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Why Physicians Recommend Palliative Care

Dr June Kim Radiation Oncologist

What is palliative care?

At Turville Bay, palliative care is given throughout a patient’s experience with cancer to improve their quality of life. “The goal is to relieve pain and discomfort thereby helping them maintain independence,” says Dr. June Kim, Radiation Oncologist.

Palliative care for cancer patients addresses psychological, social, and even spiritual problems along with pain. At Turville Bay, palliative care is not used to treat the cancer itself, it is used to treat the symptoms and side effects of the cancer and its treatment. Palliative care can begin at diagnosis and continue through cancer treatment and follow-up care. The earlier palliative care starts, the better the outcome.

“Palliative care requires continuous teamwork,” says Dr. Kim, “including a radiation oncologist, nurses, therapists, dosimetrist, physicist and at times, clergy, social workers, and rehab technicians.”

Does palliative care make a difference?

The benefits of palliative care on a patient’s quality of life have been shown in numerous studies. According to the National Cancer Institute (NCI), clinical trials found that patients who received palliative care along with treatment for advanced cancer reported having a better quality of life and mood than patients who did not receive early palliative care. Patients who received palliative care also scored higher on their ability to cope with their cancer.

Palliative care can also increase survival rates. A landmark study showed patients who had early palliative care in conjunction with cancer treatment had a longer median survival than those who had cancer care alone.1

Are palliative care and hospice the same?

Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis and be given at the same time as treatment. Hospice care is often given later in the patient’s journey. Hospice care doesn’t mean that treatment stops. It means the type of treatment and goals of care changes to things like managing pain and other symptoms while helping patients reach their goals in the time that’s left.”

Is palliative care recommended for all cancer patients? Any person with any type or stage of cancer can benefit from palliative care. If you or a loved one feel you could benefit from palliative care, ask your doctor for a referral.

Sources: 1. Early palliative care for patients with metastatic non-small-cell lung cancer at Massachusetts General Hospital (www.ncbi.nlm.nih.gov/pubmed?term=20818875)
2. National Cancer Institute (NCI)

In her Hands- Stereotactic Radiosurgery

Dr Mackay Stereotactic Radiosurgery

As a radiation oncologist and the Medical Director at Turville Bay, I am continually grateful for being part of such a high quality practice in the beautiful area of Madison, WI. One of my favorite aspects of my practice is that I have had an amazing opportunity to develop and grow the intracranial stereotactic radiosurgery (SRS) program at Turville Bay over the past four years. Many centers throughout the US perform stereotactic radiosurgery, but it is our unique, individualized, non-invasive technique that I believe makes the Turville Bay way most exceptional. For many of our patients, this is a life changing experience.

Once I meet with a patient regarding SRS treatment and it is determined that it is most appropriate for them, the planning begins. I orchestrate our team that will prepare an individualized plan including a medical physicist, specialized radiation therapists and the neurosurgeon. We begin with the simulation, at which time a very specific stereotactic mask is created. This is one of the keys to success of our treatment because the technique we use to create this mask allows us to achieve millimeter accuracy and reproducibility. The therapists, physicists and I create the mask to allow for ultimate accuracy, and I will admit, we are one very skilled, picky group.

The simulation session takes around 1-2 hours, and after that time the patient is able to leave the department and relax while the SRS team begins the behind the scenes planning. The information from simulation is transferred to the planning station and this is where the art and math occur. I work together with the neurosurgeon to perfect the treatment location, and the medical physicist to perfect dose distribution and quality assurance.

The patient will return to our department the following morning, will be set up on the treatment table in their perfectly constructed mask, and will undergo the treatment that has been ideally designed for him or her. Our team works so fluently together that it is like a ballet, with smooth motions between well designed steps to ensure that the treatment is performed flawlessly. The patient does not feel discomfort.

After the SRS treatment is complete, it is always wonderful to connect with the patient and their family to reflect on how treatment went and expected follow up. The diligence our team puts into each of these plans, and the wonderful technology we have to allow us to do so is something I see everyday, but it is in this moment that I can celebrate with them, because I know we have changed their lives for the better.

Madison’s 2017 Cancer Survivors & Thrivers Ice Cream Social

Cancer Survivors Event 2017

June 4th 2017 1:00PM-3:00PM

Each June Turville Bay hosts our Cancer Survivors and Thrivers Ice Cream Social. It’s a time to celebrate all of you who have been affected by cancer. Whether in remission, treatment or caring for a loved one, this event is an opportunity to relax, have fun and to connect with others in a similar situation. “It’s our shared experiences that make this event so special,” explains Dr. James Richardson, Radiation Oncologist.

