Category Archives: Patient Care

Real Hope for Stage 4 Lung Cancer

An Important Question  

What options are there for stage 4 non-small cell lung cancer patients with limited metastatic disease – the cancer has spread to less than 3 organs other than the lung? 

Study after study have shown that most failures of chemotherapy are exactly at the places of the original lung cancer, and not new sites.  So why not focus on those areas instead of giving more “maintenance” chemotherapy? 

An Important Clinical Trial  

Dr. Daniel Gomez and colleagues spearheaded a clinical trial (ClinicalTrials.gov space NCT01725165) that randomly assigned stage 4 lung patients to “maintenance” chemotherapy versus local therapy (mostly radiation, but some with surgery) versus no treatment at all. 

The multi-center study was published in the British journal called The Lancet Oncology in December 2016, pages 1672-1682.  To be eligible for the clinical trial, stage 4 non-small cell lung cancer patients had standard chemotherapy and were in relatively good shape after chemotherapy treatment. 

A Breakthrough Result 

Although only 74 lung cancer patients were entered into the clinical trial from 2012 to 2016, a real breakthrough result was seen.  The breakthrough result was that the local therapy group (radiation or surgery) survived 12 months versus 4 months for the “maintenance” chemotherapy group.  The clinical trial was closed early because the doctors saw better results in the local therapy group (radiation or surgery) versus the “maintenance” chemotherapy group. 

Where Do You Go from Here?  

As a CyberKnife cancer specialist in Dayton Ohio, CyberKnife offers our stage 4 non-small cell lung cancer patients real hope.  And CyberKnife can help you beat your non-small cell lung cancer without surgery.  No pain and no incisions. Real hope for another year of symptom free survival. 

If you have any questions about your lung cancer, please feel free to call me, Dr. Edward Hughes at 855-Dayton 1.  Or visit our website and I guarantee that I will see you within 1-3 days of your phone call.

A Cancer Diagnosis: 5 Questions You Need to Ask Yourself

Take the time to ask yourself these important questions.

Facing cancer is one of life’s biggest stresses.  Your mind and your heart seem to race in a thousand different directions all at once.  And everyone has a story or an opinion.  You don’t know who or what to believe. 

So it’s important to settle down and take some time alone to answer some questions BEFORE you talk to your cancer doctor.

 1.  Do I really understand what’s going on with my cancer? 

2. Where can I get information about what is likely to be ahead of me?  And how much information do I really want? 

3.  What are my biggest fears and worries about the future? 

4. How much am I willing to go through in order to gain more time? 

5. How much does my family really know about my wishes? 

That checklist is an important first start.  I’d recommend trying to answer these questions for yourself.  I know it’s difficult.  But at the end of the day, only you know what is best for you. 

If you have any questions about your cancer diagnosis or treatment, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.  I guarantee that I will see you in consultation within 1-3 days of your call.

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.

SOMETIMES WEIGHT LOSS CAN BE A BAD THING

Weight loss is not always a good thing when you are a cancer patient.

Weight loss is not always a good thing when you are a cancer patient.

Often times people experience sudden weight loss that sends them to see a doctor. All too often this is the symptom that leads to a cancer diagnosis. Cachexia-the loss of muscle mass associated with cancer-is a fancy word for an all too common symptom of newly diagnosed patients with advanced lung cancer.  Every doctor knows cachexia when they see it, especially in patients with locally advanced lung cancer. Patients experience loss of muscle instead of fat because muscle is easier for the body to metabolize into the much needed calories. Cancer itself can also cause a dramatic inflammatory response which adds to this loss regardless of how many calories are eaten.

The overall weight loss and loss of muscle mass in cancer patients can be profound. Cachexia affects 50-80% of cancer patients. And the results of cachexia can lead to a continuing decline in overall health and continued impairment of immune function. Remarkably, cachexia is the direct cause of death in 20% of cancer patients. So patients with locally advanced lung cancer are already behind the 8 ball even before starting treatment, treatments that may include chemotherapy and radiation therapy. A vicious cycle starts that can lead to further loss of appetite and fatigue, compounding the cachexia.

