chemotherapy

Living with cancer in the country: Many Wyoming residents must leave home to seek the care they need

Source: trib.com
Author: Katie King

Bob Overton is all too familiar with the 140-mile stretch of land between Thermopolis and Casper.

He and his wife, Sherry, made the two-hour trip in their white pickup dozens of times while Bob was undergoing treatment for lymphoma in 2015. Even with the help of Alan Jackson and Martina McBride’s music, the hours still lagged, with nothing to stare at except endless grassy plains.

“That trip is pretty monotonous, and it doesn’t get any better with time,” he recalled.

But the couple didn’t have a choice. Their hometown of Thermopolis, population 3,009, doesn’t offer the care Bob needed.

And the Overtons aren’t alone.

As the least populated state in the country, Wyoming appeals to those in search of space and wilderness. But the peace and quiet comes with drawbacks: Services that urban residents may take for granted, like advanced medical care, aren’t readily available for thousands of people living in small towns and rural areas.

Many of those battling cancer in Wyoming subsequently end up seeking treatment in Casper, according to Rocky Mountain Oncology’s Patient Navigator Sam Carrick. She said the center is the only medical facility in the state that offers radiation, chemotherapy and Positron emission tomography scans.

Other areas may offer one or two of those services, but many prefer the convenience of a one-stop shop, she said.

About 15 percent of their patients are from out-of-town, added Carrick, who is responsible for guiding all patients through the treatment process. She said it’s often devastating for people to learn that they can’t get the care they need at home.

“First you are hit over the head with a diagnosis that you didn’t want, and then you can’t get treatment at home, so you have to travel and be away from your family members or pets,” she said.

Some patients drive back-and-forth, but temporarily relocating often becomes necessary during the more intensive treatment phases.

And that was the case with Bob. The 75-year-old initially remained in Thermopolis, only traveling to Casper for intermittent doses of chemotherapy. But he said that wasn’t possible while he was undergoing radiation, which he needed daily for 30 days.

Sherry remembers breaking down into tears when she realized they had to leave home. Already faced with the possibly of losing her husband, not to mention mounting medical bills, the thought of relocating for a month was overwhelming.

“That was just more than I could handle … I just thought, ‘How are we going to do this?’” she said.

***
Battling cancer is difficult for anyone, but those living far away from treatment centers need extra help, said Wyoming Foundation for Cancer Care treasurer Kara Frizell. Finding the money for gas and hotel accommodations can quickly become a serious problem.

“It’s not something you can just come up with,” she explained.

Frizell said the Casper-based charity annually spends between $20,000 and $30,000 assisting patients with necessary travel expenses. The nonprofit also oversees a network of volunteers, called Angels, who help out-of-towners feel at home by delivering meals or dropping off gift baskets.

***
Robert Rasmussen also lives in Rawlins, but he hasn’t had much of a chance to grow attached to the town. He moved from Tuscon, Arizona, in search of peace and quiet. But about a year after moving, he was diagnosed with stage four throat cancer last fall. It quickly became apparent that traveling back and forth to Casper for treatment wasn’t a safe option.

Sitting in his bed in January at the Shepherd of the Valley Healthcare Community — where he’s recovering from surgery — the emaciated 50-year-old removed his oxygen mask and explained that intense radiation and chemotherapy treatments left him far too nauseous and exhausted to drive.

Rasmussen temporarily relocated to Casper in October and brought along his dog, Piggy. The Australian Shepherd is family, and he couldn’t bear to be without her.

“She’s the only thing that keeps me together,” he explained.

Although Rasmussen was worried hotels wouldn’t allow animals, Carrick arranged for both patient and pet to stay at the Sleep Inn in Evansville. The patient navigator also connected him with the cancer foundation to help with the bill.

The hotel staff has since fallen in love with Piggy, according to general manager Carmen Bartow. Employees walk her each day, sneak her treats from the breakfast buffet and even take her to visit her dad.

“She’s our mascot,” said Bartow.

The manager said the inn annually receives about 15 guests who are in town for cancer treatments, likely because of their close proximity to the oncology center. The hotel offers discounted rates for its sick visitors and employees try to help them out in any way possible.

“If we can’t help one another out then there is something wrong with us,” she said.

Rasmussen greatly appreciates everyone who made it possible for Piggy to stay in Casper.

His condition is serious, and distracting himself from the possibly of death isn’t easy, he explained. Surrounded by feeding tubes and beeping monitors, it’s impossible to forget his situation.

“I try to read or watch TV or just focus on something different, but when I’m just sitting here by myself, it’s hard,” he said.

But Rasmussen said he can manage with Piggy by his side for support.

Although his former home in Tuscon was closer to advanced medical care, Rassmussen said he prefers living in small towns because its safer and more peaceful.

“I don’t have any regrets [about moving],“ he said. “City life isn’t for everybody.”

