radiation

RJR Slapped with $6.5M verdict over musician’s mouth cancer

Source: blog.cvn.com
Author: Arlin Crisco

R.J. Reynolds was hit with a $6.5 million verdict Tuesday for the part jurors found the company played in the mouth cancer a Florida musician developed after years of smoking. Harewood v. R.J. Reynolds, 2007-CA-46331.

The award followed the Florida 11th Circuit Court jury’s conclusion that nicotine addiction and cigarettes caused the oral cancer doctors diagnosed Glenn Simmons with in 1995. Simmons, a bassist in bands throughout much of his life, began smoking as a teenager and smoked about a pack a day for decades. He died in 2003, at age 48, from complications related to cancer-related radiation therapy. Monday’s verdict found Reynolds liable on fraud and conspiracy claims related to a sweeping scheme to hide the dangers of cigarettes. However, while jurors awarded Simmons’ daughter, Hanifah Harewood $6.5 million in compensatory damages, they rejected a claim for punitives in the case.

The case is one of thousands of Florida’s Engle progeny lawsuits against the nation’s tobacco companies. They stem from a 2006 Florida Supreme Court decision decertifying Engle v. Liggett Group Inc., a class-action tobacco suit originally filed in 1994. Although the state’s supreme court ruled that Engle progeny cases must be tried individually, it found plaintiffs could rely on certain jury findings in the original case, including the determination that tobacco companies had placed a dangerous, addictive product on the market and had conspired to hide the dangers of smoking through much of the 20th century.

In order to be entitled to those findings, however, each Engle progeny plaintiff must prove the smoker at the heart of their case suffered from nicotine addiction that legally caused a specific smoking-related disease.

Key to the seven-day Simmons trial was the link between his smoking and his mouth cancer. During Monday’s closings, Reynolds’ attorney, King & Spalding’s Randall Bassett, argued the cancer’s location and Simmons’ relatively young age at diagnosis were inconsistent with smoking-related oral cancer. Bassett noted that defense expert Dr. Samir El-Mofty, an oral pathologist from Washington University, concluded Simmons’ cancer stemmed from an infection related to a tooth extraction. “Not a cancer caused by smoking, but a cancer caused by a virus that sometime along the way Mr. Simmons had been exposed to,” Bassett said.

But Harewood’s attorney, Koch, Parafinczuk, Wolf & Susen’s Austin Carr reminded jurors that Simmons’ treating physician, Dr. Francisco Civantos, a South Florida otolaryngologist, believed cigarettes caused Simmons’ cancer. “Dr. Civantos is the more credible, experienced, the more competent physician and surgeon,” Carr said during Monday’s closings. “He is the doctor that you should believe over [the defense] witness.”

September, 2018|Oral Cancer News|

Head and neck Cancer: Overcoming Challenges in Treatment

Source: www.curetoday.com
Author: staff

Itzhak Brook, M.D., M.Sc., shares the story of his initial diagnosis and treatment for cancer of the head and neck, outlining the challenges that came along with treatment, with fellow board member of the Head and Neck Cancer Alliance Meryl Kaufman, M.Ed., CCC-SLP, BRS-S.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, can you please share your story about your cancer diagnosis in 2006 and the treatment that followed and also the subsequent surgery that you went through?

Itzhak Brook, M.D., M.Sc.: Once I learned I had cancer and my doctors removed it when they had to biopsy, I needed to receive radiation therapy. I did not get any chemotherapy, and the radiation therapy lasted six weeks, five days a week. It was very difficult to experience the radiation, and the side effects start to accumulate within a few days. And I had to deal with inflammation of the mouth, mucositis, difficulty in swallowing and pain in my throat, and I experienced a burning of the skin around the area of radiation, weakness and then difficulty maintaining intake of food. After a while, I could lose weight, and I tried to persevere because I knew that I had to receive the treatment to get better and soldier through it until it was over.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And some people have such severe side effects from the radiation that they actually require a feeding tube to support them during their treatment. In that case, often patients are encouraged to eat and drink and use that feeding tube to supplement what they’re able to eat and drink. Did you find that there were certain foods that were difficult for you to swallow and you needed to avoid during that time?

Itzhak Brook, M.D., M.Sc.: I was fortunate that I was able to maintain my hydration and nutrition without the feeding tube. And in my trial and error, I found solid food, cold food, such as watermelon, ice cream and sour cream. I tried to consume high-calorie food so that even though I don’t eat as much, I would still take calories in and not lose a lot of weight. I was lucky I lost only 5 pounds, but some people lose more. The most important thing is to stay hydrated, get enough food and get enough water, which at that time was a real challenge, as the nausea increased over time. But fortunately, I had a very good support system in the place where I got it. I had a radiation oncologist who had advised me and told me and helped me cope with the side effects.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And how important was your support system at home? Who supported you and helped get you through that treatment?

Itzhak Brook, M.D., M.Sc.: Obviously, that’s very, very important. My wife and children were very supportive of me, and they knew that I was going through a rough time and tried to help me in all the other ways possible. Also, at work, I got a lot of understanding and support from my team of co-workers. I was then in the military. I was in the U.S. Navy and got my treatment at Walter Reed, and they were very, very helpful in trying to ease it.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: And then when the cancer came back, you faced a laryngectomy. Can you talk to us about what that meant to you and what sort of associated fear and stigma you experienced?

Itzhak Brook, M.D., M.Sc.: Well, the most important thing was that they caught the cancer, and that was because I saw an otolaryngologist every month, and this is done for the first year and second year because that’s the time when more recurrences happen, in those two years. And when the cancer was diagnosed, they tried to remove it through an endoscopy and direct biopsy, but it was already too difficult, as it had gotten into the areas where simple procedures couldn’t work. And then they realized that I needed an experienced physician to do it, and I went for a second opinion to another otolaryngologist in a different city. And he referred me to another one because he felt that person would be the best to do it.

