Monthly Archives: April 2016

Is American Medicine Rigged? The Truth about Lung Cancer

Are American patients being told all of their options?

Are American patients being told all of their options?

The Presidential primary election season has been eye-opening, with outcries by candidates from both parties of a “rigged system”. The “establishment” has recoiled from such talk. But shining the light on “the accepted way” of doing things has made all Americans more aware of the pitfalls of the system.  And asking probing questions is never bad.

It’s taken two lung cancer specialists from “Down Under” at the MacCallum Cancer Center in Australia to shine the light on the lung cancer surgery establishment in America.  In a thoughtful review of the existing studies of stereotactic ablative body radiation therapy (SABR) versus lung surgery, Dr. Siva and Dr. Ball make a compelling case for the use of SABR to treat early stage non-small cell lung cancer patients.  Dr. Siva and Dr. Ball conclude “SABR and surgery had similar estimated overall and disease-free survival.”  Their study was recently published in the prestigious  journal,  The Oncologist 2016; 21:1-6.

The situation is exactly the same as 30 years ago when I started training in radiation oncology at Harvard.  The raging controversy at that time was lumpectomy and radiation therapy versus mastectomy.  Despite study after study showing that lumpectomy and radiation was exactly the same as mastectomy, the vast majority of early stage breast cancer patients still underwent mastectomy.  But it’s always been hard to get surgeons to tell patients about surgical alternatives for early stage cancers, whether it’s breast cancer or lung cancer.

Did you know that only 14 of 50 states in America require that physicians inform early stage breast cancer patients of lumpectomy and radiation as an alternative to mastectomy?  Any wonder that those same states have more women undergoing radiation and lumpectomy than surgery?

Do you know how many states require that doctors tell early stage non-small cell lung cancer patients of using stereotactic ablative body radiation, or SABR for short, to cure early stage lung cancer versus surgery?  Exactly 0! Any wonder that many early stage lung cancer patients have never even heard of stereotactic ablative body radiation (SABR), like that delivered by Cyber Knife?  Or that the information given to them was inaccurate or incomplete?

Dr. Michael Steinberg and colleagues from UCLA looked at 102 early stage non-small cell lung cancer patients treated with stereotactic radiation (SABR)-56% had no prior knowledge of SABR before meeting a radiation oncologist.  Among those 102 patients, 39 patients had prior lung surgery for a previous lung cancer.  And 90% of those patients would rather have had stereotactic ablative body radiation, like that delivered by Cyber Knife, than another lung surgery (Lung Cancer 2015; 90:230-233).

So what’s an early stage lung cancer patient to do?  I have a modest proposal.  Early stage lung cancer patients need to be “difficult patients.” All of us doctors know the type – asking a lot of questions, having many family members present, and coming armed with a lot of facts found on the Internet. Challenging your physician can sometimes be a good thing.

So if you have any questions on your early stage non-small cell lung cancer, please feel free to call me, Dr. Edward Hughes at 855-DAYTON1

 

I PASSED THE TEST- CAN I KEEP SMOKING?

Our friendly staff will help to make your low dose lung screening easy and painless.

Our friendly staff will help to make your low dose lung screening easy and painless.

 

Lung cancer screenings can give smokers a false sense of security. An unexpected consequenceof lung cancer screening showed that many smokers continue to smoke.  It was as if a negative low-dose CT scan gave them a new lease on their smoking lives. But a recent study showed that they are not off the hook.

Screening Low Dose CT scans for Lung Cancer Save Lives

The National Lung Screening Trial (NLST) was a breakthrough discovery.  Low-dose CT scans were done on 53,454 men and woman smokers every year for 3 years. The NLST showed a 20% decrease in lung cancer deaths. That’s 20,000-30,000 Americans saved from lung cancer death every year.  And it’s covered by most insurance companies.

So with a Negative CT Scan Can I Still Smoke?

In short, the answer is NO! The men and women in the NLST continue to be monitored. A recent “second look” analysis showed that those who stopped smoking for 7 years had an even greater decrease in lung cancer deaths – over 30%.  That’s huge!

Dr. Nichole Tanner of the Medical University of South Carolina authored the study that was published last month in the American Journal of Respiratory and Critical Care, March 1 2016.  Dr. Tanner commented to OncologyPractice.com that “this study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic.  The findings highlight the importance of integrating smoking cessation efforts and lung cancer screening programs.”

So What Does This Mean for Smokers?

The benefits of screening smokers with low dose CT scans are colossal.  Coupled with stopping smoking, the number of Americans saved every year would fill Great American Ball Park. And there are no excuses for not having a screening because CT scans are painless, done in minutes with minimal radiation exposure, and low cost.

Stop smoking programs get a lot a lip service but it’s hard to do.  But there’s good news. There are a lot of options for quitting smoking, like prescription Chantix, hypnosis, acupuncture, and even cell phone apps like on Livestrong.com.  So there’s no time like the present to put down the cigarettes and call for an appointment to be scheduled for your low dose CT scan.

