Today, a cancer diagnosis holds less cause for fear. Continuous innovation in medicines, procedures and therapies gives fresh hope to patients that lives can be spared and lived to the fullest.
Cancer remains one of the most dreaded diagnoses of all.
While there’s still cause for concern, recent major advances have brought fresh hope for patients facing this invasive disease. From new screening tests that promote earlier diagnoses to refined procedures, medications and treatment plans, oncologists are better equipped than ever before to improve their patients’ survival rates.
Even better, these advances impact positively on every type of cancer, including some promising crossover treatments never used before.
Lung cancer is the world’s leading cancer killer, taking the lives of more people each year than breast, colon and prostate cancers combined. More than 160,000 men and women died from lung cancer in the United States last year. One of the reasons is that lung cancer is seldom diagnosed in its early stages. By the time the cancer reaches Stages 3 and 4, survival rates are severely reduced.
Dr. Nameer Al Mardini, a board-certified medical oncologist at the SwedishAmerican Regional Cancer Center in Rockford, says the number of new diagnoses has started to decline these past 10 years, although the relative number of deaths has not declined.
“The majority of our lung cancer patients are diagnosed in Stage 4, at which point a cure is simply not feasible,” Mardini explains. “Now, there is hope that a new screening program will begin to change this situation.”
Last March, SwedishAmerican Hospital was designated a Lung Cancer Screening Center by the American College of Radiology. The voluntary program recognizes facilities that are committed to practicing safe, effective diagnostic care for patients with the highest risk for lung cancer.
In order to receive this elite distinction, a facility must be accredited by the ACR in computed tomography in the chest module, and must undergo a rigorous assessment of its lung cancer screening protocol and infrastructure. Also required are procedures for follow-up patient care, such as counseling and smoking cessation programs.
Lung cancer screening with low-dose computed tomography scans and appropriate follow-up care significantly reduces lung cancer deaths. In December 2013, the United States Preventive Services Task Force recommended screening of adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.
“We have always hoped for some sort of screening to detect lung cancer early,” Mardini says. “After multiple studies, this low-dose CAT scan offers new hope that we can diagnose early enough to truly impact the survival rates.”
At SwedishAmerican Hospital and its medical center in Belvidere, highly specialized lung scans are performed using the industry’s most cutting-edge computer tomography (CT) scanner machine, the Optima CT660.
The low-dose scanner is a 128-slice machine, meaning it reduces the radiation dose by 40 percent, providing diagnostic accuracy at a significantly lower dose of radiation than traditional scanners. The machine is twice as fast as older CT units and produces the clearest images possible, allowing experts to diagnose with greater accuracy, providing early detection and prevention across a wide spectrum of procedures.
“Medicare is willing to subsidize up to 320 scans, costing hundreds of thousands of dollars, to save one life,” Mardini says. “SwedishAmerican covers part of the cost as well, bringing it down to a very reasonable level, or in some cases, free.”
Now the focus is on making the public aware of the availability of the screening and convincing the target patient group that it’s vital to their survival.
“So many patients are afraid of finding out that something is wrong,” Mardini says. “If they take the risk of waiting, it may be too late to effectively treat their lung cancer. But if we catch it early enough and can surgically remove the cancer, there’s a high chance of cure.”
Getting the word out has been challenging, Mardini says. When lung cancer reaches Stage 4, and has spread to other areas, there is low chance that the patient will survive two years.
“I cannot emphasize enough the importance of getting screened and the fact that Medicare pays most or all of the cost,” Mardini says.
In addition to receiving excellent medical care, SwedishAmerican’s lung cancer patients benefit from working with nurse navigator Carly Schutte in the pulmonary clinic.
The multidisciplinary Lung Clinic team meets on a weekly basis to discuss some of the more-complicated cases,” Schutte says. “I work closely with each patient who is referred to the Lung Clinic as a liaison between the patient and the specialists involved in his or her treatment program. I’m available 24/7 to answer questions, provide support, or to help them find resources and solve issues such as transportation to the clinic for treatment.”
Any cancer treatment is a scary process for patients, Schutte adds. Her role is to be there for them and to provide as much information as they need to deal with surviving their lung cancer.
“Each patient’s treatment is uniquely designed to address particular needs,” Schutte says. “I go with them to appointments, identify any treatment barriers and follow through on the care they receive.”