But a recent study published in the journal Lancet Oncology shows that help is on the way for locally advanced lung cancer patients who suffer from cachexia (Lancet Oncology February 19, 2016) Dr. Jennifer Temel, a cancer specialist at Harvard’s Dana-Farber Cancer Institute, looked at 2 different phase 3 studies-the gold standard of clinical studies-of 979 patients with advanced cancer.  653 of these 997 patients were treated with the new drug Anamorelin and 326 were treated with a placebo-a pill with no active ingredients.

After only 12 weeks, those patients who took the drug Anamorelin gained weight compared with patients who took only the placebo.  Of course, there were side effects-the main one was elevated blood sugar.

From my point of view as a cancer specialist, the studies with Anamorelin are a good start. Our advanced lung cancer patients need all the help that they can muster to help combat the side effects of chemotherapy and radiation therapy.  More research will be needed to refine the role of Anamorelin to treat cancer related weight loss and muscle loss. But I’m glad that help is on the way.

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

Cancer Care in the US 2016: The Good, the Bad, and The Ugly

good-bad-uglyThe Good News

So the good news is that America is winning the war against cancer, slowly but surely, especially for the so-called “Big Four” – lung, breast, prostate, and colo-rectal cancer. Dr. Julie Vose, the current president of the American Society of Clinical Oncology, commented in her society’s recent report entitled “The State of Cancer Care in America, 2016”. Dr. Vose said last week “We have seen mortality rates decline on the average of 1.5% annually over the past decade, even greater declines for the 4 most common cancers.  Additionally, the number of survivors is expected to grow from 14.5 million to 19 million in 2024.”

The Bad News

Despite President Obama’s recent announcement of a near billion dollar “Moon-Shot” against cancer, Dr. Vose went on to say “However, all of the advances are set against the backdrop of unsustainable cost and a volatile practice environment.”

So what does that mean in plain English?  The cost of cancer care is skyrocketing, especially the cost of chemotherapy drugs.  And so many patients simply cannot afford to pay.  In fact, medical bills represent one of the single biggest causes of a family’s financial stress. Dr. Blase Polite, the immediate past chair of the American Society of Clinical Oncology’s government relations committee, said “It is the cost of cancer drugs themselves as well as the increased burden the patient’s face with rising deductibles and higher cost sharing by insurance companies.”

So in plain English again, insurance premiums are going up and deductibles are going up even faster-all costing the cancer patient more money.

The Ugly News

Whatever your politics, ObamaCare has dramatically changed the landscape of cancer care in America.  Independent community practices-once the mainstay of cancer care only a decade ago-are vanishing.  The independent cancer clinics are either closing or being bought out by hospitals where the cost of cancer care is much more.

Despite the passage of ObamaCare, 35 million non-elderly people remain uninsured, and 31 million more are “underinsured” because their deductibles, the actual out-of-pocket costs, are many thousands of dollars.  A $5,000-$6,500 deductible with an ObamaCare insurance policy simply cannot be paid by many Americans.

And for our senior patients, Medicare Advantage programs that now comprise 30% of all Medicare patients can be problematic.  For example, our own senior men with prostate cancer are shocked when I tell them that I provide 3 different types of radiation for their prostate cancer, but their insurance companies will decide on whether or not they undergo Cyber Knife, IMRT, or implants.  So access to the right treatment is now a major concern. Often times insurance carriers ignore which treatment actually costs less and which is more effective.

So with more pressure on cost and access, can quality be far behind? Are we setting ourselves up for insurance carriers making your medical decisions? Simply put, I never thought I would be posing that question.  I wonder whether President Obama’s Moon Shot has already missed its target?

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

5 Things You Need to Know When Meeting with Your Cancer Specialist

The information you provide on your forms is important. Come to your visits prepared.

