A Battle for Her Life

Sarah, third from right, and her family.

When Nurse Sarah Latham was diagnosed with a rare colorectal cancer, she did her research and chose UAB for treatment. As dean of the College of Nursing at Jacksonville State University and a former instructor in the UAB School of Nursing, Sarah is well-versed in the clinic and classroom. ”I was willing to go anywhere,” she says. ” I determined the place most likely to save my life—and that was UAB.”

“Something Is Wrong”
Four years ago, Sarah began experiencing frequent and troubling stomach discomfort—abdominal pain and diarrhea—and decided to visit her local gastrointestinal specialist.
I’d had a colonoscopy three years before that was perfectly normal … but my GI specialist, Dr. Amin, listened to me when I said, “Something is really wrong. I know my body.” He said, “Well, let’s do a colonoscopy.” He found a tumor.

Sarah was immediately referred to a surgeon in the area for treatment. When he suggested immediate surgery without obtaining a firm diagnosis, it gave Sarah pause.
As a nurse, that seemed all wrong to me—that you would have a treatment plan without a diagnosis. If you find cancer, you need to look for metastasis before you develop your treatment plan, because it is an important factor in how you’ll proceed.

The surgeon also balked when Sarah mentioned she’d like to get a second opinion.
If a physician or healthcare provider resists a second opinion, that’s a red flag. He was a little bit disrespectful and said, “Well, you can go to UAB, but they’ll tell you the same thing.” As it turned out, they told me the opposite.

Life-Saving Decisions
Sarah left her appointment and immediately began researching her condition.
I very aggressively began learning everything that I could about cancer treatment centers. I researched the National Comprehensive Cancer Network (NCCN) and decided that I would only be treated at a member facility because they are the most cutting edge and state of the art. Then I researched literature and treatments for colorectal cancer, and I narrowed my selection to four National Comprehensive Cancer Network institutions that really stood out for their work with colon cancer: City of Hope in L.A., M.D. Anderson in Houston, Memorial Sloan-Kettering in New York, and guess what? UAB.

Sarah went even further, researching specific surgeons with the help of her brother-in-law, an interventional radiologist. They selected their top choices at UAB and Memorial Sloan-Kettering.
We both felt that those two people were probably the best of the best for colon cancer. What we didn’t realize was that I would wind up with a very rare kind of cancer that was not going to be treated surgically.

With the diagnosis she later received, Sarah recognizes that had she stayed with the local surgeon, she might not be alive today.
Had I gone with his recommendation, he would not have known that I had lymph node involvement until maybe too late. The evidence-based guidelines for my kind of cancer at Stage III did not include surgery; outcomes are better with chemo and radiation only. A teaching point for patients is that treatment should be evidence-based, that is, based on repeated studies, common outcomes, and meta-analysis.That was a critical decision early on: that I would only work with a physician who based the treatment plan on evidence-based guidelines.

There was one more factor, in addition to NCCN-affiliation and adherence to evidence-based principles, that Sarah weighed heavily.
At that time, UAB was the only hospital of the four with MAGNET status. As a nurse, I know that it is very hard to achieve MAGNET status; MAGNET status is a type of credentialing that suggests you’re going to get the absolute best nursing care possible, and that in fact was my experience.

“Is It Malignant?”
With her choice made, Sarah began making calls.
I self-referred to UAB, which I find amazing and wonderful because some medical centers will not allow you to do that. I was seen at The Kirklin Clinic very quickly—the next week. At the time, they did a biopsy, but here’s the most wonderful thing on earth—they had a pathologist in the room during the procedure so that when the gastroenterologist sampled the tumor, he was able to look right then, right there at the cells and make a diagnosis. I asked if it was malignant and he said, “Yes, it is.” Knowing right then really helped me. I have to tell you … any patient will tell you … the waiting is agony.

During her appointment, Sarah also underwent an endoscopic ultrasound to identify whether her lymph nodes were affected.
It turns out that I did have a lymph node that was involved, and they could actually biopsy it during that procedure. Think back to the local surgeon: He didn’t even consider an endoscopic ultrasound. The lymph node was not palpable, so he would not have found it. I could have had surgery, but still had cancer. Having the pathology report immediately was something I thought was absolutely, very, very patient-focused.

