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Understanding the Nexus of Aging and the Increase in Cancer Risk

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As Americas’ Greatest Generation continue to age studies are revealing that with the increase in the age of the population comes an increase in cancer risk. The nexus of age and cancer is supported by National Cancer Institute (NCI) research. The convergence of an overall aging population and a peak cancer incidence among those aged 65 to 74 will result in a significant rise in the number of people diagnosed with cancer. In addition, as people age the types of treatments and the eligibility and ability for older patients to participate in clinical trials diminishes.

According to the most recent statistical data from NCI’s Surveillance, Epidemiology, and End Results program, the median age of a cancer diagnosis is 66 years. The median age at diagnosis is 61 years for breast cancer, 68 years for colorectal cancer, 70 years for lung cancer, and 66 years for prostate cancer.

Healthcare professionals treating older cancer patients often discover other health conditions that may limit the use of specific therapies. Unless there is sufficient evidence that older patients can benefit from standard dosage of some therapies, clinicians can be reluctant to give older patients potentially beneficial treatments. This practice of less intensive therapy in aging patients is historically understandable; however, a growing field of geriatric oncologists now consider chronological age insufficient evidence for denying aggressive cancer therapy.

The solution to this aging dilemma, like the disease, is complex and we need to better understand how the biological underpinnings of aging affect the onset and trajectory of cancer. Reasons for this increase of cancer with aging can be contributed to the fact that living longer increases our exposure to things that have been shown to be contributing factors in determining cancer risk, such as exposure to sunlight, radiation, environmental toxins and noxious by-products of metabolism that increase with age. “Most aging cells develop genomic changes that make them more susceptible to the carcinogens in the environment,” says oncologist Lodovico Balducci, who studies and treats cancer in the elderly at the Moffitt Cancer Center in Tampa, Fla. In addition, the various immune defenses that keep our tissues healthy begin to break down with age.

Some of the more serious health conditions that are more common in adults over 65 that may impact the response to a cancer diagnosis include; high blood pressure, heart disease, lung disease, diabetes, kidney disease and arthritis. These co-existing conditions must be taken into account when designing cancer treatment protocols for older patients. For those older patients with cancer, knowing how treatments will be affected by these contributing factors is important to understanding how to respond to the process of therapy.

But progress towards better understanding is underway. A joint collaborative effort with the National Institute on Aging (NIA) and the Samuel Waxman Cancer Research Foundation is underway which will promote and support interdisciplinary research projects, sharing of resources, and development of new technologies and approaches to better understand how the physiological changes associated with aging affect cancer development, progression, and response to therapy. NCI is also committing more resources aimed to increase enrollment for older patients in clinical trials.

Proper Screening and Lifestyle Changes Can Impact Cancer Risk

GCC February Blog Image 2 (640x427)When Cheryl and her husband of thirty-five years sold their business and headed off to retirement, they looked forward to having more time to dedicate to their three children and four grandchildren. Discovering a lump in her left breast while on vacation dramatically altered their retirement plans and her outlook on the future. With no family history of breast cancer, the results of her mammogram were stunning. Cheryl was diagnosed with Stage 2 triple negative ductal carcinoma breast cancer.

Cheryl is not unlike many thousands of women who receive an unexpected breast cancer diagnosis. While aware of the disease and its impact on the lives of those suffering from it, the thought of receiving the bad news is one stuck in the back of the mind, hopefully never to be realized.

In 2018, an estimated 266,120 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 63,960 new cases of non-invasive breast cancer. Death rates have been decreasing since 1989, but approximately 40,920 women in the U.S. are expected to die in 2018 from breast cancer. About 85% of breast cancers occur in women who have no family history of breast cancer. The two most common risk factors are gender and growing older. While you can’t change some breast cancer risk factors there are some risk factors that you can control.

