M. D. Anderson Cancer Center
Date: February 2009
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>> Everyone you know has been touched by cancer one way or another, whether a friend or a family member.
>> She basically came in and said I am going to beat this.
>> I just can't imagine, I mean what if I hadn't had the care or the treatment or the drugs that I was given.
>> And as our population ages, the incidence of cancer will continue to rise.
>> The number one risk for cancer is increasing age.
>> Over the next half hour we will discuss the current state of cancer.
>> As we have discovered a lot more about cancers, we found out that each one is a unique kind of disease.
>> The focus of cancer research and share what the future of cancer prevention, diagnosis and treatment might look like.
>> Clinical trials, opportunities to get access to drugs that we can't get commercially since they have special technology like the Proton Center or like our BrainSUITE.
>> There are now more agents and more therapies that have been approved in the past eight years than there were in the past thirty years in lung cancer.
>> This is somewhere where they can be a part of something that is really special.
>> There is good news on the horizon, so join us for this edition of MD Anderson: Making Cancer History.
>> Welcome to MD Anderson Cancer Center, I am Ron Stone, Jr. and for over six decades MD Anderson has focused solely on cancer. Many of the innovations and clinical treatment and research have been done by doctors right here, and guidelines that are used by doctors around the world were first developed by doctors at MD Anderson. This is the first in the series of six programs where we follow those doctors and their patients, and through their eyes get a better understanding of this disease that affects so many lives all around the world. We will start with the patient named Deb who says she owes her life to the doctors at MD Anderson.
>> I had just purchased this home, raising horses came out and it looked like a good property to raise horses.
>> Deb's excitement over her new home in Cleveland, Texas was overshadowed by constant headaches that kept getting worse.
>> This is a woman who is healthy, vibrant, very active, works on a horse ranch, shows horses throughout the country.
>> I had a mare that was foaling and it was like three or four o'clock in the morning time to go check and looked and the mare was down, so went out there and I actually got to hear the birth I didn't see and I had gone temporarily blind. And so, I went to the doctor, they said I had a sinus infection, treated me for thirteen weeks, well it wasn't a sinus infection.
>> Deb's local doctor ordered a CAT scan of her brain and it did show a brain tumor. Two days later she was at MD Anderson.
>> She had a very large tumor in her brain that was pushing on the brain. So, they went in, they removed a very large tumor from her brain and in fact, we got the imaging then the next day. The pathology came back adenocarcinoma, which is one of the very popular variants of lung cancer. We then did chest x-rays, CAT scans and saw that she had tumors in her lung, as well as another tumor in her brain that was smaller. So, she would be classified or called a stage IV and patients don't ever like to hear stage IV. They don't like to hear the word metastatic, but that is what Deb was.
>> When I met Dr. Kim I went in and this man said look... He was very straightforward. He said here is what we are dealing with. Showed me a chart, this is what is normal, but he had told me very early on, I am going to do everything to make these numbers work in your favor.
>> I told her I said, you just have to remember that you presented with brain metastasis. This is stage IV. I hope we are having this conversation again next year. I am going to help you as much as I can.
>> Deb's cancer required immediate treatment, but that is not usually the case. You should take your time, learn all you can before deciding where to go for treatment, and what treatment options to pursue.
>> While some cancers might be considered less serious or less significant, they are still cancer.
>> You owe it to yourself to do research, talk to your doctor and family, and then make an informed decision about your care.
>> I can understand the anxiety that exist with patients. They get diagnosed, they feel like this cancer has been smoldering inside of them. I think the best advice is to take a step back and as long as they are not losing weight and they are still active and can travel, that is the best time to come see us.
>> There are lots of patients who come here who had the wrong diagnosis or an inadequate treatment plan and it is always more difficult to try to salvage that situation when you are part way down the path and things aren't going well than it would have been to start at the beginning and to take a different strategy that was maybe more appropriate for what you have.
>> So, what happens when a new patient comes to MD Anderson for treatment or for a second opinion?
>> We are organized around different kinds of cancers. So, when you call in, the first issue is we have to decide what kind of cancer you have. And in some cases that is pretty easy and in some cases it is pretty complicated because cancer is really dozens or maybe even hundreds of different diseases. And we are such a specialized place that it is important that number one we know the right diagnosis and number two we get you to the right group.
>> The importance of clear and precise imaging is evident in the size and depth of the diagnostic imaging department at MD Anderson.
>> We do around 1,800 procedures a day, CT scans, MR scans, ultrasounds, most of the diagnoses from an imaging standpoint come out of that department, and it is the largest department actually in the institution.
>> In the imaging department much of the work happens behind the scenes.
