Oncologists

Oncologists satisfied with e-consults after chemotherapy reactions

Posted by

0


Key takeaways:

  • An e-consult program for oncologists and allergy specialists had a mean turnaround time of 19.7 hours.
  • Nine out of 10 oncologists surveyed were very satisfied with this turnaround time.

Oncologists were satisfied with an electronic system for consulting with allergists about hypersensitivity reactions during chemotherapy, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

However, specialists need to become more familiar with the system, Aleena Banerji, MD, allergist and immunologist, and Kimberly G. Blumenthal, MD, MSC, quality and safety officer, both in the division of rheumatology, allergy and immunology, department of medicine, Massachusetts General Hospital, and colleagues wrote.

woman receiving chemotherapy
About half of the chemotherapy hypersensitivity cases that prompted e-consults with allergy specialists did not require formal allergy consultations. Image: Adobe Stock

“Chemotherapy hypersensitivity reactions have an incidence rate ranging from 10% to 15% for carboplatin but increases to more than 20% to 30% after seven cycles of treatment,” Banerji and Blumenthal told Healio in a joint statement.

“Incidence rates of hypersensitivity reactions to paclitaxel and docetaxel are approximately 10% and occur most often during the first or second treatment,” they continued.

Hypersensitivity reactions can range from a mild skin rash or hives to severe, life-threatening anaphylaxis, the authors said.

“Symptoms can appear within minutes of starting the chemotherapy infusion, which can be very scary to patients,” Banerji and Blumenthal said.

Milder reactions can be treated with antihistamines, but when the reaction is severe, trained staff need to be knowledgeable about managing anaphylaxis, they continued.

“Additionally, when a hypersensitivity reaction occurs to first-line treatment, a different second-line agent may be used, which can be associated with worse clinical outcomes for the patient,” Banerji and Blumenthal said.

The system’s success

Clinicians can use electronic consultations (e-consults) when they have questions for other clinicians about care for specific patients in outpatient treatment. These asynchronous communications rely on information available in the electronic health record.

Massachusetts General Hospital supports more than 20,000 e-consults each year across multiple specialties, the authors said, with an expected turnaround for each e-consult of 72 hours.

“The allergy/immunology group has been involved in the care of hundreds of patients with chemotherapy hypersensitivity reactions, but communication about care was frequently by text, phone or email,” Banerji and Blumenthal said.

“These communications were not subsequently documented in the patient’s chart and led to a lack of understanding of the care plan by the whole team, delays in patient care and suboptimal coordination of care,” they said.

The hospital instituted the e-consult program specific to hypersensitivity reactions (HSRs) during chemotherapy in October 2020 to reduce time to allergist recommendations and to improve formal documentation in the EHR.

Between October 2020 and August 2021, hospital personnel completed 165 e-consults specifically about chemotherapy HSRs. The mean turnaround time for these e-consults was 19.7 hours (standard deviation, 24.7 hours).

Each one of these e-consults included clear recommendations using the standard smart phrase in the EHR documentation, the researchers said, and 87 (53%) patients did not need a formal allergy consultation after the e-consult was completed.

The researchers distributed surveys to 47 oncologists before and after the e-consult program was launched. Fourteen (30%) responded to the pre-launch survey, 14 (30%) responded to the post-launch survey and 10 (21%) responded to both.

Seven of the 10 (70%) oncologists who answered both surveys said they primarily used email or texts to contact allergists for guidance when a patient had an HSR due to chemotherapy. The other three used the Epic system to request consultations.

Also, nine of the 10 oncologists who responded to both surveys were very satisfied with their methods for obtaining guidance from allergists in the pre-launch survey, and the 10th was somewhat satisfied.

All 10 of these oncologists also said that contacting an allergist was easy and that they spent less than 15 minutes coordinating allergy care for chemotherapy HSRs. Eight (80%) said they were very satisfied with allergy team response times.

According to the post-launch survey, four of the 10 (40%) continued to use email to contact allergists, and three of them only used email, but all 10 also said that they were very satisfied with their consultation methodology.

Further, 70% of the referring oncologists said that the e-consult’s reply speed was better after the program was launched in the post-launch survey, compared with 40% in the pre-launch survey, although the program did not have any impact on the time that oncologists spent coordinating care with the allergy team.

Nine (90%) of 10 oncologists additionally said that they were very satisfied with the time it took to receive a response from the allergy team once the program was launched, and six (60%) said the program was slightly or significantly better than the previous model for collaboration.

The oncologists unanimously said that the information in the e-consult was helpful for patient care as well.

In the free responses to a survey question about how the e-consults could be improved, two oncologists said they preferred to maintain other options for communication, and one expressed confusion about when a chemotherapy HSR e-consult should be ordered instead of a formal in-person consultation.

Looking ahead

E-consults save costs and improve efficiency in care by preventing the need for formal allergy consult visits, the researchers said, with an average turnaround of less than a day compared with more than 3 months in waiting time for outpatient clinic visits.

The less frequent use of texts and emails for consulting with allergy staff also is an improvement, the researchers continued, because the EHR does not document these communications. Also, texts and emails may lead to safety issues by not complying with health privacy laws and because of their absence in the EHR.

The researchers additionally said they expected more of the oncologists to use the e-consult program because of how it improves patient care. They also expressed surprise that the oncologists spent the same amount of time coordinating care, which they attributed to an existing culture of efficient patient care for HSRs.

“We were surprised about the lack of global understanding around an e-consult program, as our institution has vast experience with using e-consults,” Banerji and Blumenthal said. “Additionally, the lack of universal acceptance around using e-consults with clear benefit to patient care suggests we need to provide better education around e-consults.”

Based on these findings, the researchers called e-consults specific to chemotherapy a useful tool for consultations to improve patient care and EHR documentation, but overall success will depend on specialists who are familiar with the program.