February, 2018|Oral Cancer News|

Evolving role of surgery in multidisciplinary care for head and neck cancer

Source: www.onclive.com
Author: Danielle Bucco

Even with the advent of systemic therapeutic advancements to the armamentarium of head and neck cancer, surgery and novel techniques continue to rapidly evolve to effectively treat patients and leave less opportunity for adverse events (AEs).

Additionally, the role of the surgeon has changed to be a more integrative role in patient care.

“We are more precise and more integrated with other therapeutic modalities,” said Joseph A. Califano, MD. “Together, we work as a team and that is the best way that patients can receive their optimal outcomes. We do not just want to cure their cancer but to get back to function and wellness.”

In an interview during the 2017 OncLive State of the Science SummitTM on Head and Neck Squamous Cell Carcinoma, Califano, a professor of surgery at the University of California, San Diego, discussed how surgery factors into modern multidisciplinary care for patients with head and neck cancer.

OncLive: Please provide an overview of your presentation on surgery for patients with head and neck cancer.
Califano: I discussed the fact that the surgery that we do now for head and neck cancers is very different from what used to be done 15 to 20 years ago. Our ability to do effective surgery is good, but now we can do it in a way that leaves patients with excellent function and cosmetic results.

When you see someone walking down the street who has had major head and neck surgery, you wouldn’t know it because we are doing new techniques that are going through natural orifices to do major significant surgeries.

Can you discuss robotic surgery in this space?
Robotic surgery is part of what we do as head and neck surgeons. It is effective in terms of taking care of tumors—particularly in the throat, the tonsils, the back of the tongue, and perhaps even in the nasopharynx. Ordinarily, we cannot get to them unless we have robotic instrumentation. The beauty of robotic surgery in this setting is that we can have patients with excellent function, good swallowing, good voice, and rapid recovery from a significant procedure that was not available 10 years ago.

How do you believe surgeons fit into multidisciplinary care in head
and neck cancer?
Multidisciplinary care is one of the most important things that we practice when we take care of patients with head and neck cancer. It is not just medical professionals who do chemotherapy or radiation surgery; it is a whole host of other people, such as speech pathologists, dentists, dieticians, social workers, nurses, occupational therapists, and physical therapists.

The reason this is so important is that the effects of our therapy combined are good in terms of curing cancers. The AEs need to be treated. We need to get people back to not just curative cancer, but functioning and happy, as well.

What is your message to community oncologists who do not understand the importance of surgery when systemic therapies are available?
Together as a team, we can do much more effective therapy and leave people with much better functions than we could in isolation. The second message is that surgery has rapidly evolved in the past 5 to 10 years. If you are a community oncologist or a community radiation oncologist, you do not realize that we can treat diseases that 10 years ago were treated with radiotherapy alone. We can very effectively treat with surgery alone or in combination with radiation therapy to reduce the AEs. Those AEs are what our patients are going to feel 10 or 15 years down the road.

For example, the risk of stroke after radiotherapy long term is as high as 6% at 12 years. If we can treat people effectively with surgery alone, then we can eliminate that risk of stroke and eliminate some of the long-term effects of other therapies.

What are some big concerns in head and neck cancer and what would you like to see addressed in the next 5 to 10 years?
Some of the newer targeted therapy and immunotherapy approaches are going to blend in well with surgery; it will be one way we can tell whether someone responds to a systemic agent. For example, if a patient receives immunotherapy alone and has a complete response, we can do a minimally invasive surgery to not only make sure that we clear the disease but even to document that there is no disease and spare the patient additional therapy.

The second thing I would say is that we are going to have a host of imaging technologies available. They are just starting to become clinically applicable. We are going to know exactly where the tumor is so that when we do surgery, we can make sure that we get all the cancer [out] most of the time and reduce the need for additional therapy, such as debilitating combination therapy. We can choose who is good for surgery, who is not, and who is better treated with other therapeutic approaches, such as radiation, chemotherapy, immunotherapy, and targeted therapy.

How is surgery an integrated part of the team?
Historically, we are unlike a lot of other surgeries. We follow our patients throughout the rest of their lifetimes and we are an integrated part of the care team. There are other things we can do as surgeons, for example. We can move salivary glands out of the way of radiation for patients with good saliva function to swallow better and have a better quality of life.

We do not think of ourselves as an isolated [group] to take out the cancer, but we are also there to reconstruct, rehabilitate, and help people get on their way to being well.

The head and neck is all about who we are, how we interact socially, and how we feel about ourselves. Social things that we do with other people are eating, talking, and communicating. There are many who now have these functions after head and neck cancer.

December, 2017|Oral Cancer News|

Young men should be required to get the HPV vaccine. It would have saved me from cancer.

Source: www.thedailybeast.com
Author: Michael Becker

In December 2015, at the age of 47, I was diagnosed with Stage IV oral squamous cell carcinoma.