On her first visit, Sarah had an endoscopic ultrasound, biopsies, and a meeting with her surgeon.
I found the scheduling to be remarkable. My surgeon had the pathology report immediately so we could start deciding what our options were and what we were going to do.

“I Was Blindsided”
The pathology report revealed not only that Sarah’s tumor was malignant, but also that she was facing a very rare cancer.
My tumor was squamous cell instead of adenocarcinoma. Squamous cell is a completely different kind of cancer, and it is very rare in the location where I had mine. It is usually associated with gynecologic cancer, and I had not even thought of that. My surgeon said to me, “Before we do anything, we have to rule-out GYN cancer.” Think again back to my experience with the original surgeon: He did not have a clue that we needed to look at my uterus and cervix. I had not considered that my tumor might be a metastatic lesion; if there is a primary tumor somewhere else, then your prognosis is poor. I was prepared to hear the tumor was cancer, but I was blindsided to learn that I might have widespread metastasis.

The surgeon said he would get me an appointment for GYN biopsies the next week.The nurse, Suzanne McNeil, heard me say, “Oh my God, I don’t think I can wait a week.” She said, “Give me just a minute.” She advocated for me. She got on the phone and was able to get me worked in with a GYN oncologist that day. It was the most powerful demonstration of patient advocacy that I can even imagine. She knew how to work the system in a positive way to advocate for the patient.

Good News
Sarah’s cancer was not gynecologic or a metastatic lesion.
The experience that I had with Dr. Barnes in GYN oncology was awesome. In fact, he called me the next day, on a Friday night at 7:30 p.m., to tell me that he had gotten the pathology report back and I did not have GYN cancer. Those are examples of advocacy for the patient, of kindness. To me, I had selected those care providers because of their competence and because I had the best possibility of a good outcome. But when I got to these highly competent people, they were also caring and compassionate, and that is the perfect combination. It was absolutely unbelievable.

Trust, but Verify
With Sarah’s strong healthcare background and the fact that her cancer was rare, she knew a second opinion was the necessary next step.
I told the team at UAB that I really trusted them, but I have always been taught that a second opinion is appropriate, especially if your condition is rare. It was critical to me that I be part of the decision-making process, and UAB encouraged that.

Sarah chose Memorial Sloan-Kettering in New York for her second opinion and began lining up her appointment. The surgeon in New York said she’d only need to send pathology slides.
I called Suzanne McNeil at 1 p.m. on a Monday to ask her to mail my pathology slides. Sloan-Kettering called me at noon on Tuesday and said that they had arrived. I was stunned that Suzanne had stopped immediately in the middle of her busy day and overnight mailed my slides. That is stellar customer service, exceeding my expectations. Who would go to that kind of trouble and expense? UAB did that for me.

Sarah and her husband flew to New York immediately and went through the same diagnostic tests they’d encountered at The Kirklin Clinic.
Everything they did was what they did at UAB, which made me feel good. Then the surgeon began quoting evidence-based guidelines to me, which were the exact same things that the UAB surgeon had said, almost verbatim. I said, “Okay, this is the right diagnosis, and we know what the right treatment is. It’s not surgery for me. It’s chemo and radiation.” Then the surgeon at Memorial Sloan-Kettering said, “I’m happy to treat you, but you need to look up a guy named Marty Heslin at UAB, because he is as good as I am and you will get as good of treatment from him as you get from me.” Guess who I had seen at UAB? Marty Heslin.

“How Many Cases?”
Sarah’s surgeon at Memorial Sloan-Kettering had one more task for her.
He said, “The one thing you’ve got to find out before you commit to a treatment, because your cancer is so rare, is how many cases they saw last year at UAB. This is so rare that even cancer treatment centers can go a whole year without seeing one like yours. If they didn’t see anybody last year, we might want to look at other options for you.” I said, “So how many did you see at Sloan-Kettering?” He said, “I saw ten.” When I got back to Birmingham, I asked the same question, and the answer was 12. I knew that I was in the right place with the right treatment.

