Category Archives: Dr. Edward Hughes

VA Medical Centers Beat Lung Cancer with the CyberKnife

The VA knows the importance of the CyberKnife for treating our veterans with lung cancer.

In the study of more than 1,600 veterans with early-stage lung cancer, stereotactic radiosurgery, like that delivered by the CyberKnife, more than doubled the chances of surviving compared to conventional radiation. Importantly, the study was conducted at VA Medical Centers over the past decade. The study was presented at the 2016 meeting of the American Society of Therapeutic Radiology and Oncology or ASTRO.

Dr. Brian Kavanagh, a Past President of ASTRO, told the Medscape news, “Although we are talking about treatments of an advanced technology that has only been allowed in the last 10 years or so, it is also smarter, more efficient and more cost effective way to do things. It involves fewer trips to the treatment center for the patient, fewer side effects, and is generally easier to take.” CyberKnife treatments for lung cancer are painless and can take as little as 20 minutes each. Only 3-5 treatments are needed.

CyberKnife has also been shown to be just as effective as open surgery for patients with early stage lung cancer, but without the hospitalization, the risks of open surgery, and the pain and recovery. CyberKnife is available only at First Dayton Cancer Care in the Dayton Region. And CyberKnife is the only radiation device that breathes with you as it tracks your tumor with every breath.

If you have questions about treatment of your early stage lung cancer, please feel free to call, Dr. Edward Hughes at 855-DAYTON1. I guarantee I will see you within 1-3 days of your call.

First Dayton Cancer Care Celebrates 14 Year Anniversary

Dr. Hughes enjoys being able to spend a lot of time with patients answering all of their questions. He is able to do that in his own practice.

Local cancer doctor, Ed Hughes, MD, PhD, feels that his cancer patients have rights. They have a right to the best medical care possible. They have a right to choose a treatment that is best for them. They have a right to superior health care at a reasonable cost. They have the right to treatment done quickly. They have the right to quality of life. They have a right to stay in Dayton for world class medical care. The reason this doctor left the hospital 14 years ago is even more important today. As more and more physicians sell out to big hospitals, they are losing their rights.

First Dayton Cancer Care was opened in 2003 because Dr. Hughes believes cancer patients have the right to the best. He is an expert in Radiation Oncology. He uses radiation technology to destroy cancer cells throughout the body. It is virtually painless to the patient. “Radiation therapy is all we do. This is not a side service to us. I have a team of experts. This is our passion,” states Dr. Hughes. Over the past 14 years, Dr. Hughes and his team have given more than 126,500 radiation treatments to more than 7,000 people from the southwest Ohio region.

Dayton has some of the most advanced cancer fighting tools in the world thanks to Dr. Hughes. He has been the driving force to bring advances like robotic seed implants for prostate cancer, Intensity Modulated Radiation Therapy (IMRT) and the CyberKnife Stereotactic Radiation Therapy to our city. He has always been on the forefront of these medical breakthroughs.

Dr. Hughes was one of the first oncologists in the country to use Stereotactic Radiation Therapy. He makes financial investments, often foregoing profits, because he wants his patients to have world class cancer treatments right here at home. Dr. Hughes states, “People ask me all the time, ‘If the CyberKnife is such phenomenal technology then why doesn’t every hospital have one?’ I can honestly tell them that is not a profitable service line. It is simply better medicine. And I believe as a physician, my most important mission is to save lives using every possible tool.”

We asked Dr. Hughes why he chose to leave the hospital and open his own center in today’s challenging health care market. “When I worked at the hospital I was always being told what I could and could not do for my patients. Owning my own practice allows me to care for them as individual people. I can do so much more this way.” For example, First Dayton is the only center in the region to actually pick up patients for their treatments. It is a free car service. Mary of Centerville tells us, “It has been a true blessing to have such fine people drive me to my daily appointments. My kids all work. I don’t know how I would have made it otherwise.”

When you have been told you have cancer, you want answers immediately; so Dr. Hughes will see patients within 1-3 days of their first phone call. Dr. Hughes often spends over an hour with his patients and their family at their initial visit. “I want to learn about this person. I want to present all of the treatment options and help the patient decide what will give them the best chance to beat their cancer. I want to answer all of their questions. I couldn’t spend this much time when I worked at the hospital. People with cancer are scared. Patients want hope.”