More simply, I have advanced cancer of the head and neck. While initial treatment with grueling chemo-radiation appeared successful, the cancer returned one year later in both of my lungs. My prognosis shifted from potentially curable to terminal disease. The news was shocking and devastating—not just for me, but for my wife, two teenage daughters, and the rest of our family and friends.

Suddenly, my life revolved around regular appointments for chemotherapy, radiation therapy, imaging procedures, and frequent checkups. I made seemingly endless, unscheduled hospital emergency room visits—including one trip to the intensive care unit—to address some of the more severe toxicities from treatment.

All told, I suffered from more than a dozen side effects related to treatment and/or cancer progression. Some are temporary; others permanent. These include anxiety, depression, distorted sense of taste, clots forming in my blood vessels, dry mouth, weight loss, and many more.

My cancer started with a human papillomavirus (HPV) infection, a virus that is preventable with vaccines available for adolescent girls since 2006 and boys starting in 2011. The Food and Drug Administration (FDA) has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. These vaccines provide strong protection against new HPV infections for young women through age 26, and young men through age 21, but they are not effective at treating established HPV infections. It was too late for me in 2011 when the HPV vaccine was made available to young men, and I was 43 years old.

According to the Centers for Disease Control and Prevention (CDC), more than 30,000 new cancers attributable to HPV are diagnosed each year. Unlike human immunodeficiency virus (HIV), which is spread by blood and semen, HPV is spread in the fluids of the mucosal membranes that line the mouth, throat, and genital tracts, and can be passed from one person to another simply via skin-to-skin contact.

While most HPV cases clear up on their own, infection with certain high-risk strains of HPV can cause changes in the body that lead to six different types of cancer, including cancers of the penis, cervix, vulva, vagina, anus, and head and neck (the last of which is what I have). Two of these, HPV strains 16 and 18, are responsible for most HPV-caused cancers.

Researchers believe that it can take between 10 and 30 years from the time of an initial HPV infection until a tumor forms. That’s why preventing HPV in the first place is so important and the HPV vaccine is so essential.

However, only 49.5 percent of girls and 37.5 percent of boys in the United States were up to date with this potentially lifesaving vaccination series, according to a 2017 CDC report. In sharp contrast, around 80 percent of adolescents receive two other recommended vaccines—a vaccine to prevent meningococcus (PDF), which causes bloodstream infections and meningitis, and the Tdap vaccine to prevent tetanus, diphtheria, and pertussis.

Even if you don’t think your child is at risk for HPV now, they almost certainly will be. HPV is extremely common. Nearly everyone gets it at some point; in fact, the CDC estimates that more than 90 percent and 80 percent of sexually active men and women, respectively, will be infected with at least one strain of HPV at some point in their lives. Around one-half of these infections are with a high-risk HPV strain.

As a cancer patient with a terminal prognosis, I find it infuriating that the HPV vaccine is tragically underutilized more than a decade since its introduction. Two simple shots administered in early adolescence can reduce a child’s risk of receiving a cancer diagnosis much later in life.

Parents who oppose the use of vaccines cite popular misconceptions that they are unsafe, ineffective, and that immunity is short-lived. Others argue that receiving the HPV vaccine may increase sexual promiscuity. Films like Vaxxed based on research that has been discredited, and directed by a researcher who fled the United Kingdom due to the misleading uproar he created, are still quoted as science.

Regardless, the fact remains that millions of adolescents aren’t getting a vaccine to prevent a virus known to cause cancer. We must counter untrue, exposed, and discredited research that keeps some parents from having their children vaccinated and put an end to the campaign of misinformation.

Viruses that are preventable, such as HPV, should be eradicated just like previous success with polio and smallpox. Cancers that are preventable through HPV vaccination should be prevented. The safety and efficacy of these vaccines are no longer subject to serious debate (PDF). Research has shown that vaccinations work; they keep children healthy, save lives, and protect future generations of Americans—but only when they are utilized.

The lesson: Don’t wait. Talk to your pediatrician about vaccinating your 11-year-old boys and girls against HPV today to eradicate this cancer-causing virus.

I only wish my parents had that opportunity when I was young, as it could have prevented the cancer that’s killing me.

December, 2017|Oral Cancer News|

Complex cancer decisions, no easy answers

Source: blogs.biomedcentral.com
Author: Jeffrey Liu

With the many different options now available for the treatment of cancer, it can be very difficult for both clinicians and patients to decide on the best possible treatment strategy, particularly when faced with a complicated cancer. In this blog, Dr Jeffrey C. Liu reflects on the challenges encountered in cancer decision making, particularly when presented with difficult cases.

When treating cancer, sometimes the treatment decisions are straightforward and unambiguous. For example, surgery is the treatment of choice for an early, uncomplicated tongue cancer. However, many times, the recommendation for cancer treatment is not straightforward and requires combination treatment – one or more of surgery, radiation or chemotherapy.

As a head and neck cancer surgeon, I work with a team to make these treatment decisions, and usually team consensus is achieved. However, when we are faced with the choice of multiple treatments that all have the same chance of cure available, it seems to result in a never ending discussion amongst our team.