The information you provide on your forms is important. Come to your visits prepared.

To say a cancer consultation is stressful is putting it mildly.  You arrive 15 minutes early for the appointment. You have to dig out your insurance card and an id. You’ve filled out the 5 pages of medical forms that look just like the other forms you filled out at the other doctor’s offices.  You’re in no mood now to smile for the identification photograph.  Now you’re asked to get in a gown and sit in an exam room for another 20 minutes or more.  Feeling out-of-control yet?  Well,  there really are a few things you can do to help you get the most out of your visits.

1. Be Prepared 

Just like a Boy Scout- Be Prepared. More than you can imagine, a lot depends on how well you and your cancer specialist communicate.  And talk is a 2 way street. It’s not just telling the doctor what’s wrong and him/her giving you statistics. It’s also your listening to them and the doctor listening to you.  Let’s face it.  Talk isn’t cheap, and everyone is pressed for time. You have very little time to develop a good working relationship with your doctor. From day one, your preparation will help establish good communication that will carry through all stages of diagnosis, treatment and recovery.

So it’s a good idea to be upfront with your doctor and let him/her know about your other medical conditions, previous surgeries, other cancers and treatment, prescription medicines, over-the-counter medicines, and herbal supplements. Don’t assume “it’s all there in the record.”  Make a list and bring it with you.  You may not realize it, but how well you’re handling your diabetes may impact on how well your chemotherapy works on your breast cancer or how well your radiation works on your prostate cancer.

2. The Only Dumb Question Is the One That’s Not Asked  

And even more questions come up after the consultation. So write those down so that you can talk with your cancer specialist at the next visit.  It often takes time for you to process everything that you have been told. If you still have a lot of questions, rather than calling the office with one at a time, schedule a follow up visit. This way you can have ample time to ask and more importantly, to understand.

A list of questions may be a real help.  A consultation with a cancer specialist is always stressful – a thousand things are racing through your mind. That’s why it’s also key to bring a family member or a close friend with you.  That person can take notes for you to look at later. They often hear things that you don’t because you are focusing on something else that was said.

3. Not Everyone Learns the Same Way

Communication takes many forms and not everyone learns by reading.  Some people do best by watching a video, others by listening.  The Internet may be useful, but the information may not always be reliable.  If you don’t understand what’s going on, let your cancer specialist or other medical team members know about it right away.

4. Good information gives real power over your cancer.

Poor information not so much.  Your neighbor or friend at church may mean well, but it’s really hard to find 2 patients with exactly the same cancer, at exactly the same stage, and exactly the same medical problems. What works for someone else may not work for you. And remember, cancer care is still an art, but there is always a good deal of science.

5. Your Doctor Doesn’t Know It All

I strongly recommend getting to know other members of your cancer care team who are not doctors.  Registered nurses, nurse practitioners, physician assistants, licensed medical assistants, radiation therapists, chemotherapy nurses, and swallowing therapists are also your keys to success in diagnosis, treatment, and recovery.  These professional, knowledgeable team members can answer medical questions and help with personal guidance throughout this difficult time.

Not every physician is familiar with every available cancer treatment technique. Your physician may only know about the treatment offered at his facility first hand. An experienced physician will continue to explore any and all treatments available in his/her field of study, but do not assume this is the case. Seek a second opinion from someone outside of their group when possible. I often give second and third opinions. I will help a patient to understand all of their treatment options, not just the ones I offer. My goal as an oncologist is to find the best possible treatment for a patient to beat their cancer. I encourage people to call me anytime for another opinion.

4 Key Things You Can Do When a Loved One Has Cancer

We celebrated Mother’s Day this past Sunday. I cherished the phone call that I made to wish my own mother a Happy Mother’s Day.  I enjoyed seeing my wife’s daughters and family wish her the same. Mothers are the ultimate caretakers. Everyone needs to be cared for at different stages in their life.

