Delaying cancer screening tests during COVID puts patients at risk

Delayed cancer screenings in COVID era put patients at risk

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When the COVID-19 pandemic began, life as we knew it came to an abrupt halt. That included routine healthcare visits, as many providers postponed appointments and cancer screening tests that were deemed “non-essential.”

In the United States alone, an estimated 22 million cancer screening tests were disrupted by COVID-19 from April to June 2020. As a result, about 80,000 patients could be at risk for delayed or missed diagnoses.

The IQVIA Institute for Human Data Science recently published these estimates as part of its report on shifts in healthcare demand, delivery and care during the COVID-19 era. In this article, we’ll look at how diagnostic procedures for some of the most common cancers are impacted. We’ll also share some tips to help you move forward with your cancer-related care in a timely and safe manner.

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Proton therapy cancer treatment significantly lowers the risk of second cancer compared to IMRT and 3DCRT

Proton Therapy significantly lowers risk of second cancer

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X-ray (also called photon) therapy has long been known to cause the development of potentially deadly new cancers in patients who undergo radiation therapy to treat their cancer. However, research shows that patients who choose proton therapy for cancer treatment have a significantly lower risk of developing a second cancer later in life.

In a  comprehensive study published last month in Cancer, the prestigious, peer-reviewed journal of the American Cancer Society, researchers at Stanford University found that patients who were treated with x-ray therapy developed more than three times as many new cancers as patients treated with proton therapy.1

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Lung Cancer Awareness Month

Lung Cancer awareness efforts focus on smoking prevention

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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

 

how to reduce radiation-induced heart disease

The Heart of the Matter: Proton Therapy Can Prevent Radiation-Induced Heart Disease

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Content and information provided by Rebecca Bergeron, RN, BSN, OCN Director of Clinical Services for Provision CARES Proton Therapy Knoxville

February is American Heart Month, and it is the perfect time to talk about preventing unnecessary radiation dose to the heart, often times causing radiation-induced heart disease. When people begin their fight against cancer, they are most likely not thinking about reducing their future risk of heart disease; however, this is certainly something we are thinking about at Provision CARES Proton Therapy.  (more…)

Mediterranean Diet to Reduce Lung Cancer

Reduce the risk of lung cancer with Mediterranean diet

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Replacing saturated fat with polyunsaturated fat impacts reduce risk of lung cancer

By Casey Coffey MS, RD, LDN

According to recent studies, benefits of polyunsaturated fats have been widely reviewed by looking at the relationship between dietary components of the Mediterranean diet and cancer risk, diabetes, cardiovascular events, and Alzheimer’s disease. Within these studies, the primary conclusion shows correlation between fat intake and risk associated with lung cancer.

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Protons offer promise for reirradiation

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For those with cancer who have already an initial course of radiation therapy, a recurrence of their disease can be an understandable cause for concern.

With conventional (X-ray) based radiation, we generally can only safely give one round of treatment to the primary site of disease. But with proton therapy, because of its ability to zero in on the cancer and spare healthy surrounding tissue, a second course of treatment could offer hope to patients with recurrent tumors. (more…)

Conventional radiation for lung cancer damages heart

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Note: This is the first in a monthly series of blogs that will be authored by Dr. Ben Wilkinson, radiation oncologist and medical director for Provision Center for Proton Therapy. Dr. Wilkinson will cover a variety of topics related to proton therapy treatment and cancer care.

For some years now, the damage conventional radiation can do to the hearts of breast cancer patients has been documented in the medical literature.

Now, we’re seeing the same effects in lung cancer patients. (more…)

Dosimetrists focus on finding perfect proton path

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Not too long ago, radiation prescribed for cancer treatment was calculated by physical measurement and mathematic formulas worked out by hand.

Now computers do much of that detail work, but the job of a dosimetrist is as important as ever in making sure patients receive the right dose of radiation in exactly the right place. And thanks to advancements in the field—the development of proton therapy and advanced application technologies such as pencil-beam scanning, sophisticated software modeling platforms and high tech imaging capabilities—patients receive precise, customized therapy that’s the best in the world.

Kevin Kirby is one of six dosimetrists who work at Provision Center for Proton Therapy. These experts in the delivery of radiation for treatment of cancer work with radiation oncologist and physicists to determine the best treatment plan and then ensure its successful delivery, says Kirby, who spoke recently at a patient chat, held each Wednesday at the proton therapy center. The talks provide information on a variety of topics of interest to patients and their families.

“Our job is to create (proton therapy) dosage that focuses just in the tumor,” Kirby says. “We figure out the best way to position the patient so we can minimize any radiation to excess tissue.”

