Blogs

Patient Centered Cancer Care? Its More than Checking the Boxes

Dr Michelle Mackay Turville Bay

At Turville Bay we practice patient centered care. Visualize this: the patient is central to their own care. They share information with their doctor and in turn the physician shares information with the patient. This mutual sharing of detail provides that patient with the tools to make decisions that are right for their own healthcare. Dr. June Kim, a radiation oncologist at Turville Bay, says that decision-making power is powerful medicine, and I agree. A cancer diagnosis can be a terribly humbling time for some people as treatment and technology become the focus of their lives. Suddenly thrust into a part of healthcare they may never have faced personally; the learning curve can be steep. Separating fact from fiction is important to every patient. In open discussions with patients we do a lot more than check the boxes of steps that they must take.  As patients are referred to Turville Bay Radiation Oncology Center for radiation therapy as part of their cancer care they share their state of mind and their health concerns. That helps us provide their patient centered care.

In the weeks following a patient’s first visit to Turville Bay, they receive daily treatment. During this time, they build bonds with their radiation therapists, nurses and physicians that often surprise the patient. We provide healthcare, and many patients tell us, a sense of wellbeing through those daily interactions. The therapies are state-of-the-art, the technology is incredible, but it’s the human connection that makes the journey a little easier.

Stereotactic Radiosurgery: a Primer for Patients

Dr Michelle Mackay Turville Bay

As patients are referred to Turville Bay Radiation Oncology Center for stereotactic radiosurgery, an overview of their surgical experience can be meaningful. The technology employed to perform incision-free treatment is quite specialized. The physicians and healthcare teams that do this work are not typically known to most of today’s healthcare patients. Every patient has questions and some may be anxious. What will this “surgery” be like? How will I feel? What will my recovery be like? Will it work?

Though complex planning precedes the day of treatment, the patient sees little of this. Typically, stereotactic radiosurgery consists of one to five treatments. This surgery effectively kills the tumor while seemingly decreasing potential side effects. During the procedure we focus scores of radiation beamlets from multiple angles on the tumor (or other target) with submillimeter accuracy. Each beam has very little effect on the brain tissue it passes through, but when these tiny beams meet, a strong dose of radiation is delivered. Rather than surgically removing the tumor, we destroy the DNA of tumor cells to ablate the tumor. As a result, these cells lose their ability to reproduce and die.

The patient’s experience is straight forward compared to traditional surgery. The time needed to complete a stereotactic treatment is approximately one hour, depending on the size and shape of the target. As the patient reclines on the machine’s treatment couch, a stabilizing mask is put in place. During the procedure:

  • You won't feel the radiation, it is painless.
  • You only hear a minimal hum from the machine.
  • You'll be able to interact appropriately with your treatment team.

After the procedure: 

  • The stabilizing mask will be removed.
  • You may experience fatigue and possibly headache.
  • You'll be able to eat and drink after the procedure.
  • We prescribe rest for a day or two.

Follow up appointments are scheduled. In the coming weeks the tumor will shrink and die because it’s DNA was destroyed, and the tumor is ablated in the surgical process.

Patient Centered Care

Dr Michelle Mackay Turville Bay

“Caring for the cancer patient’s health includes caring for their mental health. The evidence is pretty conclusive, an interdisciplinary approach to care maximizes the medical and technical gains we are making with cancer. Patient-doctor research has focused on patient satisfaction, comprehension, and the patient’s ability to adjust to their life with cancer. How does patient centered care actually work?

We’ve found that clear and continuing communications strengthen the patient-provider relationship. This in turn plays a critical role in the patient adapting to health-enhancing lifestyle changes. We know that, for example, smoking cessation can be a critical step for a cancer patient’s recovery. But, where mental health is concerned, will the patient deal with uncertainty while maintaining hope and following protocols? To achieve patient centered care, patients have to communicate with us, expressing their needs, preferences, and expectations as well as their concerns throughout treatment. Having a patient share power by offering meaningful involvement in choices related to treatment is characterized by mutual trust, respect, and commitment to their own health and to the protocols we ask them to follow. Patient effort can wane when fatigue swamps them and depression can become an issue. It is in these critical periods that patient centered care is most valuable. We can uncover a flagging spirit by discussing those difficult topics candidly during these periods of treatment.