Take for example an advanced tonsil cancer. These cancers can sometimes be removed first with surgery, a process which removes both the primary cancer and the lymph nodes in the neck. Then, depending on the pathology results, patients may need radiation treatment, chemoradiation or sometimes no further treatment at all. Meanwhile, chemoradiation alone, and no surgery, is an excellent option. Whether the patient receives surgery or no surgery, the chance of cure is pretty much the same. However, based on the need for additional treatment after surgery, the patient may have better, equivalent, or worse function than chemoradiation alone.

How then can a patient make a decision with imperfect data? I wish I could help my patients better with these complex decisions. Most patients will make this decision only once in their lives. With the increased emphasis on patient autonomy, there is sometimes a feeling to just “present the options and let the patient decide.”

However, when a group of smart experienced doctors who all treat the same cancer, cannot reach an agreement, how is a patient with no experience expected to make the right decision? There is not enough time to explain to patients the observations of hundreds of such decisions and their thousands of outcomes. Some patients are so overwhelmed by the decision, that they just want someone to tell them what to do. Others have so many questions and concerns that they get lost in the details and paralyzed by the process. I don’t know the right answer for such patients.

Unfortunately, there is no option but to choose a treatment strategy and move forward. We all carry the hope that one day, with more research and better understanding, such complex decisions for the treatment of cancer, will become the easy ones.

October, 2017|Oral Cancer News|

Penn surgeons become world’s first to test glowing dye for cancerous lymph nodes

Source: www.phillyvoice.com
Author: Michael Tanenbaum, PhillyVoice Staff

Surgeons at the University of Pennsylvania have achieved a global first with the use of a fluorescent dye that identifies cancerous cells in lymph nodes during head and neck cancer procedures.

The study, led by otorhinolaryngologist Jason G. Newman, seeks to test the effectiveness of intraoperative molecular imaging (IMI), a technique that illuminates tumors to provide real-time surgical guidance.

More than 65,000 Americans will be diagnosed with head and neck cancers in 2017, accounting for approximately 4 percent of all cancers in the United States, according to the National Cancer Institute. About 75 percent of these cancers are caused by tobacco and alcohol use, followed by human papillomavirus (HPV) as a growing source for their development.

Common areas affected by these cancers include the mouth, throat, voice box, sinuses and salivary glands, with typical treatments including a combination of surgery, radiation and chemotherapy.

Lymph nodes, which act as filters for the immune system, are often among the first organs affected by head and neck cancers as they spread or resurface. Initial surgeries may leave microscopic cancerous cells undetected in the lymphoid tissue, heightening the risk that a patient’s condition will return after the procedure.

“By using a dye that makes cancerous cells glow, we get real-time information about which lymph nodes are potentially dangerous and which ones we can leave alone,” Newman said. “That not only helps us remove more cancer from our patients during surgery, it also improves our ability to spare healthy tissue.”

With the aid of a fluorescent dye, surgeons are able to key in on suspicious tissue without removing or damaging otherwise healthy areas. Previously adopted for other disease sites in the lungs and brain, the practice now allows Newman’s team to experiment with indocyanine green (ICG), an FDA-approved contrast agent that responds to blood flow.

Newman explained that since tumor cells retain the dye longer than most other tissues, administering the dye prior to surgery singles out the areas where cancer cells are present.

The current trial at Penn will enable researchers to determine whether ICG is the most suitable dye for head and neck cancers and provide oncologists with a deeper understanding of how cancer spreads in the lymph nodes.

October, 2017|Oral Cancer News|

Blood test for HPV may help predict risk in cancer patients

Source: www.newswise.com
Author: University of North Carolina Health Care System

A blood test for the human papillomavirus, or HPV, may help researchers forecast whether patients with throat cancer linked to the sexually transmitted virus will respond to treatment, according to preliminary findings from the University of North Carolina Lineberger Comprehensive Cancer Center.

HPV can cause oropharyngeal cancer, which is a cancer of the throat behind the mouth, including the base of the tongue and tonsils. Studies have shown that patients with HPV-positive oropharyngeal cancer have better outcomes than patients whose cancer is not linked to the virus.

Preliminary findings presented at this year’s American Society for Radiation Oncology Annual Meeting suggest a genetic test for HPV16 in the blood could be useful to help assess risk for patients, and could help identify patients suitable for lower treatment doses.

“Our work on this blood test is ongoing, but we are optimistic that ‘liquid biopsy’ tests such as ours may be useful in the personalization of therapy for many patients with HPV-associated oropharyngeal cancer,” said the study’s senior author Gaorav P. Gupta, MD, PhD, UNC Lineberger member and assistant professor in the UNC School of Medicine Department of Radiation Oncology.

