Monthly Archives: May 2016

Targeted Therapy Improves Radiosurgery for Patients with Metastatic Melanoma To the Brain

Radiosurgery, like that delivered by Cyber Knife, plays a big role for patients with metastatic melanoma with spread to the brain.  It’s an all too common situation-as many as 25-50% of melanoma patients develop brain metastasis during the course of their disease.  And 20-50% of all deaths among melanoma patients are linked to spread to the brain. 

But there is now good news, especially for metastatic melanoma patients whose tumors carry that BRAF V600 E mutation – about 50% of all patients with melanoma.

Physician researchers from NYU’s Langone Medical Center in NYC showed that treating metastatic melanoma patients with drugs that inhibit the BRAF mutation after radiosurgery did better than those patients on BRAF inhibitors before radiosurgery for their brain metastasis. 

And the survival results were significant with 41% of metastatic melanoma patients surviving at 12 months after radiosurgery and treatment with the BRAF inhibitor drugs compared to 19% for those patients who did not have the mutation.  The inhibitor drugs included dabrafenib, vemurafenib, or the dabrafenib/trametinib combination. 

Dr. Amparo Wolf, the senior author of this study, told Medscape Medical News, “What we have shown is for the first time median survival of melanoma has passed 1 year.”  The paper was published in the May 2016 issue of the Journal of Neuro Oncology and presented at the recent meeting of the American Association of Neurological Surgeons. 

From my point of view, the implications of the study are huge.  Firstly, it’s great news for metastatic melanoma patients whose cancer has spread to the brain.  Secondly, using targeted therapies, like the BRAF inhibitor drugs, opens up the possibility of using other targeted therapies against many other cancers, like lung, breast, prostate, kidney, and colon cancer.  Finally, I believe that the use of targeted therapies, identified by genetically mapping an individual patient’s cancer, and combining a precision drug with radiosurgery is the wave of the future. 

If you have any questions about your brain tumor or brain metastasis, please feel free to call me, Dr. Edward Hughes, at 855-Dayton1

Prostate Cancer – 3 New Landmark Studies in 2016 You Need to Know about

CyberKnife Iris.tif

The Cyber Knife offers amazing benefits to treating prostate cancer. Better outcomes, fewer side effects, greater quality of life.

1.  Stereotactic ablative body radiotherapy (SABR), like that delivered by Cyber Knife, is just as good for curing early stage and intermediate stage prostate cancer as more traditional radiation options, like IMRT or permanent radiation seed implants. 

Researchers at the University of Texas Southwestern Medical Center (UTSW) in Dallas showed that stereotactic ablative body radiotherapy or SABR resulted in prostate cancer control rates of 98.6% at 5 years.  Importantly, 63.7% of those men had so-called intermediate risk disease and 36.3% had low risk disease.  The study was published in the European Journal of Cancer 59:142-151, 2016.

Only a few patients had moderate side effects, but the specialists at UTSW used a LINAC based radiosurgery, not Cyber Knife.  At First Dayton Cancer Care, our rate of grade 3 toxicity is much lower-   a tribute to our team as well as the Cyber Knife itself.  Cyber Knife is the only stereotactic  radiation system that continuously tracks prostate movement during treatment, thereby minimizing collateral damage to the bladder and rectum.

2. Stereotactic ablative body radiotherapy (SABR), like that delivered by Cyber Knife, is every bit as good as proton therapy, at a fraction of the cost and far less time consuming for the patient. Cyber Knife is done is 1 week versus 6-8 weeks with proton therapy.

In the study of 1,327 prostate cancer patients treated at the University of Florida Health Proton Therapy Institute in Jacksonville, the 5 year PSA control rates were 99% for low risk prostate cancer patients and 94% for intermediate risk patients.  And the side effects were the same as that delivered by Cyber Knife. The study was recently reported in the International Journal of Radiation Oncology, Biology and Physics 95:422-434, 2016. The reduced treatment time plus the fact that Cyber Knife  costs a fraction of what proton therapy costs, makes treatment with Cyber Knife a winner all the way around.

3. Radiation therapy added to hormonal therapy (called ADT or androgen deprivation therapy) cut in half the risk of men dying from prostate cancer.

