Casey rings the victory bell after completing cancer treatment at Provision CARES Proton Therapy Knoxville

Surviving Breast Cancer (Part 4)

By

Casey’s Story: Ringing the Bell

Casey is a two-time breast cancer survivor who is sharing her experience during her proton therapy treatments at Provision CARES Proton Therapy Knoxville. Catch up on her story first by reading parts one, two and three of her blog series.


There is something about ringing that bell at Provision CARES Proton Therapy Center.

After my final radiation therapy treatment, my friends, family and co-workers gathered around me  as I rang the bell three times, symbolizing an end to treatment and a new beginning to a cancer-free life.

Victory.  Celebration.  Gratefulness.

It takes time to actually realize that the most difficult journey in my life is really going to be over soon and it will be time to be well again.  I remember my brother Pete telling me at this exact time last year, “Winter never lasts forever and Spring never skips its turn.”  I thought about his words every single day.

Something very valuable I learned during my journey:  choose your providers very carefully.  Do your research in every way possible.  As a Care Coordinator, I would always tell a prospective patient that they owed it to themselves to learn about and evaluate several  treatment facilities before choosing where they would receive their care.  This thought process served me well during every step of my journey.

Without the care of Dr. Brig and his amazing staff at Brig Center for Cancer Care, my surgeon Dr. Danielle Duchini and the entire staff at Provision CARES Proton Therapy, I would not be where I am today.  I am well on my way to health and wellness and beating breast cancer.

I will be forever grateful to so many people and hope to pay it forward for as long as I can.


Provision CARES Proton Therapy would like to thank Casey for sharing her story. Please visit our website to learn more about the benefits of proton therapy for breast cancer and read other patient success stories.

Benefits of proton therapy for liver cancer

Liver cancer patients may benefit from advantages of proton therapy

By

Proton radiation therapy can improve the overall survival rate for liver cancer patients, according to a new study. The good news for proton advocates comes on the heels of another study identifying predictors to help reduce liver damage from radiation, which could give doctors better insight when determining a patient’s treatment plan.

In a news release from the American Society for Radiation Oncology (ASTRO), Laura Dawson, MD, President-elect of ASTRO and a professor of radiation oncology at the Princess Margaret Cancer Center in Toronto, remarked on the promise this shows for patients with hepatocellular carcinoma, an often fatal type of liver cancer. “There is hope for patients with liver cancer, with more treatments becoming available in recent years,” said Dawson. “These studies show that protons, like photons, may be used to treat patients with HCC with a high rate of tumor control and a reduced risk of adverse effects.”

About Liver Cancer

One of the largest organs in the body, the liver filters harmful substances from the blood, makes bile to help digest fats and stores sugar for energy.

In 2016, there were approximately 83,000 people living with liver cancer in the United States. While that makes it a relatively less common disease in the U.S., it is still the second leading cause of cancer death around the world. According to the National Cancer Institute, the 5-year survival rate is just 18.4%.1 In comparison, more common cancers like breast (89.9%) and prostate (98%) have much higher survival rates.2,3 

The most common type of liver cancer is Hepatocellular carcinoma (HCC), a disease in which cancer cells form in the liver tissue. Treatment options for HCC include surgery, ablation therapy, immunotherapy, radiation therapy and others. While the American Cancer Society says surgery may be the best option to cure liver cancer, it’s not always possible. A partial hepatectomy, where the cancerous part of the liver is removed, might not be an option if the patient has other liver disease, like cirrhosis. A liver transplant is also difficult because it can take too long for a donor to become available.

“Surgery remains the gold standard,” noted Nina Sanford, MD and colleagues from Massachusetts General Hospital in Boston. “But donor livers are a scarce resource, and a large proportion of patients are either technically or medically inoperable.”

