DiversityNursing Blog

Dr. Edward Soffen

Source: www.livescience.com

Dr. Edward Soffen is a board-certified radiation oncologist and medical director of the Radiation Oncology Department at CentraState Medical Center's Statesir Cancer Center in Freehold, New Jersey. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

As a radiation oncologist, my goal is to use radiation as an extremely powerful and potent tool to eradicate cancer tumors in the body: These techniques save and extend patients' lives every day. 

Historically, radiation treatments have been challenged by the damage they cause healthy tissue surrounding a tumor, but new technologies are now slashing those risks.

How radiation therapies work

High-energy radiation kills cancer cells by damaging DNA so severely that the diseased cells die. Radiation treatments may come from a machine (x-ray or proton beam), radioactive material placed in the body near tumor cells, or from a fluid injected into the bloodstream. A patient may receive radiation therapy before or after surgery and/or chemotherapy, depending on the type, location and stage of the cancer. 

Today's treatment options target radiation more directly to a tumor — quickly, and less invasively — shortening overall radiation treatment times. And using new Internet-enabled tools, physicians across the country can collaborate by sharing millions of calculations and detailed algorithms for customizing the best treatment protocols for each patient. With just a few computer key strokes, complicated treatment plans can be anonymously shared with other physicians at remote sites who have expertise in a particular oncologic area. Through this collaboration, doctors offer their input and suggestions for optimizing treatment. In turn, the patient benefits from a wide community of physicians who share expertise based upon their research, clinical expertise and first-hand experience. 

The result is safer, more effective treatments. Here are five of the most exciting examples:

1. Turning breast cancer upside down

When the breast is treated while the patient is lying face down, with radiation away from the heart and lungs, a recent study found an 86 percent reduction in the amount of lung tissue irradiated in the right breast and a 91 percent reduction in the left breast. Additionally, administering prone-position radiation therapy in this fashion does not inhibit the effectiveness of the treatment in any way.

2. Spacer gel for prostate cancer

Prostate cancer treatment involves delivering a dose of radiation to the prostate that will destroy the tumor cells, but not adversely affect the patient. A new hydrogel, a semi-solid natural substance, will soon be used to decrease toxicity from radiation beams to the nearby rectum. The absorbable gel is injected by a syringe between the prostate and the rectum which pushes the rectum out of the way while treating the prostate. As a result, there is much less radiation inadvertently administered to the rectum through collateral damage. This can significantly improve a patient's daily quality of life — bowel function is much less likely to be affected by scar tissue or ulceration. [Facts About Prostate Cancer (Infographic )]

3. Continual imaging improves precision

Image-Guided Radiation Therapy (IGRT) uses specialized computer software to take continual images of a tumor before and during radiation treatment, which improves the precision and accuracy of the therapy. A tumor can move day by day or shrink during treatment. Tracking a tumor's position in the body each day allows for more accurate targeting and a narrower margin of error when focusing the beam. It is particularly beneficial in the treatment of tumors that are likely to move during treatment, such as those in the lung, and for breast, gastrointestinal, head and neck and prostate cancer. 

In fact, the prostate can move a few millimeters each day depending on the amount of fluid in the bladder and stool or gas in the rectum. Head and neck cancers can shrink significantly during treatment, allowing for the possibility of adaptive planning (changing the beams during treatment), again to minimize long term toxicity and side effects.

4. Lung, liver and spine cancers can now require fewer treatments 

Stereotactic Body Radiation Therapy (SBRT) offers a newer approach to difficult-to-treat cancers located in the lung, liver and spine. It is a concentrated, high-dose form of radiation that can be delivered very quickly with fewer sessions. Conventional treatment requires 30 radiation treatments daily for about six weeks, compared to SBRT which requires about three to five treatments over the course of only one week. The cancer is treated from a 3D perspective in multiple angles and planes, rather than a few points of contact, so the tumor receives a large dose of radiation, but normal tissue receives much less. By attacking the tumor from many different angles, the dose delivered to the normal tissue (in the path of any one beam) is quite minimal, but when added together from a multitude of beams coming from many different planes, all intersecting inside the tumor, the cancer can be annihilated. 

5. Better access to hard-to-reach tumors

Proton-beam therapy is a type of radiation treatment that uses protons rather than x-rays to treat cancer. Protons, however, can target the tumor with lower radiation doses to surrounding normal tissues, depending on the location of the tumor. It has been especially effective for replacing surgery in difficult-to-reach areas, treating tumors that don't respond to chemotherapy, or situations where photon-beam therapy will cause too much collateral damage to surrounding tissue. Simply put, the proton (unlike an x-ray) can stop right in the tumor target and give off all its energy without continuing through the rest of the body. One of the more common uses is to treat prostate cancer. Proton therapy is also a good choice for small tumors in areas which are difficult to pinpoint — like the base of the brain — without affecting critical nerves like those for vision or hearing. Perhaps the most exciting application for this treatment approach is with children. Since children are growing and their tissues are rapidly dividing, proton beam radiation has great potential to limit toxicity for those patients. Children who receive protons will be able to maintain more normal neurocognitive function, preserve lung function, cardiac function and fertility. 