Banerji and Blumenthal said the authors are now developing ways to educate their medical colleagues about the use of e-consults with an understanding of how they lead to improvements in patient care.

“Additionally, our goal is to evaluate the benefits and challenges of using e-consults in a larger number of chemotherapy hypersensitivity reactions,” they said

Perspective

Cosby A. Stone Jr., MD, MPH

For certain types of chemotherapy such as platinum drugs and taxanes, immediate hypersensitivity reactions are fairly common. The longer a patient is receiving these drugs, the higher the chance is of experiencing one. For patients who are on these drugs for more than 12 cycles, the chance is almost 50% that they will have a reaction at some point.

There also is a chemotherapy for head and neck cancer (cetuximab) that is a little more likely to cause an immediate reaction in the parts of the country (the Southeastern U.S., mostly) where alpha-gal allergy is present.

Other types of chemotherapy do have hypersensitivity reactions, but they are not as common. They are more like other drugs in their reaction rates. Depending on the drug, you get different profiles of reactions that are possible to experience. This paper appears to mostly focus on the immediate types of reactions based on their description.

Oncologists in our system at Vanderbilt will usually reach out to their allergist colleagues via a consult request in our EHR after a reaction. But typically, they will also reach out personally via phone, EHR messages or HIPAA compliant messaging. The initiation of provider-to-provider communication is important when you are managing an event that might limit a patient’s ability to receive first-line therapy for cancer.

E-consultations can improve care in these cases. Currently, we do not have a formal system promoting e-consultations, but it definitely is something that we do for our oncologists when they or their patients need us to. It is like using the EHR to have a back-and-forth conversation.

I personally think that the most efficient way to go about it, for us, has been to have the oncologist reach out with a referral, let us know what they observed during the reaction, and then we facilitate the patient getting seen by me or a colleague within a week, so we don’t slow down their chemotherapy treatments.

We (the allergists) will then have a telehealth or in-person consultation with the patient to discuss the reaction and the management options. Then we go back to their treating oncologist with recommendations, at which point we all try again using a modified plan under careful observation (sometimes in the hospital setting) and see how it goes. Sometimes we will use chemotherapy skin testing to identify a culprit allergen, but oftentimes it is not necessary since the history is enough to let us know what to do.

So, the system described in this study is similar to my experience. I think we are all trying to tackle this problem of making sure that our vulnerable cancer patients don’t fall through the cracks and miss out on their key chemotherapy treatments even if they have reactions to them. We want to make things safe and keep the quality of what we are doing up to the highest level.

It is important for the public to be aware that there are protocols that can make it possible even for a patient who has had an immediate reaction or allergy (anaphylaxis type) to chemotherapy to tolerate it safely. We use specialized, slow infusion protocols called desensitization protocols to deliver the drugs without setting off their reactions.

It is more work for everyone to treat a patient who has become allergic to their chemotherapy, but it is work that is worth doing to make sure they don’t miss out on the best drugs for their cancer. I have patients that I suspect are still alive today because they did not have to miss out on the drug that was actually working against their tumors.

Finally, I think these authors did a great job in trying to figure out how to facilitate good communication at their institution. When you are dealing with an allergic reaction, 80% to 90% of good medical care going forward comes down to communication amongst the treating team and the patient, in my experience.

Cosby A. Stone Jr., MD, MPH

Assistant Professor in Allergy/Immunology, VUMC Drug Allergy Research, Vanderbilt University Medical Center

Radiation therapy takes advantage of cancer’s poor DNA repair abilities – an oncologist and physicist explain how

Posted by

0


Nearly half of all cancer patients undergo radiation therapy as part of their care. Ionizing radiation, or the emission of high-energy waves or particles, works as a therapy by damaging a cancer cell’s DNA. It’s an effective tool for killing cancer cells because they are generally much less adept at DNA repair compared to healthy cells. Damaging specific parts of DNA prevents cancer cells from reproducing, effectively killing them.

A major limitation of radiation therapy is the damage it may cause as it passes through healthy organs to get to tumors located deep in the body. The need to protect healthy organs limits the dose of radiation that can be delivered to cancerous tissue, thereby reducing the chance of successful treatment.

Overcoming this challenge has long been a mission for medical physicists and radiation oncologists like us. Improvements to radiotherapy will enable clinicians to not only better control tumors overall, but also open the door for more favorable outcomes in patients with cancers that are more resistant to radiation.

Fundamentals of radiation therapy

At the heart of radiation therapy lies the fundamental principle that cancer cells are more susceptible to radiation than healthy cells. However, there are exceptions. Sometimes resistance to radiation in cancer cells may be comparable or even greater than that of their neighboring cells.

When tumors lie close to vital organs that are highly sensitive to radiation, such as the brain or the bowels, it significantly limits the amount of radiation that can be delivered. In cases where tumors are significantly less sensitive to radiation than the organs surrounding it, radiotherapy may not be the best choice. Radiation therapy involves directing strong beams of energy to kill cancer cells.

Patient immobilization is another key aspect to reducing toxicity from radiation. Patients need to be completely motionless during treatments to ensure that the beam of radiation mainly targets tumors and not the healthy tissues surrounding them. If a patient moves during treatment, it can mean the radiation beam is partly or even entirely missing the cancer target. This scenario both underdoses the cancer and increases the risk of harming healthy tissue.

There are a few common types of radiotherapy that deliver radiation in different ways:

External beam radiation therapy

External beam radiation involves directing radiation from an outside source to a single part of the body.

Linear accelerators, commonly referred to as LINACs, are currently the most common technology used in radiation treatments. These machines generate beams of high-energy electrons and X-rays that can be aimed at cancer tissue with precision. The high energy of these beams allows in-depth penetration into the body to reach tumors.

Another form of radiotherapy is proton beam therapy, or PBT, which directs protons instead of X-rays at tumors. Currently, PBT is only available at a limited number of locations. It is typically recommended for specific populations such as pediatric patients because, unlike X-rays, it has an adjustable range that minimizes the effects of radiation on organs beyond the target area, potentially reducing toxicity.