Traditional radiation therapy has had limited success historically, especially for patients with liver damage from hepatitis or cirrhosis. One of the most serious side effects is radiation-induced liver disease (RILD), which can be fatal. Since proton therapy avoids unnecessary radiation to healthy liver tissues, new research suggests it may reduce the risk of RILD.

Study 1: Protons vs. Photons for Liver Cancer

A clinical investigation spearheaded by Sanford and colleagues at Massachusetts General studied proton versus photon radiation therapy for HCC patients who were not candidates for surgery.

“In the United States, patients with HCC tend to have underlying liver disease, which could both preclude them from surgery and make radiation therapy more challenging as well. So, having therapy option that is less toxic could potentially help many patients,” said Dr. Sanford. The study’s authors also noted, “Although dosimetric studies have demonstrated a theoretical advantage using proton therapy,4,5 there have been no clinical studies. We sought to compare outcomes of patients treated for HCC with either modality.”

Researchers followed 133 patients who were treated from 2008 to 2017. The average overall survival for those treated with proton therapy was 31 months, compared to just 14 months for patients treated by traditional radiation. After two years, the overall survival rate for proton patients was 59%, while traditional radiation only had a 28.6% rate.

Not only did the study observe improved survival rates, they also noticed a decrease in non-classic radiation-induced liver disease. Patients receiving proton therapy had a 26% lower risk of RILD, as compared with photon radiation (odds ratio, 0.26; P=.03;).6

Sanford and her colleagues concluded the improved overall survival time could be the result of lower occurrence of RILD, noting that their findings should lead to more research comparing proton and photon radiation for HCC.

“Proton radiation therapy delivers less radiation dose to normal tissues near the tumor, so for patients with HCC, this would mean less unwanted radiation dose impacting the part of the liver that isn’t being targeted,” said Dr. Sanford. “We believe this may lead to lower incidence of liver injury. Because many patients with HCC have underlying liver disease to begin with, it is possible that the lower rates of liver injury in the proton group are what translated to improved survival for those patients.”

Study 2: Identifying Predictors for Liver Damage

A second study sought to identify predictors that could help doctors determine proper proton radiation dosage, while minimizing the risk of RILD in patients with HCC. Led by Dr. Cheng-En Hsieh, MD and colleagues at Chang Gung Memorial Hospital in Taiwan and University of Texas MD Anderson Cancer Center in Houston, the study found that the ratio of unirradiated liver volume to standard liver volume is actually the most crucial RILD predictor. In other words, the volume of liver untouched by radiation is more important than the dose of radiation delivered.

“Our data indicate that if a sufficient volume of the liver is spared, ablative radiation can be safely delivered with minimal risk of RILD, regardless of dose,” said Dr. Hsieh.

This study looked at 136 patients with HCC and found a “volume-response” relationship between the liver radiation and RILD. Patients who had a higher volume of their liver exposed to radiation, regardless of dosage, had a higher risk of developing complications.

Identifying this predictor is significant because it allows doctors to better plan a patient’s treatment. Knowing how much of the liver will be exposed to radiation can help determine whether proton therapy is a good option. The study’s authors concluded that if a sufficient volume of the liver can be preserved, proton therapy is an effective treatment of locally advanced liver cancer and the risk of complications is minimal.

Personalizing Your Treatment

“Knowing which metrics predict a greater risk for liver damage can help guide radiation oncologists in determining how to balance the benefits and risks of treatment,” said ASTRO’s Dr. Dawson, stressing that both of these studies highlight the need for a personalized radiation therapy plan when treating liver cancer. “There is rationale for the use of protons for some patients, but the evidence to date is not sufficient for a general recommendation of protons above photon therapy for all HCC patients.”

At Provision CARES, patients will always receive personalized treatment. Our Cancer Care Experts can talk to you about your specific diagnosis and schedule you for a consultation with one of our Board-Certified Radiation Oncologists. Once it’s determined whether proton therapy is right for you, our team of radiation therapists, medical physicists, dosimetrists, oncologists and others will formulate an individual treatment plan designed to destroy the cancer cells, avoid unnecessary radiation to nearby healthy tissue and organs, and minimize the risk of side effects.