Personal behaviors, such as diet and exercise, and taking medicines that contain hormones can impact the chances of getting breast cancer. Drinking alcohol is clearly linked to an increased risk of breast cancer. The risk increases with the amount of alcohol consumed. Being overweight or obese increases the risk in women after menopause. The American Cancer Society recommends you stay at a healthy weight throughout your life and avoid excess weight gain by balancing your food intake with physical activity. Moderate and vigorous physical activity lowers risk for postmenopausal breast cancer. Vigorous physical activity lowers risk for pre-menopausal breast cancer, according to the recently released American Institute for Cancer Research “Breast Cancer Report.”

Early detection of breast cancer is the leading factor in the historic decline in cancer deaths. With screening mammography, treatment can be started earlier in the course of the disease, possibly before it has spread. Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74.

“The importance of love and life hits you square in the face and it takes a strong toll on your body and spirit,” says Cheryl of her diagnosis and treatment regimen.  Today she is more than one year cancer free.

For more than 25 years, Gettysburg Cancer Center has been committed to providing cancer care in a community-based setting close to home. The all-encompassing oncology and hematology programs provide a complete range of diagnosis, treatment, and follow-up care for all types of cancer.

Early Detection and Treatment May Prevent Cervical Cancer

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Each year, an estimated 12,820 women in the United States will be diagnosed with some form of cervical cancer. Approximately 4,200 women die from the disease each year, and more than a quarter of a million women will live with the disease each year.  While the numbers can be daunting, when detected early, 91 percent of those diagnosed with cervical cancer will survive.

Long-lasting infections with certain types of human papillomavirus (HPV) cause almost all cases of cervical cancer. Normal cells of the cervix can gradually develop pre-cancerous changes.  These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that may turn into cancer.

The two main types of cervical cancer are squamous cell carcinoma and adenocarcinoma and represent the vast majority of cancer of the cervix. Only some of the women with pre-cancers of the cervix will develop cancer, and it may take several years for cervical pre-cancer to change to cervical cancer. For most women, pre-cancerous cells will go away without any treatment, but others will have their pre-cancers turn into invasive cancers.

Detecting and treating all cervical pre-cancers may prevent true cervical cancers. The Pap test (or Pap smear) and the HPV test may prevent cervical cancer by detecting pre-cancers before they can turn into an invasive form of cancer. During the past several decades, screening has reduced deaths from cervical cancer by finding the cancer early and treating it or preventing it from developing.

For women it can be very hard not to be exposed to HPV. Passed from one person to another during skin-to-skin contact with an infected area of the body, HPV can be spread rapidly and easily.

Available vaccines can protect against infection with the HPV subtypes most commonly linked to cancer. These vaccines help prevent pre-cancers and cancers of the cervix. The vaccines require a series of injections and may cause some mild side effects. The most common are is short-term redness, swelling, and soreness at the injection site.

The American Cancer Society recommends vaccinations for girls and boys beginning at age 11 or 12. HPV vaccination is also recommended for females 13 to 26 and males between the ages of 13 and 21. Vaccination at older ages is less effective in lowering cancer risk. No vaccine provides complete protection against all cancer-causing types of HPV, so routine cervical cancer screening is still recommended.

For more than 25 years, Gettysburg Cancer Center has been committed to providing cancer care in a community-based setting close to home. A leader in Oncology care across the region since 1989, Gettysburg Cancer Center’s cancer team provides screening and treatment options to women across York and Adams County.

For the latest information on early detection and treatments for cervical cancer, contact the Gettysburg Cancer Center.

The Value of a Community-Based Cancer Center

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The diagnosis of Cancer most often is accompanied by an intense emotional reaction, denial and a deep sense of dread and fear. The initial reaction is to seek the most information about the disease and the best treatment options available, no matter the cost of time and expense. The travel can impose a significant burden on cancer patients and their families already struggling with a significant life challenge.

In the historically famous but small community of Gettysburg, Pennsylvania, The Gettysburg Cancer Center (GCC) is meeting the challenges of providing expert comprehensive medical oncology, radiation, diagnostic and radiology services to their community in one location, eliminating the need to travel to regional centers.  With access to expert clinicians and staff, GCC is able to offer quality and comprehensive care in one location.

