Monthly Archives: July 2016

Breast Cancer Genetics Equals 50% Less Chemo

Genetics testing shows that 50% of breast cancer patients do not need chemotherapy.

Genetics testing shows that 50% of breast cancer patients do not need chemotherapy.

Wouldn’t it be great if you knew whether or not your breast cancer will come back? If a crystal ball could help you decide what type of treatment to have now. Chemotherapy and/or Radiation Therapy? Double Mastectomy vs. Lumpectomy? Will I develop distant metastasis – cancer spread to other organs like bone, brain, liver or lung?

Genetics Testing Can Now Answer Some of These Questions

The landmark breast cancer study called MINDACT showed that breast cancer patients deemed clinically high risk by their doctors but low risk by a genetic study (called MammaPrint) had identical survival whether or not the women had chemotherapy or not.  The 5 year rate of surviving without distant metastasis was 95.1% in those women with clinical high risk features but low genetic risk for their breast cancers. The MammaPrint test is a genetic study on your actual breast cancer itself, not on your normal tissues. It is not like testing for BRCA1/2.

50% Less Need Chemo!

Dr. Martine Piccart, chair of the MINDACT study that enrolled 6,693 women in 9 countries, told Onc.Live, “The important message here is, among the clinically high risk patients, the clinical use of MammaPrint is associated with almost a halving of the use of chemotherapy.”  That is a big number.  What the MINDACT study showed is that half of those women whose doctors thought they had high risk breast cancer did not need chemotherapy at all.

The MammaPrint genetic study was able to sort out those women who really need chemotherapy and those who did not.  And that is because many of those high risk breast cancer women really had a low genetic risk for a recurrence.  So it’s genetics, not size that matters in breast cancer treatment.

From my point of view as a breast cancer specialist, the MINDACT study is huge, providing  level I evidence – the best scientific evidence – that MammaPrint can spare many women the side effects and cost of chemotherapy.

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

Lymphedema Causes in Breast Cancer Survivors

photo credit:theplasticsurgerychannel.com

photo credit:theplasticsurgerychannel.com

When you hear that you need breast cancer surgery, your first thought is getting the best treatment.  With your focus on cure, you might forget the talk about side effects, especially a condition called lymphedema. 

Lymphedema is the buildup of lymph fluid in the hand, arm, breast, or armpit on the same side that you had your breast cancer surgery.  Swelling, pain, and reduced movement can occur-months or years after surgery-causing more emotional upset and lower quality-of-life. 

Study clears up confusion about Lymphedema Causes

Dr. C. M.  Ferguson and colleagues at the Massachusetts General Hospital in Boston looked at 632 newly diagnosed breast cancer patients between 2009 and 2014.  Their study was published in the March 1 issue of the internationally recognized Journal of Clinical Oncology (J Clin Oncol 2016; 34:691-698). 

The primary goal of the study was to measure the actual risk of a number of common situations faced by breast cancer patients each and every day after surgery.  Dr. Ferguson and colleagues conclusively showed that common situations like blood draws, intravenous injections, and blood pressure readings in the same arm as the surgery are not associated with lymphedema.  Importantly, air travel and injury to the arm are also not conclusive causes of lymphedema. 

The main possible causes of lymphedema are axillary lymph node dissection surgery, lymph node radiation, cellulitis infection, and obesity. 

As a breast cancer specialist, I can now assure my breast cancer patients with real facts. The common events in their care after surgery like blood draws, blood pressure reading, and intravenous injections in the same arm appear not to be major causes for lymphedema.  Is this study practice changing?  Probably not. Many more women need to be studied and for a longer time.  But the study is a good first start. It may allow breast cancer survivors some peace in not having to worry about these routine medical procedures.

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

 

You Need an Experienced Head and Neck Cancer Doctor

An experienced radiation oncologist can save you from head and neck cancer.

An experienced radiation oncologist can save you from head and neck cancer.

A landmark study of over 6,200 patients with head and neck cancer treated with radiation therapy revealed a startling result.  The cure rates increased by 21% – a huge number – for those patients treated by an experienced radiation oncology doctor. Dr. I.  J.  Boero and colleagues from the University of California, San Diego published their study in the March 1 issue of the prestigious Journal of Clinical Oncology (J Clin Oncol 2016; 34:684-690).