>> There is a whole team behind that physician including the radiologist who interprets the imaging, the technologist, the nurses. They are here to give you the best care and you may not be aware of it, you may never even meet them, but they are here working hard really to provide the best care for you as a patient.
>> Interventional radiology is a highly technical subspecialty within the radiology department.
>> Basically a specialty where we use imaging tools like CT scanning, like MR scans, ultrasound or regular x-rays to guide us to either obtain a sample as in a biopsy or to do a more therapeutic procedure like injecting chemotherapy into arteries that are feeding a tumor.
>> Radiologists and pathologists work together to determine the cancer type and stage.
>> Most of the diagnoses actually come from biopsies or other types of procedures that would yield actual samples of the tumor that can lead to the accurate diagnosis, but in terms of staging, the imaging is critical.
>> The stage of the tumor is vital in determining the treatment plan.
>> Staging is determining where that cancer is in its natural history so to speak. Is it early, is it late, is it somewhere in between. If you have a patient who comes in with an early stage, surgery might be the most appropriate in terms of curing that disease. If somebody comes in later stage, then they may need some chemotherapy or radiation therapy prior to surgery or in lieu of surgery that surgery may not be the best option for that patient.
>> Having all the facts is key to the outcome for the patient.
>> More information is always very powerful. The patients will feel reassured that they have explored all the options possible and then can initiate treatments.
>> At MD Anderson, each patient is assigned a team of specialists to work on their care before they ever walk in the door for their first visit. Multiple doctors, therapists, nutritionists, social workers and others will work with the patient to develop the very best care plan to fit their disease and of course their life.
>> In most institutions, physicians are organized by specialty, such as a group of surgeons or a group of radiologists. That can mean a lot of walking or even driving to see many different specialists. In the early 90's MD Anderson was physically organized around physician specialty not by cancer type.
>> We put some pedometers on some patients to see how far they actually had to walk to kind of get through that initial process. And some of them were walking a mile and half just to kind of get through those additional appointments.
>> MD Anderson was reorganized around cancer types with physicians in multiple disciplines being grouped together. This created a team approach with a level of unmatched collaboration and expertise.
>> The treatment of cancer is really evolving over time. In the past, when we didn't have a lot of options you could talk to one physician and pretty much hear the entire story. Times have changed and we cannot be presumptuous to think that one physician has all the right answers.
>> There are very few places that have the same approach where no one particular physician is acting alone, you are acting as a team to really optimize the care for that particular patient.
>> We have allowed our teams to become very specialized, so if you think about the people that are involved in your treatment they just treat your kind of cancer. They have done it for five, ten, fifteen years. We have equipped them with the best technology, the best resources, the best specialists, so that the team that you have is very focused in a narrow way and the scale of the institution allows us to do that. If you are in a place that had a smaller scale you couldn't devote those kinds of resources in such a concentrated way. So, I think all of those things roll together to make the place what it is.
>> When I am seeing a patient in the lung cancer clinic and I have a question for a surgeon or for a radiation oncologist I can walk across the hall and find one and talk to them. Our clinics our built so that there is a lot of dialogue going on between these disciplines.
>> Each patient's case is reviewed by a group of physicians in a planning conference.
>> Get our colleagues together in a room and put our brains together and try to figure out what the best approach is to treat that particular patient.
>> Our radiologists are trained in cancer imaging and they participate in those conferences and through those conferences there is continuing education between the physicians to really educate each other between the disciplines so that you can optimize the care for that particular patient. You understand how a disease might progress if it was untreated, where you might look next to see if there is any progression of tumor or metastasis. And so you learn about the different disease states in training and as well as you gain experience and so we have a group here that not only has individual expertise but has a collective expertise.
>> If you come for a treatment recommendation or treatment to see me, you don't get just my opinion, you get the opinion of those 50 people who have all looked at your slides, who have all looked at your images, and then kind of came to a consensus around what the best recommendation for you is.
>> With a team of specialists on their side every patient is assured the best treatment possible, but cancer of course is more than just tumor cells. Doctors here understand they must customize the care for each patient to fit their and their family's lifestyle.
>> When I was diagnosed I had never taken time for television, so I called the cable company and had them come out and put every station in, so I climbed into bed and I thought well if you are dying, you know you got to -- what, watch TV, that is all you can do.
>> That was not the case. Doctors at MD Anderson carefully consider all treatment options to make sure patients like Deb can maintain a quality of life while they battle cancer.
>> I think a major benefit for the patient is that they are seeing a team here and that team communicates with each other, to talk about what is the best solution for that patient, weighing all the different components of that person's life. Whether it is their livelihood or whether it has to do with other risk factors, where they live, what sort of treatment they want to have implemented for them, what works best for them.