Adams Diagnostic Imaging (ADI) is an integral part of the GCC. An ACR Certified Imaging Center, ADI is a fully accredited facility focused on providing comprehensive diagnostic services. Whether it is MRI, PET-Scan, Stand Alone CT, Nuclear Medicine, Ultra sound or XRAY, the professional staff at ADI has the latest diagnostic tools available to serve their patient’s specific and individualized needs at affordable prices for the insured and those who self-pay. Their Physicians and highly trained technologists are certified through the ARRT with comprehensive experience and knowledge in radiology. The facility provides flexible scheduling to better accommodate patients by offering longer time slots to improve the patients’ recovery experience.

Clinical trials are an important part of the constantly evolving process of bringing new treatments to market to improve patient outcomes. At GCC, clinical trials are conducted after exhaustive research and development in the lab and are offered to patients to treat or prevent the recurrence of the disease. The first site in the United States to enroll a patient in a pivotal oral chemotherapy trial for all patients with advanced malignancies, GCC clinical trials are some of the most advanced in the field of cancer treatment. The clinical research department at Gettysburg Cancer Center is on the cutting edge of cancer clinical trials.

For more than 25 years, Gettysburg Cancer Center has been committed to providing cancer care in a community-based setting, close to home. The Center works with Hershey Medical Center’s Surgical Oncology Department for all solid tumor board conferences and also collaborates with John Hopkins University and NHI for complicated patient diagnoses.

The Gettysburg Cancer Center prides itself on providing individualized treatment, utilizing the best technical approach, and recognizing each individual patient’s psychological, emotional, and spiritual needs during their journey with their illness and healing.

For more information about Gettysburg Cancer Center, visit www.gettysburgcancercenter.com.

Gene Therapy. A New Frontier in Medical Innovation

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Cancer is a disease that is experienced by young and old and by every economic and social segment of the world populace. At some point in everyone’s life, cancer will affect us individually, a member of our family or one or many of our friends and acquaintances. The American Cancer Society projects there will be 1,688,780 new cancer patients and 600,920 deaths due to cancer in 2017, for a disease that does not discriminate by race or national origin.

Cancer is where abnormal cell growths form in the body and interfere with normal, healthy body functions. Not new to the world stage, cancer dates back to ancient times. Today, after millennials of research and discovery, new treatments for a vast array of cancer types are being studied, many with promising results.  One such new treatment called chimeric antigen receptor T-cell therapy (CAR-T) involves taking samples of T-immune cells called T-cells from a patient, genetically engineering them, and putting them back in to fight the cancer. Co-developed with the drug giant Novartis, the therapy, CAR-T, genetically alters a patient’s own immune cells to target and destroy cancer cells.

“We’re entering a new frontier in medical innovation with the ability to reprogram a patient’s own cells to attack a deadly cancer,” said FDA Commissioner Dr. Scott Gottlieb. The process takes about 22 days and begins with the extraction of a patients T cells, exposing them to the vector which genetically transforms them. They’re then expanded and frozen for shipment back to the patient. During the out-of-body processing of the cells, the patient receives chemotherapy to wipe out any remaining T cells to avoid interference with the, soon to be, newly implanted cells.

“This is a major advance, and is ushering in a new era,” said Malcolm Smith, a pediatric oncologist at the National Institutes of Health. The treatment appears to strengthen a patient’s immune system allowing their own body to fight the cancer. The treatment is recommended for cancer patients who have run out of options for traditional therapy. The new therapy is only currently available for patients 25 years or younger. Thus far, 83 percent of patients are experiencing positive survival results.

While overtly touting the success of gene therapy, researchers are tempering their enthusiasm after experiencing some significant life threatening side effects in 47 percent of the studies participants. These side effects have resulted in brain swelling and deaths, casting a shadow over the field. Seizures and hallucinations were also relatively common, but temporary. Though concerning, the side effects have been successfully managed with drugs. Quality control and how to standardize the potency and purity of living cells extracted from each patient are also a concern. Because of the risks, the treatment is only currently available at 20 US hospitals. The individualized nature and relatively small patient population both drive up the cost of the treatment for now.

“This is a big paradigm shift, using this living drug,” says Dr. Kevin Curran, a pediatric oncologist at Memorial Sloan Kettering Cancer Center that will soon be offering the treatment. “It will provide a lot of hope. This is the beginning.”