While cancer will strike more than 1.6 million Americans in 2015, treatments like these are boosting survival rates. In January 2014, there were nearly 14.5 million American cancer survivors. By January 2024, that number is expected to increase to nearly 19 million. 

But make no mistake — radiation therapy, one of the most powerful resources used to defeat cancer, is not done yet. As we speak, treatment developments in molecular biology, imaging technology and newer delivery techniques are in the works, and will continue to provide cancer patients with even less invasive treatment down the road.

Source: www.livescience.com

ELIZA MURPHY

It’s a battle they never thought they’d face, let alone at the same time.

Missy and Brooke Shatley, a mother and daughter from Prairie Farm, Wisconsin, both have cancer. They were diagnosed only 13 days apart.

“It’s that unbelief,” Missy, 38, told ABC News of her reaction when they learned the devastating news. “You feel numb like this can’t really be happening. This is happening to somebody else, it could never be you.”

Missy was diagnosed with stage 2 cervical cancer on December 26, the day after Christmas.

“I went in for my annual physical and that was the result of it,” she explained.

Then on January 8, Brooke, Missy and her husband Jason’s oldest child, was diagnosed with stage 3 ovarian cancer.

“Why us? Why?,” Missy asked. “Is it something in our water? Is it genetic? Why both of us in such a short time frame? The doctor said it’s not the water, it’s not the environment, it’s just a freak act of nature.”

Before Missy’s diagnosis, Brooke, 14, had been experiencing severe abdominal pain that went undiagnosed for several weeks.

“The doctors told us she had a baseball-sized hemorrhagic disc and it would go away on its own and we should just wait,” Missy explained. “We waited for a few weeks and thought, ‘This is ridiculous,’ and we sought a second opinion.”

The Shatley’s then took Brooke to see the same specialist that had just diagnosed her mom days earlier. The devastating news was that Brooke’s tumor was larger than they originally suspected and needed to be operated on immediately.

“It was a four-and-a-half hour surgery,” Missy recalled. “It was a football-sized tumor. It had intertwined in her abdomen. You couldn’t tell by looking at her belly, but it was football-sized.”

The brave mother-daughter duo began undergoing intense treatments at the same time in Marshfield, Wisconsin, about two hours from their home--understandably weighing heavily on husband and father Jason, a dairy farmer, who was traveling back and forth to take care of them while also tending to their other two children and maintaining their farm.

“It’s hard,” Missy said. “Just to even think, ‘That’s my wife and daughter,’ how does anybody deal with that? Plus we have two other kids at home so he’s trying to be a husband, father, keep up with the farm, he’s being pulled in so many directions, how do you even begin?”

This week has been better for the family, however. Both Missy and Brooke are back home, resting and enjoying their time, although possibly brief, out of the hospital.

Missy just completed her final round of radiation and chemotherapy on March 2. She now must wait eight to 12 weeks before they can tell how effective the treatment was on her cancer.

Brooke still has one more round of chemo to complete, tentatively scheduled to begin on March 9.

Although their simultaneous diagnosis has been difficult, Missy says, in a way, it’s been nice to have that newfound bond with her daughter.

“You don’t want to experience it with anybody, but if you have to, doing it as a mother-daughter is helpful,” she said. “You’re bonding over raw emotions. It’s definitely a connection that you form.”

On March 28 their community is holding a benefit for the resilient pair, which Missy says is just one of the generous things they’ve done to help throughout this process.

“Not in a million years could I imagine the outreach we’ve had,” she said. “The surrounding communities have been phenomenal. We have a dairy farm so we’ve had people volunteer to do chores, saw wood, make meals, provide transportation for the other kids when we need it--anything and everything they’ve offered up.”

Most importantly, she added, “Prayers, lots of prayers.”

Source: http://abcnews.go.com

By Carolyn Kylstra

1. They work 10- or 12-hour shifts, often without breaks.

Actually, make that 13 hours.

2. Those 10- or 12-hour shifts? They might just start at 6 am. OR AT 6 PM.

BuzzFeed

Rise and shine!

3. They have no idea what they’re about to encounter literally every time they go to work.

NBC / Via uproxx.com

4. Except they know for sure that they will be doing paperwork. Lots and lots of it.

Pixar / Via youtube.com

5. They’re usually taking care of about six (or more) patients at any given time…

CBS / Via cambio.com

Source: www.buzzfeed.com

By SYDNEY LUPKIN

A court will determine whether a 17-year-old girl, under something called the "mature minor doctrine," can be forced to undergo chemotherapy after she refused treatment for her cancer.