Their conclusion was clear; high volume radiation oncology doctors did better for their patients than low volume doctors. Volume indicates how many patients they treat in a year with a cancer of the head and neck region.

A BIG CANCER CLINIC IS NOT THE SAME AS EXPERIENCE

If you ask me, it is not a surprising conclusion.  What was surprising was the magnitude of the difference.  Head and neck cancer patients have a 21% better chance of survival if they are  treated by an experienced head and neck radiation oncology physician.  The second surprising conclusion was that the benefit is not seen with patients who are treated with conventional radiation therapy performed at many hospitals. This concludes the argument that the better result with high-volume radiation oncology doctors are not due to the experience of other team members, including the medical oncologist, nurses, speech pathologist, or the radiation therapists who actually set up the patients and treat them on a day-to-day basis.  IMRT takes much more skill and experience on the part of the radiation oncology doctor than conventional head and neck radiotherapy.

SEEK EXPERIENCE IN HEAD AND NECK CANCER TREATMENT

So experience counts. A lot.  Finding an experienced radiation oncology doctor is the key first step in successful treatment of your head and neck cancer.  When seeking a physician to treat you, ask them how many patients do they treat with this type of cancer. For instance, many cancer centers today are joined with urologists, so their focus is prostate cancer. Many are attached to a neuroscience center, so their focus is brain and spine. Seek a physician who has experience with head and neck cancers.

At First Dayton Cancer Care, we have the most experienced, high-volume radiation oncology doctors in Southwest Ohio.  If you have any questions about your head and neck cancer, please feel free to call Dr. Edward Hughes or Dr. Donald Marger at 855-Dayton 1.

The Fight for Freedom from Insurance Companies

USA-Independence-day-best-greetings-2014Independence is the freedom from dependence on or control by another person, organization, or state. Unfortunately today physicians and patients have lost their independence. Physicians are now controlled by hospital administration, government policies, and insurance companies. Patients are dependent on their insurance company. This lack of independence has placed a great strain on how medical care is given in the United States of America. First Dayton Cancer Care is fighting for the right to practice medicine in a way that is best for our patients, not someone’s bottom line.

INSURANCE PRIOR AUTHORIZATIONS

Any person with insurance who has tried to have a procedure should know the term prior-authorization. This is where the patient and the physician must ask the insurance carrier permission to give treatment. This authorization is solely based on the ‘plan’ that patient has contracted and the formulary that insurance carrier has established for the diagnosis and the treatment requested. They can deny authorization regardless of what the physician feels is the best medical choice. This authorization can take up to 30 days; if initially denied, the entire process can take 60 days. And if authorization is given, there is no guarantee of payment.

The Ohio State Medical Association (OSMA) and First Dayton’s practice manager have spent the past year fighting for Ohio Senate Bill 129 which would regulate how carriers handle prior authorizations. While not every agenda item was approved, we will see an improvement in this process over the next two years. The two key items that will affect the patient the most are more timely decisions and payment for authorized procedures and medications.

KEY CHANGES

Insurance carriers now must give authorization in a timelier manner. For urgent care services consideration must be given within 48 hours of initial request and within 10 calendar days for non-urgent care. This will allow the patient and the physician to move forward with treatment quicker so that a patient is not anxiously waiting to begin very important treatments like that for cancer.

If prior authorization was given, insurers will no longer be able to retroactively deny payment for a claim. This is excellent news for patients and physicians. It basically means that insurers must do what they promise and pay for what they should.

We hope that this change to the authorization process will help patients and physicians alike. Physicians have the training and experience to make the decisions for that individual patient. The doctor to patient relationship is so important to quality health care. We must continue to fight insurance carriers and the government from dismissing the importance of this relationship. The beauty of medicine is treating the entire person not simply the disease on paper. This can only be accomplished when a physician is able to get to know this individual person and work together for their health.

First Dayton stays independent of the hospital systems so that our patients maintain their right to choose the best radiation therapy available today and we will continue to fight insurance carriers for this choice.