Trust. The process of building trust takes time, but we’ve found it to be invaluable. We align our goals with the patient as those vary from person to person. We do our best to adapt to their needs throughout treatment. And above all, we communicate with the patient and their care team. Patient centered care is our core belief that together with the patient we’ll provide the best possible care.”

Celebrate Survivors & Thrivers

Dr Michelle Mackay Turville Bay

Once you’ve heard the words “you have cancer” your life is changed. Surviving the disease is just one part of this journey. Patients quickly learn a lexicon of medical terms, face myriad appointments, sort through their own emotions along with those of their loved ones, they may deal with economic uncertainty, and more. Treatment plans are unique to each patient and their experience is just as unique. But each year we see more Americans surviving cancer, and more of us living with cancer. The 16.9 million survivors and thrivers among us are testament to how far we’ve come in this battle. And it’s something we celebrate the first Sunday in June every year.

We gather on a Sunday afternoon under big canopies. There’s music and ice cream, there’s dancing and laughter. After all we are part of a community we never sought to join that has the strong bonds formed of shared journey. Put us together in one place and it becomes a party! Women and men, young adults and seniors, those that are cancer free, currently in treatment, and those living with cancer, their families, kids, and caregivers celebrate how far we’ve come together. It’s an event that we look forward to each year, I hope you’ll join us.

If cancer has touched your life join us on Sunday, June 2 from 1-3 for Madison’s Cancer Survivors & Thrivers Ice Cream Social. The event is free to all. There’s plenty of Chocolate Shoppe’s ice cream. Live music and joy fill the air. We wouldn’t miss it.

Surgery Without a Knife

Dr. James Richardson Turville Bay Radiation Oncology Madison Wisconsin

It’s called stereotactic radiosurgery (SRS) but it’s not surgery in the traditional sense. There's no incision. One of the tools in our arsenal at Turville Bay is a non-surgical radiation therapy used to treat abnormalities and tumors of the brain. This surgery is far less invasive than neurosurgery which requires incisions to skin, skull and membranes surrounding the brain tissue itself. For the patient, SRS nearly eliminates surgical recovery time.

It begins with an incredible piece of technology, a linear accelerator called TrueBeam. Our team of radiation oncologists use our TrueBeam LINAC to deliver radiation therapy every day to patients from south-central Wisconsin.

But with stereotactic radiosurgery, Dr. Michelle Mackay teams with a neurosurgeon and a team of others using 3D imaging to target high doses of precisely-targeted radiation. The equipment is specialized, focusing many small beams of radiation on the tumor or other target. Each beam has very little effect on the tissue it passes through, but when all the beams intersect a powerful dose is delivered cutting off blood flow to the tumor and disrupting the DNA of tumor cells so they can no longer replicate. There are few side-effects usually limited to a headache. We recommend resting after the procedure.

Weeks of preparation and calculations go into preparing for the radiosurgery at Turville Bay. But to the patient the process is incredibly fast and life altering. In a single outpatient treatment appointment, the tumor begins to shrink rapidly. SRS is used to treat noncancerous (benign) and cancerous (malignant) brain tumors, including meningioma, paraganglioma, hemangioblastoma and craniopharyngioma. It may also be used to treat cancers that have spread to the brain from other parts of the body (brain metastases).

The success of Turville Bay’s stereotactic radiosurgery program is notable. An additional TrueBeam LINAC is currently being added at Turville Bay and will be in use by summer.

Beyond Radiation Therapy

Dr Michelle Mackay Turville Bay

Caring for a patient’s health sometimes means treatment beyond the radiation therapy that about three quarters of cancer patients receive. As a radiation oncologist I am often called upon to help patients in other ways through a cancer diagnosis and treatment. Like palliative care, given throughout a patient’s treatment, to improve a patient’s quality of life. A recent post to Turville Bay’s Facebook page was written by a woman with metastatic cancer. She is one of the millions of Americans living with chronic cancer. Frustrated by the interchangeable use of the terms hospice and palliative care, Sarah Debord is on a mission to stop “medical illiteracy.” What are these two very different kinds of care and when are they used?

