Loma Linda Women’s Cancer Center : one of its own

Herbert Atienza, spokesman from Loma Linda University Medical Center, writes about the new women’s cancer center, which will be dedicated on March 20, 2013 :

The new Women’s Cancer and Surgical Oncology Center provides personalized patient care in a setting designed to encourage coordination and communication among all participants in a patient’s treatment – including physicians, nurses, therapists, surgeons, counselors, and the patients and their families themselves.

As Director, Mark Reeves, M.D., explains, “The center brings together – both physically and figuratively – gynecology and surgical oncologists with medical and surgical oncologists in a collaborative way that ensures comprehensive, seamless care for the patient. Each patient receives an individualized treatment plan that is developed and reviewed through the collective input of medical, surgical and radiation oncologists, pathologists, radiologists, and an entire team of specialists. Each plan is based on a patient’s diagnosis, values and life circumstances.”

Helping implement this treatment plan is a team of specially trained nurse navigators who help guide the patient through the continuum of care and provide patients the support and education they need to prepare for treatment and ongoing monitoring. The center also encourages the involvement of families throughout the course of treatment, including during clinical as well as educational visits.

“We also place high value in the non-medical dimensions of care,” said Dr. Reeves. “As a result, our center focuses on treating the whole person through support groups, exercise programs, access/referral to social work, dieticians, psychological services, spiritual support and other long-term needs of each patient.”

Adjacent to the medical and surgical centers is Loma Linda University Cancer Center’s Proton Treatment and Research Center, the first hospital-based proton therapy center in the world. Established in 1990, today the center uses proven-effective proton beam technology for many types of cancers, and has treated more patients than any other proton treatment center in the world.

 

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Proton therapy for breast cancer in Oklahoma

OKLAHOMA CITY – Breakthrough medical technology is now used to fight breast cancer at ProCure in Oklahoma City. The center is one of only 10 across the country that uses proton therapy. The treatment finds and blasts specific tumors with radiation, sparing the rest of the body and healthy tissue.

According to Dr. Nancy Cersonsky, a radiation oncologist, patients report less pain and tiredness and fewer side effects when treated with proton therapy. “Our prostate cancer patients can go through treatment while going to work everyday and having no bowel or urinary toxicity,” she said.

Until now, the Oklahoma City center has used proton beams to treat prostate cancer and head and neck tumors, but never breast cancer. Clinical trials are now open for patients with stage one to stage three breast cancer. Doctors hope proton therapy will be the future of cancer treatment.

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Child with brain cancer needs proton therapy

Alexander’s parents tell the story of their son and are making an urgent appeal in the hope of raising the funds to pay for his life saving proton treatment in America.

 « In November 2012, Alexander complained of feeling unwell. As he stood up he lost the power in his left arm and leg and collapsed. Alexander was rushed to the hospital where they performed an MRI scan which showed lesions in the cerebellum. After a number of surgical interventions, were given the devastating news that Alexander had a stage 4 brain tumour. Diagnosed with medulloblastoma, a type of malignant brain tumour and life limiting condition, we were also told that the tumour had broken up and travelled down his spine. The outlook was very bleak. The plan was to start an aggressive chemotherapeutic approach followed by radiotherapy and then more chemotherapy.

In March 2013 Alexander had an MRI scan to see how well the cancer had responded to the induction chemotherapy. Before the positive results of the MRI scan were known, Alexander’s oncologist at the John Radcliffe explored the option of proton radiotherapy abroad. Proton treatment is a much kinder and less harmful to the body especially that of a young child. It creates little to no collateral damage to other organs, good tissue and bone structure compared to traditional radiotherapy.  He contacted a number of facilities, but due to the treatment time frame, and the waiting list for the machines, extensive spread of the cancer we were told that they would not accept him for treatment and we would have to undergo traditional radiotherapy here in the UK.

Not to be deterred, we contacted The Massachusetts General Hospital in Boston, USA and quickly arranged for his case history and latest scans to be reviewed, hoping that in their opinion Alexander would be a good candidate for proton and whether they could treat him in the very near future.

On Friday 29th March 2013 we got the fantastic news that The Massachusetts General Hospital in Boston would be happy to accept Alexander for proton radiotherapy treatment due to his response to the chemotherapy -with every chance of a cure. Boston miraculously has an opening at the end of April beginning of May for Alexander.