SwedishAmerican was among the first in the nation to earn the Joint Commission’s Gold Seal of Approval distinction as a Lung Cancer Center of Excellence because of its integrated approach to providing world-class lung cancer care.
Breast cancer is another success story in the battle against cancer.
The percentage of five-year survival rates for breast cancer patients is climbing. This is not only because of well-established mammography programs that catch some cancers earlier, when they can be more effectively treated, but also because of refined chemotherapy and radiation treatments that are effective at reducing side effects.
Dr. Peter Mahler and his colleague Dr. Jason Duelge, both radiation oncologists at the Beloit Cancer Center, a cooperative venture of the Beloit Health System and the University of Wisconsin, agree that surgery, medical advances, chemotherapy and radiation are proving to be lifesavers. They make note of the newly released mammography guidelines from the American Cancer Society (ACS).
“The new guidelines are not quite as aggressive,” Mahler says. “The age to begin regular mammograms has been changed from 40 to 45. Research is suggesting that, for most women, there is very little gain from beginning earlier than 45.”
Adds Duelge: “The ACS also recommends that women ages 55 and older have mammograms every other year, instead of every year.”
The U.S. Preventive Services Task Force has recently drafted new recommendations related to breast cancer screening, which include every-other-year screening for women age 50 to 74, and consideration for screening for women age 40 to 49.
The reason, Mahler and Duelge say, is because too many women in the 40 to 45 (or 40 to 49) age bracket are having biopsies that prove negative – no cancer.
“This results in a lot of unnecessary anxiety because the majority of abnormalities seen on mammograms in young women are benign,” Mahler explains.
When early stage breast cancer is diagnosed, it can be cured with surgery or treated with a regime significantly gentler than that used a decade ago, Mahler says.
“Up to 10 years ago, breast cancer radiation treatments required that women come in five times each week for six to seven weeks,” he says. “We have been able to cut that treatment time down to three to four weeks, with equally effective results, by marginally increasing the amount of radiation dose in each treatment.”
“It’s much easier on the patient because, even though the daily dose is slightly greater, the duration of treatment and total dose are lower with equal cure rates and milder side effects,” says Duelge.
Mahler points out that, with this less-intense radiation treatment, patients experience fewer interruptions in their lives while enjoying an equivalent 5- to 10-year survival rate, in the 90-plus percent range for early-stage disease.
“For patients who are diagnosed in Stage 0 to Stage 1, we’re seeing patients do well on a consistent basis,” Mahler says. “Even Stage 4 patients are doing a bit better, while those in Stage 2 and Stage 3 also have a longer life expectancy.”
The very early stage breast lesion, what is sometimes referred to as Stage 0, has a very high cure rate (nearly 100 percent) and the amount of treatment required has been reduced.
“When we catch a breast cancer that early, we’re able to use a much lower treatment that might include surgery without radiation, or radiation without surgery, but with hormone therapy, or, perhaps in some cases, no treatment at all, with close observation,” Duelge says. “The advantage is that, with reducing or eliminating some treatments, we’re reducing the side effects patients may experience.”
Mahler explains that these Stage 0 lesions, a pre-cancer technically (and perhaps confusingly) named ductal carcinoma in situ (DCIS) is the most common type of pre-cancer, one that starts inside the breast’s milk ducts. It is called non-invasive because it has not spread beyond the milk duct into surrounding tissue, to the lymph nodes or through the blood. DCIS is diagnosed with a biopsy and is not considered life-threatening, although it can increase the risk of a patient’s developing an invasive type of breast cancer later by about 30 percent.
“With DCIS, we don’t have to be as aggressive,” Mahler says. “And the survival rates are 98 to 99 percent.”
Along with surgery, radiation therapy and chemotherapy have long been powerful weapons against cancer.
Dr. Iftekhar Ahmad, a board-certified radiation oncologist at OSF Saint Anthony Medical Center in Rockford, says new techniques are bringing new hope to cancer patients, offering not only improved survival rates, but also enhanced quality of life.
“Radiation is used in 60 to 75 percent of all cancers, so it’s an integral part of oncology treatment,” Ahmad says. “Radiation can be used as a curative agent, for post-operative treatment or as a palliative therapy to control symptoms. Recent advances have impacted radiation treatment across all three of these areas.”