Guests appreciate the joyful and inspiring atmosphere at the event. “I love attending the Ice Cream Social every year with my family!  It is a happy and upbeat event filled with people appreciating life and the gift of time with each other!” says Susan Smedley Gerber, lung cancer survivor and advocate. The serene setting, overlooking Lake Monona, also adds to the appeal. Everyone is welcome, there’s no cost to attend and parking is free.

At our 7th annual event, we will once again offer 10 flavors of delicious ice cream for free, thanks to our dedicated sponsor, Chocolate Shoppe Ice Cream. We will also have musical entertainment provided by another incredible partner, Westside Andy.

In addition to ice cream and entertainment, the event provides an opportunity to interact with healthcare providers and agencies that offer cancer programs, such as Gilda’s Club Madison, to facilitate connections if you’re seeking additional support.

This event embodies the Pure Patient Care that we offer at Turville Bay. Sponsoring it is our way of showing you how much we care about those affected by cancer. We want you to know that you are not alone on this journey.

We hope to see you there – June 4th 1:00-3:00 at Turville Bay 1104 John Nolen Drive

Stereotactic Radiosurgery Advances In Madison WI

Dr Mackay and nurse Stereotactic Radiosurgery

Research in the field of neurology and of cancer has contributed to the uptick in the use of Stereotactic Radiosurgery or SRS. Conceived by a team of neurosurgeons and physicists in Sweden about 50 years ago, the use of SRS has become increasingly useful in treating abnormalities of the brain. Breakthroughs in the technology that delivers precisely targeted radiation in fewer high-dose treatments than traditional therapy is providing better outcomes for certain patients. Using non-surgical radiation therapy to treat functional abnormalities and small tumors of the brain is preferred to traditional surgery in some patients, according to Dr. Michelle Mackay, Medical Director of Turville Bay Radiation Oncology Center in Madison, WI. “Turville Bay’s stereotactic radiosurgery program is growing,” Mackay says. “Using advanced technology we’re able to perform delicate brain surgery without a knife, and change a life.”

One of the most important areas in the practice of stereotactic radiosurgery is treating tumors of the brain and neck. Radiosurgery is gaining acceptance in the field of Neurology for a number of reasons. When the target, a tumor that’s benign or malignant, is found in a difficult spot such as deep within the brain, or the patient is to fragile for traditional surgery, SRS might be used. With no anesthetic needed, no hospital stay, no recovery period, and no real downtime, stereotactic radiosurgery provides certain patients with better outcomes. “With our team of specialists, this technology, and an intensive treatment plan, we’ve found that SRS works incredibly well,” says Dr. Mackay.

The process of SRS is uniquely different than traditional surgery. Prior to treatment day, a team of specialists works together on the patient’s treatment plan. The team includes a neurosurgeon a medical physicist and dosimetrist, specially trained radiation therapists, oncology nurses, and a radiation oncologist. The plan is completely individualized to both patient and treatment target. Together they deliver the treatment according to that plan, often in a single visit; as the patient lies on the treatment couch of Turville Bay’s TrueBeam linear accelerator, a robotic arm controlled by a computer moves around him or her. It focuses radiation precisely where it is needed, avoiding the healthy brain tissue that surrounds the tumor. “The work is made possible by a team with years of expertise and this advanced piece of technology,” says Dr. Mackay, referring to Varian’s TrueBeam. “The precision is quite amazing.”

Madison’s Healthcare Technology Center Today

Dr. Michelle MacKay

In this new year, much is changing in healthcare: insurance, hospital partnerships, and even the way we look at healthcare. As a physician that cares for patients at what may be the toughest time of their life, it seems improvements in the healthcare technology we use have taken a backseat to other news. These technology improvements are essential in providing treatments that enable patients to live longer lives and thrive. In radiation oncology, we use radiation therapy in three rather unique ways. First, in the treatment of cancer. The exquisitely fine targeting of radiation beams delivers radiation therapy directly to the tumor(s) at brief intervals, every day for a few weeks. We kill cancer cells without harming healthy tissue, because improvements and breakthroughs in technology have made it possible.