A Loyal Fan
From the initial finding of the cancerous tumor, to going through a diagnosis, and determining the treatment, the things that make me such a loyal fan of UAB and The Kirklin Clinic are:

  • A. Most importantly, they are delivering the highest quality care possible that is based on evidence. Evidence-based treatment gives you the best patient outcome.
  • B. UAB is the only MAGNET hospital that met the other criteria that I wanted. MAGNET status is an indicator that you’re going to get superb nursing care and in fact, that’s exactly what I got.
  • C. What also made it magnificent for me was that the individuals that I interacted with were kind and caring, and just as importantly, they were efficient and were patient advocates. If they knew a way to make something happen positively for me, they went the extra mile.

They encouraged my participation in the decision making. They respected that I wanted to be sure before we started, and to contrast that with the response that I got from the original surgeon when I began to try to talk diagnosis, treatment, biopsies, and looking for metastasis, he seemed offended. At UAB when I talked the lingo, they welcomed it and told me anything I wanted to know. There was a night-and-day difference. The philosophy of the institution permeates the care, because at UAB they want you to be as well informed as you can be. They want you to participate in the decision making. They’re not threatened or challenged when they have a well-informed patient. I’ve been a nurse for almost 40 years and I know that is true.

When I learned I had cancer, I began working my offensive plan. I set out to find the best team of doctors and nurses, with the best “track record.” My search was deliberate and methodical without regard for location … I was willing to go anywhere. Through an objective evaluation, I determined the place most likely to save my life—and that was UAB.

“Gentle, Kind, and Encouraging”
After her diagnosis with her team at The Kirklin Clinic, Sarah began a five-week chemotherapy and radiation course at UAB Hospital.
I had two weeks of in-patient 24/7 chemotherapy and, unfortunately, two more weeks of hospitalization from complications from the chemo. The unit manager, Faye Williams, leads a phenomenal team of nurses. At one point, I had a “near code” situation and the Rapid Response Team was there within minutes; I saw my kind, gentle nurse run for the crash cart and begin emergency procedures. My specialty is critical care, and as I watched that coordinated team effort during the crisis, I actually relaxed thinking, “These guys really know what they’re doing!”

My radiation oncologist, Dr. Jacob, could not have been better. The people were so kind. Even the parking attendants were gentle, kind, and encouraging. My nurse in radiation-oncology, Sandy Brant, called me at home, sometimes in the evening, to check on the severity of my side effects. My family and I went into treatment aiming for a cure, and I decided that I could put up with anything if there was a possibility of remission.

A Happy Ending
Today Sarah’s cancer is in remission, and she lives each day with hope and a strong faith. Sarah lives in Gadsden with her husband Joel; They have two adult sons and a daughter-in-law.

UAB study finds sigmoidoscopy reduces colorectal cancer rate

Image of internal organs - ColonResearch conducted at the University of Alabama at Birmingham as part of a national study reveals that flexible sigmoidoscopy — a screening test for colorectal cancer that is less invasive and has fewer side-effects than colonoscopy — reduces deaths due to colorectal cancer.

Overall, colorectal cancer deaths were reduced 26 percent and new cases were reduced 21 percent as a result of screening with sigmoidoscopy, according to findings of the Prostate, Lung, Colorectal and Ovarian  Cancer Screening Trial that appeared online May 21, 2012, in the New England Journal of Medicine.

As part of the PLCO trial, a population-based, randomized study funded by the National Cancer Institute, a total 154,900 men and women ages 55-74 were randomly assigned to receive flexible sigmoidoscopy screening (intervention group) or usual care (control group) between 1993 and 2001. Control group participants were screened only if they asked for it or if their physician recommended it. Members of the intervention group were screened upon entering the study to collect a baseline measure and again three to five years later. All participants were followed for approximately 12 years.

UAB enrolled more than 6,000 participants. Compliance was one of the highest among all 10 sites — 96 percent at baseline and 75 percent at five years.

“This trial allowed us to identify an evidence-based screening tool other than colonoscopy to reduce the number of new cases and deaths from colorectal cancer. This finding is important because not all individuals have access to colonoscopy, which is more expensive and has to be performed by specialty physicians,” says Mona Fouad, M.D., M.PH., principal investigator of the UAB PLCO site, director of the UAB Division of Preventive Medicine and co-leader of the Cancer Control and Populations Sciences program at the UAB Comprehensive Cancer Center.