We are now making an urgent appeal in the hope of raising the funds to pay for his life saving proton treatment in America. Our goal is to reach £255,000 in the next 2 weeks to cover the cost of treatment. We know it’s a tall order but hope and pray that with your help, we can make this happen. »

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Proton therapy center in Seattle brings hope

The first treatment center of its kind in the Northwest has just opened in Seattle. Until now, cancer patients in the Seattle area like Pat Purcell had to travel 1,000 miles for proton therapy.

In 2011, Pat Purcell, 50, got a phone call from his doctor with the results of a biopsy of his prostate. He considered several treatment options, including robotic surgery and various forms of radiation, but his doctors told him that with proton therapy, his life expectancy would be unbelievably good.

Purcell was sold. That was a crucial consideration for him, worried about side effects. But the closest proton therapy center back then was in southern California. That, said Purcell, was the only down side.

Purcell thinks it’s probably the best decision he ever made : “I’m just like I was before and I’m not having to deal with incontinence, impotence, rectal bleeding and all the potential side effects from other modalities”.

Now, proton therapy is also available in the northwest. Eighty-thousand people have received proton therapy and the new center on the campus of Northwest Hospital treated its first patient this month. It’s an expensive therapy, but it’s generally covered by insurance. The Seattle proton therapy facility is just the eleventh of its kind in the United States.

“Proton therapy is amazing and it’s going to impact health care in the Pacific Northwest like nothing else,” predicted Purcell.

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ASTRO supports proton therapy for prostate cancer

At a recent meeting, the Board of Directors of the American Society for Radiation Oncology (ASTRO) approved a statement regarding the use of proton beam therapy for prostate cancer.

ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. On March 14, 2013, ASTRO has issued a statement supporting the use of proton beam therapy to treat prostate cancer as long as patients are enrolled in clinical trials or within prospective registries.

ASTRO said that the collection of treatment and outcomes data in these contexts is essential for developing a consensus on the role of proton therapy for prostate cancer. Such information will help radiation oncologists understand the effectiveness of proton therapy compared to other radiation therapy modalities, such as intensity-modulated radiation therapy (IMRT) and brachytherapy.

Noting that proton therapy is not a new treatment for prostate cancer, ASTRO pointed out that its use is still evolving and comparative efficacy evidence is still being developed.

“We look forward to new and innovative research that will more clearly define the role of proton beam therapy for localized prostate cancer among the currently available treatment options”, said ASTRO Chairman Dr. Michael L. Steinberg.

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Protons Target a Rare Tumor Type

After months of sinus discomfort he had attributed to allergies, Noel Pagan finally decided to visit an ear, nose and throat specialist in August 2012. The news was startling. An extremely rare tumor, clival chordoma, was found at the base of his skull.

The tumor was removed by surgeons at Mount Sinai Hospital in New York City. For follow-up treatment, members of Pagan’s treatment team suggested proton therapy as an option because of the sensitive location of the tumor. Neither Pagan nor his wife, Tracy, was familiar with the treatment. So, they researched proton therapy on the web.

An online video featuring Frank Mackinson, a cancer survivor and the first patient treated at ProCure Proton Therapy Center in Somerset, New Jersey, convinced Pagan that proton therapy was the right choice.

“Seeing someone else go through the process — putting the mask on his face, lying down on the table for treatment — and experiencing minimal side effects was encouraging,” Pagan said. “Knowing that another man underwent treatment and is doing well was hugely important for me.”

Mount Sinai Hospital referred Pagan to Dr. Oren Cahlon, a radiation oncologist and medical director at ProCure New Jersey to see whether he would benefit from proton therapy. He would. Pagan received 41 proton treatments as an outpatient from November 2012 to January 2013.

“Clival chordomas are rare tumors near the base of the brain and skull that can be difficult to treat with standard radiation therapy,” said Dr. Cahlon. “These tumors are ideal targets for the highly precise nature of proton therapy to reduce the risk of tumor recurrence and minimize damage to the brain and visual nerves.”

Chordomas represent a one-in-a-million diagnosis; about 300 Americans are diagnosed with chordomas each year. In recent months however, ProCure New Jersey has successfully treated six chordoma patients.

 

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Review – Pediatric proton therapy program awarded

The University of Florida Proton Therapy Institute (UFPTI, Jacksonville) was granted a special award for its pediatric program at the annual Celebration of Excellence Awards event of the UF Shands Cancer Center.