Sources

  1. Cancer Stat Facts: Liver and Intraheptic Bile Duct Cancer. National Cancer Institute. Read More
  2. Cancer Stat Facts: Female Breast Cancer. National Cancer Institute. Read More
  3. Cancer State Facts: Prostate Cancer. National Cancer Institute. Read More
  4. Gandhi SJ, Liang X, Ding X, et al. Clinical decision tool for optimal delivery of liver stereotactic body radiation therapy: Photons versus protons. Pract Radiat Oncol 2015;5:209-218.
  5. Wang X, Krishnan S, Zhang X, et al. Proton radiotherapy for liver tumors: Dosimetric advantages over photon plans. Med Dosim 2008; 33:259-267.
  6. Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Surival. International Journal of Radiation Oncology. Read More
  7. Predictors of Radiation-Induced Liver Disease in Eastern and Western Patients with Hepatocellular Carcinoma Undergoing Proton Beam Therapy. International Journal of Radiation Oncology. Read More

 

Lung Cancer Awareness Month

Lung Cancer awareness efforts focus on smoking prevention

By

Lung Cancer Awareness Month is dedicated to educating the public about the prevalence of the disease in the United States, and providing resources on prevention, screening and treatment.

According to the American Cancer Society (ACS), lung cancer will kill more than 140,000 people in 2019, making it by far the leading cause of cancer death among both men and women. It is the second most common cancer in both men and women (not counting skin cancer). For men, prostate cancer is the only cancer more common, while in women breast cancer is more common.

Smoking is the leading cause of lung cancer. The ACS reports 80% of lung cancer deaths are caused by smoking.1 However, non-smokers can also develop the disease. This could be caused by exposure to radon, secondhand smoke, air pollution, asbestos, diesel exhaust or other chemicals.

PREVENTION IS KEY

With such a high percentage of lung cancer cases linked to smoking, efforts to reduce the prevalence of the disease are largely focused on kicking the tobacco habit.

“Smoking continues to be the #1 most preventable cause of death and disease in the U.S.,” says Kerri Thompson, Public Health Educator for the Knox County Health Department (KCHD) in Knoxville, Tenn. “It kills so many people and it’s something that can be prevented.”

Thompson spearheads KCHD’s tobacco prevention programs, which focus on three main areas: Youth Prevention, Secondhand Smoke Reduction and Smoking Cessation (quitting). Through educational programs designed to teach children about the dangers of smoking, KCHD hopes to dramatically reduce tobacco product usage in our next generation.

“We’re trying to change the trajectory so, hopefully, we can have an impact on lung cancer,” Thompson notes. “Having (our youth) not use tobacco or not be addicted to nicotine in the first place is really key to addressing the huge impact that smoking has on society.”

Knox County’s programs aimed at youth education actually have a trickle-down effect, impacting its Secondhand Smoke Reduction and Smoking Cessation efforts, as well. Children tend to share resources they receive in school with their parents in hopes they will then try to quit. One of these resources is the Tennessee Tobacco Quitline. This is a free service that offers personalized support from counselors who are trained to help you kick the habit. More resources to help you quit smoking can be found at Smokefree.gov.

When it comes to quitting, Thompson says relapse is common, so persistence is very important. “When someone quits smoking, on average it takes seven to 10 times for someone to quit for good. Many people think since they’ve been smoking for years, the damage is already done, so what’s the point in quitting.” However, if there’s one thing she hopes people take away from Knox County’s education and prevention efforts, it’s this – “It’s never too late to quit.”