Should You Be Scanned?

Screening is recommended for:

Smokers age: 55-75                                                                                                                             Smoked: 1 pack per day for 30 year                                                                                                               2 packs per day for 15 year habits                                                                                            Current smokers or smokers who quit within the past 15 years

If you think you need a lung cancer screening, please feel free to call me, Dr. Ed Hughes, at 855-Dayton1.

Lightning Can Strike Twice: Why Follow-up Visits Are Important

A new study of over 32,000 patients showed that survivors of certain cancers, namely head and Cancer-Screeningneck cancer, bladder cancer, and lung cancer are at an increased risk of another, yet different cancer.  And the second cancer can be lethal – and it’s called non-small cell lung cancer.

Dr. Geena Wu presented her research from the City of Hope National Medical Center at the recent 2016 annual meeting of the Society of Thoracic Surgeons Dr. Wu and colleagues looked at the SEER national database of 32,058 patients with a prior cancer who then went on to be diagnosed with a lung cancer 6 months or later following completion of their initial treatment.

Dr. Wu found that patients with a history of certain, specific cancers had higher rates than expected of getting non-small cell lung cancer years after their first cancer was cured.  Survivors of head and neck cancer, lung cancer, and bladder cancer were especially at risk.  Even survivors of lung cancer were at risk for coming down with a completely different second, unrelated lung cancer.  And it follows that smoking is not only the likely culprit of not only the first cancer, but the second one as well. Smoking can cause multiple cancers.

As a cancer specialist, I see patients for follow-up visits each and every day.  I hear the same story.  “I’m finally done with surgery.  I’ve been through months of chemotherapy and weeks of radiation.  And now I have to come for follow-up visits, not just for months but for years? So why won’t you specialists just give me a break?”  The answer, without question is that follow-up visits are important. You need to continue to be screened for other cancers.

Unfortunately there is no limit on the number of cancers a person can get. Especially when you are talking about cancers that can be driven by lifestyle choses such as tobacco use. Cancer screenings like mammograms, colonoscopies, skin checks, and low dose lung cancer CT scans all still need to be performed on a regular basis for cancer survivors. These routine follow ups are more important for survivors than for those who have never had cancer.

I hear our survivors tell me on a day-to-day basis, “But can’t my family doctor just do the follow-up visits?”  I think that follow-up visits by primary care physicians are ideal, but a recent poll of primary care physicians showed the two thirds preferred follow-up visits for cancer be done by cancer specialists, not the family doctor.  I think that primary care physicians are already put upon to look after your general health in a 15 minute visit.  I think the cancer specialists are uniquely trained to spot early signs of recurrent cancer as well as spotting the symptoms of a new, unrelated cancer.  Once again, early detection is key to survival.  Follow-up visits with your cancer specialist is time well spent.

If you have any questions, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

SOMETIMES WEIGHT LOSS CAN BE A BAD THING

Weight loss is not always a good thing when you are a cancer patient.

Weight loss is not always a good thing when you are a cancer patient.

Often times people experience sudden weight loss that sends them to see a doctor. All too often this is the symptom that leads to a cancer diagnosis. Cachexia-the loss of muscle mass associated with cancer-is a fancy word for an all too common symptom of newly diagnosed patients with advanced lung cancer.  Every doctor knows cachexia when they see it, especially in patients with locally advanced lung cancer. Patients experience loss of muscle instead of fat because muscle is easier for the body to metabolize into the much needed calories. Cancer itself can also cause a dramatic inflammatory response which adds to this loss regardless of how many calories are eaten.

The overall weight loss and loss of muscle mass in cancer patients can be profound. Cachexia affects 50-80% of cancer patients. And the results of cachexia can lead to a continuing decline in overall health and continued impairment of immune function. Remarkably, cachexia is the direct cause of death in 20% of cancer patients. So patients with locally advanced lung cancer are already behind the 8 ball even before starting treatment, treatments that may include chemotherapy and radiation therapy. A vicious cycle starts that can lead to further loss of appetite and fatigue, compounding the cachexia.

But a recent study published in the journal Lancet Oncology shows that help is on the way for locally advanced lung cancer patients who suffer from cachexia (Lancet Oncology February 19, 2016) Dr. Jennifer Temel, a cancer specialist at Harvard’s Dana-Farber Cancer Institute, looked at 2 different phase 3 studies-the gold standard of clinical studies-of 979 patients with advanced cancer.  653 of these 997 patients were treated with the new drug Anamorelin and 326 were treated with a placebo-a pill with no active ingredients.

After only 12 weeks, those patients who took the drug Anamorelin gained weight compared with patients who took only the placebo.  Of course, there were side effects-the main one was elevated blood sugar.

From my point of view as a cancer specialist, the studies with Anamorelin are a good start. Our advanced lung cancer patients need all the help that they can muster to help combat the side effects of chemotherapy and radiation therapy.  More research will be needed to refine the role of Anamorelin to treat cancer related weight loss and muscle loss. But I’m glad that help is on the way.

If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1