“The approval of CAR T-cell therapy for pediatric leukemia marks an important shift in the blood cancer treatment paradigm,” says the American Society of Hematology. “We now have proof that it is possible to eradicate cancer by harnessing the power of a patient’s own immune system. This is a potentially curative therapy in patients whose leukemia is unresponsive to other treatments and represents the latest milestone in the shift away from chemotherapy toward precision medicine. Today’s approval is the result of over a decade of hematology research, including research funded by the National Institutions of Health (NIH).”

Cancer Research: Not Always an Exact Science

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It is the question most frequently asked of doctors by patients who have just received a diagnosis of cancer, “Why me?” It is usually asked by those who thought they were living a healthy lifestyle and had little expectation of receiving the devastating news. Others may have been aware of near or distant family members who had a form of cancer.

While much progress has been made in the effort to understand multiple forms of cancer and the development of effective treatments, the answer to why some people get the disease and others do not remains predominately an elusive mystery. Cancer is known to be caused by changes, or mutations, to the DNA within cells that can cause the cell to stop its normal function and may allow a cell to become cancerous. Some faulty genes that increase the risk of cancer, known as inherited cancer genes, and genes that increase the risk of cancer called cancer susceptibility genes can be passed on from parent to child. But most of genetic mutations appear to occur after birth and aren’t inherited.

Environmental influences such as smoking, radiation, viruses, persistent exposure to cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise has been proven to provide a more definitive answer to the “Why Me?”. Even with this accepted knowledge, some people who share one or more of these environment factors appear to avoid a cancer diagnosis altogether.

Why do some cancers spread and kill patients, while many remain docile?  Seeking the answer to this question has researchers redirecting their approach for answers from why some get cancer to why so many do not. Ruslan Medzhitov, an Immunobiologist at Yale, says “You can inject the same virus into different hosts and get vastly different responses.”

Diagnosis and treatment becomes art and science. Researchers continue to develop and identify predictive tests based on gene mutations and patterns of gene regulation.  These tests assist in targeting the right therapies and treatments for each patient.  Research related to the micro-environments in which the cancer lives and spreads will provide beneficial to the prevention and early detection of cancer.

The field of oncology remains focused on a holistic approach factoring in the environment, genetic factors, and physiology, in the hopes of finding a concrete, science based answer to the “Why Me?”

To learn more about the clinical trials and research that Gettysburg Cancer Center offers its patients, click here.

Support Groups Can Help Cancer Patients Regain Sense Of Normalcy

Receiving a cancer diagnosis can be one of the most traumatic and stressful moments of a lifetime. Often the unknown aspects of treatment and the potential outcomes can trigger strong emotional feelings of shock and anger. The sense of “why me” is often a common initial experience for many cancer victims when they are informed of their disease. The disruption of daily social patterns due to the regiment of treatments that follow diagnosis can add additional strain and stress to the patient and their immediate family members.

Daily routines, family roles and future plans will be determined by a regiment of treatments and medications that often pose additional physical symptoms and challenges to everyday living. The support of family and friends during this process is critical to help the patient regain a sense of normalcy and maintain emotional stability and can provide assistance to reduce distress that can play a critical role in determining the patient’s clinical outcome.

Formal support groups can help people with cancer feel less depressed and anxious about their disease, help them feel more hopeful and enable them to manage their emotions better. Support groups can be peer-led (facilitated by individual group members), professional-led (by trained counselors) or informational, led by doctors and professional facilitators who focus on providing disease related information. Some groups will be organized around the type of cancer, age of the patient or the stag of the disease. Some groups are also available for family members and care givers because a cancer diagnosis doesn’t only affect the patient but also their family and friends.

“Support groups can be effective in many ways,” says Claire J. Casselman, Social Work Coordinator and Complementary Therapies Clinician, University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan. “Meeting and talking with other people whose lives are affected by cancer can create a sense of community or commonness that helps relieve the stress of isolation that many people experience.”

