360° of Cancer Care

There is nothing quite so terrifying as hearing the word “cancer” come out of a doctor’s mouth. Cancer is personal. It takes an emotional, spiritual, psychological and financial toll. It affects friends, family and loved ones. But mostly cancer triggers fear like little else. Many find strength to fight through their fear as they find a path to recovery.

Fifteen years ago I lost a dear college friend to an aggressive form of breast cancer that she’d been battling since she was 20. Had she developed it today, she likely would have survived. That’s the good news.

Technology and treatments keep improving and getting more fine tuned and individualized. Chemo and radiation no longer pack as huge a wallop as they once did. Physicians from varying disciplines are now working together seamlessly to create personalized care programs for patients. No cancer case is ever treated just like another.

Research and clinical trials are revealing a new host of medicines that are better tolerated and more successful for a variety of cancers. And just as comforting is the additional support available for cancer patients—from support groups to meditation and yoga classes to nutritional counseling and even assistance with hair and makeup.

The Hunt Cancer Institute at Torrance Memorial Medical Center, fully accredited as a comprehensive cancer program by the American College of Surgeons Commission on Cancer, is a clear leader in these advancements in targeted treatments, technology, research and applying a 360-degree approach to cancer care.

Torrance Memorial physicians who specialize in cancer treatment predict that someday a cancer diagnosis will not be considered fatal but instead 100% treatable—if not curable. In fact, most say they see this happening within their—or their children’s—lifetimes.

Why is this? Because standard cancer treatments are evolving rapidly, creating a paradigm shift into therapies that are less toxic and with fewer side effects, creating a better quality of life for the patient and faster healing.

Just ask Thomas Wood. In June, the 71-year-old from Rancho Palos Verdes went home two days after surgery to remove cancer in his right upper lung and lymph node. “I felt little pain. Very little. I took a Tylenol, but that was it. A week later, I’m out shopping for a new range for our kitchen. It’s amazing,” says Wood, who witnessed his father battle lung cancer.

“I lost my dad to lung cancer at 55 years old in 1952. If he’d been going through it today, he could have beat it.”

This type of quick recovery—especially at an advanced age and after receiving several rounds of chemo and radiation in the months prior to surgery—would not have been possible just 20 years ago, according to Wood’s physician, Clark B. Fuller, MD, a thoracic and cardiothoracic surgeon who helped pioneer minimally invasive video-assisted techniques in thoracic surgery. These techniques allow small incisions to be made instead of large ones and utilize the aid of a camera, as well as precise robotic equipment.

“In the mid-1990s, most patients [undergoing similar surgeries] were in the hospital 10 to 12 days,” Dr. Fuller explains. It took longer to heal back then, as surgeries involved much larger incisions—often spreading the rib cage apart. This approach required more pain relief and anesthesia management as well, increasing risk.

Dr. Fuller now teaches his minimally invasive technique to physicians across the country. “Instead of a big incision with ribs spread apart, these are all incisions 5 to 15 millimeters long. We’re able to do the exact same operation a bit better with less pain for the patient and a much faster recovery period.”

When patients are in pain, their bodies—at any age and any level of fitness—will have a harder time tolerating further treatments, due to a lack in strength. “So if they need additional chemo and radiation, they are more likely to tolerate it since they didn’t have to undergo pain from such a big cut. In fact, patients are 50% more likely to complete it [chemo and radiation] than if they had undergone a standard surgical approach,” says Dr. Fuller. “There are only a handful of hospitals that can do that surgery after chemo and radiation. It’s a very sophisticated way of treating patients.”

Equally encouraging is how chemo and radiation did not give Wood the intense side effects that his father and many others likely endured in the past. “From February 1st, I had 25 radiation and five chemo treatments administered by a team of five to six doctors, and everything went well. Only toward the very end of radiation did I get a sore throat. I found out later that’s very common. It’s hard to swallow. But I had a brief period of this—so very lucky,” says Wood. “I’ll be 72 soon, and I’ve got a full head of grey hair and only lost a little weight I probably needed to lose!”

SMARTER MEDICINE

While physicians have been able to fine-tune chemo and radiation levels to make them a bit more tolerable, much research is being conducted in alternative and targeted treatments. Many in the industry see a future when chemo and radiation are replaced by molecularly targeted treatments or checkpoint inhibitors—therapies that kill only cancer cells without touching healthy tissue or white blood cells, keeping immune systems intact. Chemo and radiation kill all fastgrowing cells; targeted therapies will not.

