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.

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.


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.


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%.


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“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.


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.


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

Is Late Night Snacking Putting You at Risk for Breast Cancer Recurrence?

kitchenclosedFasting for 13 or more hours at night, including sleep, just may help reduce the risk of breast cancer recurrence.  And the effects were huge – a 36% higher risk for breast cancer recurrence for women who did not fast. This study of 2,413   non-diabetic women with early-stage breast cancer was published in the March 31, 2016 issue of JAMA Oncology.

Dr. Ruth Patterson, the senior author of the study, told Medscape Medical News “To our knowledge, this is the first paper examining nightly fasting and breast cancer progression.”  Dr. Patterson went on to say, however, that “the data are not mature enough to make clinical or public health recommendations.”

 As always, the study raised more questions that it answered.  And is likely to take a decade of research to confirm these results.  But I believe the current results are simple and yet profound.  So do what your grandmother always told you, “The kitchen is closed after dinner.”  This simple recommendation of not eating after dinner results in a huge decrease in the chances for breast cancer cure after treatment.

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


Is American Medicine Rigged? The Truth about Lung Cancer

Are American patients being told all of their options?

Are American patients being told all of their options?

The Presidential primary election season has been eye-opening, with outcries by candidates from both parties of a “rigged system”. The “establishment” has recoiled from such talk. But shining the light on “the accepted way” of doing things has made all Americans more aware of the pitfalls of the system.  And asking probing questions is never bad.

It’s taken two lung cancer specialists from “Down Under” at the MacCallum Cancer Center in Australia to shine the light on the lung cancer surgery establishment in America.  In a thoughtful review of the existing studies of stereotactic ablative body radiation therapy (SABR) versus lung surgery, Dr. Siva and Dr. Ball make a compelling case for the use of SABR to treat early stage non-small cell lung cancer patients.  Dr. Siva and Dr. Ball conclude “SABR and surgery had similar estimated overall and disease-free survival.”  Their study was recently published in the prestigious  journal,  The Oncologist 2016; 21:1-6.

The situation is exactly the same as 30 years ago when I started training in radiation oncology at Harvard.  The raging controversy at that time was lumpectomy and radiation therapy versus mastectomy.  Despite study after study showing that lumpectomy and radiation was exactly the same as mastectomy, the vast majority of early stage breast cancer patients still underwent mastectomy.  But it’s always been hard to get surgeons to tell patients about surgical alternatives for early stage cancers, whether it’s breast cancer or lung cancer.

Did you know that only 14 of 50 states in America require that physicians inform early stage breast cancer patients of lumpectomy and radiation as an alternative to mastectomy?  Any wonder that those same states have more women undergoing radiation and lumpectomy than surgery?

Do you know how many states require that doctors tell early stage non-small cell lung cancer patients of using stereotactic ablative body radiation, or SABR for short, to cure early stage lung cancer versus surgery?  Exactly 0! Any wonder that many early stage lung cancer patients have never even heard of stereotactic ablative body radiation (SABR), like that delivered by Cyber Knife?  Or that the information given to them was inaccurate or incomplete?

Dr. Michael Steinberg and colleagues from UCLA looked at 102 early stage non-small cell lung cancer patients treated with stereotactic radiation (SABR)-56% had no prior knowledge of SABR before meeting a radiation oncologist.  Among those 102 patients, 39 patients had prior lung surgery for a previous lung cancer.  And 90% of those patients would rather have had stereotactic ablative body radiation, like that delivered by Cyber Knife, than another lung surgery (Lung Cancer 2015; 90:230-233).

So what’s an early stage lung cancer patient to do?  I have a modest proposal.  Early stage lung cancer patients need to be “difficult patients.” All of us doctors know the type – asking a lot of questions, having many family members present, and coming armed with a lot of facts found on the Internet. Challenging your physician can sometimes be a good thing.

So if you have any questions on your early stage non-small cell lung cancer, please feel free to call me, Dr. Edward 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.