And fortunately, we have fewer laryngectomies today, partly because of the experience in doing it is less prevalent and you need to find what I found: the person who knew it best. And they finally removed it, but the understanding that I needed laryngectomy was very difficult. I suddenly realized that my voice would be lost, and I like to speak. Like anyone, I like to lecture, and accepting that I would have to lose my voice was very difficult. I remember that as a medical student some 50 years ago, when I saw laryngectomies, I said to myself, “If I ever have to make a choice, I would never give up my choice even if it cost me my life.” But once I had a choice and I also understood that I could still speak—differently, but I could speak—I made the decision very quickly. There was no doubt in my mind that in order to stay alive, I was going to do it, and I don’t regret it.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s so important for people to understand that there is life after laryngectomy or glossectomy, in the case of having your tongue removed or part of your jaw. There is life, there is rehabilitation and there are ways to go about learning how to speak and swallow again in the face of these challenges. What is something that you wish you had known prior to the diagnosis or during that time period that you can give to other people facing the same situation?

Itzhak Brook, M.D., M.Sc.: I wish I had known that I needed to go to the best physicians who are experienced in the field to do the procedure, and I should not have avoided to make the decision right away but take the time to search for the best person who could help me. I also wish that I had known that even though I was prepared for the procedure, my physicians, nurses and speech pathologists did prepare me, helped me, and they explained to me that experiencing this is completely different from all the words and explanations. And it’s still a very difficult period to undergo this major surgery and be in the hospital completely helpless. But it was worth it because even though it was difficult, I got my life back, and I still believe that life is a very, very precious thing. And if you need to lose something to gain life, it’s worth it.

September, 2018|Oral Cancer News|

Head and neck cancer: Novel treatment approaches

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, traditionally the treatment for head and neck cancer has been surgery, radiation, chemotherapy or some combination of those three. But there are some new and emerging treatment approaches to head and neck cancer along with many other cancers. Can you tell us a little bit about immunology? What is immunotherapy in the care of the head and neck cancer patient?

Itzhak Brook, M.D., M.Sc.: Most days, we don’t get cancer because our immune system is like the police department of our body. They detect cancer early and eliminate it. Unfortunately, in the case of cancer, the cancer cells can fool the immune system, and they go undetected and cause the disease. The main advantage of immunotherapy is that we are using the body’s defenses, the immune system, to kill the cancer in a much better way than the chemotherapy. Chemotherapy destroys the cancer cells, but it also affects the body cells. Immunotherapy is more precise. It is directed only to the cancer cells, so the rest of the body stays unscathed. That’s the beauty of immunotherapy. So, immunotherapy is an evolving field in cancer. They have many, many new drugs in the pipeline, and many studies are being done. But right now, there are several drugs that are good and seem to help in a patient with cancer, cancer that has already spread or that surgery cannot reach. The body’s own immunity would reach it.

One of them is monoclonal antibodies that were developed specifically for the cancer cells, and the other one is checkpoint inhibitors, which overcome the attempt by the cancer cells to fool the immune system and protect the cancer cells from their own immunity. So, by blocking those checkpoints, the body’s own immunity comes in and destroys the cancer cells. Those drugs are very promising because first of all, they are more effective in getting only the cancer cells. They do cause fewer side effects, and we are hopeful that they would be the new armamentarium that we will have for head and neck cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: So, would you say that’s something you should ask your physician about to find out what clinical trials and what types of medications are offered for your specific type of cancer at the time of diagnosis?

Itzhak Brook, M.D., M.Sc.: Absolutely, and that is depending on your own illness, on the seriousness or stage of the illness. And your physician would be able to consult the right specialist to tailor the specific treatment for you, and that’s very important because now we have a new tool that can augment the chemotherapy. And many of those treatments are given in combination. Conventional treatment with chemotherapy plus immunotherapy seems to work very well in many patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. The future is exciting in that regard. In the case of the HPV-positive oropharyngeal cancers, there has also been a lot of interest and push toward robotic surgery in caring for that patient population. I know that that’s not for everybody, and it’s more suited for some of the smaller tumors because of the side effects that might go along with it. What is your understanding of the role of robotic surgery in the care of head and neck cancer patients?

Itzhak Brook, M.D., M.Sc.: Robotic therapy is an amazing new procedure. It’s being done using the robotic tools that are able to do the surgery in a much less invasive way without traumatizing many of the normal tissues of the body. They cause less damage. The recovery period is shorter, and patients benefit from it tremendously. In that procedure, there is a robotic machine that the surgeon operates, and it allows very, very precise ability to cut the cancer out, and it does cause less long-term damage to the tissues and less deformity, you may say. And that’s a wonderful tool. But unfortunately, as you said, it is limited to areas of the body that the robot can reach. And when the cancer is in places that are not reachable by the robotic approach, one needs to use the conventional approach. But even in that area, there is a development of using endoscopic surgery where one can use a laser and the endoscopic approach, or the laser can kill or burn out the cancers that are more deeply located in the throat, again saving major surgery and even saving removal of the larynx from patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s right. And also, there’s a push toward de-escalation of the radiation and the chemotherapy in some of these HPV-positive patients, as well, because the tumors are more responsive to the treatment. So, there are many studies going on looking at whether we can do less treatment for the different types of diseases. As you spoke earlier, I think finding the right specialists is important; not everybody is a specialist in all these new and advanced technologies. If you’re looking for robotic surgery, find that specialist that really does a lot of robotic surgery and is an expert in that field. The same is true for the immunotherapy and other treatment approaches as well. So, I think being your own advocate, again, to find these different alternative options and these new treatments in clinical trials becomes exceedingly important in the age of all these new discoveries.