Image-guided radiation therapy

In the early 2000s, researchers incorporated CT scanners into LINACs. This enabled real-time imaging of the patient’s anatomy just before or during treatment. By acting as the eyes of the care team, imaging reduced uncertainty about the location of tumors and improved the precision and accuracy of radiation therapy.

Newer linear accelerators are now incorporating MRIs, which significantly improve visualization of patient anatomy and tumors, further advancing treatment precision and accuracy.

Patient laying on stomach in a radiotherapy machine, green lasers crisscrossed over their exposed back
Patients need to stay still during radiotherapy to ensure the beam stays on course.

Researchers are also adding positron emission tomography, or PET, scanners that provide information about the metabolic function of tumors. This advance makes it possible to increase the radiation dose specifically at the most active areas of tumors.

Adaptive therapy

An emerging approach to radiation therapy called adaptive therapy uses imaging to dynamically adjust treatment as the tumor or its positioning changes each day.

In conventional radiation therapy, patients receive the same treatment plan across multiple treatment sessions. However, adaptive therapy may apply several adjustments or lead to a completely new treatment plan in order to address changes to the tumor’s condition over the course of treatment.

Historically, the concept of adaptive therapy was more theoretical than practical. It faced many challenges, including a lack of suitable imaging technologies. Additionally, creating a treatment plan involves heavy computational work and collaboration among various specialties within a care team. The fact that the process needs to be repeated multiple times renders adaptive therapy particularly resource-intensive and time-consuming. However, researchers are looking into ways to use artificial intelligence to automate some of these steps to make this approach more practical.

Brachytherapy

Brachytherapy – stemming from the Greek word “brachys,” meaning “short” – is another widely used method in radiation therapy. It involves placing a radioactive source called a seed near or directly inside a tumor or affected area, reducing the distance from the radiation source to its target.

In contrast to external beam radiation therapy, where radiation often must pass through healthy tissue to reach cancer cells, brachytherapy applies radiation directly to the tumor. This technique is particularly advantageous for certain cancer types that are accessible through noninvasive or minimally invasive procedures, such as skin cancers, gynecological tumors and genitourinary tumors.

Diagram showing the insertion of high-dose radioactive wires to treat prostate cancer
By placing the radioactive source inside the body, brachytherapy can target tumors more directly than external beam radiotherapy. Cancer Research UK/Wikimedia Commons, CC BY-SA

The conventional approach to brachytherapy involved using needles to place or inject radioactive seeds inside or adjacent to the cancerous tissue. These seeds would remain in the body either temporarily or permanently, with the goal of irradiating the area at a low dose over a long period of time.

An increasingly popular form of brachytherapy called high-dose rate brachytherapy involves using a tube to guide a more highly radioactive seed directly to the affected tissue before removing it after a few minutes. The seed emits a high dose of radiation in a short period of time, which enables clinicians to treat patients quickly in an outpatient setting.

Future of radiation therapy

Radiation therapy is continually evolving to more effectively and precisely treat cancer.

For example, a technique that delivers radiation at an ultra-high rate called FLASH-RT has shown promise in its ability to increase dosages without excessive toxicity. Researchers are also exploring treatments using ions heavier than protons to more effectively damage DNA in cancer cells and enhance the efficacy of radiation therapy.

Advances in the field hint at a future of more personalized radiation therapy, highlighting the fusion of technology and medical expertise in the fight against cancer.

Aging U.S. Population a Challenge for Oncologists

Posted by

0


Older patients will have different care goals, preferences, geriatric oncologist says

By 2030 the entire Baby Boomer generation — now estimated by the U.S. Census Bureau to number over 73 million people — will be older than 65.

“This is really important for us who care for individuals with cancer because the peak incidence of cancer diagnosis is in the eighth decade of life,” explained Tullika Garg, MD, MPH, a specialist in geriatric oncology at Penn State Health in Hershey, Pennsylvania, during a session at the Society of Urologic Oncology annual meeting. “It is also the second leading cause of death in people who are 85 and older.”

Urologic oncologists are not going to be immune from the demographic trends, she noted, adding that the incidence of genitourinary cancers is going to increase precipitously in older adults in the next few years.

Garg emphasized that oncologists should realize that older cancer patients are going to be different from their younger counterparts — particularly in terms of age-related conditions, as well as treatment goals and preferences — pointing to results from the GOSAFE (Geriatric Oncology Surgical Assessment and functional rEcovery) study, which assessed 977 geriatric patients prior to undergoing cancer surgery, and found that:

  • 20% had difficulty walking
  • 10% had a history of one or more falls
  • 37% were taking more than five medications
  • 31% had decreased food intake prior to surgery
  • 66% screened positive for frailty

These conditions actually inform why geriatric cancer patients have different goals and preferences, Garg said. “They’re worried how cancer treatment will impact their current geriatric conditions.”

For example, she added, results from a survey of 226 patients ages 60 and older who had a limited life expectancy due to cancer, congestive heart failure, or chronic obstructive pulmonary disease showed that if the outcome from treatment was survival, but with severe functional impairment or cognitive impairment, 74.4% and 88.8% of these patients, respectively, would not choose treatment.

Quoting the late geriatric oncologist Arti Hurria, MD — “Our patients want to know if they are treated, just how sick they are going to get, they want to know if they will be able to continue to function, and if their memory will be intact” — Garg noted that “ultimately between the combination of geriatric conditions and goals and healthcare preferences, our goal is to balance under- and overtreatment in this population.”

However, older adults are a heterogenous group, she said. “And we don’t have great data on how to make these decisions, and our clinical trial data are largely based on younger, healthier patients. We have to find ways to evaluate our patients — figure out who is fit, and then tailor care to what their needs are.”