BEAT SKIN CANCER WITHOUT SURGERY

It is hard to imagine on a stormy day like today, but for many of us, Spring Break is right around the corner. You are never too young or too old, to take care of your skin. Dr. Hughes explains his state-of- the-art treatment for skin cancer that is simple and painless. No cutting. No scars. And takes just a few minutes to have fresh new healthy cancer free skin.

Medical Costs: Still a Guessing Game?

The same drug, the same procedure, the same test but prices can vary greatly depending on who provides the service. Patients have a RIGHT to know the price so they can make smart choices or set up a payment plan.

Any consumer knows that the secret to staying on a budget is comparing prices when you shop.  In today’s world, the internet gives us excellent resources to do this easily. We search for the best price. That’s easier said than done in America’s Health Care System, where the prices for doctor visits, diagnostic tests and surgical treatments can be hard to find out in advance. 

Only 14 of 50 states in America have laws that call for “Price Transparency” – knowing the cost of care before it’s done. 

Now President Trump has proposed “Price Transparency” for all healthcare providers.  The goal is to help patients shop around for a CT scan, MRI scan, or even a hip replacement; the same way they shop for food, clothing, and shelter. 

Ohio politicians also dipped their toes in the “Price Transparency” swamp.  The Ohio House of Representatives and Senate unanimously passed the Healthcare Transparency Law in June 2015.  Gov. Kasich promptly signed the bill shortly thereafter. 

But the Ohio Hospital Association (OHA), joined by the Ohio State Medical Association (OSMA), had a judge issue an order preventing the law from going into effect on January 1, 2017-an astounding 18 months after it was enacted. In 18 months, these groups could not establish regulations that insurers agreed upon. Everyone is looking out for themselves regardless of what is best for the patient.

All parties involved have given lip service to this Healthcare Transparency Law yet it has been legally blocked from taking effect. They claim the problem is lack of  available information because of too many contracts with different prices.  It’s hard to believe that Big Hospitals do not know the upfront costs of their own CT scans, cardiac stress tests or hip replacements.  It just does not ring true.

Smaller practices typically use the same 25 medical codes, so they should be able to easily create a cost estimator for those top codes. The patient will need to understand that this is simply an estimate. Once the claim is filed the insurance carrier could leave more or less responsibility to the patient.  A reasonable percentage of variance should be easy to establish. Typically an estimate is just that – it could vary 5% more or 5% less.

There’s just no need to keep healthcare prices a guessing game.  Our Governor, The Honorable John Kasich, needs to hear from you.

Governor Kasich can be reached at 614-466-3555. Call him or his staff and tell them how you feel about this issue. Your voice really does matter. 

And don’t just stop there.  Next time you are at a doctor’s office or getting a CT scan or having surgery, ask what your out-of-pocket cost will be.  You do have time to shop around.  Medical costs should not be a guessing game any longer. 

I know what I am talking about.  First Dayton Cancer Care has been providing upfront, out-of-pocket cost for patients since opening in 2003.  It is just the right thing to do. 

If you have any questions about your cancer, its diagnosis or its treatment, call me, Dr. Edward Hughes, at 855-DAYTON1.

America: Time to Take Back Your health Care

“We will no longer accept politicians who are all talk and no action, constantly complaining but never doing anything about it.  The time for empty talk is over.  Now arrives the hour of action.” President Donald J.  Trump Inaugural Address 2017

 The Action 

Ohio State House representative Jim Butler, R-Oakwood in Kettering, is a politician who is taking action.  Rep.  Butler introduced the Healthcare Price Transparency Law in June 2015.  Remember that date-  June 2015, over 18 months ago.  The law passed unanimously, and was signed by Governor Kasich.

 The Reaction  

Yet the Ohio Hospital Association (OHA), joined by the Ohio State Medical Association (OSMA), filed a lawsuit in late 2016 to block the law from starting on January 1, 2017.  The OHA and OSMA claim they need more time.  As if 18 months is not enough. 

