Category Archives: Quit Smoking

1 in 4 Lung Cancers are in Never Smokers

When every extra day counts, turn to the CyberKnife.

Did you know that “never smokers” make up 28% of new diagnosis of early stage non-small cell lung cancer patients?

 Dr. Eric Lim and colleagues from London looked at 2,170 British men and women who had  lung cancer surgery from March 2008 to November 2014.   

The remarkable finding was that “never-smokers” with lung cancer increased each and every year from 13% in 2007 to 28% in 2013.  And the trend was due to a dramatic increase in the absolute numbers of “never smokers” with lung cancer.   Fifty five percent of those patients with lung cancer were found “incidentally.”  That is to say, their lung cancers were found by CT scans, PET-CT scans, X-rays, or MRI’s ordered for other reasons-not because their physicians suspected lung cancer.  Only 14% of patients had symptoms of lung cancer-like coughing up blood or profound shortness of breath. 

Like many good medical studies, Dr. Lim’s article raises more questions than answers.  Were these lung cancer patients who were “never smokers” exposed to second-hand smoke at home or in the workplace?  What about other exposures, like chemical toxins, in the workplace?  Are there differences in “never-smokers” who live in the city versus out in the country?  What about family history?  Do the same trends hold for people in the US? 

So whether it’s family history, genetics, race or just bad luck remains to be seen.  But the good news is that lung cancer caught early is highly curable.  Cure rates are now in the 80-90% range for 5 years.  And you may not need surgery at all.  Many studies have now shown that Cyber Knife radiosurgery is equal to or even better than open surgery for patients with early stage lung cancer.  And Cyber Knife is done as an outpatient-no incision, no pain, and no long hospital stays; eliminating the complications that go along with surgery.

So if you have any questions about your lung cancer, please free to call me, Dr. Edward Hughes

10 Steps to Beat Lung Cancer

CT Scans are painless and non-invasive.

CT Scans are painless and non-invasive.

Screening for lung cancer can save lives – 26,000 to 36,000 Americans every year – by use of low dose CT scans. Dr. Florian Fintleman from Massachusetts General Hospital in Boston reported on the 10-step model at the 2016  American Roentgen Ray Society (ARRS) meeting in Los Angeles.

Dr. Fintelman’s program can be summarized as follows:

  1. Patient Eligibility:
    • Current smokers age 55-77 years old
    • Former smokers age 55-77 with a 30-pack-a year history
    • Former smoker who quit within 5 years
  2. Physicians and Patient Education:
    • Educating primary care physicians on the US Preventative Services Task Force (USPSTF) guidelines and results. Stressing that nearly 30,000 lives can be saved every year. Only 15% of lung cancer patients are found with stage I or stage II disease, with survival rates of 80-85%. With lung cancer screening, that percentage can nearly be doubled, saving many more lives when the lung cancer is caught early.
    • Medicare (CMS) requires a visit between the referring physician and patient, with the visit focusing on “counseling and shared decision making”, i.e. part of a routine visit.
  3. Ordering screening lung CT scans:
    • CMS guidelines call for a physician or qualified non-physician provider such as a nurse practitioner, physician assistant or nurse specialist to order the low dose CT scan.
    • Patients who would simply like a CT scan screening may self refer as long as they meet the screening criteria.
    • First Dayton Cancer Care has special LDCT Lung Screening order forms with the established criteria. We will even acquire the prior authorization if needed. Call us today.
  4. Image Acquisition:
    • The American College of Radiology (ACR) and CMS established parameter for low dose, non-contrast CT scan optimal for lung screening.
    • First Dayton Cancer Care is an approved imaging facility through the Intersocietal Accreditation Commission with the longest accreditation term that they grant so you can be rest assured that the best possible low-dose, non-contrast CT lung screenings will be given here.
  5. Image Review:
    • At First Dayton Cancer Care our scans are read by board certified diagnostic radiologists from ProScan Imaging, a nationally recognized group of radiologists based in Cincinnati.
  6. Communication with Physicians:
    • Clear and concise reporting to referring physicians is provided within 24-48 hours of scan.
    • Images are available for viewing by physicians who so desire.
    • Images are compared to any previous screening scans if made known by the patient or ordering physician.
    • Referring physicians will get a telephone call from the Medical Director, Dr. Edward Hughes, to follow up on any positive CT Scans. Referring physicians can call Dr. Hughes for his medical opinion regarding further follow up, like biopsies and/or PET/CT scans.
  7. Communications with the Patient:
    • First Dayton Cancer Care will educate the patients with a negative screening to continue to follow up with their General Practitioner and the importance of routine care and need for future screenings.
    • Clinical research showed that an unexpected result from screening was the patients with a negative CT scan felt they have a new lease on life and continue to smoke. So we stress that a smoking cessation and or an appointment with their General Practitioner to discuss this habit is imperative.
  8. Quality Improvement
    • CMS has begun a program to collect data on lung screenings. They are just beginning to role out this registry but the hope is that these results will help fine-tune the guidelines and provide some benchmarks for further understanding the importance of these screenings.
  9. Cost/Insurance Coverage
    • Since December 2013, many private insurers will cover the cost of this routine screening for those meeting the criteria.
    • CMS covers lung cancer screening by its own criteria since February 2015 for those enrolled in the registry. Medicare is rolling this registry program out and hopefully soon all screening centers will be enrolled.
    • For other eligible patients, a low dose CT scan is only $99, the cost of a couple of cartons of cigarettes.
  10. Research Frontiers
    • As always, many questions remain unanswered, like the optimal interval between CT scans and how long should one have low-dose screenings.
    • Stereotactic radiosurgery, like that delivered by the Cyber Knife, has the same results as open surgery, but without the risk of thoracotomy. And the risk of surgery is not only confined to surgical complications, but there is a defined risk of death from thoracotomy, especially in elderly patients with multiple medical problems.