Another important part of our practice is stereotactic radiosurgery, the delivery of radiation to areas that are difficult to reach by traditional surgery, or, in patients whose health makes them a poor candidate for traditional surgery. Many of the radiosurgeries we perform at Turville Bay are to reach intracranial (brain) tumors, both benign and malignant. Along with a neurosurgeon, a medical physicist, specially trained radiation therapists and a complex treatment plan, I perform stereotactic radiosurgery. To the patient, it can be life altering. Often in one single treatment using an incredible piece of technology we eliminate the tumor and the symptoms. There is no downtime, no traditional surgical recovery time, no hospital stay. The patient arrives at Turville Bay for radiosurgery, our team follows the patient’s highly individualized treatment plan, and the patient returns to daily life that day. We do recommend rest immediately following treatment, and usually a slight headache is the only side-affect. Life altering indeed.

Healthcare technology is somewhat costly. And the training needed to employ it is expensive and ongoing, as it is constantly being refined and updated. Yet today this technological healthcare delivery system allows us to conquer some of the most daunting illnesses we face. It’s something to celebrate, right here in Madison, Wisconsin.

Lung Cancer By The Numbers

Dr. James Richardson

As we look ahead at welcome changes happening in screening for lung cancer it is helpful to look at the numbers. When we do, it’s hard to understand why anyone would smoke: 1 in 5 deaths in the United States are related to the use of tobacco. More than 158,000 Americans will be lost to lung cancer this year, and 87% of them are due to tobacco. Staggering evidence has been in front of us since the 1960’s. And yet we continue to use tobacco, though in slowly dwindling numbers. If we eliminated the use of tobacco we would cut lung cancer deaths to the core.

Lung cancer is a silent threat to those that use or have used tobacco, to those exposed to radon in the home, and those exposed to asbestos and certain chemicals or metals in the workplace. Yes, there are other causes of lung cancer plus one we’re not sure of yet, though evidence is mounting: the use of e-cigarettes or vaping. I think of lung cancer as a silent killer because it begins simply, possibly from a tiny scar or lesion in the delicate lining of the lungs or bronchi, and grows without hindrance and without symptoms.  Often, by the time there are symptoms, lung cancer is locally advanced or may have spread making treatment more difficult.

We now use protective gear provided in the workplace that’s proven to save lives. We know that radon is present in soils containing uranium like ours here in central Wisconsin and having basement air checked is easy to do with home test kits available at hardware and home stores. We know that tobacco presents the biggest threat to our health taking more lives each year than colon, prostate and breast cancer combined.

In the past, screening for lung cancer was not based on science. X-rays and sputum tests could be requested by a patient but were not reliable. Screening had no real guidelines and that meant that patients were symptomatic by the time they were diagnosed. At Turville Bay we know that finding and treating lung cancers before symptoms occur means a better chance of a good outcome.

Finally, a study underway since 2001 involving thousands of individuals has produced compelling data. It found that heavy tobacco users who got low-dose CT scans had a 20% lower chance of dying from lung cancer than those who got chest X-rays. The evidence was so powerful that Medicare, Medicaid and many insurance companies will now cover annual low-dose CT screening for those that meet certain criteria:

  • Adults aged 55-80
  • Having smoked a pack a day for 30 years or the equivalent in 15 years
  • Currently smoke or quit within the last 15 years
  • Have a physician’s order requesting the screening

Protocals are coming to our local clinics. Soon we hope to see the death rate from lung cancer in our population reduced. No, these long awaited screening guidelines are not going to solve the problem. But it’s a start. My message? Take control over your health. Quit tobacco and embrace a healthy lifestyle. You’ll breathe easier. We all will.

Metastatic Cancer: A Growing Population

Understanding metastatic cancer is essential to treating patients, helping families cope, and lending support and information to our community. While the focus in cancer care is early diagnosis, it is estimated that as many as 30% of early stage breast cancers, for example, become metastatic cancers. Yet research lags in this field. Why are some cancers more likely to metastasize than others? Why are some cancers more difficult to detect leading to a diagnosis later than we would like? And why do some cancers simply spread faster? Meanwhile, with increasing regularity, we are able to give the gift of more time to some metastatic cancer patients through treatment. Why do some people tolerate ongoing metastatic cancer care better than others?