The Old Game of Hide and Seek  

Patients have a right to know the cost of their healthcare.  Would you shop at Kroger or Elder-Beerman only to know the price 30 to 60 days later?  Would you by a house only to know the price 30 to 60 days later after closing?  So why is the price of healthcare any different than the cost of food, clothing, and shelter?  The Ohio Hospital Association and the Ohio State Medical Association want to keep the price of their services far from transparent. 

Trying to find the true cost of your medical care-before the procedure-is difficult to say the least.  What makes it even more stressful is that you are doing this when you are sick.  The cost of healthcare seems the least of your worries in a crisis. 

So how does Ohio rate compared to other states as far as healthcare cost transparency?  In 2016, the Healthcare Incentives Improvement Institute gave Ohio a solid “F” along with 42 other states.  That’s right, in the vast majority of states in the US, the cost of healthcare is far from transparent. 

The Hour of Action  

So what can you do as the patient?  Most of your health care visits and procedures are “elective” or non-urgent, in medical terms.  So you have time to find out.  You have the right to know from your hospitals and your doctors the out-of-pocket expenses to you before the procedure.  It is your health and your money in the end. 

But don’t wait for politicians to solve your life and death problems.  Take back your life and take back your health care.  Demand the costs of your health care before the procedure.  You will be shocked at the price differences among hospitals and doctors. 

First Dayton Cancer Care has been providing out-of-pocket cost estimates for patients at the start of their care since 2003.  It can be done, despite what the Ohio Hospital Association and the Ohio State Medical Association will lead  you to believe. 

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

Ohio’s Healthcare Price Transparency Law- What are the Hospitals Afraid of?

Price Transparency advocacy is not new and not just in Ohio. This graphic is from a 2013 Forbes article.You can read here.

In June 2015, the Senate and House of Representatives in the state of Ohio passed unanimously the Healthcare Price Transparency Law. The law was signed by Governor John Kasich shortly thereafter. This law would require hospitals and physicians to provide a reasonable estimate to patients prior to procedures and tests. This would allow the patient to make decisions on whether or not to have the services, to shop for a lower price, or to determine how they are going to pay for this bill.

Our own local State Representative Jim Butler, Republican from Oakwood and Kettering, offered and sponsored the law. Mr. Butler has worked with the Ohio State Medical Association (OSMA) and the Ohio Hospital Association (OHA), as well as a number of lobbying organizations to help implement the Healthcare Transparency law so it is workable for both healthcare providers and patients. Jim Butler’s letter to the President of the OHA can be found on his website.

Now 18 months later, OSMA recently joined a lawsuit with the OHA to block the implementation of the law. They argue that it is not possible to get this reasonable estimate in a timely manner because insurance carriers determine the out of pocket cost and there are simply too many insurance plans. In late December, Williams County Common Pleas Court judge J.T. Stelzer issued a 30 day restraining order blocking the law from taking effect on January 1, 2017.

PATIENTS HAVE A RIGHT TO KNOW THE COST

The Ohio Hospital Association now argues that insurance carriers ‘set the price’ and the hospitals have no control over these prices. But this is false. It is the hospitals who negotiate a contract with the insurance carriers to determine the cost of each and every procedure. While the insurance carrier negotiates a contract with the patient regarding co-pays and deductibles, it is the hospitals who are responsible for the cost. Most people do not realize that the same test procedure will cost different amounts from one facility to another. Sometimes up to 75% more. For those with health insurance such as Medicare where you have a 20% responsibility, a $2500 CT scan and a $400 CT scan is a significant difference; a $500 out of pocket bill in the hospital or a $80 bill at an independent outpatient facility.  People have a right to shop around for quality and cost.

A staff member of mine recently sent her son to a physical therapist at a local hospital while she herself was seeing a physical therapist in an independent practice. Her son’s bill for a 15 minute appointment to have his pinky finger worked on cost her $250. While her 1 hour appointment for her back cost only $65 at the independent practice. She tells me had she known the high cost with the therapist working for the hospital, she would definitely made him go to the other facility.

