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Cancer Series: Innovations In Treatments

An artist's rendering of the Scripps Proton Therapy Center.
An artist's rendering of the Scripps Proton Therapy Center.
Cancer Series:Innovations and Treatments
GUESTS:Dr. William Stanton medical director of Scripps Cancer Center at Scripps Mercy Hospital San Diego. Peggy Pico, KPBS Science and Technology reporter

CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. The new treatments and therapies for treating cancer can present overwhelming choices for patients, especially for those still trying to cope with the diagnose itself. In our continuing series on living with cancer, we focus today on the innovations of cancer treatment, and new ways hospitals are helping cancer patients manage their treatment. I'd like to welcome back KPBS science and technology reporter, Peggy Pico. She's sharing her professional expertise, and her personal experience with breast cancer. And Peggy, hi. PICO: It's good to be here. CAVANAUGH: And joining us also, Mr. William Stanton and medical director of Scripps cancer center. Welcome back STANTON: Thank you for having me. CAVANAUGH: Now, Peggy, let me start out with an update on you. You had to stay home yesterday. You had a little setback. PICO: I did. I'm on the road to recovery, but it takes a little longer than I thought. So fatigue is still setting in. And I like to think of it now as more of a marathon than a sprint. I was so happy to be on the road to recovery that I think I might have done a little bit. But I understand from all the experts, including doctor Stanton here, that this is typical behavior of recovery. CAVANAUGH: I'm wondering, is this is the up and down nature of cancer treatment and ONE'S response to it, one of the things you try to explain to patients? STANTON: Absolutely. It's very important to manage expectations early on because some people may have to alter their work partners a little bit. We often ask patients if they wouldn't be better served by being treated on the weekend for example or on a Friday so they have a little time to recover. Most cancer treatments now take several months. And it's a roller coaster. CAVANAUGH: Exactly there seem to be a number of new ideas and innovations taking place in cancer treatment. We see much of that coming into practice here this San Diego. For instance, doctor, Scripps La Jolla just got a giant proton radiation machine. And we're wondering, how is this machine different from traditional radiation devices? STANTON: Yes, we actually got not just a machine a whole proton center. CAVANAUGH: Yes. STANTON: And a cyclo-Tron in the middle of it. To understand how a proton might be different from regular radiation, in regular radiation, electrons are accelerated by a linear accelerate, and they hit a heavy metal target and make X-rays. Then those X-rays are directed to the patient. In proton therapy, the actual proton particle is directed at the patient. And particle therapy has the following advantage. Think of a tumor as being a sugar cube in your body. Regulation radiation therapy is pretty good at limiting the scattered radiation in front of and at the sides of the sugar cube. So as the radiation goes in, it can be not impacting the surface of the skin or the size beyond the tumor inside the body. Unfortunately, regular radiation doesn't stop at the back face of that sugar cube. CAVANAUGH: Right. It keeps ongoing STANTON: And protons stop. CAVANAUGH: Ah, okay STANTON: So we were able to spare tissue and minimize the collateral damage. CAVANAUGH: Reidy children's hospital is interested in using this proton radiation machine. Would it be particularly helpful in some types of juvenile cancers? STANTON: Especially in children cancer. Not one area that it first was used. And the reason for that is because you want to avoid tissue behind that cancer. And children's spinal tumors are very delicately radiated because you don't want to injury the spinal cord right in back of the tumor. CAVANAUGH: Peggy, was radiation an option in your cancer treatment? PICO: Yes, radiation was an option. It would have improved my survival rate, but I opted out of it which was a choice I had because of some of that collateral damage that they're talking about. Even though there's all sorts of new innovations in radiation to really pinpoint it like he says, my concern -- I had some concern about collateral damage. I would never recommend that to somebody else, it was a personal decision, but I was interested in the new cyclotron because of that sort of controlled radiation, andee if that proves to be true CAVANAUGH: That's interesting. Another innovation suggest robotic surgery, which I understand is being used a lot firefighter prostate cancer surgery. Why would it be particularly good for that sort of cancer? STANTON: Well, sure. The robotic surgery is done by making small incisions in a patient's abdomen and putting in cools. Now, the cools have instruments at the end of them, and you -- the surgeon actually, once the tools are there, sits down at a consol away from the patient, and begins to manipulate those tools. And imagine that you're able to make that little pinser that's going to cut move only a millimeter. And you can do that by having your whole hand in a glove and having the whole hand squeeze. But at the other end of the instrument, it's much more finally coordinated. So you have fine motor skills, par excellence. And that's very important in prostate surgery because it's a very, very difficult area to see when you open up the abdomen. You look down, and you often are cutting areas that you're feeling rather than seeing. And with the robot, you actually see what you're doing. CAVANAUGH: What other cancers might this be applicable to? STANTON: We are using it in gynecologic cancers at Scripps. We have the da-Vinci robots, the surgical instruments that we use in three of our campuses. And we also use it in lung cancer now. CAVANAUGH: That's fascinating. I want to move on to an innovation that doesn't have to coso much with a treatment as it does with an organization of a treatment because I know that cancer patients can have a rough time navigating through their treatment, all their appointments, different doctor, different places they need to be, and now hospitals are using people that they call patient navigators. Perhaps you can tell us Peggy a little bit more about what patient navigators are supposed to do. PICO: Patient navigator, and I'll refer this back to doctor Stanton for the -- they have some actual real result, not