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Genetic Testing for Cancer, is it the Right Decision for You?

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Knowing something is almost always better than not knowing. Cancer will impact one in three people over their lifetime; a statistic that suggests that contacting the deadly disease is a matter of random chance. Knowledge that one is in the “more likely to get” column can be seen as good news, resulting in closer monitoring and additional testing that could potentially lead to earlier discovery and therefore an increased chance of treatment and survival.

Most cancer risks are directly related to personal behaviors such as using tobacco or over exposure to the sun or other cancer-causing substances and activities. Family cancer syndrome (inherited cancer) can occur when inherited gene mutations that are passed from generation to generation increase the odds of contracting the disease. Only about 5% to 10% of all cancers are thought to result directly from gene mutations inherited from a parent.

Family history of the same type of cancer; cancers developing at earlier ages; multiple family members contacting identical or rare cancers or cancers experienced in multiple generations are some cancers thought to be indicative of family cancer syndrome. Cancer occurrence within close relations is more cause for concern than those in distant relationships. For some rare cancers, the risk of a family cancer syndrome is relatively high with even one case. Some types of cancers have no known mutations linked to an increased risk and others may have known mutations, but no way to test for them.

Genetic testing can be performed by either a blood or cheek swab sample and do not detect whether a person has cancer; testing indicates whether a person carries a change in one of their genes which can increase cancer risk. Most people will not benefit from genetic testing for cancer, but those who have a strong indication of family gene mutations may be able to take actions that lower the risk of the disease.

BRCA1 and BRCA2 are the most common genes involved in hereditary breast and ovarian cancers and a positive connection to these genes can also indicate a higher risk for other cancers, but nearly 85% of breast cancers occur in women who have no family history of the disease. No genetic test can determine whether a person will develop cancer with certainty.

The results of genetic testing can be beneficial in making medical decisions for cancer treatment, additional screening and prevention. Selecting the correct test and interpreting the results accurately can be complex, and the decision to have the test may impact personal relationships with other family members. For these reasons, the decision to undergo genetic testing is a very personal one, and one that should be made after considering all unique circumstances.

Availability of Oral Chemotherapy Drugs on the Rise

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When we think about chemotherapy (chemo) treatment for cancer, more often than not we harbor visions of intravenous (IV) injections of chemicals with complicated names, usually being administered in sterile medical environments with the patient surrounded by attending oncology professionals. But advances in chemotherapy drugs over the past decade are quickly changing the perceptions most of us have developed about chemotherapy and how it is administered. The fact that chemotherapy is available in oral (pill) form for numerous types of cancer is a surprise to many. In fact, an estimated 30% of cancer drugs in development are oral, and the trend is increasing.

With cancer survival rates consistently increasing over the past decade, cancer is becoming a chronic illness for cancer patients. The ability to receive extended cancer therapy protocols at home and by mouth is beneficial in time, convenience and cost that accompanies typical IV administered treatments. Oral anticancer medications (OAMs) have become available to treat many different cancers, including lung, leukemia, colorectal, kidney, and prostate and have been shown to be as effective as other forms of treatment. “The efficacy of chemotherapy pills … are similar to the traditional intravenous therapy, with research showing that the overall survival with oral chemotherapy is the same as patients would have with traditional intravenous chemotherapy,” says Dr. Hannah Luu, California-based oncologist and CEO and founder of OncoGambit.

However, OAMs shift much of the responsibility for proper administration from attending medical professionals to the patient and family members. Dr. Luu cautions, “Chemotherapy pills have the potential to cause the same serious toxicities as intravenous chemotherapy. If used incorrectly, they can potentially have fatal outcomes. It’s important for patients to be aware of their treatment plan and take their chemotherapy drugs accordingly. It’s even more important that the patient doesn’t take the missed pills with the next dose.”

Doctor appointments are still necessary with the use of OAMs, to perform regular scans or blood tests to ensure the medication is working safely and effectively. Handling of these oral medications requires careful attention as well as consistent adherence to the treatment regimen. Not skipping doses is critical to effective treatment.

A recent study showed that both providers and patients face barriers from insurance carriers on the use of OAMs. Some insurers cover OAMs as a prescription drug benefit, rather than a medical procedure. Delays in getting approval may be labor intensive and take several weeks. Out-of-pocket costs can vary and may require additional administrative support to overcome.