Defined as a cancer that has spread from the primary site, or the part of the body it started, metastatic cancer in many ways remains a mystery. We know that cancer cells can break away from a primary tumor and travel to other areas of the body through the bloodstream or lymph system. And, these cells need to be able to grow and thrive in another area of the body and avoid attacks from the body’s immune system. Many of these cells die, and those that are able to grow elsewhere in the body may lie dormant for years before they begin to grow, if at all. Primary cancer cells that have metastasized to distant locations within the body may no longer be exactly the same as the cells in the tumor they started, making them harder to treat. Currently, the goal of treatment for metastatic cancer is to control the growth of the cancer, and/or to relieve symptoms. It’s a form of palliative care: improve quality of life by keeping the patient comfortable.

The physicians and staff at Turville Bay Radiation Oncology Center see metastatic cancer patients for palliative care. Radiation therapy is often used to shrink tumors, reducing pain and other symptoms. Defined as care given to patients with cancer and other debilitating diseases to relieve pain, manage symptoms, and improve quality of life, palliative care may play a part in extending life. This care is delivered by a team of people including but not limited to a physician, nurse, social worker, chaplain, and pharmacist, to patients at any age and stage of serious life-limiting illness regardless of life expectancy. Often misunderstood, palliative treatment was found to be an effective addition to standard cancer treatment for people with metastatic non-small-cell lung cancer in a groundbreaking study reported by the New England Journal of Medicine. It found that patients that received palliative care in addition to standard cancer treatment early in their care were less likely to suffer from depression and lived longer than those that received no palliative care.

While researchers are studying new ways to kill or stop the growth of primary cells and metastatic cancer cells, there is a focus on new ways to boost the immune response against tumors. With all the research, improved treatments, clinical trials, mountains of data, and teams of healthcare professionals, a growing number of patients with recurring cancers are often now living with cancer. A Stage Four diagnosis is no longer a “rapid countdown to dying,” says blogger Mary Beth Williams who was diagnosed with metastatic melanoma. A metastatic cancer may be treated with palliative care using systemic therapy (chemotherapy, biological therapy, targeted therapy or hormonal therapy) or local therapy including surgery and radiation therapy, and often a combination of these treatments. Ms. Williams describes what the staff at Turville Bay sees, as well, when she says, “…the effects of metastatic cancer play out in many different ways. Some of us get better. Some of us hold steady. And some of us die, because mortality is an inevitable side effect of living.”

“Those living with metastatic cancer have been left out of the cancer conversation. They will not survive cancer; some may live with metastatic cancer for months or even years. Their need for treatment, support and encouragement goes on while family, coworkers and friends struggle to understand the disease,” says Dr. Michelle Mackay, Medical Director at Turville Bay Radiation Oncology Center in Madison, WI. “As a community we need to educate ourselves. By doing so, we can help those with metastatic cancer, while seeking the more lasting impact of desperately needed research.”  

“Please understand that those living with metastatic cancer don’t refer to themselves as “survivors,” says Dr. James Richardson of Turville Bay. “If we work together, with the goal of prolonging survival, offering treatment that may help relieve cancer-associated symptoms, it leads to an improvement or stability in their quality of life. This care may give them time to enjoy life, but rarely cancer-free. It’s a growing population and they are in need of more research.”

This year, Turville Bay has refocused its annual Madison Area Cancer Survivor’s event on Sunday, June 5, to include those with metastatic cancer. Now called Madison’s Cancer Survivors and Thrivers Ice Cream Social, Turville Bay’s physicians and staff are rededicated to educating the public and celebrating the strides made. The Survivors and Thrivers event is free and open to all area cancer survivors and those with metastatic cancer, patients in treatment, caregivers, families, friends and healthcare providers. “This event always inspires us,” says Dr. Mackay. “We see former patients and current patients, their caregivers, kids and grandkids. We’ve shared a time in their lives and been changed by it. We want everyone to feel welcome.”

TomoTherapy - Planning, Patient Positioning, Precise Treatment Delivery

“TomoTherapy is basically another linear accelerator, it’s just packaged a little bit differently,” says Dr. James Richardson. Acquired to complement Turville Bay’s Varian TrueBeam linear accelerator, TomoTherapy is proving useful in treating certain cancers. Tomo offers “ flexibility in our ability to treat various tumors and some of the constraints that we run into with patients with their body habitus or hardware in the body.”