Itzhak Brook, M.D., M.Sc.: Fortunately, the knowledge of experience in those procedures, the laser and the robotic surgery, is becoming more prevalent in the United States. And when I had my cancer, when I needed to make choices 10 years ago, there were only a handful of experts. But right now, almost every major medical center has an expert in those fields, so it’s more available for people.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. So, even if you have to travel a distance to get to those major medical centers, it’s worth the effort and travel and time to be able to seek these other opinions and see what your other options are before pursuing your treatment.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes, I agree.

September, 2018|Oral Cancer News|

Cancer biology graduate student travels ‘ROCKy’ road toward a cure for post-radiation dry mouth

Source: medicalxpress.com
Author: staff, University of Arizona

The United States is in the midst of a head-and-neck cancer epidemic. Although survival rates are relatively high—after treatment with chemotherapy and radiation—survivors can suffer permanent loss of salivary function, potentially leading to decades of health problems and difficulties eating.

It is unknown why the salivary gland sometimes cannot heal after radiation damage, but Wen Yu “Amy” Wong, BS, a University of Arizona cancer biology graduate student, may have taken a step toward solving that riddle.

Radiation often comes with long-term or even permanent side effects. With a head-and-neck tumor in radiation’s crosshairs, the salivary gland might suffer collateral damage.

“When you get radiation therapy, you end up targeting your salivary glands as well,” Wong said. Losing the ability to salivate predisposes patients to oral complications and an overall decrease in their quality of life. “Salivary glands help you digest food, lubricate your mouth and fight against bacteria. After radiation, patients could choke on their food because they can’t swallow. They wake up in the middle of the night because their mouth is so dry. They often get cavities.”

Favorite foods may lose their flavor. “Saliva produces certain ions that help you taste,” she said. “Patients lose the ability to enjoy food. The best steak is very bland to them.”

The quest to restore salivary function in post-radiation head-and-neck cancer patients starts with learning why the salivary gland is unable to heal itself after radiation damage.

Wong’s study may have helped to unravel this mystery. Her team looked closely at two proteins, E-cadherin and β-catenin, which allow communication between cells. Normally, these proteins bind cells together, but after radiation damage, these connections are severed. “Think of them as telephone wires,” Wong said. “Radiation is like lightening hitting a telephone pole. That breaks the ability of one friend to talk to another on the other side of the city.”

Just as a maintenance crew can repair downed telephone poles after a storm, the body is able to heal itself after injury. Unfortunately, in post-radiation dry mouth, salivary glands’ ability to regenerate might be blocked.

In the lab, Wong was able to artificially force the regeneration of salivary glands, allowing her to learn where there are obstructions in the regeneration process. Wong particularly was interested in something called the ROCK pathway, which might go awry in the wake of radiation, blocking E-cadherin and β-catenin from reuniting.

“If I use an inhibitor to prevent this ROCK signaling pathway, these two proteins come back together,” Wong said.

The next step is to learn more about how a defective ROCK pathway blocks salivary glands’ natural ability to regenerate following radiation damage. Unlocking this secret could uncover novel ways to treat or cure post-radiation dry mouth.

Earlier this month, Wong and her co-authors were recognized by the American Physiological Society for their investigation, which was published in June by the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology. Wong, along with Maricela Pier, BS, a research specialist with the UA College of Medicine—Tucson Department of Cellular and Molecular Medicine, and Kirsten Limesand, Ph.D., of the UA Cancer Center and professor of nutritional sciences with the UA College of Agriculture and Life Sciences, was selected for the APSselect award, given to the best articles in physiological research.

Wong selected Dr. Limesand’s lab as her “home base” throughout her graduate studies because “I wanted to connect with a woman in science who understands the difficulties. She was very easy to talk to, and the people in the lab provide a very nurturing environment. She is a great mentor.”

Dr. Limesand takes her role as a mentor seriously, and finds it deeply satisfying.

“Hands down, the most rewarding aspect of my career is training students,” Dr. Limesand said. “They’re our next generation of scientists, tackling the big questions that need to be solved.”

Dr. Limesand is a professor with the UA Cancer Biology Graduate Interdisciplinary Program, which emphasizes translational research to address significant problems relating to cancer development and treatment. Students are prepared for careers in cancer research through an interdisciplinary approach involving faculty members from a wide range of disciplines.

“I have students from cancer biology and physiological sciences, and I’ve been on committees of genetics students and immunobiology students,” said Dr. Limesand. “These diverse perspectives add to the research we’re doing.”

August, 2018|Oral Cancer News|

Smarter cancer treatment: AI tool automates radiation therapy planning

Source: news.engineering.utoronto.ca
Author: Brian Tran

Aaron Babier (MIE PhD candidate) demonstrates his AI-based software’s visualization capabilities. (Credit: Brian Tran)

Beating cancer is a race against time. Developing radiation therapy plans — individualized maps that help doctors determine where to blast tumours — can take days. Now, Aaron Babier (MIE PhD candidate) has developed automation software that aims to cut the time down to mere hours.

He, along with co-authors Justin Boutilier (MIE PhD 1T8), supervisor Professor Timothy Chan (MIE) and Professor Andrea McNiven (Faculty of Medicine) are looking at radiation therapy design as an intricate — but solvable — optimization problem.

Their software uses artificial intelligence (AI) to mine historical radiation therapy data. This information is then applied to an optimization engine to develop treatment plans. The researchers applied this software tool in their study of 217 patients with throat cancer, who also received treatments developed using conventional methods.

The therapies generated by Babier’s AI achieved comparable results to patients’ conventionally planned treatments. — and it did so within 20 minutes. The researchers recently published their findings in Medical Physics.

“There have been other AI optimization engines that have been developed. The idea behind ours is that it more closely mimics the current clinical best practice,” says Babier.

If AI can relieve clinicians of the optimization challenge of developing treatments, more resources are available to improve patient care and outcomes in other ways. Health-care professionals can divert their energy to increasing patient comfort and easing distress.