Gettysburg Cancer Center, a leader in oncology care across south central Pennsylvania since 1989, is dedicated to providing all-encompassing oncology and hematology programs and a complete range of diagnosis, treatment, and follow-up care for patients. For more information call (717) 334-4033.

Immunotherapy Drug Is Providing Exciting Results in the Treatment of Lung Cancers

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Alex was in his early 40s when he was diagnosed with Stage 4 Lung Cancer. A non-smoking, healthy man, who exercises regularly and eats relatively well is not who most people think of when they think of lung cancer.  However, people exactly like Alex are the new faces of lung cancer diagnoses. Alex is also one of a select few who qualified for a new targeted therapy drug recently approved by the FDA.

Lung cancer is the leading cause of cancer death globally, causing 1.7 million deaths a year. In the United States, it is expected to kill more than 154,000 people in 2018, but recent studies are producing credible progress in finding new drugs that, when combined with more traditional chemotherapy, are greatly improving the survival rates among lung cancer patients. The findings are dramatically changing the way physicians are treating lung cancers. “What it suggests is that chemotherapy alone is no longer a standard of care,” said Dr. Leena Gandhi, a leader of the study and director of the Thoracic Medical Oncology Program at the Perlmutter Cancer Center at New York University Langone Health.

So far, four drugs called checkpoint inhibitors, which unleash the patient’s own immune system to kill malignant cells, have been approved by the FDA. “I’ve been treating lung cancer for 25 years now, and I’ve never seen such a big paradigm shift as we’re seeing with immunotherapy,” said Dr. Roy Herbst, Chief of Medical Oncology at the Yale Cancer Center.

In the trial, patients with metastatic nonsquamous non-small cell lung cancer (NSCLC) who received the drug pembrolizumab (Keytruda) plus chemotherapy had improved overall survival and progression-free survival compared with just chemotherapy alone.  The results from the KEYNOTE-189 clinical trial were presented at the annual meeting of the American Association for Cancer Research (AACR) in Chicago on April 16 and published concurrently in the New England Journal of Medicine.

One of the main factors in the high rate of death due to lung cancer is that the disease is most often undetected until it has spread to other organs of the body. Lung cancer is the second most prevalent form of cancer in men and women and the top cancer killer among both sexes. In addition to the encouraging results from immunotherapy drugs, a newly discovered protein is showing promising results in detecting lung cancer earlier, providing new advanced treatment options to patients at the earliest stages of the disease. “The use of CKAP4 as a biomarker could change current practices regarding the treatment of lung cancer patients, and the diagnostic accuracies may be markedly improved by the combination of CKAP4 and conventional markers,” says Yuichi Sato, Division of Molecular Diagnostics, Kitasato University.

While the news of earlier discovery and new treatment options is very good, reducing risk factors for the disease remains the best approach to avoiding cancer. Exposure to tobacco smoke is one of the leading causes of lung cancer. Smoking marijuana and using electronic cigarettes may also increase the risk of lung cancer, but the actual risk is unknown. People who work with asbestos in a job such as shipbuilding, asbestos mining, insulation, or automotive brake repair and who smoke have a higher risk of developing cancer of the lungs. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer. Having your home tested for the presence of Radon is a good and economical method for reducing the risk. Some people also have a genetic predisposition for lung cancer. People with parents, brothers, or sisters with lung cancer could have a higher risk of developing the cancer themselves.

Understanding cancer and how to treat it is constantly evolving toward the day when a cure is discovered. The cure is not here yet, but treatment options have greatly improved in recent decades. The treatments and methods used in clinical trials are promising in every environment in which they are tested. For more information on advancements in cancer detection and treatment, visit https://gettysburgcancercenter.com/.

What is Your Cancer Stage and Why is it Important to Know?

 

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One of the many new terms that patients hear when receiving a cancer diagnosis is “stage”. Along with a long list of other medical terminology used by caregivers to describe cancer, the stage of cancer is used to describe the level at which the cancer has progressed. The stage of cancer will determine where the disease is located, if or where it has spread, what other parts of the body it may have affected, and the patient’s estimated survivable rate. The stage is the most credible indication of the cancer’s progression at a given period of time and is determined by patient procedures and tests such as physical examinations, imaging scans, biopsies, blood tests, surgery or other genetic testing. Even though this is extremely important information, nearly half of the patients diagnosed with cancer in the past two years are unaware of their disease’s stage.