Furthermore, she pointed out that traditional pre-treatment evaluations focus on chronological age, “which we know is not a great marker of fitness.”

Garg suggested that oncologists should consider adopting the concept of the Geriatric 5 Ms — representing mind, mobility, medications, multicomplexity, and matters to me — to help determine a patient’s fitness for treatment.

“One thing I would really like to do more in my own practice — and I think something which is really important for all of us — is to do cognitive screening,” she said. “Cognitive impairment really impacts the ability to provide good informed consent for surgery, and also impacts a patient’s risk of delirium in the postoperative period.”

Finally, Garg suggested that oncologists use frailty screening tools such as the Geriatric 8 questionnaire and the TUG (Timed Up & Go) test, assess patients’ risks of chemotherapy toxicity with tools such as the Cancer and Aging Research Group’s chemotoxicity calculator, and cultivate relationships with geriatricians.

She also advised oncologists to be mindful of ageism, and their own individual biases regarding age.

“My patients have taught me a lot about what is important to them, and they do worry about their cancer,” Garg said. “Certainly they care about the other non-traditional outcomes I talked about — but they do worry about their cancer, and our goal is to get them whatever treatment we can provide that is tailored to all of their goals and preferences.”

source: Medscape

‘Like’ it or not: The dos and don’ts of social media for oncologists

Posted by

0


Just as physicians became accustomed to wearing pagers 40 years ago or being tied to smartphones 2 decades ago, many have become active on social media as it entered their practices.

The 21st century’s primary communication channel has become such a part of everyday life that several members of the cancer care community formed Collaboration for Outcomes using Social Media in Oncology (COSMO), which held an inaugural, virtual two-day meeting last year.

Source: Adobe Stock.

COSMO began as a crowdsourced group of professionals interacting on Twitter regularly about 6 years ago, according to Don S. Dizon, MD, FACP, FASCO, head of community outreach and engagement at the Cancer Center at Brown University and head of the breast and pelvic malignancies program at Lifespan Cancer Institute.

Don S. Dizon, MD, FACP, FASCO

Don S. Dizon

“It was an informal network of professionals who wanted to look at social media collaborations and really answer the question of why we need to do it now,” Dizon told Healio. “Instead of doing the lofty ‘because you should,’ or relying on altruism, we were just trying to get down to what can we gain professionally from it, but also outlining the risks more clearly.”

Two of COSMO’s planning committee members, Dizon and Deanna J. Attai, MD, FACS, spoke with Healio about the dos and don’ts of social media use among oncologists.

Attai, associate clinical professor of surgery at David Geffen School of Medicine at University of California Los Angeles, said Twitter has evolved over the past decade from a novelty among physician health care providers for sharing information at meetings to an essential tool for a variety of reasons.

Deanna J. Attai, MD

Deanna J. Attai

“One is public health messaging, and I think this has been exemplified due to the COVID pandemic,” said Attai, who has held roles as working group and/or social media editor with Annals of Surgical Oncology, JCO Oncology Practice and ASCO. “I’m definitely seeing more and more physicians really embrace the use of social media to help get accurate information out.”

But in operating a Twitter account, for instance, there can be a fine line between tweeting from a professional or a personal point of view. For Attai, the take-home message is simple: own your content.

“Instead of now saying, ‘Keep your content professional,’ what I say is, ‘Yes, like it or not, as a physician, you’re held to a different standard by the public,’” Attai said. “If you want to put out pictures of you at parties or in a bathing suit at a beach, just own your content. And you must be prepared because that may have a negative impact on you professionally.”

Social media beginners may not understand that a simple “like” on a tweet can be translated as an endorsement and seen by fellow users, according to Attai. Depending on the subject matter — endorsing a tweet about a sports team would seemingly have fewer potential pitfalls than one from a divisive political figure — interacting with social media can lead to trouble a social media novice didn’t see coming.

Dizon embraces all social media channels and encourages everyone to do the same, but he also recommends beginners take some time before engaging.

“Come on in, the water is fine,” Dizon said. “No one is going to advise you to join all of the various platforms. (But when you do), observe, watch and listen until you’re ready (to engage).”

Once oncologists are comfortable interacting on Twitter and overcome any hesitations to join a platform or a conversation, there are many benefits that can help them professionally in practice, according to Attai and Dizon.

Attai has been a regular moderator of #BCSM (breast cancer social media), a weekly forum that began in 2011 as a place for providers, patients and others to discuss breast cancer questions and concerns. In 10-plus years, Attai’s biggest takeaway has been how the weekly Twitter meeting place has improved practitioner-to-patient communication.

“I think many of us feel we have great relationships with our patients, and we encourage them to talk about everything — their treatments, side effects, everything else. But it became apparent very quickly that online you see a very different side of the patients than you do in the exam room, kind of their unfiltered view,” Attai said. “Initially, I was the only doctor on the chat and I didn’t quite have a sense of what my role was or how I really fit in. I just did a lot of listening and realized that, in the office, we’re barely scratching the surface of the patient experience.”

Social media can also be a place for physicians to interact easily with peers who they may otherwise have trouble finding, according to Dizon and Attai. Becoming social media-friendly can lead to research collaborations, not unlike COSMO itself.

They also recommend that, for oncologists, it may be a place where they can easily disseminate and discuss factual information with others, talk about specific clinical research and, perhaps, play a role in increasing trial accrual.

Attai and Dizon said social media users should read information in posts carefully before sharing them and do a small amount of digital homework before fully engaging in a conversation.

“In surgery, one of the things they say is the reason surgery residency is so long is because you need to learn when not to operate, right? So, you don’t have to participate in every discussion. You don’t have to respond to every comment,” Dizon said.

“Most of us just want to have constructive and mutually beneficial conversations,” he said. “You want to take a couple seconds, especially when you’re new, to just make sure that’s a conversation you actually want to have.”

Oncologists are guardedly optimistic about AI. But will it drive real improvements in cancer care?

