaccine, we could drastically reduce the incidence of cervical cancer. We want to encourage people to talk to their family physician.”

For lung cancer—the most common and deadly cancer worldwide—a recently published national trial has shown the benefits of CT scans for people at a high risk of developing lung cancer. These high-risk patients are those over 50 with what’s called a 30-year pack history— smoking a pack of cigarettes a day for 30
years or two packs a day for 15 years or other equivalent, Dalton says.

“The most common symptom of lung cancer is none at all,” Dalton says. “By the time it’s showing up as persistent coughing or wheezing, the disease is pretty far advanced. We’d like to catch the disease early before it is advanced and spreads to other areas of the body.”

Preventive CT scans in those highrisk patients can do that. Insurance does not cover the scan, which costs about $300, but treatment if needed is covered, Dalton says.

CyberKnife—Alternative To Surgery
For patients who aren’t candidates for surgery either because they aren’t healthy enough or their cancers are too far advanced, a new alternative to surgery offers hope. You may have heard of the Gamma Knife, which surgeons use to deliver high doses of radiation to extremely targeted areas to treat brain cancer. The CyberKnife® expands on that with a robot system offering the same accurately targeted dose of radiation to tumors anywhere in the body.Accuracy is important as concerns grow about the dangers of lifelong exposure to radiation.

For example, CyberKnife offers lung cancer patients who aren’t candidates for surgery a better chance of successful treatment, says Dr. Scott Williams, vice chairman of the Department of Radiology, Oncology and Biophysics at the Eastern Virginia Medical School and medical director of Sentara Advanced Radio Surgery.

“Many of our lung cancer patients are lifelong smokers and are not healthy enough to have a portion of their lung removed,” Williams says. “Or if they also have cardiac disease, they can’t tolerate a major chest surgery. Ten years ago, we could offer conventional radiation with a 30 percent chance of controlling the tumor. Now with early stage lung cancers, we have a 90 percent chance of controlling those tumors with CyberKnife.”

CyberKnife also has been effective in reducing pain in patients with tumors pushing on their spines, Williams says. “I had one patient who got his treatment on Friday and came back in on Monday and told me his pain was gone—it had stopped almost immediately,” he says. Williams also has successfully treated patients who suffered up to 15 years with neuralgia (unbearable, shooting facial nerve pain). “I’ve seen them back in three weeks and the pain is gone,” he says. Williams, who trained on the first CyberKnife during his residency, hopes to be a part of national trials further testing CyberKnife later this year comparing its effectiveness to surgery for cancer patients who are healthy enough for cancer surgery.

National Trials
Used to be, FDA trials of state of the art cancer drugs, therapies and treatment options were available only to patients who could travel to major cancer centers such as Johns Hopkins. Now patients can be part of such trials (which have been reviewed by the National Cancer Institute but not approved by the FDA), without leaving Hampton Roads, says Dr. John Q.A. Mattern II, medical director of Riverside Medical Center’s Hospice Unit and assistant professor of internal medicine at Eastern Virginia Medical School. Mattern has treated cancer patients for more than 30 years.

“If you’re a cancer patient in 2011, ask your doctor if there is a clinical trial you might participate in,” Mattern says. “The nice thing about patients accessing a national trial or protocol is they get state of the art therapy, the current best and the potential of taking the treatment to the next level up.” Some clinical trials require blood tests and scans to be done more frequently than the insurance-funded standard of care, and those additional treatments are paid by the sponsor of the trial, Mattern says.

Integrative Care
As cancer treatments become more successful, some medical practices are focusing more on educating patients, better managing pain, emphasizing nutrition and exercise, and offering supportive treatment such as massage and music therapy.

“All of a sudden the cancer treatments we have work,” says Dr. Laura Kerbin of the Peninsula Cancer Institute. “When I was in training a little over 10 years ago, 50 percent of patients that were diagnosed with cancer died (from cancer). Now 60 percent live and 40 percent die from the cancer. And of the 40 percent, they are living a lot longer than they would have 10 years ago. Because people are living longer, we need to know how to better take care of them so they have better quality of life.”

At the Peninsula Cancer Institute, the integrative medical approach offers patients therapeutic massage, music therapy, nutritional counseling and pain management along with treatment for the cancer, Kerbin says.

The health care team also focuses on controlling not just the tumors but alsothe pain and other symptoms, some of which may be side effects of medication. “Pain has a horrible impact,” she says. “When you’re in pain, you don’t eat. You don’t move. You don’t leave the house.”

Education also is a key part of care. After a person at Peninsula Cancer Institute is diagnosed with cancer, he or she meets with a patient educator and gets a notebook that outlines the treatment and key information. “We really feel the patient needs to be an active participant in his or her care.” These aren’t just feel-good solutions— research has shown that losing weight reduces the risk of breast cancer recurring and that patients who exercise during treatment have a better treatment experience, Kerbin says. Another study showed that patients who got palliative care to control pain and symptoms of lung cancer lived longer and better, she says.

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