“Right now treatment planners have this big time sink. If we can intelligently burn this time sink, they’ll be able to focus on other aspects of treatment. The idea of having automation and streamlining jobs will help make health-care costs more efficient. I think it’ll really help to ensure high-quality care,” says Babier.

Babier and his team believe that with further development and validation, health-care professionals can someday use the tool in the clinic. They maintain, however, that while the AI may give treatment planners a brilliant head start in helping patients, it doesn’t make the trained human mind obsolete. Once the software has created a treatment plan, it would still be reviewed and further customized by a radiation physicist, which could take up to a few hours.

“It is very much like automating the design process of a custom-made suit,” explains Chan. “The tailor must first construct the suit based on the customer’s measurements, then alter the suit here and there to achieve the best fit. Our tool goes through a similar process to construct the most effective radiation plan for each patient.”

Trained doctors, and often specialists, are still necessary to fine-tune treatments at a more granular level and to perform quality checks. These roles still lie firmly outside the domain of machines.

For Babier, his research on cancer treatment isn’t just an optimization challenge.

“When I was 12 years old, my stepmom passed away from a brain tumour,” Babier shares.

“I think it’s something that’s always been at the back of my head. I know what I want to do, and that’s to improve cancer treatment. I have a family connection to it. It adds a human element to the research,” says Babier.

August, 2018|Oral Cancer News|

Silent no more: Woman lends voice to hope after cancer

Source: health.ucsd.edu
Author: Yadira Galindo

Singing hymns in church has always brought Cynthia Zamora joy. Today, her once sharp intonation has given way to a raspy voice. But Zamora is thankful that she has a voice at all after spending three months without the ability to utter even one syllable.

“I miss going to church and singing with people,” said Zamora. “Although, if I am in the back I’m still singing. I’m just hoping they don’t hear what sounds like a 13-year-old pubescent boy back there, because that’s how I sound. I know God thinks it’s beautiful, so I don’t worry about it. I just go on with life.”

In 2017, Zamora bit her tongue while sleeping, splitting her tongue nearly in half. She was referred to a specialist when her wound would not heal. They found a 5.4-centimeter tumor that enveloped more than half of her tongue. To save her life, her surgeon, Joseph Califano, MD, delivered grim news: Zamora would have to undergo a glossectomy — the surgical removal of all or part of the tongue.

“By the time I saw her she was really having a hard time speaking and swallowing,” said Califano, director of the Head and Neck Cancer Center at UC San Diego Health. “With Cynthia that was a difficult discussion because it was unclear how much tongue we would save and how good the function would be with the remaining tongue that would be preserved.”

A multidisciplinary team of experts that included medical oncology, surgical oncology, reconstructive surgery, radiation oncology, speech therapy, nutrition, psychiatry and a host of others came together to design a comprehensive plan to eradicate an aggressive, stage IV squamous cell carcinoma and deliver the best quality of life for a woman who was about to undergo a catastrophic surgery.

“The tongue is critical. It’s one of the strongest muscles we have in our body. In speech, our tongue is moving so rapidly within the confines of our mouth in order to generate and make certain sounds in conversation that we find it’s hard to grasp how complex that action is,” said Liza Blumenfeld, speech-language pathologist at Moores Cancer Center at UC San Diego Health. “Without a tongue you’re having to compensate for all of that movement with other structures, your lips, your cheeks and your jaw.”

During a 12-hour surgery, Califano would remove a large portion of Zamora’s tongue and place a breathing tube and feeding tube before a reconstructive microsurgeon would step in to replace the portion of tongue that was removed.

“The primary goal of surgery is to remove the cancer as best we can while sparing as much normal tissue as possible,” said Califano. “It was a challenging surgery in that we had to cut just right to save enough tongue so that she would have some function and we could still get well around the tumor. We were able to save less than half her oral tongue. That wasn’t a lot.”

Ahmed Suliman, MD, a plastic surgeon who specializes in reconstruction after cancer treatment, was tasked with reconstructing her tongue.

“When you remove the majority of the tongue you can’t really function,” said Suliman. “You can’t swallow and articulation is limited. We had to rebuild a tongue to provide bulk so that Cynthia could move food in her mouth in order to swallow and to speak.”

He used a method called anterolateral thigh perforator flap (ALT). Suliman cut a 6 by 8 centimeter tissue of skin and fat from Zamora’s leg to shape and create a new tongue. The replacement tongue does not move, but because Califano was able to spare the base of her original tongue, Suliman was able to reconstruct using the remaining tongue base to preserve some movement for Zamora. Suliman sutured the new tongue, attaching one artery and a vein from the neck using a microscope.

The reconstructive surgery and dissection of cancerous tissue in her tongue and lymph nodes left Zamora temporarily unable to walk, talk or eat. One of the advantages of performing an ALT is that minimal thigh muscle, or none at all, is cut when extracting tissue for the new tongue. This allows for a faster recovery because Zamora did not lose leg muscle function, so with physical therapy Zamora was on her feet fairly quickly.

Skin and fat tissue are more resilient to radiation therapy than muscle, said Suliman, making this tissue more ideal for someone like Zamora, who received treatment following surgery.

“The success of management of these advanced cancers rely on the coordinated efforts of a multi-disciplinary oncologic team,” said Suliman. “This leads to better planned surgery, good preoperative and post-operative care, and follow up. The success of complex cases is higher and outcomes are better, as demonstrated by Cynthia.”

While Zamora was undergoing physical therapy and speech therapy, she was also undergoing chemotherapy, radiation and was receiving an experimental immunotherapy called Pembrolizumab (Keytruda), an antibody that inhibits the abnormal interaction between the molecule PD-1 on immune cells and the molecule PD-L1 on cancer cells, allowing the immune cells to recognize and attack tumors. Pembrolizumab is FDA-approved for some cancers, such as melanoma but is still under a clinical trial for squamous cell carcinoma of the head and neck .