To avoid over-treating patients and to spare them from toxic treatment side effects, UNC Lineberger’s Bhisham Chera, MD, an associate professor in the radiation oncology department, led studies testing whether favorable-risk patients with HPV-positive oropharyngeal cancer can be treated successfully with lower doses of radiation and chemotherapy. A phase II clinical trial using this de-intensified regimen have shown “excellent” cancer control, Chera said.

The researchers used a number of selection criteria to identify patients who can benefit from lower-doses: patients had to be positive for HPV, and they had to have smoked fewer than 10 pack years. Chera said this system is not perfect, however. The researchers have seen cancer recur in non-smoking patients as well as “excellent” cancer control in longtime smokers.

“This has led us to question whether we can get better prognostication with other biomarkers,” Chera said.

They developed a test that can detect HPV16 circulating in the blood, and found that circulating HPV16 DNA was detectable using the test in the majority of a group of 47 favorable-risk oropharyngeal cancer patients.

In a finding that seems counterintuitive, they discovered that very low or undetectable HPV16 pretreatment levels in their blood actually had higher risk of persistent or recurrent disease for chemotherapy and radiation treatment. In contrast, patients with high pretreatment levels of HPV16 in their blood had 100 percent disease control.

They hypothesized that, potentially, the patients with undetectable/low pre-treatment HPV16 levels in the blood may have different, more radiation/chemotherapy resistant cancers.

“Our current theory is that these patients with low or undetectable levels of HPV16 have a different genetic makeup—one that is perhaps less driven purely by HPV, and thus potentially less sensitive to chemotherapy and radiation,” Gupta said. “We are performing next generation sequencing on these patients to search for additional genetic markers that may give us a clue regarding why they have a worse prognosis.”

They also identified a subset of patients who rapidly cleared the HPV16 from their blood. Researchers hypothesize that they could use their findings to further stratify patients who may be eligible for lower intensity treatment.

“A tantalizing – and yet currently untested – hypothesis is whether this subset of ultra-low risk patients may be treated with even lower doses of chemoradiotherapy,” Gupta said.

October, 2017|Oral Cancer News|

Head and neck cancer is more common than you think

Source: www.irishtimes.com
Author: Jamie Ball

Well over 1,000 people in Ireland are diagnosed each year with cancers of the head and neck, with almost three-quarters of cases being attributed to smoking and alcohol. Yet this pernicious form of cancer very often goes under-reported, or sufficient heed isn’t paid to the warning signs that, if caught early, may be the difference between life and death.

This is why July 27th will mark the third World Head & Neck Cancer day, taking place across 53 countries. The 2017 National Cancer Strategy highlights the importance of prevention, detection and diagnosis, and education and awareness is key for early recognition of the disease.

According to James Paul O’Neill, Prof of Otolaryngology, Head and Neck Surgery in Beaumont Hospital, Dublin and the Royal College of Surgeons in Ireland, there can be many different types of cancers within the head and neck, each with their own tissue characteristics and biological behaviour.

“Cancers may develop in several areas of this region, including the mouth, throat, larynx (voice box), glandular tissue (thyroid), salivary tissue (parotid gland), lymphatic tissue, nose, sinuses and skin. Patients have a large variety of symptoms and signs according to the subsite of the disease,” says O’Neill.

He says surgery incorporates many different techniques and skills, as the region has essential functional roles, such as talking, breathing, smelling, hearing, chewing and swallowing.

“We are now in the age of highly-specialised technological innovations. There is a drive towards minimally invasive surgery because we can perform the same surgery except with reduced morbidity to surrounding structures.

“Chemotherapy overall offers little in head and neck oncology, with an overall survival difference of approximately 6.5 per cent, but a hike in morbidity of nearly 50 per cent.

“Overall, some head and neck cancers have an excellent prognosis, but unfortunately two-thirds of all our patients present with advanced disease at the time of diagnosis. If these patients fail our first line of therapy, their prognosis is often very challenging. Head and neck cancers often advance quickly and given the anatomical complexity of the region, frequently impinge on or directly invade the patient’s airway,” says O’Neill.

Following a diagnosis of Laryngeal cancer in 2014, Sligoman Donal Connor had his larynx removed in Beaumont Hospital, under the care of Prof O’Neill and plastic surgeon Barry O’Sullivan. Despite his diagnosis, Connor had never smoked, and remained fit and active all his life.

“This was life-changing surgery, but it gave me a chance to have a life and get rid of this tumour, which was making me hoarse and very unwell,” says Connor. “I now have a little prosthesis, or speaking valve, in my neck, which helps to project my voice. I have to put my finger in the hole in my neck, which is called a stoma, every time I want to speak, which can be very tiring. Conversation for me is the biggest challenge, as I cannot raise my voice if I need to call someone, and I cannot speak over the radio, television or in a crowded situation,” says Connor.

“I now breathe through the stoma, which must be cleaned and cared for on a daily basis, and so it’s much easier for me to get chest infections. I understand my neck looks different and people stare at it, but by now I’m used to this type of attention.”