Posted by

0


Artificial intelligence 
Over the course of my 25-year career as an oncologist, I’ve witnessed a lot of great ideas that improved the quality of cancer care delivery along with many more that didn’t materialize or were promises unfulfilled. I keep wondering which of those camps artificial intelligence will fall into.

Hardly a day goes by when I don’t read of some new AI-based tool in development to advance the diagnosis or treatment of disease. Will AI be just another flash in the pan or will it drive real improvements in the quality and cost of care? And how are health care providers viewing this technological development in light of previous disappointments?

To get a better handle on the collective “take” on artificial intelligence for cancer care, my colleagues and I at Cardinal Health Specialty Solutions fielded a survey of more than 180 oncologists. The results, published in our June 2019 Oncology Insights report, reveal valuable insights on how oncologists view the potential opportunities to leverage AI in their practices.

Limited familiarity tinged with optimism. Although only 5% of responding oncologists describe themselves as being “very familiar” with the use of artificial intelligence and machine learning in health care, 36% said they believe it will have a significant impact in cancer care over the next few years, with a considerable number of practices likely to adopt artificial intelligence tools.

The survey also suggests a strong sense of optimism about the impact that AI tools may have on the future: 53% of respondents said that such tools are likely or very likely to improve the quality of care in three years or more, 58% said they are likely or very likely to drive operational efficiencies, and 57% said they are likely or very likely to improve clinical outcomes. In addition, 53% described themselves as “excited” to see what role AI will play in supporting care.

An age gap on costs. The oncologists surveyed were somewhat skeptical that AI will help reduce overall health care costs: 47% said it is likely or very likely to lower costs, while 23% said it was unlikely or very unlikely to do so. Younger providers were more optimistic on this issue than their older peers. Fifty-eight percent of those under age 40 indicated that AI was likely to lower costs versus 44% of providers over the age of 60. This may be a reflection of the disappointments that older physicians have experienced with other technologies that promised cost savings but failed to deliver.

Hopes that artificial intelligence will reduce administrative work. At a time when physicians spend nearly half of their practice time on electronic medical records, we were not surprised to see that, when asked about the most valuable benefit that AI could deliver to their practice, the top response (37%) was “automating administrative tasks so I can focus on patients.” This response aligns with research we conducted last year showing that oncologists need extra hours to complete work in the electronic medical record on a weekly basis and the EMR is one of the top factors contributing to stress at work. Clearly there is pent-up demand for tools that can reduce the administrative burdens on providers. If AI can deliver effective solutions, it could be widely embraced.

Need for decision-support tools. Oncologists have historically been reluctant to relinquish control over patient treatment decisions to tools like clinical pathways that have been developed to improve outcomes and lower costs. Yet, with 63 new cancer drugs launched in the past five years and hundreds more in the pipeline, the complexity surrounding treatment decisions has reached a tipping point. Oncologists are beginning to acknowledge that more point-of-care decision support tools will be needed to deliver the best patient outcomes. This was reflected in our survey, with 26% of respondents saying that artificial intelligence could most improve cancer care by helping determine the best treatment paths for patients.

AI-based tools that enable providers to remain in control of care while also providing better insights may be among the first to be adopted, especially those that can help quickly identify patients at risk of poor outcomes so physicians can intervene sooner. But technology developers will need to be prepared with clinical data demonstrating the effectiveness of these tools — 27% of survey respondents said the lack of clinical evidence is one of their top concerns about AI.

Challenges to adoption. While optimistic about the potential benefits of AI tools, oncologists also acknowledge they don’t fully understand AI yet. Fifty-three percent of those surveyed described themselves as “not very familiar” with the use of AI in health care and, when asked to cite their top concerns, 27% indicated that they don’t know enough to implement it effectively. Provider education and training on AI-based tools will be keys to their successful uptake.

The main take-home lesson for health care technology developers from our survey is to develop and launch artificial intelligence tools thoughtfully after taking steps to understand the needs of health care providers and investing time in their education and training. Without those steps, AI may become just another here today, gone tomorrow health care technology story.

Atrocious State of Cancer Treatment in the U.S.

Posted by

0


Story at-a-glance

  • Despite a decades-long war on cancer, and the “most advanced” treatments known to 21st-century oncologists, many cancer diagnoses remain a death sentence
  • Patient requests for possible experimental, natural or outside-the-box treatments are typically denied by oncologists who refuse to deviate from the hospital’s standard protocol
  • The film “Surviving Terminal Cancer” follows the story of those who have survived terminal cancer by bucking the system and taking their health and cancer treatment into their own hands

Being diagnosed with glioblastoma multiforme, a type of brain tumor, is considered a death sentence by modern medicine.

Despite a decades-long war on cancer, and the “most advanced” treatments known to 21st century oncologists, people who develop this aggressive, fast-growing cancer are given a prognosis of about 15 months to live — if they’re lucky.

Aggressive treatment, including surgery, radiation and chemotherapy, is often started, even though oncologists know it won’t cure the disease. If you ever find yourself in this type of nightmarish scenario, you can imagine the desperation you would feel to find something, anything, that might offer hope.

Most people turn to their oncologists or neurosurgeons with such requests for possible experimental or outside-the-box treatments, but you’re unlikely to receive any help that deviates from the hospital’s standard protocol.

It’s not that such treatment options don’t exist; they do. The problem is that the oncologist can’t, or won’t, prescribe them. To do so would risk his or her reputation and even medical license, should you decide to sue.

The film interviews a number of oncologists that carefully describe their predicament. But the problem is even larger than this. Modern cancer care is not set up to treat you, an individual. Their primary goal is to validate experimental therapies for future cancer patients many years down the road.

Due to regulatory red tape, drug-company greed, failures in the scientific process and lack of a universal will to do what’s best for each and every patient, modern cancer care fails an unacceptable percentage of the time.