>> Quality of life is the number one thing we have to assess in a patient and I think here at MD Anderson we are spoiled. I have so many specialists who could help a patient that have more knowledge than I do about pain medication, about nausea, about all of the different aspects that affect a cancer patient, regardless of whether they are actually receiving treatment or not.
>> MD Anderson has developed several programs to help patients and their families deal with the physical and emotional stress of cancer.
>> Many patients can benefit from our supportive care group which focuses just on the symptoms, managing the symptoms of disease and with pain.
>> There is also free classes, support groups, and an outreach network of survivors, all designed to provide support when and if patients need it. Within a few days Deb realized her life was not over just because she received a cancer diagnosis.
>> When you realize, wait a minute, it is going to be okay. I mean this doctor is telling me, we are going to do everything we can. It is going to be okay and it was okay.
>> Her will and her mindset were very impressive to me. She basically came in and said I am going to beat this.
>> Throughout this program we talked about cancer, but the reality is there is no such one thing as cancer. There are cancers, hundreds of them. The physicians at MD Anderson understand what makes each person's cancer unique, so here they don't treat cancer, they treat your cancer.
>> As we have discovered a lot more about cancers, we found out that they really each one I is a unique kind of disease and while there are some similarities of, some colon cancers are alike, and lung cancers are alike, each one has a lot of unique features.
>> Dr. Kim plays an important role at MD Anderson in advancing research of targeted therapies to lung cancer patients.
>> We are one of the few places in the country that has demonstrated a track record where we tell the patient this is what we want to do. We are going to test your tumor tissue and try to give you the right therapy based on your tumor characteristics. You will read about this from other places, but we are the only ones doing real time biopsies. And this is our BATTLE Program.
>> BATTLE stands for Biomarker-based Approaches of Targeted Therapies for Lung Cancer Elimination.
>> The premise of this program which has now enrolled over 200 patients in less than two years is to give patients the opportunity to be treated with a good drug in lung cancer. They are all oral drugs, so these are pills you can take and at the same time allow us to study an individual patient's own tumor and see how it does with one of these drugs. Now, we make the determination of which drug they get based on what we see in their tumor.
>> Deb's case is a great example of why this type of research is needed.
>> When he prescribed the type of chemo that he was going to give me, he said it was a little out of the norm, but it was something that he felt he wanted to do and he did. I did six months of chemo and never looked back.
>> Back in 2002 we didn't have any of the new molecularly targeted biologic therapies. I saw Miss Shafer about a month ago and she is still stable. She has never received anything past six cycles of chemotherapy for stage IV lung cancer which spread to the brain. I have no good explanation as to why other than she had great luck and great will. This is why the research is so important because wouldn't we like to have more patients who presented like Deb and be able to say her tumor has this marker in it and that is why this chemotherapy worked so well.
>> Studying a patient's success from a particular treatment is another way scientists at MD Anderson are furthering research.
>> In the clinic we have gone backwards a little bit. Everybody likes to pursue science by testing it in the lab and then taking that information and bringing it to the clinic. Well, that is one way. We call that from bench to bedside. The other way to take research is starting at the bedside and then taking it to the bench, and both of these describe what we called translational research. What I do is more of the latter. That is making observations in the clinic, seeing what works, and then trying to bring our scientists in and figure out why it works.
>> Targeted therapies are the future of cancer treatments.
>> I am hopeful that the research we are doing now yields very good investments in the future. It all requires laying a framework and a foundation. And by doing this and by being proactive right now in our research of gathering tissue, testing patients, individual tumors, finding these different markers in their tumors, as well as in their blood. Hopefully in the next ten years, we will be able to take their piece of tissue, put it into a machine, test for the 100 biomarkers or panel of markers and figure out which drugs work best for them.
>> Clinical trials are vital to advancing cancer research. Cancer patients get access to medicine, technology and a level of expertise that you just can't find anywhere else.
>> MD Anderson has the largest clinical research program in the nation offering more than 1,000 clinical trials.
>> What we have seen over the last 20 years is a terrific expansion of knowledge that comes from investments in research and basic scientific activities. We specialize in trying to bring those ideas to clinical areas as quickly as possible.
>> The number of treatments being offered to patients is rapidly expanding as clinical trials make new discoveries.
>> Lung cancer has really undergone a revolution and the revolution is just beginning. There are now more agents and more therapies that have been approved through rigorous testing in clinical studies in the past eight years than there were in the past 30 years in lung cancer.
>> Many people have misconceptions about clinical trials.