Hospice care is given most often in the last 6 months of life. It may be given in a hospital setting, in a specialized facility, or it can be received at home by a visiting nurse, as our SSM Health at Home colleagues offer.  End of life is a part of life and hospice care helps patients and their family’s transition through it.

Palliative care, however, can be offered at the time of diagnosis or anytime thereafter in a patient’s cancer journey. Palliative care focuses on treating symptoms of the cancer and sets the goal of improving quality of life. Since it is also designed to reduce stress and worry, palliative care may include pastoral care. It can be financial counseling for those struggling with the cost of treatment and childcare. It might include nutritional care. Here at Turville Bay it is a type of radiation therapy used to treat metastatic cancer, to reduce pain, control symptoms, and to provide patients with better quality of life. Sarah says, “It won't change the outcome of their disease, but it will improve the completeness of care they receive along the way.” Think of palliative care as the support we need when a cancer diagnosis may not be curable, but manageable.

We advocate for palliative care at the appropriate times and we deliver a form of it here in our center.  It treats the patient as a whole, with appropriate goals given the disease state, and can significantly improve quality of life.

A Vaccine That Prevents Cancer? Opt In.

Cancers related to HPV, or human papilloma virus, are on the rise in the United States with about 32,000 new cases diagnosed in 2017. Closer to home, we’re seeing more cancers related to HPV in our clinic here in Madison, WI, particularly cancers of the head, neck and throat. These cancers are affecting a younger population aged 25-50.

The virus that causes at least 6 cancers is so prevalent the Center for Disease Control estimates 1 in 4 men and women in the US are currently infected with it. HPV is transmitted by intimate skin to skin contact and, in most cases, goes away on its own with infected cells returning to normal before causing health problems. But in some cases, the body does not clear the infection and eventually cancer of the mouth, throat, cervix and others can occur. We know that HPV causes cancer, but there’s a lot we do not know, and so research continues. Complicating the issue is this: only one of these cancers is routinely screened for, cervical cancer in women. 

There’s a solution to this problem. It begins with a remarkably effective vaccine that actually blocks the virus and prevents cancer. "This vaccine is the best way to protect our youth from developing cancers caused by HPV infection," says CDC Director Robert Redfield. 

We know the vaccine exists, it has for years. Though proven safe we have failed to protect our population. The CDC said that last year nearly 66 percent of adolescents aged 13-17 received the first dose in the vaccine series, and nearly 49 percent of adolescents received all the recommended doses to complete the series. We’re falling dramatically short of Wisconsin’s goal to vaccinate 80% of all boys and girls by the age of 13 with just 35-37% of all kids vaccinated. That’s not enough to protect the next generation from the 6 types of cancer we know are HPV-related.

Here’s how we prevent 6 cancers-

  1. Vaccinate everyone by the age of 13. In fact, evidence now shows there is some benefit to vaccinating adults (link to https://www.medpagetoday.com/obgyn/cervicalcancer/75551 ) until age 45.
  2. Pediatricians strongly recommend the vaccine for children, and parents need to opt in to prevent cancer.
  3. Our public healthcare policies should step up outreach like the innovative project on the UW campus encouraging students getting their flu shot to immunize against HPV and prevent cancer.
  4. Develop a system to screen for HPV-related cancers. Currently the best screening for oral cancer comes from your dentist. Ask for a screening every year. But there are other cancers related to HPV infection and we need to screen for them as well.

On a personal level, take control of your health.

  • Know the benefits of using condoms correctly and consistently. 
  • Reduce the number of sexual partners, it lowers risk of infection. 
  • Understand the role oral sex plays in the spread of HPV.
  • And as with all cancer prevention, taking good care of your personal health can make a difference.