While Zamora continued aggressive treatment and attended physical therapy, she also met with Blumenfeld.

“Teaching somebody to regain their speaking and swallowing abilities during head and neck cancer treatment is really difficult,” said Blumenfeld. “Being able to understand what their abilities were like before, and being able to understand what their new normal looks like, helps us play on their strengths and their ability to compensate with other structures.”

Blumenfeld and Zamora worked together targeting the sounds that she had problems expressing. Zamora had to slow her speech and exaggerate each sound, compensating with her vocal chords for sounds she can no longer make with her tongue.

It is a tedious process but in three months Zamora was speaking well again.

“Previously, I was well pronounced with an expansive vocabulary. I had to be patient with myself and use more expressions in my eyes, hands and face. Sometimes I have to pick words I wouldn’t normally use because I can’t use my original vocabulary. Quality is better than quantity,” said Zamora.

“You have to want to be able to communicate in order to talk, and I wanted that more than anything, because I am a person who loves to communicate. I haven’t got singing down yet, but hopefully that will come.”

Zamora’s vocal chords are healthy and with time, patience and modifying her technique, Blumenfeld thinks that Zamora will be singing “proudly, loudly sometime soon.”

“There are people that come into your life as patients and your mind is blown by their strength of character, their humor, their wisdom, and their willingness to fight. Cynthia really embodies all of those things,” said Blumenfeld. “From the first day she was insistent that she was going to come out of this as a stronger, better person. She has really shown me, even in my own personal life, to never give up and to set your mind on a set target, and you simply do not deviate from that.”

In addition to regaining her speech, Zamora would need to relearn to eat. This was her last hurdle to recovery. It was only in early 2018 that she began to eat without a feeding tube.

“I would encourage everybody to think for a moment of what life would be like. Grab your tongue with your teeth and try to talk without a tongue. Try to think about, when you take a bite of a sandwich, everything that’s going on in your mouth,” said Blumenfeld. “In order for us to be able to chew, we have to be able to manipulate food, move it from one side of our mouth to the other side of the mouth. We have to be able to organize all that food on top of our tongue and propel that food backwards in order to swallow it. Without a tongue that becomes almost an impossible task.”

Thankfully, Zamora mastered the ability to eat again and laughs when recalling eating half a lava cake in front of her shocked family during a restaurant outing. She eats crispy fried chicken and just about anything she wants.

“With a little patience and care, and one step, baby steps, along the way, you can do anything,” said Zamora. “Look at me. I had no tongue, and I’m talking. I’m eating. I’m drinking. I’m doing great. There is life after this surgery. Don’t give up. Keep going. Be strong. Be stubborn. You can do it, you can.”

State not allowed to investigate death at cancer center

Source: kdvr.com
Author: Rob Low

Lakewood, Colo. – When 80-year-old Virginia Cornelius died at a Rocky Mountain Cancer Care Centers’ location in Lakewood on February 27, the on-site doctor insisted it must’ve been a heart attack.

But the adult children of Cornelius aren’t convinced and tell the FOX31 Problem Solvers their efforts to find the truth have been stymied, partly because cancer centers generally aren’t regulated by the Colorado Department of Public Health and Environment.

Cornelius was receiving radiation treatment for cancer of the larynx in her throat. But her daughter, Susan Hutt, says her mother’s general health on February 27 was fine.

“They took her vital signs. They were better than mine,” Hutt said.

She said she was later told by a radiation tech that her mother was having trouble swallowing just before the procedure began but the treatment was allowed to continue anyway, when something went very wrong inside the patient room.

“All the sudden the door flies open and a curtain and the therapist is screaming in the hall, somebody call 911, somebody find the doctor,” remembered Hutt.

Hutt and her brother Gary Cornelius always sat in a waiting area next to the radiation room for all of their mother’s treatments having no idea that during every procedure their mother’s hands were strapped to a bed.

“We walk in and there is our mother on the table, hands restrained, the mask for radiation therapy with the oxygen that goes into it is up on a table, is hanging up above her. And there is no one in there. She is not responsive, but no one is doing CPR,” said Hutt.

Hutt said it appeared the radiation tech ran out of the room without ever performing CPR.

“Minutes are passing before the tech returns with not a code cart, which I would expect as I’m a nurse in a hospital and they are readily available, but what looked like a fishing tackle box. She puts it on the floor and can’t open it,” Hutt said.

By the time paramedics arrived her mother was dead.

According to the 911 call obtained by the Problem Solvers, a dispatcher is heard advising paramedics, “They (Rocky Mountain Cancer Care Centers) are asking that you not walk through the main lobby, they don’t want that, they want you to go through the back door. I’m not sure why.”

Hutt says she found that suspicious but what she said was even more concerning was learning the “Code Blue” panic button on the wall, which meant to summon emergency help, didn’t work. Plus, the radiation tech who had been treating her mother left before the Jefferson County Coroner arrived.

“Extremely suspicious, that the person present that finds a person down is not able to be interviewed by the coroner,” said Hutt.

The coroner’s report listed the final cause of death as “Acute Heart Failure.” But no autopsy was done.

Minutes after their mother’s death and in a state of shock, Hutt and her brother Gary Cornelius said the cancer care center’s on-site doctor convinced them no autopsy was needed. It’s a decision they now regret.

Several weeks after their mother’s death, Hutt and her brother were able to obtain their mother’s radiation logs.

According to the logs shared with the Problem Solvers, Virginia Cornelius’ treatments normally lasted three to four minutes. But on the day of her death, the treatment appeared to have lasted ten minutes.

Hutt and her brother wonder if their mother received too much radiation at once, or worse was forgotten about and possibly left to choke to death, unable to sit up and remove her oxygen mask.

“A side effect of head and neck radiation is a mucus that is so thick you don’t just clear your throat and get rid of it,” said Hutt.