In fact, Hugo Hool, MD, a board certified medical oncologist and hematologist with 15 years of experience in research and patient care, says he entered the field of cancer care due to these “glimmers of light” he saw while in early training and fellowship, suggesting “these days would come.”

“It’s a paradigm shift. We’ve gone from the Stone Age to the Bronze Age and we want to modernize oncology using our genome as the guide,” says Dr. Hool. “Instead of hitting people over the head, we can treat them with less side effects and with more efficacy. We can turn off cancers [with new treatments] and use the body’s own immune system to our benefit.”

According to Dr. Hool, oncology is at the forefront of technology with ever-increasing tools and new tailored treatments. “I am most excited about the treatments that stimulate our own immune systems to fight cancer for us. A new class of drugs called checkpoint inhibitors, like those known as PD-1/ PDL-1 inhibitors/blockers, are very promising. Several have been approved in the past several months. While the cancer is trying to grow, these checkpoint inhibitors can stop the cancer from getting past the body’s own surveillance system. This is how the body’s immune system is suppose to prevent cancers from developing.”

Dr. Hool is currently using two PD-1 inhibitors called nivolumab and pembrolizumab with patients. He added that at the American Society for Clinical Oncology (ASCO) conference in June a phase III study was presented showing how effective nivolumab was—even besting chemotherapy in lung cancer.

Targeted therapies are also proving to be valuable tools. A patient of Dr. Hool’s with both breast and lung cancer is currently receiving a targeted medication tailored specifically for the exact mutation found in her tumor, the Epidermal Growth Factor Receptor (EGFR).

“She had surgery to remove both her lung and breast cancer and now is going forward with a radiation protocol combined with this targeted agent that is specifically tailored for her mutation called Erlotinib. This is a pill she will take on a daily basis,” explains Dr. Hool. “This is a new paradigm in the treatment of cancer to tailor therapy based on molecular or genetic mutations found in those cancers. Erlotinib, for instance, is proving in clinical trials to be better than chemotherapy when tailored to the patient’s tumor genetics. It has less nausea and common side effects than standard chemotherapy, offering a better quality of life during treatment.”

David Chan, MD, a cancer specialist and author of the book Breast Cancer: Real Questions, Real Answers, is a lead investigator on multiple clinical trials and has firsthand knowledge of how quickly cancer care is evolving. “We are very excited to be involved in a national effort to develop a molecular blood test for breast cancer. These kinds of tests, referred to as a liquid biopsy, will be very accurate in monitoring cancer disease status. We were selected by Genomic Health as one of 10 centers in the country based on the large volume of breast cancer patients at Cancer Care, Torrance Memorial Physician Network,” says Dr. Chan. “The study will soon be expanding to include lung cancer, melanoma and GI cancers. It’s the wave of the future in terms of cancer diagnostics and monitoring. The breast cancer program has an experienced team of specialists and sees over 400 new patients a year. We have an outstanding diagnostic program with 3-D mammograms and breast MRIs, experienced and outstanding breast surgeons, radiation therapists and medical oncologists. The care of each patient is carefully reviewed at our weekly breast conference.”

Dr. Chan has 30 years of experience and asserts that one of the strengths of the program at Torrance Memorial is the combination of experience and academic affiliations of the specialists. “We don’t have specialists who are just out of training. We’ve all been in practice for years. Many of us have taught at universities. Our newest radiation oncologist was a former professor at Yale.”

The bottom line for cancer specialists is to find a therapy that is more effective with less side effects, ideally allowing patients to live normal lives, which is what Torrance Memorial physicians strive to do. In fact, Torrance Memorial is currently participating in more than 20 clinical trials and is constantly requested by the biotech industry to open more trials in order to advance cancer research and treatment.

“People are living so much longer now with productive lives. Our patients are often able to go to work while on treatment, care for their families and go on vacations. The dramatic improvement in longevity and quality of life is gratifying to see,” says Dr. Chan.

IT TAKES A VILLAGE

It’s clear that less pain from surgery and fewer side effects from chemo and radiation played a large role in the speedy recovery of Dr. Fuller’s lung cancer patient, Thomas Wood. Without a multidisciplinary approach, his experience would not have been as seamless. Torrance Memorial physicians stress how important this approach is to their patient’s care. “A team of physicians worked together, from a radiologist to a bronchial specialist [who conducted a bronchoscopy test to examine the airways of the lungs], an oncologist, anesthesiologist and thoracic surgeon. Constant and open communication is key,” says Dr. Fuller.