THE INFORMATION IS READILY AVAILABLE

Those opponents argue that this will delay treatment because the information is not readily available. This is not true. Most insurance carriers have online system that practices can use to plug in the patient’s exact insurance plan along with the ICD-10 procedure codes that will be used. That system , in existence for years, will provide an estimate of cost based on the current contract with that facility.

First Dayton Cancer Care has been providing these estimates to our patients since opening in 2003. Radiation therapy is one of the most complicated set of billing codes in any specialty, yet we manage to provide estimates within 24 hours. Most of our patients appreciate knowing what their out of pocket expense will be so that they can begin planning for it. Many insurance carriers provide a website where their members can do a cost estimator and it will show them what each facility in their surrounding area charges. The information is readily available. In the past 13 years our billing company, MAXX Medical states that providing these estimates has gotten easier. They are able to provide an estimate within an average of +3%.

THE PATIENT IS A CONSUMER

I do agree that there are specifics to the Healthcare Price Transparency law that need to be worked out. But the state of Ohio, the OHA and OSMA have had 18 months to work this out. The state needs to establish guidelines that relieve some of the burden on the provider and to ensure that the language protects the provider if the insurance carrier provides incorrect information. However, the OSMA and the OHA needs to be advocating for the patient first. Patients do not have lobbyists fighting for them. They need to be told of their right to ask for a cost estimate.

Patients also need to respect that when an estimate is given, it does not mean that we value their payment more than we do providing quality care. We feel by providing this estimate we are helping the patient make informed decisions about both about their health and their family finances. But in all things you purchase, you demand quality and a fair price. Your health should be no different. Price transparency in healthcare is critical in today’s world.

If you are in need of excellent cancer care, call me today at 1-855DAYTON1. Not only will I see you in 1-3 days for an initial visit, but I will provide you with an estimate before treatment begins!

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.

 

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.

3 New Studies On Prostate Cancer You Need to Know About

1.  Stop PSA Screening  –   Not so Fast!

In 2012, the US Preventative Services Task Force (USPSTF) came out against routine PSA screening  for prostate cancer in men, regardless of age.  But the major study used for this recommendation was likely flawed.

More importantly, since 2012, the number of men diagnosed with advanced stage prostate cancer is increasing (Cancer Epidemiology Biomarkers Prev.  2016; 25:259-263).

Dr. Richard Hoffman, an expert in shared decision-making about prostate screening, told Medscape Medical News that “abandoning PSA screening is proving harmful.”

 From my own vantage point in our clinic, PSA testing for men ages 55-70 makes a lot of sense.  Urologists and radiation oncologists are now well aware of overtreatment of patients with early-stage prostate cancer.  Active surveillance can be offered for a number of our patients.  But missing advanced stage prostate cancer or aggressive prostate cancers can be deadly.  Most of the patients that I see in my clinic are not aware of the fact the prostate cancer is the second biggest killer of men in the US, second only to lung cancer.

2.  Artery-Sparing Radiation May Help with Erectile Dysfunction 

Dr. Patrick McLaughlin of the University of Michigan Medical School reported on the benefits of using MRIs in radiation planning for patients with early stage prostate cancer.  His study was published recently in the British journal, Lancet Oncology.  While sparing the critical arteries and nerves going into the prostate gland, Dr. McLaughlin and colleagues reported that 92% of men were still able to be sexually active even 5 years after radiation. 

In my opinion, Cyber Knife offers the best sparing of the arteries and nerves leading into the prostate of any of the radiation technologies.  And at First Dayton Cancer Care, our patients have the choice of Cyber Knife or IMRT or IMRT combined with temporary, robotic seed implants.

3.  Atkins Diet Can Help Some Side Effects of Hormonal Therapy for Prostate Cancer 

Dr. Stephen Freedland of Cedars-Sinai Medical Center in Los Angeles reported on the low carbohydrate diet and hormonal therapy at the recent American Urologic Association (AUA) annual meeting.

While on hormonal therapy for prostate cancer, the Atkins diet or low carbohydrate diet resulted in better blood sugar control and weight loss than in those men who ate a regular diet.

So there is some hope in managing the side effects of hormonal therapy or androgen deprivation therapy (ADT) for patients with prostate cancer.  Unfortunately, there was no difference in PSA levels. 

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

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