How do you feel about this?

The case will go to the Connecticut Supreme court this week to determine whether the teen, identified in court papers as Cassandra, has "the fundamental right to have a say about what goes on with your [her] body," attorney Michael Taylor, who represents the teen's mother, told ABC News. Taylor was appointed by the public defender's office, and Cassandra has her own court-appointed lawyer, but they've filed joint appeals.

Cassandra was diagnosed with Hodgkin's lymphoma in September, but decided she didn't want to complete the prescribed treatment, according to a court summary. Her mother supported this decision, but the Department of Children and Families stepped in and ordered her mother to comply with the doctor's treatment recommendation.

"It's really for all the reasons you might imagine," said Taylor, adding that he couldn't go into more detail.

Although chemotherapy is a drug that destroys cancer cells, its side effects include hair loss, nausea, pain and fertility changes, according to the National Cancer Institute.

Cassandra underwent two chemotherapy treatments in November and then ran away from home and refused to continue treatments, according to the court summary.

A court hearing ensued in which Cassandra's doctors testified, and she was removed from her mother's home and placed in state custody so that the state could make medical decisions for her.

She has been has been living at Connecticut Children's Medical Center and forced to undergo chemotherapy for about three weeks.

The Hartford Courant reported that Cassandra has an 80 to 85 percent chance of surviving her cancer if she continues with her chemotherapy.

The state Department of Children and Families issued the following statement:

"When experts -- such as the several physicians involved in this case -- tell us with certainty that a child will die as a result of leaving a decision up to a parent, then the Department has a responsibility to take action. Even if the decision might result in criticism, we have an obligation to protect the life of the child when there is consensus among the medical experts that action is required. Much of the improvements in Connecticut's child welfare system have come from working with families voluntarily to realize solutions to family challenges. Unfortunately that can't happen in every situation, especially when the life of a child is at stake."

"No one is disputing that it's very serious," Taylor said. He said there's "a good chance" Cassandra could survive her cancer with treatment, and "there's a good chance she could die if she doesn't. None of us disagree about that."

Taylor said they're trying to argue that because Cassandra is competent, she should be allowed to make this decision for herself through something called the "mature minor doctrine," which has been adopted in Illinois and a few other states but rejected in Texas. The doctrine holds that some children are mature enough to make key life decisions for themselves.

Source: http://abcnews.go.com

By Sara Cheshire

Can we predict the future of medicine? Although designer babies and a disease-free world may or may not come to pass, you can get a glimpse of the most promising and upcoming medical innovations each year, via the Cleveland Clinic.

The clinic's Top 10 Medical Innovations list, which has been an annual undertaking since 2007, contains treatments and technologies that are expected to significantly change patient care and save lives.

To be considered, each innovation must have a good chance of being available to the public in the upcoming year, says Dr. Michael Roizen, chief wellness officer at the Cleveland Clinic and chairman of the committee that decides the list. The committee must also expect it to have a significant impact on a large part of the population.

The process starts with a panel of Cleveland Clinic physicians and scientists who submit their ideas. These suggestions, which Roizen said totaled about 700 for the 2015 list, are then narrowed down and voted on by 40 physicians in a variety of health fields.

Here's what they selected for 2015:

1. Mobile stroke unit

Videoconferencing has made its way into ambulances, specifically for treating stroke victims on the go. Hospital stroke neurologists can interpret symptoms via a broadband video link and instruct an onboard paramedic, critical care nurse and CT technologist on treatment. This new technology should improve the speed of medical care, which is important as strokes quickly damage and kill brain cells.

2. Dengue fever vaccine

The World Health Organization reports that about half of the world's population is now at risk for dengue fever, which up until now was preventable only by avoiding mosquito bites. The disease is a leading cause of death and illness in children in some countries. A new vaccine has been developed and tested, and is expected to be available in 2015.

3. Painless blood testing

For those who hate large needles, a nearly painless way to sample blood will be a welcome relief. Plus, it will be cheaper and provide faster results than today's blood test. The new technology takes blood from your fingertip, and the Cleveland Clinic reports that over 100 tests can be performed on just one drop of blood.

4. New way to lower cholesterol

New self-injectable drugs called PCSK9 inhibitors have shown to be very effective in lowering cholesterol. These drugs may prove to be helpful for people with high LDL cholesterol who don't have good results with statins. The FDA is expected to approve the first PCSK9 in 2015.