just the warm fuzziness of having somebody hold your hand through the treatment. My understanding of it is it's somebody to help you navigate through the whole process, when to get your treatment, that you need a surgical doctor as well as a oncologist, they're not just appointment makers. They're actually there to help you through the journey, to help you with insurance, things like that. So that's my understanding of a patient navigator. CAVANAUGH: Right. Now you you used to be in your first career, you used to be a nurse. And I'm wondering do you now have a patient navigator or some similar kind of person who oversees? Or do you do it yourself? PICO: I don't. And I wanted one. Actually, the best thing I got, I got an American cancer society put me with a patient who had gone through the exact same thing. So I called for a lot of questions there. The place where I went, UCSD Moors cancer center, they have nurse advocates that would help you along. But one person to over athlete see the whole process I think would be very valuable. Of and doctor Stanton and I were talking, and you were saying that there's actual clinical results for your recovery; correct? STANTON: Yes, absolutely. The concept really emerged in Harlem by professor Harold freeman several decades ago. And he was able to increase the survival rate from 39% to 60, 70% in that population by using navigators. And the thing that they did is that they were not just making appointments for patients. That too is important. But they were following up and actually taking patients to the appointment, making sure they had transportation, making sure they had childcare. So they enveloped the patient with this wonderful support system. And one of my patients has been quoted as saying that our navigator at Scripps mercy was his life line. And it truly can be that important. CAVANAUGH: Are more and more hospitals getting involved in getting the idea of patient navigation into what they do for all kinds of patients, especially cancer patients? STANTON: Yes. At Scripps, we're a cancer network, accredited by the commission on cancer and the American college of surgeons, and they accredit about 25% of American hospitals, and in those, about 80% of cancer care occurs. And their new standards for 2012 will man date navigators be available at their accredited facilities. CAVANAUGH: I want to get in a question about gene and bacteria injections as two types of experimental cancer treatments. Can you give us an idea how they're being used and if they're controversial? STANTON: Well, first of all, experimental therapy should be put in the context of not some Frankensteinian experiment. It's always in the context of research that's carefully controlled, reviewed by what are called institutional review boards to be sure that the risk inherent in the research is worth it, that there are benefits that are reasonably expected is that justify any risk. And secondly, that the project is provided -- has provided the patient with a consent document written in a language and at a level of reading that the patient can understand. So this is a very carefully controlled thing. It's not just somebody's idea of going off and trying something. Now, there are many ways biological products have been used to help cancer. And some of them that you've alluded to are very interesting. I think probably the most important recent development in preventive oncology is the use of a vaccine against the strains of the HPV virus that cause cervical cancer and 25% of head and neck cancers. If children were immunized with this vaccine, we could eradicate approximately 30% of cervical cancer. That's a good example at looking at a virus to fight it off. CAVANAUGH: I think it's interesting that you make that distinction that experimental therapy is not necessarily off the wall. I mean, it has been peer reviewed. It's just simply not something that's become a standard treatment yet. I wonder though, do people need to be cautious about certain therapies that they might come into contact with that call themselves experimental? STANTON: Well, of course. I think you have to ask the question, what is the record of the researcher, have they done good research, what are the results that he or she can say that led to this project? And a very important question that I think people who are interested in research should ask is is the protocol designed so that the question asked can be reasonably answered? It's sometimes necessary to enroll 200 or 300 patients in a tree to get an answer. And it wouldn't be worth anyone participating in research if you knew up front that you couldn't answer the question. So I think it's very important for patients to spend a lot of time looking at the research document, and talking with the research coordinator and the actual researcher himself or herself. CAVANAUGH: And we have such a small amount of time. I know that people who have cancer spend a lot of time on the Internet, and they spend a lot of time researching things. Have you had to stop yourself from doing that from time to time, peggy? PICO: Oh, yes. From the beginning, I tried to not read anything that I didn't know where it was coming from in order -- just other patients or blogs. I think there's value to that. But I had to stop that because you get -- if there are 100 different postings, you'd got 100 different answers so much yes, I do limit myself on the web. Completely. CAVANAUGH: We are out of time. But I want to tell everyone next time, we'll be talking about the growing specialty of psychological counseling for cancer patients.

Additional Resources

Proton Therapy Info

KPBS Cancer Series

Part 1: A personal story and San Diego research making a difference

Part 2: Innovations in treatments

Part 3: Emotional Help and a new "normal"

Part 4: Screening

Cyclotron Animation
Cancer Series: A Personal Story
Cancer Series: Evening Edition

How much or little has really change in cancer treatments and survival rates over the last few decades? We hear from an oncologist about the range of treatments from robotic surgery to experimental therapies and chemotherapy. KPBS Science and Technology reporter will join us to talk about the hard choices patients need to make in choosing their treatment.

Several months ago Pico was diagnosed and has been undergoing treatment for breast cancer. Pico will not only share her professional expertise but allow us to experience her personal cancer journey.

Check back for dates and times for KPBS ongoing series on Cancer.

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