Dr. Chan echoes his colleague’s sentiment, adding, “With each case, we hold a multidisciplinary conference that makes coordinated treatment decisions. The team includes diagnostic radiologists, pathologists, surgeons, radiation oncologists and medical oncologists.”

This approach is especially important when treating patients with multiple conditions—requiring constant communication between physicians who may not always work together. For example, Dr. Hool’s patient with both breast and lung cancer requires a large multifaceted multidisciplinary team of physicians to treat her. “She required a large array of interventions that included chemotherapy, radiation, surgery, interventional radiology, biologic (anti-hormone) and targeted therapies for her cancers,” he explains.

Dr. Hool says his patient is doing “extremely well” and continues with treatment “in high spirits.” He credits the experience of the physicians and the strength of the team.

“It takes a facility that has a high volume of patient care to have expertise to treat someone like this. That’s what sets Torrance Memorial Medical Center and Cancer Care apart from other facilities,” says Dr. Hool. “For her care, she saw Thyra Endicott, MD, radiation oncology, and Clark Fuller, MD, thoracic surgery, as well as George So, MD, interventional radiologist, Melanie Friedlander, MD, breast surgeon, and I quarterbacked as medical oncologist. It takes a lot of talented people working together to give the patient the best care possible.”

In addition to the skilled lung cancer team, Dr. Chan adds that he is also excited to work with so many experienced physicians such as Andrew Horodner, MD, an expert in benign and malignant hematology, and Syed Jilani, MD, an expert in breast, lung, prostate and colon cancer care, Patricia Sacks, MD, a breast radiology expert, as well Neil Bhayani, MD, for liver and pancreas.

“We have strong physicians here at Torrance Memorial. It’s just exceptional that I’m able to work with such a high quality of doctors. It’s remarkable how well trained, skilled and experienced everyone is,” says Dr. Fuller.

Wade Nishimoto, MD, at California Hematology Oncology Medical Group, is an oncologist affiliated with the Hunt Cancer Institute. “The program is constantly evolving and getting better, and that’s great news for the patients we serve,” he says. “As oncologists, we are fortunate that Torrance Memorial has invested so heavily in building this program. Not all hospitals have the resources or event the interest to do so. It makes it easier to provide patients with the best standard of care possible.”

Not only does the program have the highest level of skilled team members, but the latest equipment in the diagnosis of cancer. For example, Torrance Memorial’s Polak Breast Diagnostic Center recently added digital breast tomosynthesis, or 3-D (three-dimensional) mammography. This is a proven technology and the best screening tool available for capturing breast cancer for most patients, especially those with dense breasts whose breast cancer risk is three times higher than those without dense breasts.

“3-D mammography is 41% more accurate at diagnosing breast cancer than previous technology, and decreases the “call-back” or need for additional imaging by 40%,” says Patricia Sacks, MD, medical director of the Polak Breast Diagnostic Center.

KEEPING SPIRITS UP

While less quantifiable than quality health care, a positive mental attitude is critical when fighting cancer. That’s why Torrance Memorial offers a wide variety of support services.

To navigate all the support programs available, the hospital has nurse navigators. Each patient is assigned a nurse whom they can call at any time to talk about concerns or to inquire about services including counseling, nutritional support, smoking cessation, support groups, yoga and meditation classes, and more.

Melissa Gunlund, MSN, RN, is a thoracic nurse navigator whose role is to work with newly diagnosed lung cancer patients. “I’m a resource for the patient—to educate them on what their treatment plan will look like or help them with issues such as problems getting to appointments, insurance complications or when seeking financial resources or psych-social services,” she explains. “Patients can call me any day of the week or come in and have a one-on-one to discuss what they’re struggling with so I can assess their needs. It can be terrifying to get a sudden diagnosis. I’m here to educate them and give them access to the resources they need and be someone to talk with about what they’re going through.”

The hospital holds many support groups. For more information please contact The Cancer Research Center at 310-517-4665.

Anything that can lower a patient’s stress level and provide support and hope can improve chances of survival. Physicians agree that a positive attitude is important for healing. And the healthier the attitude, the more likely a patient is to communicate well with a physician, which can make a big difference.

“I think attitude is extremely important because of compliance and also how likely it is for the patient to complete therapy,” says Dr. Chan. “They are more likely to discuss side effects and have good follow-up and communication. Going in with an open mind and having trust in their physician is important because they buy into the treatment plan and into taking care of their own health.”

“A positive attitude and mental approach is imperative to healing. I can’t quantify it—it just is,” adds Dr. Fuller.