The Patient at the Center

In the flurry of a cancer diagnosis, the symptoms suddenly explained, the lessons in patience, managing fears, and sharing the diagnosis with family and friends, it’s understandable when the patient succumbs to exhaustion both emotional and physical. So much to learn, so many appointments. A cancer diagnosis is daunting.  There is one constant at Turville Bay Radiation Oncology Center. It’s a pole star that every physician and nurse, every staffer from therapists to medical physicist lives for: the patient at the center. We put the patient right here, in the center of everything we do. Every discussion we have and each decision we make with a patient takes time as we help them find acceptance and the will to step forward again and again. The patient’s radiation oncologist, their oncology nurse and radiation therapist work in tandem to lift up that patient and as we work to heal, we work to make them whole again.

Patient centered care is more than a slogan. It is the desire, the mission, to lead and at times coax the patient through a journey that would test anyone. Not surprisingly, it is a remarkable experience for our healthcare teams as we plumb each patient’s strength in an effort to help them. We have technologies, therapies, protocols, and a deep well of knowledge in applying it. We’ve found that the outcomes are best when the patient is at the center of the diagnosis and remains there right through recovery.

HPV and Women’s Cancers

Dr. James Richardson Turville Bay Radiation Oncology Madison Wisconsin

Almost all cervical cancer cases are caused by HPV, which is a family of very common viruses. “HPV is very prevalent amongst the population,” says Dr. Richardson, radiation oncologist. Most women will be exposed to HPV through sexual contact at some point in her life. Fortunately, the vast majority of women infected with HPV will never get an HPV-associated cancer because the body’s immune system keeps the infection in a dormant and benign state. But in some cases, the HPV infection causes changes in the body’s cells. If these abnormal cells are not identified and treated, they may become cancer. Because of this and because HPV doesn’t cause any symptoms, cervical cancer screenings are very important. Click here for screening guidelines from the American Cancer Society for cervical and other women’s cancers.

The most common cancer-causing types of the HPV are HPV-16 and HPV-18. These two strains alone cause about 70% of all cervical cancer. The good news is a vaccine now exists that protects against these two HPV strains. According to Dr. Richardson, “The vaccine has been very effective in eliminating the risk of cervical cancer.” But for the vaccine to work, it must be administered to girls or boys before they are exposed to the virus, so before any sexual contact. Dr. Mackay, radiation oncologist, adds, “It’s a huge step in modernized medicine that we have a vaccine that’s targeted against virus strains that cause cancer. Getting this vaccination before exposure occurs, can help that person decades down the line.”

In addition to cervical cancer, HPV can lead to other less common women’s cancers, including vaginal, vulva and anal cancers. “Because HPV doesn’t necessarily cause symptoms, it’s very important to be conscious of your health and be aware of any changes. If you have symptoms that last longer than 2-3 weeks, then it’s time to see your primary care physician for an evaluation,” says Dr. Richardson.

Women and Cancer

Many cancers affect women, but there are eight that we address in this risk factor graphic. While most people recover from cancer with treatment, others do not. It’s important to remember that some cancers may be preventable. We’ve known for decades the tobacco causes lung cancer. Now we know that about half of all smokers will lose their life to a lung related disease including lung cancer. We also know there is a small but serious family history for some lung cancers. The risks for women are especially cruel: estrogen adds to the our risk, secondhand smoke is a risk factor, as is radon exposure in the home. Knowing your risk factors and taking action could save your life.

Of rising concern is a group of viruses known as HPV, cancer causing strains that are sexually transmitted. It is so widely occurring that it’s quite common in our population. HPV strains 16 and 18 cause 70% of all cervical cancers and other high-risk HPV viruses include 31, 33, 45, 52, 58 and a few others. The good news is that most women’s bodies clear the virus often without knowing they were infected, sparing them from cervical cancer. Further, cervical cancer is highly treatable when caught early. But cervical cancer causes almost no symptoms, the cells silently replicating until the cancer is terribly serious. A group of 3 vaccines are changing the dynamic of this disease. I recommend them.

These are just two of eight cancers we as women are at risk of in our lifetime. We know that we can reduce that risk by understanding them. And by advocating for ourselves and our health we take back a little of the control that’s lost to this difficult disease.

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