Sigmoidoscopy involves examination of the lower colon using a thin, flexible tube-like instrument, called a sigmoidoscope, to view the anus, rectum and sigmoid colon. It has fewer side-effects, requires less bowel preparation, does not require sedation and poses a lower risk of bowel perforation than colonoscopy, in which a similarly flexible but longer tube is used to view the entire colon.

Colorectal cancer is the second-leading cause of cancer-related deaths in the United States.  Previous research has shown that its incidence and mortality can be reduced with a number of screening methods, including fecal occult blood testing. However, flexible sigmoidoscopy and colonoscopy are more sensitive than FOBT for detecting pre-cancerous polyps, which may be removed during the procedure to reduce the risk of colorectal cancer.

“The most effective screening test for colorectal cancer is the one people are willing to take.  The results of this study may encourage more people to have colorectal screening with the less invasive and less expensive sigmoidoscopy,” says Fouad.

In the PLCO trial, researchers compared the overall colorectal cancer mortality and incidence in the two groups (intervention and control) and also analyzed incidence and mortality according to the location of the cancers that developed. Cancers located in the area from the rectum through a bend in the colon called the splenic flexure were defined as distal, and those located in the transverse colon to the cecum were defined as proximal. Although flexible sigmoidoscopy examines only the rectum and the sigmoid colon, participants with a suspicious finding were referred for a follow-up colonoscopy, in which both the distal and the proximal regions of the colon were examined.

After an average 12 years, participants in the screening group had a 21 percent lower incidence of colorectal cancer and a 26 percent lower mortality rate than participants in the usual-care group. The incidence of distal colorectal cancer in the screening group was reduced 29 percent, and mortality from distal colorectal cancer was reduced 50 percent. While there was no statistically significant decline in deaths from proximal colorectal cancer in the screening group, the incidence of proximal colorectal cancer was reduced 14 percent.

Cancer and the Family – Four Approaches

The diagnosis of cancer is a traumatic experience for anyone.  It changes life forever.

Trauma brings pain and suffering in many ways.  Peter Hacker stated, “Pain is a sensation; suffering is an emotion”  Betty Ferrell, RN, in her book Suffering, said, “Suffering is a personal experience not an external event.”

She quoted Spross who said, “Pain may exist without suffering and suffering without pain.”

Explore the effects of diagnosis, treatment, and living with cancer by looking at the four domains of suffering (physical, psychological/emotional, social, spiritual) for the patient and for family members (partner/spouse, children, siblings, parents, etc.) and other primary relationships (friends, co-workers, neighbors, etc.).

Some examples among many others:

Physical:  loss of strength, energy, appetite, weight, memory, sexual intimacy interest/ability, fertility; presence of pain, nausea, vomiting, dizziness; weakened immune system; change of schedule/routine; change in financial responsibilities; help with personal hygiene

Psychological/Emotional:  Fear, confusion, depression, anxiety, guilt, sadness, despair, hopelessness, anger, loneliness, weary, exhausted, denial, burdened, incompetent to give proper care; feeling out of control; thoughts of suicide; personality changes; change of values (what matters and what does not); feeling protective of loved ones

Social:  avoided by or treated differently by family/friends/coworkers, avoids or limits social interaction, tries to “protect” patient or persons in primary relationships, work discrimination (dismissed, demoted, benefits reduced), financial resources change, vacation/sick time used up with medical treatment/caregiving, life feels “on hold” so no plans for future, withdrawal from patient or primary relationships, other family members don’t help, must deal with medical system and insurance

Spiritual:  anger at God or Higher Power, confusion, loss of faith, blames self, fear is being punished, feels disconnected from self, “Why?”; feels closer to God or Higher Power–new or renewed connection; feels grateful for power and strength given to cope

Each person experiences these aspects differently.  Each of us knows only how we would feel if we were in that place–not how the other person feels.  Suffering, peace of mind, healing, the progress of the soul can be measured only by the one who embodies it.  To cope well, it’s important to create a support system through medical team, friends, support groups, individual/family counseling, faith communities.  Communicate openly and authentically with patient and persons in that support system.  Encourage all possible independence for patient and for caregivers.