More than three hours after Virginia died, her radiation log shows someone made new entries at 6:03 p.m., 6:05 p.m., and 6:07 p.m.

Hutt and her brother wonder if someone was attempting to recreate their mother’s chart after the fact. The siblings filed a complaint with the Colorado Department of Public Health and Environment but were shocked to learn the agency was powerless to investigate.

“We have no jurisdiction,” confirmed Dr. Randy Kuykendall. He’s the Director of Health Facilities and Emergency Medical Services for CDPHE.

Dr. Kuykendall says the state can investigate potential wrong-doing inside a hospital because CDPHE licenses hospitals. But he admits all 20 Rocky Mountain Cancer Centers in Colorado aren’t licensed or accredited by anyone.

It’s easy to be confused.

After all there’s a sign outside St. Anthony’s Hospital with an arrow that states “St. Anthony’s Cancer Center,” but it’s really pointing to Rocky Mountain Cancer Centers which isn’t owned or operated by the hospital even though they’re physically connected.

Rocky Mountain Cancer Centers is owned by U.S. Oncology and leases space inside the medical complex but faces none of the regulations of an actual hospital, like having a cardiac crash cart on site or a defibrillator.

“So this cancer care center doesn’t have to have a panic button, doesn’t have to have any of these emergency procedures or policies in place?” asked investigative reporter Rob Low to Kuykendall, who responded, “That would be correct, Rob.”

“We cannot allow these centers just to focus on profits over patient safety. Unfortunately, that`s a real concern,” said Hollynd Hoskins a medical malpractice attorney, who added, “If you have a facility that is not accredited and has no oversight by the state, they could be cutting corners and they could be hiring just techs at a cheaper wage rate than you would have to pay a qualified registered nurse and unfortunately that is a threat to patient safety.”

The Problem Solvers had lots of questions for Rocky Mountain Cancer Centers but Executive Director Glenn Balasky would only release a statement, that reads in part, “For a number of reasons, we cannot discuss the care provided to any particular patient treated at Rocky Mountain Cancer Centers. We can however assure you that patient care remains one of our highest priorities.”

Hutt finds it curious that Rocky Mountain Cancer Centers won’t discuss her mother’s care with the Problem Solvers when she’s willing to sign a consent form releasing RMCC from patient confidentiality restrictions.

“What’s really hard for me, I picture my mother restrained on a table with no monitor, choking to death and they brush it off like she was 80 she had a heart attack. It`s over and done. We`ll report what we want to,” said Hutt.

After repeated phone calls from FOX31, Rocky Mountain Cancer Centers had its attorney call Hutt and her brother Gary Cornelius.

The siblings told the Problem Solvers the attorney and an office manager for the cancer center told them safety changes have been made because of their mother’s death.

As for regulating cancer centers, that would take state legislation and so far lawmakers have no appetite to regulate them.

An AI oncologist to help cancer patients worldwide

Source: www.sciencedaily.com
Author: staff, University of Texas at Austin, Texas Advanced Computing Center

Comparison between predicted ground-truth clinical target volume (CTV1) (blue) and physician manual contours (red) for four oropharyngeal cancer patients. The primary and nodal gross tumor volume is included (green). From left to right, we illustrate a case from each site and nodal status (base of tongue node-negative, tonsil node-negative, base of tongue node-positive, and tonsil node-positive).
Credit: Carlos E. Cardenas, MD Anderson Cancer Center

Before performing radiation therapy, radiation oncologists first carefully review medical images of a patient to identify the gross tumor volume — the observable portion of the disease. They then design patient-specific clinical target volumes that include surrounding tissues, since these regions can hide cancerous cells and provide pathways for metastasis.

Known as contouring, this process establishes how much radiation a patient will receive and how it will be delivered. In the case of head and neck cancer, this is a particularly sensitive task due to the presence of vulnerable tissues in the vicinity.

Though it may sound straightforward, contouring clinical target volumes is quite subjective. A recent study from Utrecht University found wide variability in how trained physicians contoured the same patient’s computed tomography (CT) scan, leading some doctors to suggest high-risk clinical target volumes eight times larger than their colleagues.

This inter-physician variability is a problem for patients, who may be over- or under-dosed based on the doctor they work with. It is also a problem for determining best practices, so standards of care can emerge.

Recently, Carlos Cardenas, a graduate research assistant and PhD candidate at The University of Texas MD Anderson Cancer Center in Houston, Texas, and a team of researchers at MD Anderson, working under the supervision of Laurence Court with support from the National Institutes of Health, developed a new method for automating the contouring of high-risk clinical target volumes using artificial intelligence and deep neural networks.

They report their results in the June 2018 issue of the International Journal of Radiation Oncology*Biology*Physics.

Cardenas’ work focuses on translating a physician’s decision-making process into a computer program. “We have a lot of clinical data and radiation therapy treatment plan data at MD Anderson,” he said. “If we think about the problem in a smart way, we can replicate the patterns that our physicians are using to treat specific types of tumors.”

In their study, they analyzed data from 52 oropharyngeal cancer patients who had been treated at MD Anderson between January 2006 to August 2010, and had previously had their gross tumor volumes and clinical tumor volumes contoured for their radiation therapy treatment.

Cardenas spent a lot of time observing the radiation oncology team at MD Anderson, which has one of the few teams of head and neck subspecialist oncologists in the world, trying to determine how they define the targets.

“For high-risk target volumes, a lot of times radiation oncologists use the existing gross tumor disease and apply a non-uniform distance margin based on the shape of the tumor and its adjacent tissues,” Cardenas said. “We started by investigating this first, using simple distance vectors.”

Cardenas began the project in 2015 and had quickly accumulated an unwieldy amount of data to analyze. He turned to deep learning as a way of mining that data and uncovering the unwritten rules guiding the experts’ decisions.