LUNG CANCER SCREENING CAN SAVE LIVES

According to the National Cancer Institute (NCI), risk factors for lung cancer include tobacco use, secondhand smoke, family history, HIV infection and environmental risks like exposure to asbestos, radon  or other substances. If you believe you may be at risk for lung cancer, you should start by speaking to your doctor. A general practitioner can perform an assessment, then offer advice for your next step. This could be a referral to a pulmonologist or oncologist, or a prescription for nicotine replacement therapy. Since early detection is so important, at-risk individuals may also benefit from a lung cancer screening.

The NCI says the most effective type of screening is a low-dose spiral Computed Tomography (CT) scan. In its National Lung Screening Trial, the NCI studied people between 55 and 74 years old who had smoked at least one pack of cigarettes a day for 30 years or more. They compared low-dose spiral CT scans with another type of screening, chest x-rays. Researchers observed a 20% lower risk of dying from lung cancer in people who received low-dose spiral CT scan screenings.2

Fortunately, there are resources available to help people get screened. The American Lung Association (ALA) offers an online quiz to help you determine whether you are at risk. The ALA can also help you find information about insurance coverage and screening facilities near you.

In an effort to make lung cancer screenings more accessible, CHI Memorial Hospital in Chattanooga, Tenn. brings low-dose CT scans into the community with its Breathe Easy mobile lung CT coach. The bus serves counties from three different states in the Southeast.

PROTON THERAPY AS A TREATMENT

Given the serious prognosis of lung cancer, it’s important to evaluate all your treatment options before making any decisions. Treatment for lung cancer is based mainly on the type (non-small cell vs. small cell) and the stage of the cancer. Other factors like a person’s health and lung function should also be considered. Treatment options may include surgery, chemotherapy and radiation therapy.

Doctors and scientists have been studying the results of proton therapy in the treatment of non-small cell lung cancer (NSCLC). One study in particular showed that patients with Stage 3 NSCLC who were treated with proton therapy experienced lower rates of lung and esophagus inflammation compared to patients treated with traditional (x-ray/IMRT) radiation.3

Proton therapy for lung cancer treatment is non-invasive and usually painless. Physicians provide doses of radiation to specific areas, controlling the depth of the protons emitted and reducing the impact on the surrounding tissue. Provision CARES Proton Therapy uses a technique known as pencil beam scanning, which provides precise dose of radiation to targeted areas, resulting in a decreased risk of side effects. Proton therapy decreases the risk of damage to healthy tissue and organs surrounding the cancer. This is because the unique physical properties of protons allow the radiation dose to better conform to your cancer, avoiding unnecessary radiation to nearby areas. This is especially important for lung cancer treatment because the tumor may be close to your heart, healthy lung and other critical organs.

Since each cancer diagnosis is unique, we encourage anyone seeking treatment options to speak with one of our Cancer Care Experts to see if proton therapy is right for you.

 

Sources

  1. American Cancer Society. What Causes Lung Cancer? Read More
  2. National Cancer Institute. National Lung Screening Trial. Read More
  3. National Cancer Database Analysis of Proton Versus Photon Radiaion Therapy in NSCLC. Read More
  4. American Cancer Society. Key Statistics for Lung Cancer. Read More
  5. Proton Beam Radiotherapy and Concurrent Chemotherapy for Unresectable Stage III Non–Small Cell Lung Cancer Final Results of a Phase 2 Study. Read More
  6. High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: results of a 12-year experience at Loma Linda University Medical Center. Fractionation 10 for PBT vs 6-8 weeks for IMRT. Read More

 

National Radiologic Technology Week honors radiation therapy and medical imaging professionals..

How Radiation Therapy and Medical Imaging help shape cancer patient experience

By

Every year in early November, the American Society of Radiologic Technologists (ASRT) celebrates National Radiologic Technology Week. It’s an opportunity to recognize the crucial role that medical imaging and radiation therapy professionals play in patient care and safety. The celebration takes place during the week of November 8, which is the day Wilhelm Conrad Roentgen discovered the x-ray in 1895.