UAB knows that we must treat the patient as well as the disease.  We do so by offering treatment through our Center for Palliative and Supportive Care.

Birmingham goes smoke free

The Birmingham City Council passed tougher rules on smoking in public places yesterday. The rules, which go into effect in 30 days, will effectively ban smoking from all public places such as restaurants, bars and patios. It will also enforce a rule calling for outdoor smoking to take place at least 7-feet from entrances to buildings.

Dr. Ed Patridge of the UAB Comprehensive Cancer Center calls the moment “historic” for Birmingham.

This was, I thought, an historic event for Birmingham, and I applaud the council for their thoughtful deliberation and courage in moving forward with this. Birmingham now becomes the largest city in Alabama to go “smoke free.” Maybe this will be the stimulus for a statewide smoke-free law. Let’s hope so.

UAB receives $19 million grant to reduce cancer disparities

Researchers at the University of Alabama at Birmingham have received a five-year, $19 million National Cancer Institute renewal grant for the UAB Comprehensive Cancer Center, Morehouse School of Medicine and Tuskegee University partnership to address cancer disparities among blacks.

“A complex interplay of economic, social and cultural factors influence cancer disparities, and we are working to understand it and determine methods to solve the problem,” says Upender Manne, Ph.D., lead principal investigator and professor in the UAB Department of Pathology.
“The vision of the partnership is to become nationally recognized for contributions to research and training and to eliminate cancer-health disparities, particularly in under-served regions,” Manne says. “With this renewal, the partnership will continue to bring the benefits of advances in cancer research to disadvantaged regional patient populations, influencing their lives for decades to come.”

This tripartite research effort, initially funded by NCI as a cooperative grant in 2007, pairs federally designated, comprehensive cancer centers such as the UAB Comprehensive Cancer Center with institutions of higher learning that historically serve minorities. MSM, TU and UAB are ideally situated in Alabama and Georgia, Southern states with high cancer-mortality rates.

Partnership activities include bench- and community-level cancer research focused on understanding the causes for cancer disparities plus education and training programs that encourage students to pursue biomedical sciences and link them with seasoned investigators within the UAB Comprehensive Cancer Center.

The outreach program, which is at the core of the partnership, promotes cancer-awareness and healthy lifestyles among under-served populations and encourages minority participation in therapeutic clinical trials. The outreach program held colon-cancer screenings in the greater Atlanta area by MSM, increased physical activity and improved dietary choices among rural residents of the Tuskegee area by TU and more than doubled participation by blacks in therapeutic trials in the UAB Comprehensive Cancer Center.

“The partnership also has been a significant influence leading to sustained, integrated and organizational changes at the three institutions,” says Edward Partridge, M.D., director of the UAB Comprehensive Cancer Center and co-principal investigator.  “It also has forged great relationships between the institutions and expanded opportunities for collaboration.”

The lead principal investigator at MSM is James Lillard, Ph. D., with co-principal investigator Daniel Blumenthal, M.D. At TU, the lead principal investigator is Timothy Turner, Ph.D., and co-principal investigator is Roberta Troy, Ph.D.

During the past five years, the partnership has trained 81 scholars to perform cancer-related research. Furthermore, each of the institutions has had substantial increases in cancer research funding. At MSM, funding increased to more than $26 million in 2011 from $8 million in 2000.  During the same period, TU cancer research funding increased to more than $6 million from $2 million. The Cancer Control and Population Science Program at the UAB Comprehensive Cancer Center increased to more than $22 million in 2011 from $12 million in 2005.

MSM has established a cancer-research program with 30 faculty from diverse scientific disciplines. TU has increased its capacity to conduct cancer research by training students and scientists who focus on eliminating cancer disparities and also developed two cancer-related courses for its curriculum. Also, the National Center for Bioethics in Research and Health Care at TU was established as a national resource for cancer-disparity programs. In the past five years, the UAB Cancer Center recruited six new faculty involved in research on cancer-health disparities.

Also, in the previous funding period, partnership investigators published more than 75 peer-reviewed manuscripts directly related to cancer disparities and received funding for 17 scientific projects.