As Albert Einstein said, the definition of insanity is doing the same thing over and over again and expecting different results. This describes modern cancer treatment in a nutshell.

How One Man Survived Terminal Cancer

Ben Williams, Ph.D., professor emeritus of Experimental Psychology at University of California, San Diego, shouldn’t be here today. He should be one of the statistics — 1 of the more than 15,000 people who die from glioblastoma multiforme in the U.S. every year.1

Yet, he’s alive — 19 years after his initial glioblastoma multiforme diagnosis. His survival was brushed off as a rare fluke by his doctors, but Williams believes otherwise.

In his book “Surviving Terminal Cancer: Clinical Trials, Drug Cocktails, and Other Treatments Your Oncologist Won’t Tell You About,” he details the multi-faceted strategy he used to overcome the disease. You can hear him tell his story first-hand in the film “Surviving Terminal Cancer,” above.

It’s becoming increasingly clear that in order to outsmart cancer, you’ve got to attack it from multiple angles, especially in the case of complex brain cancer. And that’s what Williams did.

He described a mushroom extract that’s used routinely to treat cancer in Japan. It has zero toxicity, but it’s not even mentioned in the U.S.

He did his own research, finding out about the potential to use existing non-cancer medications off label to treat the deadly disease. Once a patent expires on a drug, its potential to rake in major profits plummets. As such, drug companies typically abandon them in favor of newer, more profitable pursuits.

Abandoned Drugs Show Promise but Oncologists Won’t Prescribe Them

Some of these abandoned drugs have shown promise for glioblastoma multiforme, but they’re not offered to U.S. patients. While I’m not in favor of over-prescribing medications, if you’re facing a deadly prognosis you’re probably willing to risk the side effects if it gives you a chance for survival.

High-dose tamoxifen, a breast cancer drug, is one such medication that has shown some promise in treating glioblastoma multiforme.2

The anti-malaria drug chloroquine is another.3 There’s even a good chance your neuro-oncologist may be aware of the promising studies done with these drugs, but he or she won’t offer them as a potential treatment because they’re considered experimental. As Williams said:

“It made absolutely no sense to me not to use everything that might have a benefit as long as the toxicities were acceptable. Why wouldn’t anyone want to add them? It seemed to be totally irrational that people didn’t use everything that was available.”

When Modern Medicine Fails Them, Cancer Patients Turn to Self-Medication and the Black Market

In order to survive, Williams turned to self-medicating, a dangerous prospect by any account but, again, when your life is at stake you’re willing to take the risk. And his story is not unique.

Many have traveled to other countries, forged prescriptions, feigned illnesses to get access to different medications and even traded medications and nutraceuticals on the “black market” in order to have even a chance at survival.

In Williams’ case, his daily cocktail of off-label medications and natural products worked. In just six months, his brain tumor had disappeared and it hasn’t been back since.

There are more than a handful of others who have defied odds and lived long term with glioblastoma multiforme, and they’ve taken matters into their own hands too.

Williams now spends the bulk of his time trying to help others with terminal cancer, and he makes his book, which he updates annually, free to cancer patients in need.

Natural Cancer Fighters Overlooked by Modern Medicine

Nature is an invaluable resource for fighting cancer, yet natural products, even those that have been intensely studied, are also left out of cancer patients’ treatment plans. Curcumin — one of the most well-studied bioactive ingredients in turmeric — is one glaring example.

It exhibits over 150 potentially therapeutic activities, including anti-cancer properties.

As noted by Dr. William LaValley — a leading natural medicine cancer physician whom I’ve previously interviewed on this topic — curcumin is unique in that it appears to be universally useful for just about every type of cancer.

Superficially, this appears unusual considering the fact that cancer consists of a wide variety of different nuclear genetic defects. One reason for this universal anti-cancer proclivity is curcumin’s ability to decrease the primary mitochondrial dysfunction that is likely one of the foundational causes of cancer. Once it gets into a cell, it also affects more than 100 different molecular pathways.

And, as explained by LaValley, whether the curcumin molecule causes an increase in activity of a particular molecular target or decrease/inhibition of activity, studies repeatedly show that the end result is a potent anti-cancer activity. Moreover, curcumin is virtually non-toxic, and does not adversely affect healthy cells, suggesting it selectively targets cancer cells — all of which are clear benefits in cancer treatment.

Research has even shown that it works synergistically with certain chemotherapy drugs, enhancing the elimination of cancer cells. If you have cancer, curcumin is one substance you should be taking, but your oncologist won’t recommend it.

To Survive Cancer, Many Must Defy Their Doctors

Should you bring up the fact that you are using approaches to fight cancer that are outside of your oncologist’s realm of experience — things like supplements, medical marijuana, herbal preparations, and more — you might be scolded, berated, threatened or even fired from the practice.

Williams never told his oncologists about his self-prescribed treatment; he knew it would fall on deaf ears. The cancer industry should be learning from the people who have beaten the odds and survived terminal cancer — studying their methods and trying to apply them to others — but instead they’re ignored.

It’s an unfortunate state of affairs when patients must actively defy their doctors in order to survive. As Williams explained, going against the advice of his doctors was initially an act of desperation, but it was necessary to save his life. This certainly applies to the majority of conventional oncologists, but there are exceptions — doctors who are blazing a new trail to find a cancer cure.

This includes Dr. Marc-Eric Halatsch, a professor and senior consultant neurosurgeon at the University of Ulm, Germany, who, along with colleagues have developed a new treatment protocol for relapsed glioblastoma.

It’s based on a combination of drugs (very similar to the early HIV treatments) “not traditionally thought of as chemotherapy agents, but that have a robust history of being well-tolerated and are already marketed and used for other non-cancer indications.”4 As noted in the featured film, even though the protocol uses mainstream medications, he’s put his reputation on the line to step outside the conventional cancer-treatment box.