The Radiologic Technologists (R.T.s) at Provision CARES Proton Therapy are an integral part of our team. They are educated in anatomy, patient positioning, examination techniques and radiation safety, allowing them to perform highly skilled and precise procedures. Most importantly, though, they are on the frontlines of caregiving during treatment. All of our R.T.s are passionate about Provision’s Culture of CARE, putting the patient’s comfort, safety and overall experience first.

To show our appreciation for the Radiologic Technology (Rad Tech) staff at Provision, we’re taking a closer look at the industry to which they’ve devoted their lives, and how their jobs help shape the cancer patient experience.

WHAT IS RADIOLOGIC TECHNOLOGY?

Following Roentgen’s discovery, the x-ray gained popularity as a way to diagnose and treat illness in the early 1900s. The x-ray machine remained the primary tool of medical imaging until the 1960s and 1970s, when newer procedures like computed tomography, mammography and sonography became commonplace in the healthcare industry1. The x-ray is also a traditional tool used for radiation therapy to treat cancer. In the 1950s, however, proton radiation therapy for cancer treatment was introduced. Since then, studies have shown proton therapy avoids unnecessary radiation to nearby healthy tissue and organs, reducing the risk of side effects2. There are now more than 30 proton therapy centers in the United States.

Modern Radiologic Technology covers two main areas – medical imaging and radiation therapy. According to the ASRT, there are several practices in which an R.T. can specialize, including general radiography, computed tomography (CT), mammography, magnetic resonance imaging (MRI), radiation therapy and others.

In the medical imaging field, an R.T. is responsible for making sure the patient is properly positioned for a quality diagnostic image. Rad Techs in medical imaging are typically specialists, like Radiographers, Mammographers, Sonographers, MRI techs or CT Techs.

A Radiologic Technologist may also choose the radiation therapy path. Radiation Therapy is the administration of targeted doses of radiation to a patient’s body to treat cancer or other diseases. In this case, an R.T. would be a member of the Radiation Oncology team and could work as a Medical Dosimetrist or Radiation Therapist.

RADIOLOGIC TECHNOLOGY AT PROVISION

Radiologic Technology is part of the patient experience from diagnosis all the way through treatment and the cancer care experts at Provision can help coordinate each step of the process. Of course, radiation therapy is at the heart of what we do – treating cancer with proton therapy – and we are proud of the work our Radiation Therapists do and the passion they show for everyone who walks through our doors. Along the course of your treatment, you may also meet MRI Techs, CT Techs, Medical Dosimetrists and other radiologic specialists.

Radiation Therapy team from Provision CARES Proton Therapy NashvilleAll of these Radiologic Technology roles are highly specialized and require quality education and experience. Most importantly, though, each of our R.T.s believes in Provision’s Culture of CARE. It is our mission to respect the dignity and value of every person by providing an environment of compassion, sensitivity and thoughtful consideration.

The Rad Tech staff at Provision is also dedicated to increasing awareness about the benefits of proton radiation therapy. In fact, the ASRT Foundation recently recognized Justin Pigg, Manager of Radiation Therapy at Provision CARES Proton Therapy Nashville, with its International Speakers Exchange Award for his efforts to promote the sharing of research, best practices and professional development in the radiologic sciences. As a recipient of this award, Pigg presented “Technical Aspects of Proton Therapy” at a Radiologic Technology conference in Nova Scotia.

THE BENEFITS OF PROTON RADIATION THERAPY

Proton therapy for cancer treatment has become a trusted method for precisely targeting tumors and reducing the risk of side effects. The advantage of proton therapy is distinct from traditional radiation therapy because the timing and dosage of proton energy can be specifically controlled. Since a proton beam can conform to a tumor’s shape and size, maximum beam energy is deposited directly into the tumor, decreasing the risk of damage to surrounding tissue and organs. Protons have unique characteristics that prevent radiation from traveling beyond the tumor. Contrastingly, traditional radiation therapy deposits energy from x-ray beams along the entire path of the beam. Radiation is absorbed from the time the beam enters the body until it exits on the other side of the tumor area.