“There’s a paradigm shift in the way community-based and academic research is planned and performed in the arena of health disparities,” says Mona Fouad, M.D., MPH, director of the UAB Minority Health and Research Center and a co-principal investigator. “These three institutions possess unique strengths for educating and training minority students, community health workers and faculty in conducting research to address cancer-health disparities.”

Source: UAB News

5 Things You Need to Know Before Undergoing Radiation Treatment

Truebeam can reduce treatment times by 50 percent or more.

If you or someone you love has cancer, chances are at some point radiation therapy will become part of the treatment regimen since 2/3 of all cancer patients will receive radiation at some point during their care. However, most patients are not very familiar with radiation therapy leading to anxiety and confusion.  This article was written to try to alleviate fear and clear up some of the common misconceptions surrounding radiation treatment.

What is radiation therapy and how does it work?

Radiation therapy (radiotherapy or radiation treatment) is the use of radiation to treat various types of abnormal growth in the body.  Most of the abnormal growth we treat is in the form of a cancer, but we also treat benign growths such as meningiomas, keloids and desmoid tumors that are local growth processes that do not spread throughout the body like a cancer does.  Radiation is most commonly given in the form of x-rays, which are invisible light particles that can pass through the body and treat tumor cells. Radiation works to control tumors by several different ways, but the most prominent is its ability to damage DNA, the genetic material that the tumor uses to grow and multiply.  When a tumor cell sustains sufficient DNA damage, it can no longer reproduce and will die. One analogy is that tumors are like “cassette tapes trying to make copies of themselves.” Radiation effectively “cuts that cassette tape” leaving it “broken” and unusable. Conceivably, the more radiation that is given to a tumor, the more likely that tumor will be destroyed.  However, normal cells of the body can also be damaged by radiation that necessitates limitations on how much radiation is given and how it is delivered.  Fortunately, normal cells of the body have ways of repairing radiation injury that cancer cells typically do not use.  Therefore, there are two main approaches in modern radiation therapy that allow us to maximize tumor control and minimize normal tissue injury: 1) Break up treatments into smaller pieces, or fractions, that give the normal tissue an opportunity to repair the damage; and 2) Deliver the radiation better by giving more dose to tumor and less dose to normal tissue.  These principles are applied to every patient we treat.

What are the different types of radiation?

As mentioned above, most radiation is in the form of x-rays (or photons) that are invisible light particles generated by machines called linear accelerators. X-rays and other commonly used forms of radiation such as electrons and gamma-rays are aimed at the patient’s tumor from outside the body because they have penetrating power. This external beam radiation therapy (EBRT) can be thought of like a “flashlight” in that we “shine” it on particular regions of the body.  As the “light” passes through the body, a portion of the beam’s energy will be delivered to that tissue.  We have very sophisticated ways of shining the radiation light that allows us to spare normal tissue while maximally treating the tumor.  In most cases, the radiation is given from multiple angles (or fields) and can be shaped by a computer-controlled mechanism that can help shield critical organs that are in the path of radiation.  Intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS) and body radiation therapy (SBRT) are radiation delivery techniques that maximize the principle of radiation dose shaping.

Another form of radiation is internal radiation therapy that can be given as “liquid” radiation medicine, commonly used in thyroid cancers, or in the form of brachytherapy, which literally means “short” therapy, involving tiny radioactive sources being implanted inside the body.  The radiation used in internal radiation therapy does not penetrate very far and so the radioactive sources must be in close proximity to the tumor cells.

What can I expect?

Most patients are introduced to radiation oncologists during a consultation that may take place in a clinic or a hospital setting.  Radiation oncologists will work with primary care physicians and other cancer specialists such as surgeons and medical oncologists to decide if radiation therapy is indicated.  If radiation therapy is indicated, then the patient will be set up for a radiation simulation, or “planning session” that typically involves a specialized CT simulation scan that allows us to generate a 3D model of the patient’s anatomy for planning purposes.  Depending on how sophisticated the plan needs to be to achieve the treatment objectives, it may take several days to design and quality check a treatment plan.  Since most patients will receive anywhere from 10 to 35 radiation treatments given on a daily basis (Monday through Friday), we need to be sure that the patient is setup and treated the same way each time. To do this, we use both immobilization (designed at time of CT simulation) and imaging techniques to provide assurance of accurate and reproducible therapy.  Most daily treatments take only a few minutes and you cannot really “feel” radiation treatments. However, because side effects can occur during the course of radiation, patients are evaluated by the nurse and radiation oncologist at least once a week.