Cancer Patients Should Have Access to the Best of Eastern and Western Medicine

Dr. Raymond Chang, who is featured in the video above, is one such pioneer in the integration of Eastern and Western medicine. He is known for his work on anti-cancer Chinese botanicals especially involving bioactive polysaccharides and medicinal mushrooms.

He and colleagues with the Institute of East-West Medicine have created the Asian Anti-Cancer Materia Database, which brings together traditional Asian medicines that have potential anti-cancer activity into one database that can be accessed by all.5 In his book, “Beyond the Magic Bullet ― The Anti-Cancer Cocktail,” Dr. Chang explained:

“While scientists win occasional skirmishes in the battle against cancer, the overall war continues to go badly. Stories abound about revolutionary drugs that may be available in the future, but offer no real help to those who have cancer today. At present, conventional approaches continue to rely on a narrowly focused strategy of treatments, with doctors using, at best, only one or two drugs or other therapies at a time.

While this may be acceptable in a laboratory setting or a clinical trial, it has done little to diminish the number of people who die each year from this dread disease. Recently, however, conventional medicine’s core strategy has been re-examined, and a new, potentially more effective approach has emerged ― one that combines the best of Eastern wisdom with Western science.”

More Than Half a Million People Expected to Die From Cancer in 2016

In 2016, nearly 1.7 million new cases of cancer are expected to be diagnosed in the U.S., while nearly 600,000 will die from the disease.6  That is nearly 1,650 people dying EVERY DAY in the U.S. alone. Public health agencies claim that we are winning the war against cancer, but from 2003 to 2012 death rates from cancer decreased by only 1.8 percent per year among men and 1.4 percent per year among women.7

Meanwhile, the 2014 World Cancer Report issued by the World Health Organization (WHO) predicted worldwide cancer rates to rise by 57 percent in the next two decades.8

The report refers to the prediction as “an imminent human disaster,” noting countries around the world need to renew their focus on prevention rather than treatment only. Christopher Wild, Ph.D., director of the International Agency for Research on Cancer, told CNN:9

“We cannot treat our way out of the cancer problem. More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in cancer burden globally.”

There is so much you can do to lower your risk for cancer, but please don’t wait until you get the diagnosis — you have to take preventative steps now. Cancer doesn’t typically develop overnight, which means you have a chance to make changes that can potentially prevent cancer from developing in the first place. Most of us carry around microscopic cancer cell clusters in our bodies all the time.

The reason why we all don’t develop cancer is because as long as your body has the ability to balance angiogenesis properly, it will prevent blood vessels from forming to feed these microscopic tumors. Trouble will only arise if, and when, the cancer cells manage to get their own blood supply, at which point they can transform from harmless to deadly. It’s much easier to prevent cancer than to treat it once it takes hold.

Top Cancer Prevention Strategies

I believe you can virtually eliminate your risk of cancer and chronic disease and significantly improve your chances of recovering from cancer if you currently have it, by following these relatively simple strategies.

1.Eat REAL Food: Seek to eliminate all processed food in your diet. Eat at least one-third of your food raw. Avoid frying or charbroiling; boil, poach or steam your foods instead. Consider adding cancer-fighting whole foods, herbs, spices and supplements to your diet, such as broccoli sprouts, curcumin and resveratrol.

2.Carbohydrates and Sugar: Sugar/fructose and grain-based foods from your diet need to be reduced and eventually eliminated. This applies to whole unprocessed organic grains as well, as they tend to rapidly break down and drive up your insulin level.

The evidence is quite clear that if you want to avoid cancer, or you currently have cancer, you absolutely MUST avoid all forms of sugar, especially fructose, which are dirty fuels generating excessive free radicals and secondary mitochondrial damage.

3.Protein and Fat: Consider reducing your protein levels to 1 gram of protein for every kilogram of lean body mass, or one-half gram of protein per pound of lean body mass. Replace excess protein with high-quality fats, such as organic eggs from pastured hens, high-quality grass-fed meats, raw pastured butter, avocados, pecans, macadamias, and coconut oil.

4.GMOs: Avoid genetically engineered foods as they are typically treated with herbicides such as Roundup (glyphosate), and are likely to be carcinogenic and contribute to mitochondrial dysfunction. Choose fresh, organic, and preferably locally grown foods.

5.Animal-Based Omega-3 Fats: Normalize your ratio of omega-3 to omega-6 fats by consuming anchovies, sardines, wild Alaskan salmon or taking a high-quality krill oil and reducing your intake of processed vegetable oils.

6.Optimize Your Gut Flora: This will reduce inflammation and strengthen your immune response. Researchers have found a microbe-dependent mechanism through which some cancers mount an inflammatory response that fuels their development and growth.

They suggest that inhibiting inflammatory cytokines might slow cancer progression and improve the response to chemotherapy. Fermented foods are especially beneficial for gut health, and the fermentation process involved in creating sauerkraut produces cancer-fighting compounds such as isothiocyanates, indoles and sulforaphane.

7.Exercise and Move More: Sit less, move around more and try to take 10,000 steps a day.  Exercise also lowers insulin levels, which creates a low-sugar environment that discourages the growth and spread of cancer cells. In a three-month study, exercise was found to alter immune cells into a more potent disease-fighting form in cancer survivors who had just completed chemotherapy.

Researchers and cancer organizations increasingly recommend making regular exercise a priority in order to reduce your risk of cancer and help improve cancer outcomes. Exercise may also help trigger apoptosis (programmed cell death) in cancer cells. Ideally, your exercise program should include balance, strength, flexibility, and high-intensity interval training (HIIT). For help getting started, refer to my Peak Fitness Program.

8.Vitamin D: There is scientific evidence you can decrease your risk of cancer by more than half simply by optimizing your vitamin D levels with appropriate sun exposure. Your serum level should hold steady at 50 to 70 ng/ml, but if you are being treated for cancer, it should be closer to 80 to 90 ng/ml for optimal benefit.