The deep learning algorithm he developed uses auto-encoders — a form of neural networks that can learn how to represent datasets — to identify and recreate physician contouring patterns.

The model uses the gross tumor volume and distance map information from surrounding anatomic structures as its inputs. It then classifies the data to identify voxels — three-dimensional pixels — that are part of the high-risk clinical target volumes. In oropharyngeal cancer cases, the head and neck are usually treated with different volumes for high, low and intermediate risk. The paper described automating the target for the high-risk areas. Additional forthcoming papers will describe the low and intermediate predictions.

Cardenas and his collaborators tested the method on a subset of cases that had been left out of the training data. They found that their results were comparable to the work of trained oncologists. The predicted contours agreed closely with the ground-truth and could be implemented clinically, with only minor or no changes.

In addition to potentially reducing inter-physician variability and allowing comparisons of outcomes in clinical trials, a tertiary advantage of the method is the speed and efficiency it offers. It takes a radiation oncologist two to four hours to determine clinical target volumes. At MD Anderson, this result is then peer reviewed by additional physicians to minimize the risk of missing the disease.

Using the Maverick supercomputer at the Texas Advanced Computing Center (TACC), they were able to produce clinical target volumes in under a minute. Training the system took the longest amount of time, but for that step too, TACC resources helped speed up the research significantly.

“If we were to do it on our local GPU [graphics processing unit], it would have taken two months,” Cardenas said. “But we were able to parallelize the process and do the optimization on each patient by sending those paths to TACC and that’s where we found a lot of advantages by using the TACC system.”

“In recent years, we have seen an explosion of new projects using deep learning on TACC systems,” said Joe Allen, a Research Associate at TACC. “It is exciting and fulfilling for us to be able to support Carlos’s research, which is so closely tied to real medical care.”

The project is specifically intended to help low-and-middle income countries where expertise in contouring is rarer, although it is likely that the tools will also be useful in the U.S.

Cardenas says such a tool could also greatly benefit clinical trials by allowing one to more easily compare the outcomes of patients treated at two different institutions.

Speaking about the integration of deep learning into cancer care, he said: “I think it’s going to change our field. Some of these recommender systems are getting to be very good and we’re starting to see systems that can make predictions with a higher accuracy than some radiologists can. I hope that the clinical translation of these tools provides physicians with additional information that can lead to better patient treatments.”

Story Source:

Materials provided by University of Texas at Austin, Texas Advanced Computing Center. Note: Content may be edited for style and length.

Journal Reference:

1. Carlos E. Cardenas, Rachel E. McCarroll, Laurence E. Court, Baher A. Elgohari, Hesham Elhalawani, Clifton D. Fuller, Mona J. Kamal, Mohamed A.M. Meheissen, Abdallah S.R. Mohamed, Arvind Rao, Bowman Williams, Andrew Wong, Jinzhong Yang, Michalis Aristophanous. Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International Journal of Radiation Oncology*Biology*Physics, 2018; 101 (2): 468 DOI: 10.1016/j.ijrobp.2018.01.114

Supportive care for patients with head and neck cancer

Source: www.oncnursingnews.com
Author: Melissa A. Grier, MSN, APRN, ACNS-BC

Supporting a patient during cancer treatment is a challenge. From symptom management to psychosocial considerations, each patient’s needs vary and must be reevaluated frequently. This is especially true for patients with head and neck cancer.

Head and neck cancers often result in serious quality of life issues. Surgical resection of the affected area can cause disfigurement that not only affects function (eating, drinking, speaking, etc) but also leads to self-image concerns and depression. Radiation therapy and chemotherapy may cause a variety of unpleasant adverse effects, including burns, xerostomia, dental caries, and mucositis. Below are some considerations to help guide nursing care for this patient population.

CALL FOR REINFORCEMENTS
National Comprehensive Cancer Network guidelines recommend early involvement of a dentist, a dietitian, and a speech therapist to help address pre- and posttreatment concerns and preserve quality of life for people with head and neck cancer. The benefits of multidisciplinary collaboration for these complex cases are many but may also result in confusion and information overload for your patient. As the healthcare team provides care, you can help explain the rationale for interventions and assist them with keeping track of recommendations. Additionally, you have a team of experts you can call on when specific issues present themselves during treatment.

KEEP AN EYE OUT
A lot goes on in the life of a patient with head and neck cancer, which means everyday activities like oral and skin care may fall a little lower on their priority list. Performing frequent assessments and assisting with hygiene is vital to preserving and improving quality of life, for example:

  • Help your patients use a handheld mirror to examine their mouth and throat.
  • Ensure that oral care products don’t contain alcohol or other ingredients that can irritate sensitive tissue.
  • Educate your patients about self-care, and guide them toward performing independent dressing changes and surgical site care.
  • Encourage your patients to report any new adverse effects or concerns so they can be addressed promptly.

MEET IN THE MIDDLE
Several factors contribute to malnutrition associated with head and neck cancers. Pain related to mucositis or radiation burns decreases the likelihood that a patient will maintain adequate oral intake. Functional changes following surgery can lead to dysphagia that impairs a patient’s ability to safely receive nutrition and medication by mouth.

To ensure adequate nutrition, many patients with head and neck cancer receive a percutaneous endogastric (PEG) tube prior to beginning treatment. It’s imperative that the patient, the dietitian, and the nursing staff maintain an open line of communication and work together to meet nutritional needs. The patient will likely struggle with losing the ability to taste food and the satisfaction of choosing what they want to eat, so it’s important to allow them to control when they want to receive tube feedings and to follow up frequently to ensure the feedings are being tolerated.