Connor says his sense of smell has been impacted hugely, while going for a swim is no longer an option either. “If water enters my stoma it would flood my lungs. I have to take great care in the shower. My stoma needs to be covered at all times around water. I am very lucky I can eat and drink most things, but I have to relax after my meals or my food will repeat on me. I cannot speak during mealtimes as I need to focus on swallowing.

“Regardless of all these negatives, I am thankful to God every day to be cancer free and given this second chance. I could go around all day depressed, and some days I do, but I try my best to make the most out of the life I have been left with,” says Connor.

“I know I had different treatments and surgeries that weren’t successful for me, but what didn’t work for me may be very successful for other cancer patients, as everyone’s cancer is different. I know now that anyone who is hoarse for more than six weeks should have it investigated. Please go to your GP, or further if needs be, and have it checked out. It may be nothing to worry about, but if it is detected early, its half the battle.”

Beating HPV-positive throat cancer

Source: www.huffingtonpost.com
Author: Pamela Tom, Contributor

National Oral, Head, and Neck Cancer Awareness Week is April 12-18, 2017

For at least two years, 47 year-old Rob Clinton of Rochester, NY, would choke on post nasal drip in the shower. He knew something was wrong in his throat but he didn’t feel any pain.

Did he have cancer? Clinton smoked cigarettes for 30 years and worked in an auto body shop where he was regularly exposed to carcinogens, but he wasn’t experiencing the typical symptoms of throat cancer. These include hoarseness or a change in the voice, difficulty swallowing, a persistent sore throat, ear pain, a lump in the neck, cough, breathing problems, and unexplained weight loss.

In November 2015, Clinton went to the dentist to have his teeth cleaned. His dentist felt Clinton’s swollen neck and recommended that he visit a medical doctor. Clinton heeded the advice and sought the opinion of an ear, nose, and throat specialist at Strong Memorial Hospital in Rochester, NY.

The ENT doctor sent Clinton to have a CAT scan and when he scoped Clinton’s throat, the doctor said, “I see something in there.”

What he saw was a tumor and there were a few other things going on too.

The Diagnosis
The biopsy showed that Clinton had Stage IVa oral squamous cell carcinoma (OSCC) at the base of his tongue—and the cancer was HPV positive. HPV stands for the human papillomavirus and a recent survey found that more than 42% of Americans are infected with HPV. While most people’s bodies naturally clear HPV after two years, some people’s immune systems do not recognize the virus and consequently, HPV can harbor in the body for decades. HPV-related throat cancer has been linked to oral sex.

The Treatment
On December 4, 2015, Clinton underwent neck dissection surgery at Roswell Park Cancer Institute in Buffalo, NY. Dr. Hassan Arshad, a head and neck cancer surgeon, removed 30 lymph nodes; two had cancer and one tumor was the size of a golf ball. One lymph node on the other side of neck and a tongue tumor would be treated with radiation.

The first of 35 radiation treatments began one month later in conjunction with Cisplatin chemotherapy infusions. That’s seven weeks of simultaneous radiation and chemo.

“I drove myself to treatment for the first five weeks. Up until the last week of treatment, it wasn’t too terrible,” Clinton says. “But then I started getting tired and my mother took me to the cancer center.”

Clinton had decided not to get a feeding tube prior to or during treatment and as the radiation and chemo attacked his cancer, he began to lose weight. The treatment reduced Clinton’s appetite because foods began to taste different. For two weeks, he also felt a burning sensation in his mouth and says his saliva tasted like hot sauce.

“It was excruciating and the worst thing I dealt with during treatment.”

Furthermore when radiation makes the throat feel tender and raw, it becomes nearly impossible to eat normally through the mouth.

Clinton was 215 pounds before treatment. After treatment, he weighed in at a mere 165 pounds. A loss of 50 pounds. In hindsight, Clinton wishes he had the feeding tube inserted while he was still strong.

“Don’t be afraid of the treatment. It’s manageable and you can get through it. I recommend a feeding tube because it’s a comfort knowing you have an option,” says Clinton.

The Recovery
While it took a month for Clinton to recover from the initial surgery, doctors say it takes at least a year for HPV+ throat cancer patients to find their “new normal”—regaining strength, adapting to lingering side effects.

Following chemo, Clinton experienced “chemo brain” or “chemo fog,” known as a cognitive impairment that can occur after chemotherapy. The patient may experience memory loss or dysfunction, and have difficulty concentrating or multi-tasking.

The radiation also took its toll on Clinton. He researched and found a salve made of calendula flowers, olive oil, beeswax, and Vitamin E oil to soothe his parched skin. Trying to gain weight was a bigger challenge. First, his taste went “totally upside down” and spicy foods were intolerable.

“A vanilla cookie tasted like black pepper,” Clinton says. “Only frozen peas and parsley tasted normal.”

And dry mouth is a common result of the radiation treatment. While both sides of Clinton’s neck received radiation, he had less saliva production on his left side. At night he would have to wake up every 40 minutes to drink water. Clinton must make certain not to become dehydrated because it causes the dry mouth to worsen. Now he chews gum almost non-stop.