With the pencil beam application ability, calculations must be made to determine the direction and length of path for the protons being channeled to the tumor. In some cases, treatment can be made challenging by the location of the tumor, on the lung, for instance, in which radiation must be administered while the patient is breathing.

“We are able to predict the motion of the lungs by using four-dimensional CT scans to develop the treatment plans,” he says.

A laundry list of equipment and programs are involved in coming up with the unique plan for each patient. In the case of the lung cancer patient, for example, a respiratory device helps plan for treatment between breaths. Medcam marries patient x-rays with CT scans to aid dosimetrists, physicians and physicists in creating the treatment protocol. A software package called “Matrix” serves as quality assurance for treatment before it starts, even sending protons into the nozzle through which they’ll be delivered to the patient. Treatment planning software serves as a “flight simulator, which also allows for changes in the treatment plan based on shifts inside a patients body during the course of therapy. Another program, Mosaiq, records the treatment itself, creating a unique therapy chart for every patient.

Among the team of caregivers, physicians prescribe and monitor treatment, physicists manage the entire process on both the equipment and treatment delivery side and therapists interact directly with patients who are receiving therapy. Dosimetrists, says Kirby, focus specifically on the way radiation—in this case, proton therapy—targets the cancer in the patient’s body.

“We take the prescription the doctor gives and determine how to deliver it,” he says.

Sarcoma rare but responsive to proton therapy

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Sarcoma represents just 1 percent of cancer cases. Bob Sisson is among the 1 percent.

“There isn’t a buddy check for sarcoma,” he says. “I don’t know how you give yourself any self-exams. It’s just bad luck.”

A cancer of the body’s connective tissue, there are approximately 14,000 cases of sarcoma diagnosed each year in the United States and represent approximately 15 percent of cancer found in children, according to the Sarcoma Alliance. About 11,300 of those cases soft tissue sarcoma, which can be found in muscles, fat, blood vessels, tendons and other tissues. Just 2,890 cases are bone sarcomas. Sisson was diagnosed with a soft tissue sarcoma known as spindle cell last October.

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“I started feeling a lump on my left hip—the left hip started getting a little larger than the right hip,” he says. That was last summer. By fall, he started to feel pain in his hip bone, and he visited his primary care physician who ordered a CT scan. There was a large tumor that had already metastasized into Sisson’s lungs.

“Maybe if I’d gone in 3 months sooner…,” he wonders.

Because the tumor was so close to key organs including the bowel and kidneys, he was not a candidate for surgery. He started chemotherapy at the recommendation of his oncologist in hopes of shrinking the tumors. But Sisson had also noticed the Provision ads on television featuring ice skating champion Scott Hamilton. He did some research about proton therapy and made a “cold call” to the Knoxville treatment center.

“I thought the proton therapy sounded good for me,” he says. “I have a background in nuclear engineering, so I’m not unfamiliar with the (concept)…. I talked to my doctor, and he said he didn’t think it would be a bad route.”

Sisson and his wife spent three hours at the initial consultation, talking with Dr. Tamara Vern-Gross and her nurse Julie Goodfellow.

“They brought in a lot of their staff people to meet with us and talk with us,” he says. “It was so great to be able to have that interaction, that they would take the time to sit there and talk to you about this.”

Because protons deposit their energy at a specific target, there is less collateral damage to surrounding, healthy tissues and organs, making it a good treatment for many cancers, including sarcoma. Vern-Gross also advised on a shorter regimen of traditional radiation therapy, completed at Provision Radiation Therapy, for the smaller tumors in Sisson’s lungs.

The tumor on Sisson’s hip responded well to the treatment, drastically reducing the size of the sarcoma. He continues chemotherapy treatment for the lung nodules.

“The facility was just first-class. Just walking into the facility you think you’re in a clubhouse. It gives you a healthy perspective, a positive perspective,” Sisson says. “I would give (Provision) the highest marks on care. I would give it the highest marks on medical (expertise) because it’s state of the art. Dr. Tamara is great, absolutely fantastic. The world is a better place to have people like her.”

As for his cancer, Sisson says he has continued to stay active—caring for his wife who suffered from a stroke four years ago, driving himself to chemotherapy, keeping up the house and yard. While he knows the odds for beating stage 4 cancer aren’t in his favor, and although his Blue Cross Blue Shield insurance would not pay for the proton therapy treatments, he does not regret the investment.

“It resolved the issue that it was supposed to,” he says, referring to the tumor on his hip. “It’s your life you’re talking about.”