And the results were huge! Radiation therapy added to hormonal therapy reduced the risk of death from 34% to 17% at 15 years. The study of 875 Scandinavian men with prostate cancer was recently published in the March 2016 issue of the Journal European Urology.  Importantly, the radiation therapy was only 70 Gy over 7 weeks, a lower radiation dose compared to 80 Gy over 8 weeks typically given to men with locally aggressive prostate cancer in the US.

Unfortunately, now that routine PSA testing in the US has declined, more and more men are faced with a diagnosis of locally aggressive prostate cancer requiring radiation therapy in addition to hormonal therapy.

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton1

Follow-Up Visits: Too much, Too Little, or Just Right?

Are you a More patient or a Less patient?

Are you a More patient or a Less patient?

Each and every day in my practice I listen to the same old questions about follow up care from my patients.  Questions about how often follow-up visits can be grouped into 2 major categories: 1) Patients who want more and 2) Patients who want less. The ‘Mores’ ask “How about getting more scans, like a PET scan, CT scan, or MRI scan?”; and the ‘Less’ ask “Why do I have to come back to you as well as my other doctors?”

For HPV positive oral pharyngeal cancer patients, the answer is now clear-cut.  Research specialists, led by Dr. Jessica Frakes from the H. Lee Moffitt Cancer Center in Tampa, studied 246 patients with HPV positive squamous cell carcinoma of the oropharynx who completed either radiation therapy alone or radiation plus chemotherapy from 2006 to 2014.  Those patients then had a PET/CT scan 3 months following completion of treatment.

Follow up visits with a patient history and physical examinations were conducted by members of the multidisciplinary team consisting of a radiation oncologist, medical oncologist or surgeon as follows: Year 1 patients followed up every 3 months; Year 2 patients followed up every 4 months; Years 3-5 patients followed up every 6 months.

As reported at the 2016 Multidisciplinary Head and Neck Cancer Symposium that I attended this past February, the vast majority of recurrences -98% to be exact- were found by physical examination alone.  98% of recurrences of the neck were found by feeling a lump in the neck.  So physical examinations, especially by a qualified specialist, are key.

Dr. B. Chera, an associate Professor of radiation oncology at the University of North Carolina Chapel Hill, told Oncology Times, “I conclude from this study that more frequent surveillance with imaging is not necessary for HPV positive oral pharyngeal squamous cell carcinoma patients.”  Dr. Christine Gourin from Johns Hopkins Hospital added, “I think we probably due too much post-treatment surveillance imaging.  And it’s true we pick up more recurrences clinically and radiologically.”

So there you have the answer. For patients with the most common form of head and neck cancer, frequent physical examinations after PET/CT scan is key.  More scanning is not beneficial, and may in fact be harmful.

If you have any questions about your head and neck cancer, please feel free to call me, Dr. Edward Hughes, at 855 Dayton 1.

 

 

Take Back Control of Your Healthcare from Insurance Companies

OSMA Logo w 3D State - Blk & Lt Blue - Drop ShadowPlease join the Ohio State Medical Association to take action today to stop Medical Insurance companies from practicing medicine!

OSMA Government Relations Team is working overtime to get SB 129 passed out of the Ohio House by the end of May.  We need your help to give one final push to your Representative to pass this legislation in the next three weeks! The insurance industry has continued to voice concerns with the bill following its unanimous passage out of the Ohio Senate. The current prior authoirzation system’s administrative burden and impediment to quality care must end.

Currently they require your physician to ask PERMISSION to treat you. The insurers decide what type of medical care you are allowed to receive.

Plus they may or may not pay for the services that they have promised to cover. This leaves you, the patient, with a huge bill or you the physician unpaid.

We are asking that insurers respond to the authorization request in a timely manner. In 2012 the average wait time for our patients was around 4 days. Now our patients wait on average of 23 days for authorization. This delays treatment and causes a lot of anxiety in people who are already anxious because they have cancer.

This Senate Bill is vital to health care in Ohio. While it doesn’t solve all of our problems with Prior Authorizations, it certainly is a giant step in the right direction. Insurance companies need to allow our physicians to treat our patients the way that their experience and expertise tells them is best for that individual person. Plus, our patients deserve timely answers and your doctors deserves to be paid what has been promised to care for you.

Senate Bill 129 will help us to achieve all of this. Please take a few moments to send a letter to let your voice be heard!

