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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

Intracranial Treatment: A Closer Look at Stereotactic Radiosurgery at Turville Bay

“We’ve been growing our stereotactic radiosurgery (SRS) program at Turville Bay to enable more treatment design options for physicians and their patients,” says Dr. Michelle Mackay, Radiation Oncologist and Medical Director.

SRS, a non-surgical method, utilizes a stereotactic linear accelerator to treat abnormalities of the brain. It offers precise delivery of a single high dose while sparing normal cells. SRS is ideal for treating brain metastases and tumors, both malignant and benign, located deep within the brain. Turville Bay’s Radiation Oncologists work in tandem with the patient’s neurosurgeon to perform the procedure. On the team also are radiation physicists, nurses, and radiation therapists.

Varian’s TrueBeam linac is the primary SRS treatment system at Turville Bay. TrueBeam works by combining highly sophisticated imaging, treatment delivery, and motion management technologies, making it possible to deliver precise treatments quickly while compensating for tumor movement.

Dr. Michelle Mackay notes that while state of the art SRS technology is crucial, “it’s the team of people caring for each patient that is especially reassuring.”

The Benefits of Caregiving

As a radiation oncologist, Dr. June Kim interacts not only with patients but also their loved ones, many of whom are, or will become, the caregiver. Caregiving, whether temporarily during cancer treatment or for longer periods of time, can be taxing but as Dr. Kim shares, caregiving can also have some surprising benefits.

“Each person involved in the patient’s life becomes part of the journey – giving your gift of time will make it memorable for your loved one and for you. The caretakers’ role in helping everyone to face the situation and maintain a positive attitude is so important,” according to Dr. Kim.

And you don’t have to be a full-time caregiver to help, Dr Kim adds, “Whether your talent is helping with well-balanced meals, running errands, participating in entertaining distractions or engaging in active listening – all become a part of the healing process.”

Dr Kim also advises caregivers to take time out for themselves.  Carve out time to do the activities that replenish your mental and physical energy. Something as simple as “listening to quiet music can have a tremendously relaxing effect on the mind and body.”

Dr Kim’s final advice is, “Don’t worry too much about the destination. Savor the journey. Make it memorable along the way by focusing on how far you and your loved one have already come.”

Get to Know Dr. June Kim

Madison Wisconsin Radiation Oncologist at Turville Bay - Dr. June KimDr. June Kim can be found on many evenings on the dance floor. “My greatest enjoyment comes from ballroom dancing,” she says, “gliding to the gentle music of waltz!” By day, Dr. Kim is a passionate advocate for her patients at Turville Bay. Her medical team and her patients are at the center of her life. “We are a complete package. Along with having state of the art technology, it is the compassionate, well-educated and well-trained staff that defines us. Their passion and commitment ensure the very best in patient care.”

Dr. Kim admires those who give their best in both their professional and personal lives. “Those who continually strive for excellence in whatever they are involved in tend to shine,” Dr. Kim notes. “I feel so fortunate to work with so many of these individuals at Turville Bay Radiation Oncology.”

“My subtle sense of humor usually sneaks up on people.”

Known for her devotion to patients, Dr. Kim uses Turville Bay’s technology in treatment. But her keen listening skills put her in tune emotionally with her patients. “This disease teaches you to enjoy the simple things in life. I am reminded of that by my patients each day.”

Dr. June Kim, Radiation Oncologist at Turville Bay Madison Wisconsin

Left: Dr. Kim with an attendee at the Turville Bay Cancer Survivor’s event, June 2015.  Top center and right: Ballroom dancing is Dr. Kim’s passion. Bottom right: Dr. Kim with her oncology nurse, Donna.

Intracranial Treatment: A Closer Look at Stereotactic Radiosurgery at Turville Bay

“We’ve been growing our stereotactic radiosurgery (SRS) program at Turville Bay to enable more treatment design options for physicians and their patients,” says Dr. Michelle Mackay, Radiation Oncologist and Medical Director.

SRS, a non-surgical method, utilizes a stereotactic linear accelerator to treat abnormalities of the brain. It offers precise delivery of a single high dose while sparing normal cells. SRS is ideal for treating brain metastases and tumors, both malignant and benign, located deep within the brain. Turville Bay’s Radiation Oncologists work in tandem with the patient’s neurosurgeon to perform the procedure. On the team also are radiation physicists, nurses, and radiation therapists.

Varian’s TrueBeam linac is the primary SRS treatment system at Turville Bay. TrueBeam works by combining highly sophisticated imaging, treatment delivery, and motion management technologies, making it possible to deliver precise treatments quickly while compensating for tumor movement.

Dr. Michelle Mackay notes that while state of the art SRS technology is crucial, “it’s the team of people caring for each patient that is especially reassuring.”

Get to Know Dr. Michelle Mackay

Dr Michelle Mackay, Turville BayDr. Michelle Mackay starts her day at home with her husband and two children like any other mom. But at Turville Bay she puts on her white lab coat and spends her days with her medical team and her patients. “Every day is different because every patient is unique," she says. Before a patient's treatment can begin, her math and physics skills are tested each day as she works with Turville Bay's medical physicists and dosimetrists. An extensive treatment  plan is created by the team for every patient. “It's work that my patients don’t see, but it’s a critical part of their care.” Each plan can take up to three weeks, depending on its complexity. As the treatment plan is completed, each patient’s journey continues as the radiation oncology portion of treatment begins.

"Radiation Therapy is one of the best weapons we have to fight cancer."

Known for her compassionate care, Dr. Mackay uses every tool Turville Bay has to beat cancer. But it’s her compassionate care that her patients appreciate most. “I never forget the human side of the fight. Hope. It’s my secret weapon.”

Get to Know Turville Bay's Dr. Michelle Mackay

Left: Dr. Mackay with her husband, Logan, and daughter, Audrey, at the Wisconsin Union.  Right: In Turville Bay’s Healing Garden.

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