UFPTI a nonprofit organization affiliated with the UF College of Medicine, dedicated to delivering state-of-the-art cancer treatment and setting new standards for treating and curing cancer. The cancer treatment facility houses both conventional radiation and proton therapy, and delivers proton therapy to 110 patients a day. The institute treats on average 20 children each day, the most of any proton therapy center worldwide.

The UFPTI pediatric proton program was selected for the highest level of dedication and patient-focused mission in caring for pediatric patients, and won the Top Team Effort Award. « The pediatric team at UFPTI does more than treat the tumor. The cohesive team places continuous effort into bettering the life of the child with cancer », the nominator said.

« Families are often displaced from familiar surroundings for six to eight weeks during the most stressful time of their lives. The team meets before the patient arrives to coordinate care and cover every aspect of anticipated need for each child and family. The whole team — physicians, medical assistants, nurses, social workers, child life specialists, and transport driver — work as a unit to provide a nurturing and safe environment for children, to celebrate treatment milestones, and to provide emotional support for the children and their families. »

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Part 7 – In the search for the best cancer therapy option, “knowledge is power”

When they first diagnosed 3-year-old Georgia with a rare Ewing’s sarcoma in June 2012, physicians at St. Luke’s Medical Center in the Philippines predicted a 20 percent chance of survival.

Amazingly, four months of chemotherapy and experimental P53 gene therapy had reduced the tumor on Georgia’s spine by 70 percent. But the side effects of those treatments also ravaged her tiny body.

In October, Becca and Nick had to choose which radiation treatment would best kill the last bits of their little girl’s tumor — and do so with as few serious side effects as possible.

Radiation oncologists at a hospital in London had reviewed Georgia’s PET scans and tipped their hand slightly in favor of Proton Therapy. Specialists in the Philippines had agreed on proton beam treatments, as well.

A teacher by training, Becca had done an amazing job mining medical information and evaluating the scientific evidence after Georgia and son, AJ, had been put to bed. But the rational was falling away to the emotional. The enormity of Becca and Nick’s looming decision was weighing on mom and dad.

On October 10, Becca wrote on her blog, The Helping Georgia Fund: “I can honestly say that these past few weeks and this week have been really stressful for me and Nick and until we know what the next step is for G, that stress is not going away. We are trying to take it a day at a time, but at the same time there are still so many questions we need answered.

“To see the stark truth about her tumor broken down into those points made us feel very dejected and just plain sad on Sunday.

“G is so happy and chatty and loves pottering around at home so to read that email and then sit with her as she chats away, is just surreal and heart grabbing. People say to us ‘cherish the moments’ and believe me we are trying to, but we don’t want to just cherish the moments. We want a whole lifetime of moments with G and AJ.

“…I think the stress is reaching G as this morning she said ‘Mummy why are you so sad? Are you going to cry mummy?’ The fact that she can even recognize and tune in to my emotions just makes my heart burst with love for our little girl; she is so switched on to how others are feeling. She has been really clingy with me at home, sometimes she literally screams if I leave the room and she is not with me.

“I find myself getting stressed out and unable to cope when she does this and then I hate myself for feeling like this. You know when you can feel the pressure mounting and the tiniest thing is going to send you over the edge? Well, that is how I feel at the moment. I also know it will pass and even as I write this I can feel myself getting it out of my system.

“Tonight it was my turn to put G to bed and she was busy wiggling her bottom at me, as 3-year-olds love to do. I was laughing and said ‘oh what a lovely view that is, what a lovely bottom’ G replied ‘is it the best bottom in the whole world mummy?’

“I am always telling her how she is the best girl in the whole world and universe and I love how she turns things around and applies it to situations. She is so utterly gorgeous and funny.

“I think Nick and I both know in our heart of hearts that Proton Therapy is the way forward for G. We have just had an email from our doctor at St. Luke’s and they have confirmed that this would be their first choice for G.

“So now we have to decide where to go and how to pay for it. Please if anyone has any connections at Jacksonville Proton Center, Florida or knows of any charities that can help with the funding please do let us know. If S. Korea is an option the costs are much lower but we daren’t get our hopes up.

“We have always said that we would love to take the children to see S. Korea and show them some of the places we used to go to. [Becca and Nick had taught school in Korea for seven years before moving to Manila to teach.] It might not be the holiday we had in mind, but it would feel right to go back to Seoul.”