For those who find the formal group setting uncomfortable or cumbersome, online support groups can offer group forums to those who live in rural areas, who are too ill to attend a meeting in person, those who are without access to transportation or patients who seek a certain amount of anonymity. Most online support groups are available 24-hours a day. When looking to the internet for a support group, a certain amount of due diligence should be exercised to verify their credibility.

Often the most effective emotional support comes from those who provide the care. As a teenager in 2015, Chandler Banko’s was diagnosed with advanced, stage 2 Hodgkin’s Lymphoma. A positive and outgoing personality, Chandler found treatment and personal emotional support he needed at the Gettysburg Cancer Center in Gettysburg, Pennsylvania. At Gettysburg Cancer Center, he found experienced professionals who were dedicated to treating not only the science of his disease but the personal emotional conditions that often accompany a cancer diagnosis and regiment of treatment. Chandler says of his battle with cancer, “No One Fights Alone.”

The Importance of Connecting Patients with Clinical Trials in Cancer Research

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Clinical Trials are at the heart of medical research and are critical to finding new paths to prevent, detect and advance new treatment methods and medications for debilitating diseases. Patients with an illness or disease participate in Clinical Trials in order to receive the benefits of the newest treatment options for recovering from their disease and to offer the best opportunity for researchers to find better treatments for others in the future. Treatments may involve new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe and may also investigate other aspects of patient care, such as improving the quality of life for people with chronic illnesses.

Providing information to patients, who have been diagnosed with a serious disease, about the specifics and availability of important Trials that may be of benefit to them is proving to be challenging.  ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants being conducted around the world and currently lists 247,989 studies with locations in all 50 States and in 201 countries. But accessing, understanding and utilizing this important data can be difficult and challenging for the average patient undergoing the emotional and physical experience of a recent diagnosis.

Former FDA commissioner Dr. Robert Califf recently delivered a talk, “Finding the Right Balance in Learning about Therapies”, at a conference in New York City. In his address he said, “Our country is experiencing an unprecedented divergence of health outcomes that mirrors gaps in wealth and education…wealthy, highly educated people are benefiting from information that allows them to lead longer, more functional lives, while others are suffering. The clinical trials enterprise has gone awry,” he said. “It’s become unnecessarily expensive, cumbersome and arcane” In his opinion the system has become so costly and onerous that most of the important questions go unasked. “Doctors are heavily conflicted between patients and the institutions they work for,” says Dr. Robert. “The rosy view that doctors and patients are discussing all options and making the best decisions flies in the face of all evidence.”

The research and pharma industry is attempting to create new pathways to connect patients with the data and, most importantly, help them understand which clinical trial is best for their particular disease. The “Innovation and Clinical Trial Tracking Factbook 2017”, is an Assessment of the Pharmaceutical Pipeline listing the thousands of new drugs currently under trial across the U.S. and around the world. VitalTrax taps into a global database of clinical trials and ultimately organizes the complex web of information into a platform that allows patients, physicians, caregivers, and families to search for relevant trials in relevant locations – in a language they can understand.

Zikria Syed, CEO of VitalTrax says his company is taking an “Open Table” approach to enrolling patients in clinical trials. “We’re making a big bet on the fact that patients would appreciate tools that put the information, and an ability to learn about clinical trials and enroll, in their own hands.”

In smaller communities around the country local oncology providers are shortening the gap of distance and time for patients seeking the benefits of clinical trials. At the Gettysburg Cancer Center (GCC), Clinical Trials are available to patients who want to participate in this important process. The localized opportunity voids the often long drive to large regional healthcare centers for Trial participants and enhances the patients understanding of the technical and practical elements of the process in a personalized but highly qualified environment.

GCC, a leader in Oncology Care across the Central Pennsylvania region since 1989, is actively involved in providing the latest in clinical trials to their patients throughout their community.

The Resulting Dread of Cancer Survival

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One of the most prolific progressions in research and development over the past decade has been the discovery and development of new treatments and drugs for cancer, for good reason. According to National Cancer Institute (NCI) statistics, cancer has a major impact on our society, both in the United States and around the world.  In 2016, an estimated 1,685,210 new cases of cancer were diagnosed in the United States and 595,690 people died from the disease. Nearly 39.6% of men and women will be diagnosed with cancer at some point during their lifetimes. It is rare to find anyone who has not dealt with the dreaded disease personally or had a family member or acquaintance suffer from one type or another of cancer.