What are the side effects?

Radiation, much like surgery, is a local and regional therapy, that is, radiation is usually aimed at only a portion of the body.  As such, all of the “good parts” and “bad parts” of radiation are where we shine the beam.  Because we can generate detailed radiation dose “maps” (radiation dosimetry) for each patient’s anatomy, we have some idea about the possible risks of toxicity for any given treatment plan.  In general, we talk about acute (early) and late side effects of therapy. Acute effects are usually temporary and occur in normal tissues that are most rapidly dividing (since they are actively using their DNA, much like the tumor cells). For example, breast cancer treatments may cause a skin reaction much like a sunburn, while radiation treatment to the belly can cause nausea and diarrhea due to injury to the digestive system cells.  These symptoms do not usually occur right away. As such, the first third of a treatment course is considered the “honeymoon period” in which little to no toxicity occurs. After that, side effects usually appear gradually and will be managed by your doctor – so be sure to tell your nurse and doctor about any symptoms you may be experiencing.  The most common side effect for all therapy is a mild tiredness that feels similar to the fatigue caused by a common cold.  In fact, many patients can continue to maintain their normal daily activities, including work, while receiving radiation.  Late effects of radiation develop after the radiation treatment is finished, and are much less common.  Patients will follow-up with their radiation oncologists and will be monitored for these late effects.

Is radiation therapy safe?

Some patients are nervous about the safety of radiation therapy.  Fortunately, radiation therapy has been used for over a century and during that time we have learned a lot about how best to deliver the therapy. As described above, radiation treatments are customized and carefully planned to avoid treating healthy organs in the target region.  Indeed, the extent of quality control for radiation therapy surpasses many fields of medicine. The radiation oncology team includes medical physicists who work closely with radiation oncologists to maintain the highest level of safety and quality control. The vast majority of the work that goes into radiation treatment occurs before the very first treatment is given. Treatment plans are evaluated using our specialized treatment planning software, and verification measurements and calculations are performed prior to therapy. In addition, each patient’s plan is reviewed by several radiation oncologists on faculty to ensure that the treatment plan is safe. Furthermore, our radiation treatment machines have multiple fail-safe measures built in to further protect the safety of our patients. During a treatment course, members of the radiation oncology team will recheck your treatment plan as well.

If you receive external beam radiation therapy (EBRT), you pose no risk to others as you will not be radioactive following radiation treatment. You can think of EBRT as light switch – when it is on, the radiation photons are present but when it is off, there are no photons.  Brachytherapy, however, does involve the implantation of very small radioactive seeds that may be present permanently or temporarily. Similarly, “liquid radiation” in the form of radioactive medicine will require special precautions for a short period of time that will be explained to you by your radiation oncologist.

All in all, your safety is our utmost concern, which is why we have such a rigorous quality assurance program in the Radiation Oncology Department at UAB!

The Power of Good Nutrition

Nutrition for Cancer PatientsWhen it comes to a cancer diagnosis, the Hippocrates quote, “Let thy food be thy medicine” rings true. According to Laura Newton, MAEd, RD, LD, food choices are especially important for people facing cancer. “During cancer treatment, patients will notice changes in their appetite and the way they experience food,” Newton says. To combat these common culinary problems, Newton, an assistant professor in the UAB Department of Nutrition Sciences, says there are certain foods and tricks patients can adopt into their diet.

“If a patient has a poor appetite, for example, and is not getting enough calories, he or she can pump up meals by adding high-calorie foods,” Newton says. She suggests adding a sprinkling of nuts to oatmeal or yogurt, or a splash of olive oil on green beans or leafy greens such as collards or spinach to increase the number of calories in the meal.