I also encourage you to send this email to everyone you know. Each one of us is a patient. Send it to everyone on your email list.

Let’s tell the insurance companies that we do not want them practicing medicine. Go to the OSMA Advocacy Center to send a letter to our government right now! Time is running out to have your voice heard.

Is Late Night Snacking Putting You at Risk for Breast Cancer Recurrence?

kitchenclosedFasting for 13 or more hours at night, including sleep, just may help reduce the risk of breast cancer recurrence.  And the effects were huge – a 36% higher risk for breast cancer recurrence for women who did not fast. This study of 2,413   non-diabetic women with early-stage breast cancer was published in the March 31, 2016 issue of JAMA Oncology.

Dr. Ruth Patterson, the senior author of the study, told Medscape Medical News “To our knowledge, this is the first paper examining nightly fasting and breast cancer progression.”  Dr. Patterson went on to say, however, that “the data are not mature enough to make clinical or public health recommendations.”

 As always, the study raised more questions that it answered.  And is likely to take a decade of research to confirm these results.  But I believe the current results are simple and yet profound.  So do what your grandmother always told you, “The kitchen is closed after dinner.”  This simple recommendation of not eating after dinner results in a huge decrease in the chances for breast cancer cure after treatment.

If you have any questions about your breast cancer, please feel free to write or call me, Dr. Edward Hughes, at 855-Dayton1.

 

WHO IS CARING FOR THE SURVIVORS CAREGIVER?

This blog was posted a while back, however, it rings true every day. Happy Mother’s Day to all the moms who took care of you.

"One person caring about another represents life's greatest value."- Jim Rohn

“One person caring about another represents life’s greatest value.”- Jim Rohn

A cancer diagnosis changes the lives of many. The patient is not the only person affected. Life also changes for those who care about and love the person with cancer especially for the person who will help the patient get through the cancer experience-the caregiver. Caregivers are the unsung heroes of cancer survivorship. Primary caregivers are a major part of the health care team because they are doing things like: giving medications on time, helping manage side effects, communicating with the physicians and nurses, taking the patient to appointments, and keeping other family and friends up to date on what is happening. This primary caregiver does all of this while trying to manage normal day to day activities. Becoming a caregiver is like taking on a second job. It is not an easy job. And it must be done with a positive attitude as the cancer patient often draws strength from the caregiver.

The question is “who is caring for the caregiver?” This is a role that a friend or a secondary family member can take on.

Depression and exhaustion are two major concerns with primary caregivers. The American Cancer Society has a Checklist for Caregivers that gives excellent advice. I strongly recommend that survivors, primary caregivers and family/friends utilize this resource. It offers tips and insights to keep the caregiver healthy inside and out.

The focus of course is to find excellent support for the cancer survivor, as it should be; but the caregiver will benefit from support too. They do not usually have time to join support groups in person, so the internet can be just what is needed. There are online support groups that are disease specific or simply cancer in general. Find the one that is easiest to use and has like-minded people. The chat rooms can be a great place to trade information and to learn from each other’s experiences. Sometimes it serves as a place to share your fears and frustrations with others who understand what you are going through. The right online chat room should be a safe place without judgment. I only ask that you use caution when taking advice regarding medical treatment and medication. Always seek the counsel of the patients health care professional. This includes beginning any new supplements. Some herbs and vitamins are very powerful and may interfere with some medications or treatments.

Know your Rights as a Caregiver. The Family and Medical Leave Act (FMLA) is a federal law that guarantees up to 12 weeks off from work per year to take care of a seriously ill family member. Your employer must hold your job and not penalize you. However, they are NOT required to pay you. FMLA only applies to companies that employ more than 50 employees or public agencies. Learn more here.

The caregiver is likely the point person for a number of legal issues as well. An Advanced Directive is a document that can help the patient to spell out their wishes in regards to their overall health care, with special attention to end-of-life care. The caregiver may also be asked to become the Durable Power of Attorney for health care decision. This has nothing to do with money or finances, but only to help carry out health care decisions. Ask your attorney or physician to help get these forms started. I recommend that these forms be completed early, while the patient is capable of making sound decisions. This really takes the pressure off of the caregiver and gives them the legal support that may be necessary when family members disagree.

Every cancer survivor needs a strong, compassionate caregiver. This caregiver needs special attention and care themselves.