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

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

But it was a bittersweet holiday for me this year. My own mother will soon be 89 years old. I know that there will not be many more of those phone calls. And while it was great seeing my wife showered with love, I also know how difficult this day was for her. It was her first Mother’s Day without her own mother. She passed away from head and neck cancer last fall. My wife spent much of last year traveling to Florida to help take care of her. Many of us have experienced this role reversal. The child becomes the caretaker.

I see this in my profession time and time again. But anytime you experience it first hand, it teaches you many new lessons. One of the charitable organizations we support is “Stand Up to Cancer.” For Mother’s Day weekend that organization ran newspaper ads stressing the power of caregivers and how much they really can help cancer survivors. Here are some tips that they had for caregivers that hit home to my wife and me.

1) They talk, you listen.

It’s harder than you think  – just listening without judging and without problem solving. Cancer patients simply want compassionate understanding. You can help care for them, but you cannot fix them or truly know what they are going through. You can hold their hand and be silent as you listen. Remember that laying hands on someone may be the greatest gift you can give.

2) Don’t ask, just do.

Instead of waiting for the cancer survivor to ask for help, just jump in and do. Most of us are too proud to ask for help even though we desperately need it. It is the everyday tasks that can be overwhelming. Simple tasks like doing laundry, grocery shopping and cleaning house become giant hurdles when the person doesn’t have the energy or strength. You can offer specific tasks that you can do for them. Helping with these little things are a huge help to the cancer survivor.

3) Learn, so you can understand.

While you will never fully know what your loved one is experiencing, you can learn what needs to be done to help them through this battle. Unless you are specifically asked, you do not want to give your opinion on medical issues. However if you understand all that is involved in their medical care, you’ll be better able to understand the treatment process and the terms being used. This way you can help the patient understand what is happening when they have so much information coming at them. You can track questions, help with appointments and know how you can be most useful. It’s best to use good Internet sources. If you are involved in their doctors’ visits, ask their nurses what are the resources that they recommend. Stick with national organization web sites for starters.

4) Keep them connected, be the bridge.

Remember that the cancer patient still wants to be part of everyday life. After diagnosis friends and even family may drift away. As a caregiver you may be in the best position to keep family and friends informed. With the Internet it’s easier than you think. There are websites like Caring Bridge and Care Monster to help you communicate with family and friends in a private forum. This also keeps you from having to explain what is going on over and over again. They can also leave messages for the survivor to read when they feel up to it. This is a way to stay connected on the survivors own time. Encourage friends and family to keep the survivor involved in everyday happenings too. This helps them feel connected and hopeful. Sometimes a loving note or words of encouragement can mean the world to the survivor who is feeling all alone in this.

Being a caregiver can be as self-less and as exhausting as motherhood. Neither the caregiver nor the mother are often told thank you, but they are both essential to the happiness and well-being of those that are in their care. So as we honor our mothers this May, take the time to say ‘Thank You’ to all the caregivers in your life. If you are a caregiver, know that you matter.

 

Why Should You Stop Smoking During Lung Cancer Treatment?

Wear a White Ribbon for Lung Cancer Awareness.

Wear a White Ribbon for Lung Cancer Awareness.

Let’s face it. There’s a lot of guilt that goes along with smokers who have lung cancer. Every week my patients tell me “I tried to quit” or “Why should I bother quitting now?” Most lung cancer patients don’t seem to get a lot of sympathy. You don’t see people wearing the white ribbon for lung cancer like the pink ribbon for breast cancer. I don’t see a lot of Hollywood celebrities lining up to go to bat for lung cancer patients. Where are all the 5K runs for lung cancer?

With all that said, many cancer specialists give little more than lip service to telling patients to stop smoking once diagnosed. Why beat them up even more psychologically when we, as their doctors, are asking them to undergo surgery, chemotherapy and radiation? But two major studies may change all that. In the first study, Dr. Meredith Shiels and her colleagues at the National Cancer Institute found that stage I lung cancer patients who survived their first lung cancer but continued to smoke were more than twice as likely as “never smokers” to die (J Clin Oncol 2014: 32; 3989-3995). That’s a big number.