The TomoTherapy treatment delivery system uniquely delivers radiation therapy in a spiral pattern (TomoHelical) or discrete-angle approach. Designed inherently for Intensity Modulated Radiation Therapy (IMRT), photon radiation is produced by a linear accelerator that travels around the patient. It moves in unison with a multi-leaf collimator that shapes the beam into beamlets, all aimed at the tumor. Typically, tens of thousands of beamlets are used in a single TomoTherapy treatment session. Software optimizes the contribution of each one to the total tumor dose, minimizing exposure to healthy tissue. Meanwhile, the couch is moving—guiding the patient slowly through the center of the ring. Treatments can be delivered continuously, from all angles around the patient. More beam directions give physicians more control in how they plan treatments—and assurance that dose will be confined to the tumor, reducing the risk of short- and long-term side effects.

Patient times are consistent with TrueBeam and TomoTherapy also offers onboard imaging, as Turville Bay physicians find more frequent CT scanning important with certain tumors.

TomoTherapy  Madison Wisconsin Radiation Oncology centerTurville Bay Radiation Oncology Center ViewTomoTherapy in Madison Wisconsin

Get to Know Dr. James Richardson

Dr Richardson Turville Bay Radiation Oncology

Dr. James Richardson, Radiation Oncologist, discusses what lead him to Radiation Oncology, who inspires him and his affinity for the water.

How did you end up working in Radiation Oncology?

I have always had a keen interest in the science of malignant tumor biology. In addition, having had several family members who had and succumbed to cancer brought me early awareness, and frankly, fear of the disease. I knew early on that based on my interest in the science and my personal experience that I would spend my career studying the disease and caring for those with cancer.

What would you like colleagues to know about Radiation Oncology?

Although radiation and its application in treating cancer may seem obscure and mysterious, it is actually a well-understood science.  When designing a treatment plan for a patient, we know exactly where the dose is precisely delivered and thus it is highly unlikely for any side effects to occur outside the radiation field. Furthermore, the state of art techniques and technology that we use at Turville Bay enable us to conform the radiation volume precisely to the cancer that we are treating in most instances. This has allowed us to escalate the dose and achieve higher tumor control rates while, at the same time, with less acute and chronic toxicities.

Who inspires you?

People who manage to maintain a positive attitude even in the face of adversity. I often see this trait in my patients who as the result of their diagnosis develop a different perspective and come to realize what is truly important in life. It is a great privilege to be a confidant to and to learn from these patients about how I should perceive my own life.

What advice would you give a patient/caregiver that is newly diagnosed?

Keep a positive attitude and be hopeful. No matter how bad a diagnosis may be, there is always potential for long term control of the disease and even a cure. Cancer, even if not ultimately curable, can be managed in a way to improve quality and enjoyment of one's life.

What do you like to do outside of work?

I enjoy cycling and/or spinning as a vigorous cardiovascular exercise and yoga to maintain and improve strength and well as calm and focus the mind. I also enjoy travelling, cooking, sailing and boating - anything near the water. I have a love and affinity for the water having grown up in San Diego.

TomoTherapy - Planning, Patient Positioning, Precise Treatment Delivery

TomoTherapy is basically another linear accelerator, it’s just packaged a little bit differently,” says Dr. James Richardson. Acquired to complement Turville Bay’s Varian TrueBeam linear accelerator, TomoTherapy is proving useful in treating certain cancers. Tomo offers “ flexibility in our ability to treat various tumors and some of the constraints that we run into with patients with their body habitus or hardware in the body.”

The TomoTherapy treatment delivery system uniquely delivers radiation therapy in a spiral pattern (TomoHelical) or discrete-angle approach. Designed inherently for Intensity Modulated Radiation Therapy (IMRT), photon radiation is produced by a linear accelerator that travels around the patient. It moves in unison with a multi-leaf collimator that shapes the beam into beamlets, all aimed at the tumor. Typically, tens of thousands of beamlets are used in a single TomoTherapy treatment session. Software optimizes the contribution of each one to the total tumor dose, minimizing exposure to healthy tissue. Meanwhile, the couch is moving—guiding the patient slowly through the center of the ring. Treatments can be delivered continuously, from all angles around the patient. More beam directions give physicians more control in how they plan treatments—and assurance that dose will be confined to the tumor, reducing the risk of short- and long-term side effects.

Patient times are consistent with TrueBeam and TomoTherapy also offers onboard imaging, as Turville Bay physicians find more frequent CT scanning important with certain tumors.

TomoTherapy  Madison Wisconsin Radiation Oncology centerTurville Bay Radiation Oncology Center ViewTomoTherapy in Madison Wisconsin

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