Monthly Archives: November 2016

Head and Neck Cancer Patients Need Not Worry about Holiday Pounds

snowmenIt’s Not Just Loss of Arm Strength But Also Your Heart Strength That’s Affected

At First Dayton Cancer Care, I see and treat many patients with head and neck cancer each and every week.  I tell them that the big battle ground will be nutrition.  I tell them I don’t want to see them lose weight because it will be muscle rather than fat that they will lose.  After I tell my patients about all the side effects of chemotherapy and radiation treatment, an overwhelming experience to say the least, many patients just smile and say “I need to lose a few pounds anyway.”

Unintentional weight loss in cancer patients-called cachexia-not only results in loss of muscle mass but also may account for loss of heart muscle function.  Cachexia is defined as >5% weight loss and 3 of 5 other factors-loss of muscle strength, fatigue, lack of appetite, loss of muscle mass, low albumin and high C-reactive protein. In a remarkable summary of many studies, Dr. Couch and colleagues showed the cachexia is a major factor in the death of many head and neck cancer patients (Head Neck; 2015; 37: 594-604).  The surprising finding is that heart trouble related to cancer weight loss may account for up to 20-30% of head and neck cancer patient’s deaths.  Even if they are first cured of their cancer.

My clinical instinct over the years was that nutrition was one key to survival.  But I never thought that weight loss in cancer patients could affect their hearts to such an extent.  If Dr. Couch’s studies hold up, head and neck cancer specialists will lose up 30% of patients from cachexia, not cancer. But even more frustrating is the fact that while intentional weight loss is fixable by good nutrition alone, cachexia or unintentional weight loss in cancer patients, is not.  So much more medical work and research is needed here.

Don’t get me wrong.  The medical and technological breakthroughs in head and neck cancer care have been nothing short of miraculous over the past decade.  But I think head and neck cancer specialists need to take nutrition, especially new ways to battle cachexia, much more seriously than in the past.

 Diagnosing Cachexia-Related Muscle Loss Is Not As Easy As You May Think

 Diagnosing muscle loss seems easy, doesn’t it?  Plain and simple.  Just have the doctor or nurse weigh you and examine you.  And taking a good medical history may help.  But it’s not just that easy.

As head and neck cancer doctors, we rely “heavily” on BMI or body mass index-a formula based on height and weight. The BMI alone may mislead cancer doctors, especially in men who have more muscle mass than women.  That’s also true in men and women who are obese – underestimating loss of muscle mass. The change in BMI alone is likely to be misleading as a measure of loss of muscle mass or cachexia.  In fact, the gold standard for body composition assessment- a CT scan of the lower spine and pelvis- is rarely used to diagnose cachexia related loss of muscle mass.  I know of not a single cancer clinic in the country that uses CT scans to assess body composition to diagnose cachexia in cancer patients.

                                                                 CANCER CACHEXIA =

3 or more symptoms                                    +                    Weight Loss > 5% within 12 months

  • Fatigue
  • Loss of Appetite
  • Decreased Muscle Strength
  • ↑CRP or ↓ Albumin
  • Low Fat-Free Muscle Mass on CT Scan
 So What Can A Head and Neck Cancer Patient Do to Diagnose Cachexia?

First and foremost, be upfront and honest with your head and neck cancer specialist.  Do tell your doctors about any loss of muscle strength, fatigue, and lack of appetite.  Ask your doctor about blood tests that measure if you are anemic, have a low level of the blood protein called albumin, or increase in the level of the broad protein called C-reactive protein or CRP for short.

The syndrome of cachexia in head and neck cancer patients-unintentional weight loss, loss of muscle mass, anemia, lack of appetite, and fatigue-is all too common.  But what is starting to be learned about this cancer syndrome may also have profound effects on your heart muscle, resulting in 20-30% of deaths in head and neck cancer patients.

So much more time and money for medical research into cachexia is long overdue.

My expert staff works closely with our patients to ensure that weight loss is at a minimum during radiation therapy. If you have concerns, please talk to me, Dr. Ed Hughes at 1-855-DAYTON.1

America’s War on Doctors

a-chart-dr-and-adminIt is a shocking fact.  The US now spends more on the administration of healthcare than on the treatment of heart disease and cancer combined.  Cancer and heart disease are the 2 major killers of Americans. 

Want to know another shocking fact?  The top 10 paying jobs at most hospitals are administrators, not doctors.  More and more administrators are needed to enforce government regulations and “quality assurance” programs.  The growth of healthcare administrators has outpaced doctors more than 10 to 1.  The chart says at all.  And all the while, healthcare costs have exploded.  But the mainstream media points the finger clearly at doctors. 

Won’t Obamacare Fix It?

President Obama’s Affordable Care Act (ACA) ignored what needed fixing and doubled down on regulations.  The major side effect of Obamacare has been an explosion in regulations  and administrators who oversee these regulations.  And it is not without financial cost.  In fact, the financial cost of healthcare administration more than accounts for the explosion in healthcare costs over the past 20 years.  President Obama is not the only one.  The explosion in healthcare administration started in the 1990’s. 

Dr. Thomas Sowell, a noted Stanford economist, said “It is amazing that people who think we CANNOT afford to pay for doctors, hospitals, and medications somehow think we CAN afford to pay for doctors, hospitals, medications, AND a government bureaucracy to administer it.” 

Obamacare may have contained costs somewhat, but at the expense of patient care and treatment.  Remember that graph the next time your insurance company denies your medicines and your care.  Instead of blaming the doctor who sits in front of you, try blaming the real culprits, the regulators and administrators of healthcare. 

Unless we start reducing healthcare regulators and administrators, all the Congressional bills and Presidential plans won’t amount to much. 

When we are with our families this Thanksgiving week, we need to pray for a reduced diet on government regulation and administration of health care. You and your family’s lives depend on it.