As the last days of October approached, Becca seemed more comfortable with protons: “It does not have an exit dose, from all our research it still feels like it should be the number one choice.

“We have to get this right for G; we have to give her the best chance we can. The tumor is near her spinal cord. That means her spine is going to be radiated. We can’t avoid that. That can lead to long-term problems with her growth. Do we add a 6 percent chance of a secondary cancer to those risks as well?

“But then nothing has been proved yet with the long-term risks of protons but if there is no exit dose, it just makes sense to do that and protect what we can.

“Her poor little body is going to be exposed to so much. If proton is what G needs then we have to find a way to resolve all the other things. Seoul is where we used to live it feels right to have that interconnectedness.”

The next month, Becca and Nick moved their family from Manila to wintery Seoul. Georgia’s first proton treatment was on November 19. Her final treatment was on January 7, this year.

MRI and PET scans will be performed on Georgia in Manila on April 8, 2013. They’ll be reviewed by her St. Luke’s medical team and be transmitted to Seoul to be studied by specialists at the National Cancer Center’s Proton Therapy Center.

And then Becca and Nick will wait.

Part 6 – In search of the best cancer therapy option, “knowledge is power”

To Becca and Nick’s surprise, the Filipino radiologists who each had advocated their own radiation specialties — IMRT, CyberKnife and Tomotherapy — to treat 3-year-old Georgia’s cancer, had come to a consensus. Proton Therapy would be best for Georgia.

Becca and Nick eagerly awaited word from specialists at a London hospital.

“On October 10, Becca returned to writing in her blog, The Helping Georgia Fund: “I can research until the cows come home but we need experts who have done this procedure to tell us the options and give advice. We need someone to say I have done this before on a Ewing’s sarcoma spinal pediatric patient and this is what I advise. We are therefore really pinning our hopes on getting this information from the UK.”

Days later and still no word from London, Becca wrote: “This is the hard thing, constantly waking up and checking email to see if we have heard anything. It is the first thing we think about in the morning and of course the last thing we think about at night.

Nick rang the Proton Center in Seoul via a number in the US but it was an answer machine, we have had a general message back from them telling us all about Proton but not actually mentioning if they do pediatrics.”

On October 15, Becca reported: After many sleepless nights Nick and I had an email on Sunday from the UK … and this is what the email said…

“The opinion is the following:

1. At the moment (and most likely in the future) surgery is not a viable option. Although surgery can remove the tumor, this would render Georgia paralyzed, incontinent, and she would have to have an ileostomy bag. Definitely not a right option.

2. Radiotherapy — conventional radiotherapy difficult, but protons might be an option. Having said that, protons are as effective as conventional radiotherapy (external beam or IMRT or RapidArc), not more effective.

We believe it might have less side effects to the healthy tissues, but in Georgia’s case we would have to irradiate the bones of the pelvis and the heads of the femurs, so damage would be done anyway.

3. The conclusion of the [UK cancer specialists] was to obtain some more images after further chemotherapy….”

The email also went on to ask if we would like G’s case sent to the radiation oncologist at the Jacksonville Florida Proton Therapy Center in the USA. This is where the UK send all their NHS patients to. And it has an excellent reputation for working with pediatric patients.

We have asked the UK team about the option of Tomotherapy which is available here but are still waiting for a response on that.

Nick and I have also found a Proton Therapy Center in Seoul, South Korea that is a third of the price of the USA. However, we are still in the process of finding out if they take pediatric patients. Nick and I lived in Seoul for four years before moving here, so we know how good the medical system is in S. Korea.

We have also asked for more explanation on the above email. From what we understand Proton and IMRT or Tomotherapy are all equally effective as a means of radiation so what we are concerned about is which is the safest option or is there no difference?

From what we have read and understood there is no exit dose with Proton so from a lay man’s perspective that seems to be a slightly safer option.

“…At the moment these are our options as we see them …”

Wait to hear back from UK as to what they think regarding Tomotherapy and whether it is a viable option (as it is available here at Makati Med).

Wait to hear back from the UK for further explanation – are they saying Proton is the safest or are they saying because there will be radiation into her bones whether we do Proton or IMRT/Tomotherapy makes no difference.

Send all of G’s records to Jacksonville Proton Therapy Center in the USA.

Send all of G’s records to NCC Proton Center in Seoul, South Korea (but first we need to have confirmation that they do pediatric patients).

Meet with our team at St. Luke’s to have our immediate questions answered.”