The American Joint Committee on Cancer (AJCC) recently released the latest edition of its cancer staging manual with new and updated staging for many types of cancer. Most cancer treatment centers started using the updated manual on January 1, 2018.

The specific stage of cancer can be determined by tests conducted prior to diagnosis or after a surgery has been performed. It can provide answers to questions concerning the size of the primary tumor, whether it has spread to the lymph nodes or other parts of the body and if the cancer is more or less likely to spread. The cancer’s stage will help determine the specific course of treatments, establish the likelihood of recovery, the estimated time to recovery and permit the patient to develop a roadmap for the challenges that lie ahead.

Most types of cancer have four stages:

  • Stage 0 is the stage that best describes cancer that is still located in the place it started and has not spread to nearby tissues. This stage of cancer is often highly curable, usually by removing the entire tumor with surgery.
  • Stage I cancer is usually a small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body and is often referred to as early-stage cancer.
  • Stage II and Stage III refers to larger tumors that have grown more deeply into nearby tissue and those that may have spread to the lymph nodes but not to other parts of the body.
  • Stage IV indicates that a cancer has spread to other organs or parts of the body and is sometimes called advanced or metastatic cancer.

Understanding your cancer stage will provide critical insight on your future treatment options, the time and direction of recovery and ultimately your likelihood for survival. It is important to be informed about all aspects of your disease so that you can be an active and well-informed participant in your own care.

The Importance of Taking Care of the Caregiver

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For cancer patients, receiving a diagnosis is often a time of fear, stress and trauma. The fear of the unknown, treatment processes and the disruption to life’s routines can be overwhelming. The experience is life altering, not only for the patient but also for family and close friends. For certain, life will never be the same for all involved.

While the initial focus and turmoil centers around the patient, the emotional impact on those who step up to be caregivers are too often overlooked. The dedication of time and resources to drive the patient to their frequent treatments, look in on them to monitor the therapies’ progress and extend their understanding and emotional support can be significant. Truly, no one fights cancer alone.

Being a caregiver can be very challenging. Many caregivers are close family and friends who are impacted equally by the diagnosis. The experience often creates a new role and unprecedented change for friend and family relationships. Feelings of confusion and stress accompany the changes in daily routines for all involved. Once relatively equal give and take relationships are now tipped more toward the cancer patient. Over an extended period of time this unbalanced set of emotional and physical needs can leave a caregiver feeling depressed and overwhelmed.

Educating yourself about the patient’s disease and the therapies and treatments they will be experiencing can help a caregiver cope with the challenges that lie ahead.  “I remember it was important for me to understand the kind of breast cancer my wife (Viola) had,” says Nathan Jones.  “It was triple-negative, so it was very aggressive. Because I had learned everything I could about Viola’s cancer, I understood that even though she wasn’t sick in bed or even in pain, her cancer was going to grow fast and we needed to be proactive.” Knowing and understanding is nearly always better and less stressful.

Many caregivers admit, usually in hindsight, that they took on too much. Accepting help from others and sharing feelings of being over taxed is never easy, but having someone assist with routine chores like cooking, cleaning, shopping and yardwork can relieve the pressure on a caregiver’s time, energy and feelings of inadequacy.  Focusing on your own needs, hopes, and desires can give you the strength to meet new challenges and understand conflicting feelings.

Support groups dedicated to caring for the caregiver are widely available in small group settings or online. Studies show that talking with others about what you’re dealing with is very important. It’s especially helpful when you feel overwhelmed or want to say things that you can’t say to your loved one with cancer.

Keeping a journal has been shown to help relieve negative feelings and stress. Share your journey with others who show interest.  Ken Owenson, caregiver and husband to a breast cancer patient says, “We find a lot of strength from sitting down with patients and giving them a place to vent some of their anxiety, and it also gives us a chance to clear our minds, too.  It’s not good to internalize it because that just makes it worse.”

For more information on how you can better manage your caregiver journey, contact the cancer care specialists at https://gettysburgcancercenter.com/contact-us/.

Cancer Mortality Rates Continue to Decline in The U.S.

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Continuing a positive trend for the last two decades, cancer death rates declined again last year. According to annual statistics reported from the American Cancer Society, the cancer death rate for men and women combined has fallen 26% from its peak in 1991. This decline translates to nearly 2.4 million deaths averted during this time period.