Have a Happy Holiday.  Please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1 about your cancer’s diagnosis and treatment.  I guarantee that I will see you within 1-3 days.

KEYTRUDA USES IMMUNE SYSTEM TO FIGHT LUNG CANCER

keytruda“It is a new day for lung cancer…  For the first time, we will be offering immunotherapy to our lung patients,” commented Dr. Stephan Zimmerman of University Hospital in Switzerland.  Dr. Zimmerman was stunned by the breakthrough trial showing that the immunotherapy drug Keytruda or pembrolizumab outperformed standard chemotherapy in a very specific group of patients with non-small cell lung cancer. Keytruda is a new cancer drug called an immune checkpoint inhibitor.  Keytruda helps your own immune system to be released to fight your lung cancer.  It’s just one of many drugs in the “personalized medicine” revolution.

KEYNOTE-024 STUDY SHOWS EXTENDED LIFE EXCPENTANCY

The breakthrough results come from the KEYNOTE-024 study published in the October 9, 2016 issue of the prestigious New England Journal of Medicine.  In this landmark study of 305 patients with advanced non-small cell lung cancer, survival (without lung cancer progression) was extended from 6 months to 10 months.  To look at the KEYNOTE-024 study another way, 70% of immunotherapy patients were alive at 1 year compared to adjust 54% of chemotherapy patients.

Although this breakthrough study is exciting, Dr. Jean Charles Soria from the Gustave Roussy Institute in France commented to Medscape, “… so the patients who are in this trial probably represent only 10% of the patients seen in clinical practice.”  But if you happen to be one of these patients, Keytruda may just be the answer for you.

WHO CAN BENEFIT FROM KEYTRUDA

Non-small cell lung cancer patients now eligible for the immunotherapy drug called Keytruda include those patients whose lung cancer biopsy showed no EGFR or ALK mutations but high levels of a cancer cell protein called PD-L1.  So it is crucial that your cancer specialists order those tests on your biopsy.

If you have any questions about your lung cancer diagnosis or treatment options, please call me, Dr. Edward Hughes, at 855-Dayton 1.

 

LOW-FAT DIET AND WATCHFUL WAITING FOR PROSTATE CANCER

Many men with early-stage, less aggressive prostate cancer are now opting for active surveillance or watchful waiting.  But in my opinion, the focus should be on the active part of active surveillance and not just watching and waiting around to see your PSA go up.  And in my opinion, active means focusing on diet and exercise. 

So why should men change?  Because study after study now suggest that low-fat eating, along with exercising and reducing stress, can stop or reverse the progression of prostate cancer in its early stages. The research was spearheaded by Dr. Dean Ornish of the University of California at San Francisco, best known for using the same approach in treating coronary heart disease. 

Although the studies were small, the results were huge.  By eating a low-fat diet, PSA levels actually decreased after only a few months.  And in another Dr. Ornish study, the low-fat diet, along with exercise and stress reduction, actually changed the way cancer genes behaved. Remarkably, the low-fat diet switched on tumor killer genes and turned down tumor promoter genes. 

Dr. Ornish told the prestigious journal Scientific American, “We found that simple changes have a powerful impact on our gene expression…Genes may be our predisposition, but they are not our fate.”  Read More Here

So what is good for prostate cancer treatment is usually good for prostate cancer prevention.  If you have prostate cancer, or if your spouse or significant other has a risk of prostate cancer, I would take a careful look at the Dr. Dean Ornish program on the internet.  And you’ll also lose weight and help prevent heart disease. Talk about a win-win program.  There is a lot of good stuff on the Dr. Ornish website. 

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

Watch this TED Talk by Dr. Ornish as he discusses the importance of lifestyle and disease.

 

CYBERKNIFE: PERFECT CHOICE FOR SENIORS WITH LUNG CANCER

CyberKnife is perfect for the elderly with early stage lung cancer. No surgery means fewer risks.

CyberKnife is perfect for the elderly with early stage lung cancer. No surgery means fewer risks.

Stereotactic radiosurgery, like that delivered by CyberKnife, has become the “standard of care” for stage I lung cancer patients considered to be medically inoperable or if a patients is too sick for surgery.  A new study of 62,213 patients 60 years and older with stage I lung cancer, showed that stereotactic radiosurgery increased the 2 year survival rate to 58% compared to 39% for seniors treated with conventional radiation. 

Dr. Andrew Farach told HemOnc Today that “Our findings indicate that physicians should feel confident recommending radiation therapy to patients who are too sick to undergo surgery or choose not to undergo surgery for other reasons.”  Dr. Farach and his colleagues reported their findings at the September 2016 meeting of the American Society of Therapeutic Radiology and Oncology(ASTRO) in Boston last month. 

THE CYBERKNIFE ADVANTAGE 

CyberKnife is the only stereotactic radiosurgery device that continuously tracks your lung cancer as you breathe.  CyberKnife treatments are painless-no incision. CyberKnife treatments are completed in only 3-5 outpatient visits.  In fact, many of our patients can drive themselves to and from visits. 

Many of our seniors have many medical problems that limit their surgical options.  And CyberKnife is a perfect alternative.  At the prestigious Massachusetts General Hospital in Boston, there has been a drop in surgery for seniors with early-stage lung cancer with many choosing stereotactic radiosurgery. 

“It is a rare situation where the more convenient therapy is also the more effective therapy,” said Dr. Farach of Houston’s Methodist Hospital at the ASTRO 2016 press conference last month. 

First Dayton is the only cancer center in Southwest Ohio using the CyberKnife to treat lung cancer. If you have any questions about your lung cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.  I guarantee that I will see you in 1-3 days of your call. Expertise. Experience. Caring. The First Dayton CyberKnife difference.