If you take oral vitamin D and have cancer, it would be very prudent to monitor your vitamin D blood levels regularly, as well as supplementing with vitamin K2, as K2 deficiency is actually what produces the symptoms of vitamin D toxicity.

9.Sleep: Make sure you are getting enough restorative sleep. Poor sleep can interfere with your melatonin production, which is associated with an increased risk of insulin resistance and weight gain, both of which contribute to cancer’s virility.

10.Exposure to Toxins: Reduce your exposure to environmental toxins like pesticides, herbicides, household chemical cleaners, plastics chemicals, synthetic air fresheners and toxic cosmetics.

11.Exposure to Radiation: Limit your exposure and protect yourself from radiation produced by cell phones, towers, base stations, and Wi-Fi stations, as well as minimizing your exposure from radiation-based medical scans, including dental x-rays, CT scans, and mammograms.

12.Stress Management: Stress from all causes is a major contributor to disease. It is likely that stress and unresolved emotional issues may be more important than the physical ones, so make sure this is addressed. My favorite tool for resolving emotional challenges is the Emotional Freedom Techniques (EFT).

Have You Been Diagnosed With Cancer?

One of the most essential strategies I know of to treat cancer is to starve the cells by depriving them of their food source. Unlike your body cells, which can burn carbs or fat for fuel, cancer cells have lost that metabolic flexibility. Dr. Otto Warburg was given a Nobel Prize over 75 years ago for figuring this out, but virtually no oncologist actually uses this information.

You can review my interview with Dominic D’Agostino, Ph.D. below for more details. Integrating a ketogenic diet with hyperbaric oxygen therapy is deadly to cancer cells. It debilitates them by starving them of their fuel source. This would be the strategy I would recommend to my family members if they were diagnosed with cancer.

Watch the video discussion. URL:https://vimeo.com/119006145

Source:mercola.com

A Shortage of Oncologists

Posted by

0


In the crucible of cancer treatment, the bonding of patients with physicians often makes the unendurable endurable. The difficulty of finding and then keeping the right oncologist can therefore be fraught. Yet this problem, not uncommon today, is on track to grow worse.

“My doctor is terribly overworked and isolated,” my friend Lucy said recently to the other members of our cancer support group. She worried that her doctor, the only gynecologic oncologist left at Indiana University’s Simon Cancer Center, would burn out. “He needs to have colleagues to help shoulder the patient load and also provide him a sense of community.”

Women with ovarian cancer are told repeatedly that we must find a specialist. Yet in many areas of the country, it is impossible. There are no ovarian cancer specialists in my small town in southern Indiana. Upon diagnosis in 2008, I was instructed to drive an hour and a half to the Simon Cancer Center in Indianapolis for the debulking operation that would be performed by a gynecologic oncologist.

Afterward, I was told that I could choose my surgeon or one of three other specialists at my state’s premier medical institution to oversee my chemotherapy regimen. At that time there were four experts treating patients with gynecological cancers there.

I picked a medical oncologist who specialized in ovarian cancer. When my doctor left for a position in another city, I was in a Phase I clinical trial, as I am now. I was assigned to the principal investigator of that trial, who happened to be a breast cancer specialist. It was unnerving to be enveloped in pink — cover-ups, forms, you name it — and told by staff members, who mistakenly assumed I was there for breast exams, to undress from the waist up. Yet her research had extended my life. After that doctor also departed, I was given to another breast cancer physician who has promised to examine my breasts only once a year.

Patients without the resources to travel, especially those with less common forms of cancer, must face greater challenges. Away from academic centers, many oncologists function as generalists who treat numerous cases of breast, prostate, lung and colorectal cancer, but who less frequently encounter esophageal, adrenal, oral, muscle, bone or brain cancers. This is an issue for patients who live in rural areas.

Are there disincentives for medical students that route them away from specializing in rarer or more lethal types of cancer, asked Dana, another member of my support group. We speculated that it must be distressing for doctors to work without colleagues.

At home and online, I was surprised to discover that the problem of finding a doctor extends to oncologists in general, not just to those with specific expertise.

In 2007, a study conducted by the American Society of Clinical Oncology (ASCO) anticipated that cancer occurrences would soon outpace oncology services. A 2014 follow-up analysis in the Journal of Oncology Practice predicted that demand will grow by about 40 percent, whereas supply may grow only about 25 percent by the year 2025. “Unless oncologist productivity can be enhanced, the anticipated shortage will strain the ability to provide quality cancer care,” the authors concluded.

The combination of an aging population and an inadequate number of newly trained professionals will harm overworked cancer physicians and underserved patients alike.

Putting on our activist hats, the members of my support group decided that we should lobby for more hires by writing a letter to the Simon Cancer Center, to be sent to the various administrators in charge of the medical school.

We included data showing that Indiana — even before the loss of our specialists — lagged near the bottom of American states in terms of board-certified gynecologic oncologists per million residents: We had about two physicians per million people, compared with a national average of about three and with about six to 10 in a few states at the top of the list.

At our next meeting, while six of us reviewed the letter, we listened in stunned silence as one of our group members told us that Lucy’s doctor had just decided to leave the Simon Cancer Center. Now there would be no gynecological oncologists there.

That night I considered the brilliant physicians who have directed my eight years of cancer treatment. Thanks to these smart and resourceful women, I have survived three years beyond the expiration date I had initially been given. I would not be alive today without their guidance and support.

The next week, when Lucy went online to the Simon Cancer Center home page and typed “ovarian cancer” into the Find a Doctor tool, she got a list of pediatric surgeons.

Like the other members of the support group, Lucy and I do not have a solution for the shortages in oncology. A microcosm of the cancer community, we can only call attention to the problem.

It is important to make the environments in which oncologists grapple with a sinister disease conducive to their well-being. Only then can they properly attend to the manifold concerns of current patients and expand the medical training of the physicians many others will need in the future.