>> The studies we run here in our department have to be beneficial for the patient. We have to believe that the patient is receiving at least at the minimum standard therapy. If there was a better therapy than the study, then that patient should receive that therapy. Also, once the drugs don't work or stop working, a patient goes off study and there should be a plan B or a plan C or a plan D outlined by the doctor up front with the patient. I have some patients who will look me straight in the eye and say well doctor if this were your mother or your family member what would you recommend? And I welcome that question because that is the question that I have to answer in my mind and in the mirror when I wake up in the morning and certainly before I go to bed at night. So, if I can't give a good answer based on that type of questioning, how can I even feel good about conducting a study.
>> Clinical trials aim to not only help today's patients, but continually develop new and improved treatments.
>> We would like to take discoveries that are made in the laboratory and would like to have them become options for people who need treatments now. So, clinical trials, opportunities to get access to drugs that you can't get commercially, options that have special technology like our Proton Center or like our BrainSUITE. Those are things that are going to radically change how we think about cancer going forward.
>> Being on the forefront of cancer research is one of the many reasons MD Anderson attracts patients and doctors.
>> It is a place of hope. It is a place that provides the best care that anybody could get worldwide for cancer and to be a part of that I think is something that hits most physicians when they come here for an interview pretty quickly. Understand that this is somewhere where they can be a part of something that is really special.
>> Prevention is of course the first step in the battle against cancer. By carefully following cancer screening guidelines you can not only prevent the disease but perhaps detect it early and find a better outcome.
>> About ten years ago we invested very heavily in prevention as a science. We built the division of cancer prevention, we established a separate clinic around cancer prevention and we began to build a group of people to focus on prevention of cancer.
>> From ethnicity to lifestyle there are many factors that increase your risk for cancer. Some can be controlled and others are genetic.
>> We all can't forget that it is an aging population and the number one risk for cancer is increasing age. So, as our population continues to get older into the 60's, into the 70's we are going to see more cancer regardless of whether you smoked or not.
>> At the cancer prevention center, patients can get routine screening and also participate in prevention studies.
>> We now have a wonderful smoking cessation program. We do a lot of population studies that help to identify risks, things that you can change in your lifestyle that might prevent you from getting cancer.
>> In addition to prevention, MD Anderson is also focusing on survivors.
>> We have started the change how we think about cancer as a disease and it has been driven by a couple of things. One is a lot more people are cured so, 40, 50 years ago maybe only 25 or 30% of the people who had cancer had long term survivals. Now, it is up to the 60, 70% there are some cancers where the cure rates approach 80, 90%.
>> The number of cancer survivors is only going to increase as prevention and treatments improve.
>> I think the chances are that the cure rate will continue to improve, the death rates will continue to fall and even for the people that aren't cured I think their survivals would become much more long lasting. So, we need to stay focused on getting those people reintegrated into what is important to them, to their job, to their family, to their home situation, to their normal community. I think that is where we need to head.
>> Patients today and tomorrow will continue to benefit from the groundbreaking work being done right here at MD Anderson, and we hope for many more happy stories just like Deb's.
>> Six years after being diagnosed with stage IV lung cancer, Deb is now living her life to the fullest.
>> I raise some horses here at home, but I have a show horse in Pilot Point, Texas and train her and we travel all over the United States. I raise dogs, very active in my church, just have a real full life.
>> Her confidence in MD Anderson and her positive attitude got her through the tough times.
>> You know when you walk in MD that you are at the right place and I just didn't have time to die. You know I have grandkids and I am sorry -- it is okay, I will die, but just not right now.
>> Her will and her mindset were very impressive to me. She basically came in and said I am going to beat this.
>> What can you say, I mean, thanks to all the doctors out there. To Dr. Kim's nurse, I mean what can you say except thank you. Thank you for giving me my life and Dr. Kim just rocks.
>> Deb can't say enough about the care she received from MD Anderson. Her advice to anyone facing a cancer diagnosis is to seek out the best.
>> Is your life important to you? I mean, we have got the greatest cancer center in the world in our backyard, and whether by backyard, it is 4-miles or 4,000, I mean I can't imagine that anyone would go anywhere else. You see such great things happening out there and to be honest I don't feel I would be here if I had gone anywhere else. I can't imagine. I just can't imagine. I mean, what if I hadn't had the care or the treatment or the drugs that I was given. I mean, I am riding my horses all the time and doing things that you know I didn't think would ever be possible.
>> Now, life is full of possibilities for Deb. Right here at MD Anderson, plenty of possibilities exist for fighting cancer and finding cures. The future is looking bright.
>> We hope you found this report on the current state of cancer informative. And please join us in April as we continue the series by looking at treatments for solid tumors, such as lung, uterine and brain cancer. And if you want to watch the show again or share with a friend, go to click2houston.com/health. Thanks for watching.
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