In the second key study, Dr. Yoshikazu and co-workers critically looked at 1,649 patients with locally advanced lung cancer harboring the EGFR mutation. Once again, the conclusion was that survival was significantly better in “never smokers” than in patients with a history of smoking.  All is not lost though. All patients with advanced lung cancer, regardless of smoking or not, benefited from chemotherapy (The Oncologist 2015:20; 307-315). 

 As a cancer specialist who meets with early stage and advanced stage lung cancer patients every day, these remarkable studies tell me that I need to be ever more mindful about getting my patients to stop smoking. Mere lip service is not going to cut it. I know, deep down, that I do the patients and their families no favors if I just ignore their smoking. And it’s just not the doctor’s concern. It will take a group effort with all cancer care providers, family doctors, nurses, technologists and even care takers. Just like chemotherapy and radiation, my lung cancer patients may not like it, but “stop smoking” will be part of the survivor plan.

5 Things Every Cancer Patient Needs to Know about Their Caretaker

caretaker3

Who is Caring for the Caretaker?

A cancer diagnosis changes the life of many. The patient is not the only person affected. Life also changes for those who love and care for the person with cancer. The biggest change occurs for the person who will help the patient get through the cancer experience- the Caregiver. The question is “Who is caring for the caregiver?” These are 5 things that each cancer patient needs to know to help their caregiver. Caregivers are the unsung heroes of cancer survivorship.

1. 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 medical professionals, 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.  Ensuring that the caregiver has what he/she needs is a role that a friend or a secondary family member can take on.

2. 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.

3. Support groups can be an essential part of a cancer patient’s healing. 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 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 patient’s health care professional. This includes beginning any new supplements. Some herbs and vitamins are very powerful and may interfere with some medications or treatments.

4. Know the Rights for 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. The 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 are public agencies. Learn more here.

5. 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.

Exercise Each Day Will Keep Cancer Away

Exercise is More Fun Together

Exercise is More Fun Together

February is National Heart Month. We are all wearing red to increase heart health awareness. What is good for the heart, is good for cancer prevention. You can reduce cancer recurrence by up to 40% by making this one simple lifestyle change!

We all know that exercise can help prevent heart disease. What’s equally true is that routine exercise can not only prevent cancer, but also help to prevent cancer recurrence. Exercise has proven to decrease the risk of colorectal cancer, postmenopausal breast cancer, uterine cancer and possibly prostate cancer. Other major studies have shown that routine exercise can also reduce the risk of cancer recurrence once you have been cured of the disease. Major studies in breast cancer and colorectal cancer have shown that routine exercise can reduce the risk of recurrence by as much as 25-40%. Let’s look at breast cancer, specifically triple negative breast cancer, the most deadly form of the disease. A study published in January 2015 in the Journal of Cancer, showed that routine vigorous exercise can increase the levels of a hormone called Irisin. Irisin was shown to have 2 major effects. First, irisin decreases cancer cell movement, an essential component of metastasis or cancer spread. Second, irisin was shown to increase programmed cancer cell death or cancer cell suicide. These results were shown in the test tube, but may have profound effects for cancer patients.

Doctors say do “routine vigorous exercise”. Does that mean you need to run marathons to prevent cancer? I don’t think so. But I do know that 3-4 hours per week of exercise is better than 1-2 hours. I don’t know whether aerobic exercise is better than strength training for cancer prevention. So what do I tell my patients? I tell them to exercise 30-45 minutes each day for 6 days of the week. I recommend alternating “strength days” with “aerobic days”.

I practice what I preach.  I take my dogs for long walks on Monday, Wednesdays and Fridays; and do Pilates on Tuesdays, Thursdays and Saturdays. It is never too late to start. At every age, at every stage of cancer prevention, or cancer survivorship; there are far reaching benefits.  Keeping Cancer Away is one of them!