Ahmad explains that these changes involve using higher doses in fewer sessions, but hinge on improved accuracy.
“It’s now safer to treat patients with radiation,” he explains. “Technology advances have made it possible to focus on the cancer while protecting the organs and surrounding healthy tissue. For example, we can now treat prostate cancer with pinpoint accuracy in a way that was not available five to 10 years ago, sparing more healthy tissue in the bladder and rectal regions. We’ve also introduced stereotactic radiation, which also gives us the ability to focus accurately on the target with high doses over a shorter period of time. We use this methodology with inoperable lung cancer. Where once we did a course of radiation over six to seven weeks that was not particularly effective, we now have the ability to radiate small cancerous tumors with higher doses in four treatments with an 80-percent control rate.”
By targeting the cancerous tumor with a shaped beam, Ahmad says, radiation hits just where the cancer is, limiting irritation while, at the same time, applying high dosages directly where they are needed, and thus increasing the chances of a cure.
This new technique represents a huge change from how inoperable lung cancer was treated in the past five to 10 years. Ahmad says OSF has offered this option since 2010 and remains the only cancer treatment center in the northern Illinois region to do so.
“We’re doing something along the same lines with brain cancer,” Ahmad adds. “We can now use stereotactic radiation to target metastasized cancer. We used to have to irradiate the entire brain. In certain cases, where the patient is otherwise in good health, we can target three or four masses and avoid whole-brain radiation unless it is needed.”
Ahmad says five high-dose radiation treatments provide better control of brain cancer, with fewer and less-intense side effects. The same success can be true of inoperable pancreatic cancer, although this is in a palliative setting.
“Another advance in cancer treatment sees the use of brachytherapy for breast cancer,” Ahmad says. “Currently, we offer partial breast radiation, and have done so since 2006, again with the most experience in the region. In early-stage disease we use partial breast irradiation as a twice-a-day treatment over one week instead of the traditional course, which is done over six weeks.”
Brachytherapy involves the placement of a special catheter in the cavity post-operative and provides equally effective results in appropriate candidates, Ahmad says.
“One of the good things about the treatments we provide is that it’s not just the technology but also the ongoing support we receive as part of the Mayo Clinic Care Network,” he says. “When we’re treating uncommon types of cancer, we have the ability to present the cases virtually, reviewing the imaging and pathology. This helps us reach a consensus of opinion and a treatment plan while, at the same time, providing more comfort and confidence to the patient.”
Ahmad says this service has allowed the cancer center physicians to learn from their peers and ensures that the patients in the northern Illinois region receive the best possible care.
Dr. Ismael Shaukat, a board-certified hematologist and oncologist at OSF, says that while chemotherapy has essentially not changed, the ways in which it’s used to treat cancer have undergone immense improvement. Further, it has proven particularly effective against leukemia.
“There are four types of leukemia, two acute and two chronic,” Shaukat explains. “In chronic myeloid leukemia, significant changes have allowed patients to actually lead normal lives.”
Depending on the type of leukemia, patients are treated with oral or injectable chemotherapeutic medications as well as the more commonly known infusion methods. But, Shaukat says, leukemia is not the only cancer that responds well to today’s chemotherapy applications.
“In terms of melanoma, new drugs are bringing hope in increasing longevity,” he says. “We are definitely seeing an improved rate of survival with higher quality of life.”
Immune-therapy is also impacting treatment.
“We use the patient’s own cells to attack the cancer,” Shaukat explains. “We’ve been using this type of treatment for the past couple of months. In addition to treating melanoma this way, we’re also beginning to use immune-therapy for lung cancer.”
Shaukat says he and his colleagues are excited about a number of recently approved oral chemotherapy medications.
“Also, we’re seeing a trend toward targeted treatments at the molecular level,” he adds. “Melanoma, in particular, has proven difficult to treat and outcomes were not good for the past 30 years. But since 2011, that’s beginning to change, thanks to a whole slew of new chemotherapy drugs. This has enabled us to look at different modalities and agents, and allowed us to explore new avenues in cancer treatment.”
Now, more than ever, a cancer diagnosis holds less cause for fear. Continuous innovation in medicines, procedures and therapies gives fresh hope to patients that lives can be spared and lived to the fullest.