In his search to combat dry mouth, Clinton says he researched solutions online and found ALTENS, or acupuncture-like transcutaneous electrical nerve stimulation. A study led by Dr. Raimond Wong, an associate professor of oncology at McMaster University in Ontario, Canada, found evidence that ALTENS may reduce patient-reported xerostomia, the medical term for dry mouth.

Clinton joined Dr. Wong’s clinical trial to determine whether ALTENS for six weeks/four days a week would be as effective as treatment for 12 weeks/two times a week.

“Four days a week, the researchers put pads on the inside of my ankles, the outside of my knee, back of my hands, between my thumb and forefingers, and between my chin and bottom lip,” says Clinton.

Clinton says ALTENS felt like little shocks and the acupuncture-like stimulation improved his saliva production by 80 percent. “Even after I stopped ALTENS, my saliva kept improving,” says Clinton.

The Survivor
Two years after cancer treatment, regular PET scans show that Rob Clinton has no evidence of cancer. In fact, the prognosis for HPV-related throat cancer is 85 to 90 percent positive if caught early. In contrast, patients who battle advanced throat cancer caused by excessive smoking and alcohol have a five-year survival rate of 25 to 40 percent.

Dr. Arshad, Clinton’s surgeon at the Roswell Park Cancer Institute, explained why.

“The majority of tonsil and tongue base (“throat”) cancers are HPV-positive, but smoking is still a major risk factor. Typically, non-smoking patients with HPV-positive tonsil/tongue base cancers present with a lump in the neck, implying that the cancer has already spread to lymph nodes. This used to mean that the patient would have a reduced chance of long-term survival,” Arshad says. “We now know that for nonsmokers who have HPV-positive cancers, metastasis to lymph nodes doesn’t carry the same poor prognosis. The newest staging system reflects that change, i.e. Some of those patients who were previously classified as stage IV are now at stage II if the cancer is HPV-positive.”

Clinton is not only faring well physically, surviving cancer changed his outlook and lifestyle.

“My life is pretty much back to normal. I get a little nervous each time I get a PET scan but so far, it shows I am free of cancer,” Clinton says. “I have a better appreciation of things. I live healthy in terms of diet and recreation. I don’t smoke or drink heavily.”

The Future of HPV+ Oropharyngeal Cancer
De-stigmatizing HPV is a key component to building public awareness and acceptance of HPV infection, and the ability to recognize the early symptoms of HPV-related throat cancer. As more and more people are diagnosed with HPV-related throat cancer, the social stigma surrounding the virus is a disturbing deterrent because HPV cancer patients are often reticent to disclose the HPV connection.

In a 2015 public service announcement, actor Michael Douglas who was treated HPV+ base of tongue cancer called for oral screenings but never said “HPV” by name. “A very common virus, one responsible for the vast majority of cervical cancers is now identified as the cause of this rapid rise in oral cancers,” said Douglas.

In the early years of the AIDS crisis, people associated infection with illness, fear, and death. It took a decade to generate a movement and begin to change the public sentiment. Now after continual education, AIDS is accepted and the focus centers on hope instead of ostracization.

Clinton hopes more people will accept that HPV infection is common—the most common sexually-transmitted infection in the U.S., according to the CDC. The American Society of Clinical Oncologists also found that by 2020, the annual number of HPV-related oropharyngeal in nonsmoking, middle-aged men will surpass the number of cervical cancer cases.

“HPV is not a shameful thing. It’s very common. It’s just that some people can’t clear the virus from their bodies,” Clinton says. “This type of cancer is the next epidemic. I feel fortunate every day that I came through it as well as I did.”

April, 2017|Oral Cancer News|

UK cancer patient receives new jaw thanks to 3D printing

Source: http://www.3ders.org/
Author: staff

3D printing techniques are being adopted with increasing regularity in surgery of all kinds, and more and more patients are seeing a hugely improved quality of life thanks to the unique benefits of the technology. The most recent success story took place in the UK, where a patient’s jawbone was entirely reconstructed using bone from his leg. The pioneering surgical procedure made use of 3D printing at various different stages.

Stephen Waterhouse was diagnosed with throat cancer eight years ago, and underwent chemotherapy and radiotherapy in order to fight it. The treatments were a great success and his cancer went away, but they had an unfortunate side effect. His jawbone had started to crumble, and emergency surgery was required before it completely disintegrated. The 53-year-old was taken to Royal Stoke University Hospital, which had purchased a new 3D printer just two years previously.

Costing the hospital trust around £150,000 (about $188K), the machine is the only one of its kind in the country, and was a crucial part of the effort to save the patient’s jawbone. A 3D model was designed from a scan of his remaining intact jaw and printed out as a mold, which was then used to reconstruct the jaw using bone taken from his fibula. The operation lasted around 12 hours and was a great success.