Newton will be providing many more tips and tricks for patients battling cancer in her upcoming presentation, Good Nutrition During and After Cancer Treatment. The lunchtime information session is open to patients and will reveal which foods can help strengthen the immune system, how to combat nausea, and ways to overcome a sour taste. Newton’s presentation will also include food safety tips and pantry secrets you should adopt, as well as sneaky ways you can incorporate more fruits, vegetables, and healthy sources of fat into your diet.

The talk is part of the UAB Comprehensive Cancer Center’s Living with Cancer Series, a monthly lunch-and-learn presented by UAB cancer experts. To reserve your spot for Newton’s talk or receive more information, contact teri.hoenemeyer@ccc.uab.edu or (205) 934-5772. A light lunch will be served.

Good Nutrition During and After Cancer Treatment
March 14th
11:30 am – 12:30 pm
1st Floor Learning Center – The Kirklin Clinic
Registration is required; light lunch served.
To register or for more information: teri.hoenemeyer@ccc.uab.edu or (205) 934-5772


What is a Clinical Trial?

Clinical trials, also called cancer treatment studies or research studies, test new treatments in people with cancer with the goal of finding more effective ways to treat the disease. As an academic medical center, UAB Medicine has a strong research component, which means there are hundreds of clinical trials being conducted on any given day, many of them focusing on cancer. Patients at UAB have an advantageous option of joining one of these trials, with support from their cancer physician, or benefitting from the newest and most effective treatments.

Each new cancer treatment goes through several levels of testing to make sure it is safe for use on people. Patients who enroll in clinical trials get up-to-date care from cancer experts and receive either a new treatment being tested, or the best available standard treatment for their cancer. Patients can also take heart in the fact they are aiding in the discovery of new treatments for future cancer patients. Many of today’s most effective treatments for breast, colon, rectal, and childhood cancers are based on clinical trial results.

Of course, clinical trial treatments may pose risks, but if a new treatment proves effective, study patients who receive it may be among the first to benefit. If you have any questions about how clinical trials work or are interested in learning more, ask your doctor, nurse, or other health professional.

Learn about the clinical trials available at UAB »


Study: Colonoscopy Saves Lives

New research published Wednesday in the New England Journal of Medicine shows for the first time, a positive impact of colonoscopy and the subsequent removal of any polyps found, on colorectal cancer deaths.

The study, first reported by the New York Times, cites 2,600 patients at the Memorial Sloan-Kettering Cancer Center who had polyps removed during a colonoscopy. Those patients saw 53% reduction in deaths from colorectal cancer compared to the general population.

Doctors compared their death rate from colorectal cancer with that of the general population, where 25.4 deaths from the disease would have been expected in a group the same size. But among the polyp group, there were only 12 deaths from colorectal cancer, which translates into a 53 percent reduction in the death rate.

While screening tests have been ordered for years, this research is the first study with evidence that screenings prevent cancer deaths.

The report’s timing is fortuitous, as March is colorectal cancer awareness month.  According to data from the CDC, approximately 60% of deaths from colorectal cancer could be prevented if proper screening guidelines were followed.

In Alabama, only 60% of people aged 50 and older have had a colonoscopy in the last 10 years.


UAB Advances in Brain Tumor Research Named Among Best of 2011

Congratulations to Markus Bredel, MD, PhD, of the UAB Department of Radiation Oncology. Dr. Bredel’s 2011 research on a type of brain tumor called Glioblastoma was named one of the top clinical research advances of the year by the American Society of Clinical Oncology.

Dr. Bredel’s findings originally appeared in the February 17, 2011, edition of the New England Journal of Medicine, the nation’s most distinguished peer-reviewed medical journal.

Bredel’s study was the first to implicate the deletion of a copy of a gene called NFKBIA as a contributing cause of glioblastoma. Mutations in NFKBIA, normally present on chromosome 14 in two copies (one each on the maternally and paternally inherited copies), have been shown to be present in a number of cancers including Hodgkin’s lymphoma, multiple myeloma, melanoma, breast, lung and colon cancer. This was also the first study to associate a deletion of NFKBIA with human cancer and is believed to be responsible for poor patient outcomes; but that could lead to better diagnosis and targeted treatments in the future.

Read more at UAB.edu »