5 ways to lower cholesterol

5. Cancer drug that doesn't harm healthy tissue

Although chemotherapy can save lives, it can be hard on the body and attack healthy cells as well as cancerous ones. A welcome breakthrough in the world of cancer treatment, antibody-drug conjugates can deliver targeted treatment without damaging healthy tissue.

6. Immune booster for cancer patients

Immune checkpoint inhibitors have been shown to prevent cancer cells from "hiding" from the immune system, allowing the body to more effectively fight these abnormal cells. Combined with chemotherapy and radiation treatment, the drugs have shown significant, long-term cancer remissions for patients with metastatic melanoma, one of the most deadly forms of cancer.

7. Wireless cardiac pacemaker

Until this point, wires have been a necessary component in pacemakers. A new wireless pacemaker about the size of a vitamin can now be implanted in the heart without surgery. Its lithium-ion battery is estimated to last about seven years.

8. New medications for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is a life-threatening disease that causes scarring in the lungs, leading to breathing difficulties and a shortage of oxygen in the brain and other organs. Life expectancy is only three to five years after diagnosis, but those numbers may change now that the FDA has approved two experimental drugs that slow the disease: pirfenidone and nintedanib.

9. Single-dose radiation therapy for breast cancer

The National Cancer Institute estimates that 40,000 women in the United States will die from breast cancer in 2014. The Cleveland Clinic cites multiple chemotherapy appointments, sometimes requiring the patient to travel long distances, as a hindrance to successful treatment. Intraoperative radiation therapy is a new solution. It treats a breast cancer tumor during surgery in a single dose, reducing time and cost spent on treatment.

10. New drug for heart failure

About 5.1 million people in the United States suffer from heart failure, according to the National Heart, Lung and Blood Institute. It is managed with a combination of drugs, but a new drug, angiotensin-receptor neprilysin inhibitor, has been granted fast-track status by the FDA because of its ability to cut the risk of dying from heart failure more effectively than current treatments.

For more information on the annual medical innovations list, including descriptions and videos, download the "Innovations" app or visit the website. A "where is it now" feature also includes updates on innovations that made the top 10 list in prior years.

"We look in past to see what we voted on to improve the process," Roizen said. "With one exception, we've been pretty good."

Source: www.cnn.com

By GILLIAN MOHNEY

One California teacher is happy to simply be back in the classroom as the new school year kicks off.

After being diagnosed with breast cancer last year, Carol Clark was forced to stay out of the classroom for nearly the entire year due to treatments and complications.

Eventually she was gone for so long, her health insurance and salary were threatened. But Clark's benefits were saved after multiple colleagues donated their sick days to the 6th grade teacher.

Clark, 56, a teacher at Jaime Escalante Elementary School in Cudahy, California, ended up receiving an additional 154 sick days from co-workers or other teachers as part of a program run by the Los Angeles Unified School District to help teachers in Clark’s situation, according to ABC News station KABC-TV in Los Angeles.

Before the donation Clark had been struggling to keep her salary and benefits. For many teachers in the Los Angeles area, once they use up their sick days and their vacation days they can start losing both their salary and health benefits.

Last year Clark missed nearly all of the school year except for just two months. Clark originally thought she would be able to come back for the spring semester, but she ended up needing major surgery after complications arose.

“I finished chemotherapy. Within a week I developed complications,” said Clark. “I couldn’t come back to school at all.”

To cover her time off, Clark used her vacation days and another 120 sick days that she had accrued over 16 years of teaching. But it wasn’t enough.

At the end of last year, she had no more sick days and was still too sick to teach. Clark had one other option. Her husband, also a teacher at Jaime Escalante Elementary School, was able to rally co-workers and other teachers to donate their sick days as part of the “Catastrophic Illness Donation Program.”

"We get paid for 180 days in the school year. So she got 154, so almost a whole year," Dave Clark told KABC-TV.

Gayle Pollard-Terry, deputy director of communications for the Los Angeles Unified School District, told ABC News that the program helps around 20 to 25 teachers every year.

“When you run out of all of your sick paid leave…if you run out, you [can] lose your health benefits and your income,” she said.

Pollard-Terry said the program can help fill the gap for sick teachers or school district employees.

She said although most donations are not as extreme as Clark’s tally, there have been at least two other donation drives where more than 150 days were raised for a teacher.

For Carol Clark the outpouring of donations from co-workers both past and present was surprising and emotional. She now has extra days to help her through new surgeries scheduled for this year.

“Other people ask me ‘What do you say to people who donate?’” said Clark. “I don’t know what to say to them. I say thank you. But that doesn’t’ seem like enough. It was really a tremendous thing that they did.”

Clark said she tried to thank her co-workers in a staff meeting but was too “chocked up” to speak. Instead she ended up writing them an email to thank them.

Source: http://abcnews.go.com