“Cancer Statistics, 2018,” was published in the American Cancer Society’s journal CA: A Cancer Journal for Clinicians. The information is also available in a companion report, Cancer Facts and Figures 2018, and on a website, the Cancer Statistics Center. Although cancer death rates continue to decline, a total of 1,735,350 new cancer cases and 609,640 deaths from cancer are projected to occur in the US in 2018.

The decline is mostly due to steady reductions in smoking and advances in early detection and treatment. “This new report reiterates where cancer control efforts have worked, particularly the impact of tobacco control,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. “A decline in consumption of cigarettes is credited with being the most important factor in the drop in cancer death rates. Strikingly though, tobacco remains by far the leading cause of cancer deaths today, responsible for nearly 3 in 10 cancer deaths.”

Lung, breast, prostate, and colorectal cancers are leading the way in lower death rates. Lung cancer death rates declined 45% from 1990 to 2015 among men and 19% from 2002 to 2015 among women. Early detection of breast cancer resulted in a 39 percent decline in death rates in women for the same period. Prostate and colorectal cancer experienced a 52 percent reduction between 1970 and 2015, primarily due to increased routine screening.

According to the report, the reduction in death rates is not equal across all ethnic, racial and social economic classes of population. The rates of new cancer occurrence are generally highest among African Americans and lowest for Asian Americans.

Cancer remains the second most common cause of death among children ages 1 to 14 in the U.S. Leukemia accounts for almost a third of all childhood cancers, followed by brain and other nervous system tumors. While child death rates due to cancer have continuously declined since 1975, cancer incidence rates increased in children and adolescents by 0.6% per year for the same period.

The report also reveals that the lifetime probability of being diagnosed with cancer is 39.7% for men and 37.6% for women. The most common cancers to be diagnosed in men are prostate, lung, and colorectal cancers. The most common cancers to be diagnosed in women are breast, lung, and colorectal cancers. Breast cancer accounts for 30% of all new cancer diagnoses in women. Liver cancer incidence continues to increase rapidly in women, but appears to be stabilizing in men.

The good news is particularly rewarding to the professionals at Gettysburg Cancer Center where their understanding of cancer and how to treat it is constantly evolving toward the day when they have a cure. Testing new procedures for identifying and diagnosing certain diseases and conditions, finding ways to prevent certain diseases or conditions before they have a chance to develop, and exploring new methods of supportive care for patients with chronic diseases are at the core of the ongoing clinical trials at the Center.

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 Best in Cancer Care Across the Community

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Healthcare and access to quality healthcare is a critical issue for individuals whether healthy or recently diagnosed with a life-threatening illness.  Most patients have experienced a private medical practice being merged into a large healthcare system and often don’t understand how that will impact their care.

While large specialized health centers can promise to offer the most advanced techniques, facilities and methods, they are usually located in large urban centers, often miles and driving hours from the patient’s home, requiring long and physically taxing commutes for frequent treatments. Although staffed with caring and competent professionals these mega centers can often feel overly clinical and crowded, giving the patient a sense of being just another number among many.

The best and most advanced treatment and care is becoming less centralized, allowing for advanced specialized care to be available within the patient’s own community, providing ease of care access and reducing the personal stresses often accompanying cancer therapy.

Gettysburg Cancer Center (GCC) has been a leader in Oncology Care in the Adams County region since 1989. For more than 25 years, the highly regarded and vastly experienced medical specialists have been committed to providing cancer care in a community-based setting close to their patient’s home. The all-encompassing oncology and hematology programs provide a complete range of diagnosis, treatment, and follow-up care in an environment that recognizes the importance of treating not only the disease but the individual person behind the disease.

With Medical Oncology, Radiation Oncology, Diagnostic Imaging, access to the latest clinical trials as well as an onsite laboratory and pharmacy, Gettysburg Cancer Center truly offers comprehensive cancer care. Their compassionate and experienced staff takes pride in providing the best possible care and personal assistance to their patients and their patient’s families. Dr. Satish Shah, Principle Medical Oncologist and Hematologist at GCC says, “Our mission is to provide individualized treatment, utilizing the best technical approach.  We focus on providing the best treatment in the right environment so that our patients can focus on getting better.”

To learn more about how GCC’s is helping their cancer patients, click on https://gettysburgcancercenter.com/about-us/testimonials/.

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.

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.