Provision CARES Proton Therapy uses the most precise form of proton therapy, called pencil beam scanning. Pencil beam scanning provides even greater customization and precision in cancer treatment. Physicians use a proton beam only millimeters wide to target the tumor area with the highest radiation dose, while controlling both the depth and the position of the beam and planning the exact point at which the proton beam stops inside the body. This means there will be no exit dose, sparing even more healthy tissue and organs from unnecessary radiation.

Proton therapy is beneficial for treating patients with a localized tumor where cancer has not spread to other parts of the body, or in situations where tumors cannot be removed with surgery. It may also be an option if a patient requires radiation therapy in addition to surgery or chemotherapy. We encourage you to speak with one of cancer care experts to find out if proton therapy is right for you.

Ultimately, Provision CARES Proton Therapy is passionate about caring for anyone who is fighting cancer. In honor of National Radiologic Technology Week, thank you to all of our Rad Techs who help us live up to that mission.

 

Sources:

  1. American Society of Radiologic Technologists. History of the American Society of Radiologic Technologists. https://www.asrt.org/main/about-asrt/asrt-history
  2. Baumann BC, Mitra N, Harton JG, Xiao Y, Wojcieszynski AP, Gabriel PE, Zhong H, Geng H, Doucette A, Wei J, O’Dwyer PJ, Bekelman JE, Metz JM. Comparative effectiveness of proton therapy versus photon therapy as part of concurrent chemo-radiotherapy for locally advanced cancer. American Society of Clinical Oncology poster session. June 1, 2019.

 

Upcoming Event: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, September 20th from  930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Upcoming Events: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, July 26th from 930-11a and Friday August 23rd from 930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Thursday, May 9th at 6:30pm or Friday, May 17th at 9:30am

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Provision CARES Celebrates Social Work Appreciation Month: Meet Marriah Mabe

By

March is Social Work Appreciation Month and this year’s theme is ELEVATE SOCIAL WORK.

Each day, nearly 700,000 social workers nationwide work to elevate and empower others, giving them the ability to solve life’s problems, cope with personal roadblocks, and get the services they need.

Provision CARES Proton Therapy Knoxville has one of the best in the field, Marriah Mabe.  Marriah joined Provision in July 2017, and she has already accomplished a lot since that time.  Marriah was instrumental in starting the Provision CARES Proton Therapy Ethics Committee.  She has developed a library of patient literature and a database of financial and community support resources for cancer patients.  Marriah has led several staff education, support, and appreciation initiatives.  She currently oversees several programs, including the Art Therapy Program, and serves as chair of the Provision CARES Ethics Committee and leads the Pediatric Program Committee.

In Marriah’s daily work, she assesses cancer patients for depression and anxiety and offers preliminary counseling and referral for advanced mental health services as needed.  Often, we forget that the costs of cancer care go beyond financing of treatment; people facing cancer are also facing lost time from work on top of additional co-pays for medications and appointments.  Marriah helps connect patients to financial assistance resources for food, medication, lodging, and transportation.

We appreciate and recognize Marriah as well as all social workers for the jobs they serve in helping others.

Provision CARES Proton Therapy Knoxville Welcomes Radiation Oncologist Dr. Lavey

By

 

Ben Wilkinson, MD, Medical Director of Provision CARES Proton Therapy Knoxville welcomes Robert S. Lavey, M.D., M.P.H. to the Provision CARES team.

Dr. Lavey has been board-certified in Radiation Oncology since 1988.  He graduated magna cum laude from Harvard University and earned his Doctorate in Medicine from Stanford University. He completed his residency in radiation oncology at Duke University and was awarded National Institutes of Health Postdoctoral Fellowships in the Stanford University Department of Medicine and the University of California, Berkeley School of Public Health.

(more…)