To answer the call for action in defeating the disease, researchers, oncologist and drug companies have turned-up the pace of research and discovery. Over the past 5 years, 68 new cancer drugs have been approved for various cancers, many producing significant improvement in outcomes for patients. In just the last ten years, drug developers and regulators have successfully shortened the R&D path for approving new cancer drugs safely and efficiently. The global market for cancer immunotherapies, cancer drugs that enlist the body’s immune system to improve patient survival rates, are expected to grow more than fourfold globally by 2022. The number of new drugs in the cancer pipeline has swelled by 45% over the past decade alone.

With the increased activity and availability of promising new therapies for the masses suffering from cancer, one would expect that a downward trend in costs would be a positive result of the new competitive environment. But increased competition and quicker access to market is not producing the expected. In previous decades, new drugs might cost around $10,000 for a year’s treatment. However, according to one recent study, today’s newly approved cancer drugs can cost a patient a staggering $120,000 to $170,000 per year.

The result of this revolution appears to come at a high cost for patients. In the past decade patients paid just 5% of healthcare provider revenue. Today the shifting responsibility to patients for these costs has risen to 35%, and the trend is expected to continue as employers continue to transfer the high cost of healthcare insurance to their employees, the trend to higher insurance deductibles and rising operating and regulatory costs. The result is that too many Americans are struggling to afford the care. Many healthcare consumers are avoiding or delaying needed care or abandoning treatment because of concerns about their ability to pay.

In a system where the patient first learns of the price of their treatment after it has been rendered, many are shocked at the staggering high price and confused and amazed by a complicated and convoluted system of service codes and the seemingly unending list of often unseen providers.  The euphoria and promise of this revolution of discovery is leading many to dread the unfathomable price of recovery and survival.

Gettysburg Cancer Center takes pride in seeking alternative financial resources that can assist its patients in managing the costs of their cancer treatment. To learn more, please contact: Erin or Kasey by calling 717.334.4033 or visiting the website at http://gettysburgcancercenter.com/patients/patient-assistance/.

Cancer of the Vallecula Can be Difficult to Treat

The Vallecula is an anatomic term for a crevice, furrow or depression and while several vallecula can be located in several areas of the body the term is most commonly used to describe a depression just behind the root of the tongue between the folds in the throat. Cancers involving the vallecula are classified as oropharyngeal cancers.

When David Magee was diagnosed with cancer of the vallecula in March 2016, he learned that his cancer was particularly difficult to treat, given the close proximity of the vallecula to the base of the tongue and voice box. “I was particularly nervous going into it (treatment) for that reason, says David. Early stage cancers of the oropharynx are generally treated with radiation therapy because of the difficulty of surgical access. Squamous cell carcinoma of the oral cavity and pharynx accounts for over 48,250 cases per year in the United States with approximately 9,575 deaths per year. Symptoms of head and neck cancers include: persistent pain, difficulty swallowing, voice changes, mouth sores, dry mouth, changes in appearance, and/or taste changes. Patients with a history of tobacco and alcohol use are at a high risk for these cancers.

David sought treatment at Gettysburg Cancer Center in Gettysburg Pennsylvania, a small town in the central part of the state famous for the great Civil War battle. “I have recommended others to come over here to this Cancer Center who may have sought treatment elsewhere at places like John Hopkins or Hershey Medical Center or places like that. People don’t always realize that there are places with this kind of expertise right here in Gettysburg.”

“No one has been more scared about the treatment process than I was…right away I was put at ease…I always felt that I was in great hands,” Said David. “I had thirty-five radiation treatments which were a little intimidating, but everything went well and I actually began to miss the people here when I was finished with my treatments.”

For David’s complete thoughts on his cancer and experience at the Gettysburg Cancer Center click on https://www.youtube.com/watch?v=yWe0x6PCwmQ.