When administering medication via PEG, pay close attention to administration instructions and drug interactions. Extended-release and sustained-release medications should never be crushed and given via PEG. Each medication should be crushed and administered individually, followed by a flush of room-temperature or lukewarm water. If a patient has several medications scheduled at the same time, assess whether administration times can be changed or allow enough time to administer them slowly to avoid patient discomfort related to a high volume of fluid. Lastly, pay attention to whether medication should be administered on a full or empty stomach and coordinate medication administration with tube feedings accordingly.

Although nurses can’t eliminate the hardship that patients will face during treatment for head and neck cancer, we can support them by providing compassionate and thorough care.

Melissa A. Grier, MSN, APRN, ACNS-BC, is a clinical content developer for Carevive Systems, Inc.

Restaging raises hope against HPV oral cancer

Source: atlantajewishtimes.timesofisrael.com
Author: Cady Schulman

Jason Mendelsohn was diagnosed with Stage 4 tonsil cancer from HPV in 2014 after finding just one bump on his neck. He survived thanks to a variety of treatments, including a radical tonsillectomy and neck dissection to remove 42 lymph nodes, seven weeks of chemotherapy, radiation and a feeding tube.

But if Mendelsohn’s cancer had been discovered today, just four years later, it would have been classified as Stage 1. That’s because HPV-related oral cancers now have a high survival rate through a better response to treatment, said Meryl Kaufman, a speech pathologist specializing in head and neck cancer management who worked for Emory University’s department of head and neck surgery for 10 years.

“Cancer staging is taking into account the HPV-related cancers,” said Kaufman, who now owns her own practice. “It was kind of all lumped together. The survival rates for people who have HPV-related cancers are much higher than the typical head and neck cancers associated with smoking and drinking.”

For Mendelsohn, finding out that patients with HPV-related cancers likely face easier treatments and higher success rates made him extremely happy.

“If I was diagnosed and I heard Stage 1 instead of Stage 4, while it’s still cancer, it would make me feel like I could beat it,” said Mendelsohn, who made a video for his children a month after his diagnosis with advice for their lives after he was gone. “When I hear Stage 4 to Stage 1, I think people have hope they can beat it. My hope is that it will give people hope that they can beat this.”

As a cancer survivor, the Florida resident wants to give hope to other patients. He talks to people throughout the world every month and is creating a worldwide survivor patient network to connect cancer survivors with patients.

“While cancer is scary, Stage 1 is a lot less scary than Stage 4,” Mendelsohn said. “Stage 4 was overwhelming. When I was looking for information, there was nothing out there that made me feel like I was going to be OK. What I’m trying to do is give people hope and let them know that it’s all temporary.”

Another way Mendelsohn is trying to reach those affected by cancer is through his website, supermanhpv.com. He shares his story, news articles featuring him and oral cancer caused by HPV, and information for survivors, patients and caregivers.

The site also features Mendelsohn’s blog, putting himself out there so people can see that someone who, just four years ago, was diagnosed with Sage 4 cancer is now a Peloton-riding, travel-loving cancer advocate.

“People see me and say (they) can’t believe (I) had cancer three to four years ago,” Mendelsohn said. “I was in bed 18 hours a day for a month. I was choking on my saliva for a month. I was consuming five Ensures a day and two Gatorades a day through a feeding tube in my stomach. If people going through that can see me working out, going on the bourbon tour in Louisville. I’ve been on an Alaskan cruise. I’ve been to the Caribbean. I’ve been to the Grand Canyon.”

Mendelsohn, who started his campaign to raise awareness of HPV and oral cancer by raising money for the Ride to Conquer Cancer in Washington, now serves on the board of the Head and Neck Cancer Alliance. The organization’s goal is to advance prevention, detection, treatment and rehabilitation of oral, head and neck cancers through public awareness, research, advocacy and survivorship.

“I feel like it’s gone from me raising money for a bike ride to me on two boards helping create awareness and raise inspiration and creating a survivor patient network,” Mendelsohn said. “Now it’s not about me and my three doctors. Now it’s about helping people with diagnosis globally. There are great doctors. I think we’re going to do great things.”

One way to help prevent children from getting cancer caused by HPV when they grow up is the Gardasil vaccine, which protects against HPV Strain 16, which causes oral cancer. Mendelsohn said 62 percent of college freshmen and three-quarters of adults by age 30 have HPV.

But he doesn’t tell people to get the vaccine. Instead, he advises parents to talk to their kids’ doctors about the benefits and risks.

“I talk about the importance of oral cancer screenings when they’re at the dentist,” he said. “And if you feel a bump on your neck, go to your ENT. I had no symptoms and just a bump on my neck, but I was diagnosed with Stage 4. I’ve had so many tell me that they didn’t know the vaccine is for boys. They thought it was just for girls.”

Kaufman said that the HPV vaccine is recommended for use in boys and girls and that it’s important for the vaccine to be given before someone becomes sexually active. The vaccine won’t work if a person has already been exposed to HPV, as most sexually active adults have been, she said.

Men are much more likely to get head and neck cancer from HPV.

“Usually your body fights off the virus itself, but in some people it turns into cancer,” Kaufman said. There hasn’t been specific research that the HPV vaccine will protect you from head and neck cancer, she said, “but if you’re protected against the strains of HPV that cause the cancer, you’re probably less likely to get head and neck cancer.”

Treatment for this cancer isn’t easy, Kaufman said. Radiation to the head and neck can affect salivary glands, which can cause long-term dental and swallowing issues. Treatment can affect the skin, taste and the ability to swallow.

“A lot of people have tubes placed,” she said. “It’s not easy. It depends on how well you respond to the treatment.”

While getting the vaccine can help protect against various cancers, awareness about head and neck cancer is the key. And knowing the signs and symptoms — such as sores in the mouth, a change in voice, pain with swallowing and a lump in the neck — is important.

“If one of those things lasts longer than two weeks, you should go to your doctor,” Kaufman said. “This can affect nonsmokers and nondrinkers. It’s not something that people expect. The more commonplace it becomes and the less stigma, the better.”