If you have any questions, please feel free to write or 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.

BREAST CANCER: THE TOP 5 THINGS YOU NEED TO KNOW

Over 8,000 breast cancer researchers and clinicians attended the San Antonio Breast Cancer

Know the results of these 5 research studies to help make treatment decisions.

Know the results of these 5 research studies to help make treatment decisions.

Symposium meeting in December 2015.  Here are some of the key highlights that I though would be important to our breast cancer patients.

1. Lumpectomy and Radiation Therapy Is Better Than Mastectomy

In a 10 year study of 37,000 women in the Netherlands, the relative risk of death was 20% lower in women who underwent lumpectomy and radiation therapy versus mastectomy alone.  The 10 year overall survival was 76.8% with lumpectomy and radiation therapy versus only 59.7% with mastectomy alone.  Importantly, the overall survival benefits held even for women who had lymph node positive disease.

  1.  With Lumpectomy and Radiation Therapy, It’s a Good Idea to Stop Smoking

Over 40,000 women were studied by the Early Breast Cancer Trialists’ Collaborative Group.  The results were clear cut-those women who underwent lumpectomy and radiation therapy but continued to smoke were at increased risk for lung cancer and heart disease.

The study was somewhat dated as the median time to entry into the study was 1983. And breast radiation therapy has improved dramatically over 30 years.  But I believe these results still ring true.

3. Skipping Chemotherapy Altogether in Postmenopausal Women with Breast Cancer

Post-menopausal women with the so-called luminal A subtype breast cancer can consider skipping chemotherapy altogether and still expect a good prognosis even when node positive (ER/PR positive, HER-2 negative). Analysis of the “old” Danish Breast Cancer Cooperative Group 77B Trial finally confirmed what many clinicians already thought: Patients with low risk breast cancer do not need chemotherapy.

4. Heart Medications Protect against Herceptin Damage

In the MANICORE  study, women taking both the beta-blocker bisoprolol (Concor) and the ACE inhibitor perindopril(Converyl, Aceon) preserved heart function.  The study may be a life saver for many of those breast cancer patients who take Herceptin for months. Herceptin is known to cause heart damage.

5. Preventing Breast Cancer Recurrence In Women with DCIS: Anastrozole May Be Just As Good As Tamoxifen

The IBIS DCIS Trial and the NRG/Oncology/ NSABP-35 trial showed that the drugs are equally effective. Anastrozole is my choice because of its fewer side effects.

Be sure that you consider these 5 facts when you are making decisions about the treatment plan that is best for you. The goal should be do treat your breast cancer without causing further health issues.

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

Lung Cancer Patients can Live Longer with this FREE Treatment

Stopping smoking can add 6 months to a late stage lung cancer patient.

Stopping smoking can add 6 months to a late stage lung cancer patient.

The cold hard facts are becoming crystal clear – patients with Stage IV lung cancer patients who quit smoking, live 6 months longer than those who continue to smoke.  “In cancer, that’s a lot,” remarked Dr. Bernard Fortin, one of the lead researchers in the soon to be published study just reported at the 16th World Conference on Lung Cancer in Denver last month. So how does that compare with the new blockbuster drugs called “immune checkpoint inhibitors” like Yervoy, Keytruda and Opdivo?  Surprisingly, stopping smoking compares quite well.  In fact, locally advanced lung cancer patients treated with those immune checkpoint inhibitors survived 9.2 months longer, compared to those patients treated with chemotherapy alone.  That’s a difference of only 3 months.  And at a cost of $10,000-$12,000 per month.  So locally advanced lung cancer patients can live 6 months more, just by putting down cigarettes. Not to mention the cost savings from that alone. Whether or not combining quitting smoking and treating with immune checkpoint inhibitors allows patients to survive even longer remains to be seen. 

So What’s a Patient To Do? 

Cancer specialists always want good data before making clinical decisions.  And now cancer doctors really do have a few good studies.  Those who attended the recent World Conference on Lung Cancer learned that most lung cancer patients are genuinely interested in quitting smoking-at least 3 studies supported that statement as reported in the Lung Cancer Advisor.

Dr. Kenneth Ward of the University of Memphis, the lead researcher of one such study, did have a personal note about his own father who was diagnosed with lung cancer a few years ago.  “He wanted to quit, but getting the attention of his physicians, his personal physician and his oncologist, to give him any help quitting was difficult.  That just wasn’t on their radar.  There were too many other important things to do.” 

That certainly is a sobering statement for all healthcare providers to think about.  Helping lung cancer patients to quit smoking may just be as important as prescribing a $10,000 a month drug.  But sitting down and spending time with patients to motivate them to quit smoking may just be harder to do.  As cancer specialists, we can spend a lot of time belly aching about electronic health records, insurance companies and Obama care, but we can no longer overlook the need to help our lung cancer patients quit smoking. 

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