According to Daya Gahir, consultant in maxillofacial and head and neck surgery, the hospital does “at least 40 major head and neck reconstructions per year. Around 10 to 15 cases will be done in this way using the printer.” The procedure is very intricate, and the hospital’s purchase of the 3D printer has revolutionized the way his team operates. “Some of the leg bone was taken then reshaped, as you have to replace bone with bone. We took away some of the skin from the leg as well and replanted it back into the neck. A face is not easy to reconstruct, it is intricate.”

New software for the 3D printer was developed last year, which allows the whole process to be planned and carried out within the hospital. Without this, Stephen may have had to travel to Germany for the operation to be completed, according to Gahir. Using the 3D printer in this way saves a lot of time and effort for patient and medical team alike, as well as cutting costs. Around £11,000 is saved for each case by carrying out the whole surgical process on-site.

Stephen is still in recovery and has praised the care he is receiving from staff, as well as the effectiveness of the surgery. “I am so pleased with the results,” he says, “you can’t tell the difference between the two sides of my mouth.”

March, 2017|Oral Cancer News|

Magnolia man joins exclusive trial in battle against cancer

Source: www.cantonrep.com
Author: Denise Sautters

Rich Bartlett is looking forward to getting back to his hobbies — woodworking and nature watching — and enjoying a good steak and potato dinner. Until then, though, he is in a fight for his life, one he plans to win.

Bartlett is a cancer patient and the first participant in a clinical trial at University Hospitals Seidman Cancer Center in Cleveland to test the safety of an immunotherapy drug — Pembrolizumab — when added to a regimen of surgery, chemotherapy and radiation therapy.

Back to the beginning
Bartlett went to the dentist in October for a checkup.

“He had a sore in his mouth he thought was an abscess,” explained his wife, Nancy Bartlett, who pointed out that, because radiation and chemo treatments cause the inside of the mouth to burn and blister, it is hard for Bartlett to talk.

“When the dentist looked at his sore, he sent Richard to a specialist in Canton, and in early November, he had a biopsy done. It came back positive for cancer.”

From there, he was referred to Dr. Pierre Lavertu, director of head and neck surgery and oncology at University Hospitals, and Dr. Chad Zender from the otolaryngology department, who did Bartlett’s surgery.

“They let us know it was serious,” said Nancy. “It had gone into the bone and the roof of the mouth, but they were not sure if it had gone into the lymph nodes. By the time we got through that appointment, it was the first part of December and (they) scheduled him for surgery on Dec. 22.”

The cancer tripled in size by then and the surgery lasted 10 hours. Doctors had to remove the tumor, all of the lymph nodes and parts of the jaw and the roof of Bartlett’s mouth.

“They harvested skin from his hand to rebuild the inside of his mouth, and took the veins and arteries and reattached everything through his (right) cheek,” she said. “He could not even have water until February because of the patch. He uses a feeding tube to eat now.”

The tube is temporary until Bartlett heals.

Clinical trial
Just before he started chemo and radiation therapies, the hospital called him about the clinical trial.

The trial is the first to use quadra-modality therapy — or four different types of therapy — against the cancer, according to Dr. Min Yao, the principal investigator.

Yao said Bartlett has squamous cell carcinoma of the oral cavity, with only a 50 percent chance of survival.

“Patients have surgery, then followed by six weeks of radiation and chemotherapy and immunotherapy,” Yao said in an email interview. “That is followed by six more months of immunotherapy, one dose every three weeks.”

Bartlett currently is in the radiation, chemotherapy and immunotherapy part of the study.

“It is too early to tell how he is responding,” said Yao. “His tumor has been resected. After the treatment, we will see them periodically with scans. Cancer often recurs in the first two years after treatment.”

Pembrolizumab originally was developed to activate the body’s immune system in the fight against melanoma. Former president Jimmy Carter was treated with the drug for his brain metastases from melanoma in 2015.

A truck driver by trade, Bartlett will undergo daily fluoride treatments for the rest of his life to protect his teeth.

“We did not realize until we got to Cleveland just how bad this was,” said Nancy. “When you have oral cancer, and they are getting ready to do radiation and chemo, you have to go have your teeth cleaned and examined and get anything done that needs to be done because radiation tends to compromise your blood flow in your mouth. That was a step we didn’t know.”

Although he was shocked to hear the outcome of that sore in his mouth, Bartlett is grateful to be a part of the trial.

“Who wouldn’t feel good about something like this? I mean, you got something that was used on Jimmy Carter, who is recovered and is now making public appearances again,” said Bartlett, who is looking forward to June when hopefully he can start eating again and enjoying his hobbies.

“I am very hopeful about this. The whole thing has been a trial. I have a dentist in Cleveland who said I was going to be in the fight of my life, and I am. I am in a huge fight. The chemotherapy is what has knocked me down the most, but I am very positive about the outcome of this.”

March, 2017|Oral Cancer News|