In its annual "Cancer Facts and Figures" report, the American Cancer Society predicts about 1,596,670 new cancer cases will be diagnosed and about 571,950 Americans will die of cancer in 2011 – more than 1,500 people a day. Cancer is the second most common cause of death in the U.S., exceeded only by heart disease. While anyone, anywhere can develop cancer, there are more reasons than ever to be hopeful for a cure.
Here in the Midlands and throughout the state, a number of dedicated oncologists, researchers, surgeons and other medical professionals are making tremendous strides in providing more targeted, effective treatments and long-term survival of cancer patients young and old. The high level of scientific research, state-of-the-art treatments and facilities, collaboration between physicians and available resources for patients and their families may come as a surprise to those who have not experienced it firsthand. Important, ground-breaking work is being done by the area’s three major health systems – Providence, Palmetto Health and Lexington Medical Center (LMC) – as well as South Carolina Oncology Associates (SCOA), the state’s only comprehensive cancer treatment center.
RESEARCH, TISSUE BANKS AND CLINICAL TRIALS
“We are excited about the research efforts here at the SCOA Cancer Center,” says Fred J. Kudrik, M.D., a medical oncologist and Research Medical Director at the 120,000-square-foot facility off of Greystone Boulevard. “The clinical studies at SCOA allow patients in Columbia to benefit from the newest anti-cancer agents before they are approved by the FDA, and without the burden of having to travel to Charleston, Durham or Chapel Hill. We are unique as a community cancer center to have access to many of these new drugs and studies that are often only accessible at the university medical center level. Clinical trials definitely move the bar forward, and it’s remarkable how much we have learned.” Kudrik says about 40 clinical trials are open right now, with three more in the works.
“So far this year we’ve entered 51 patients into clinical trials; in 2010, we put on 67 patients. SCOA is one of six national strategic sites with the Sarah Cannon Research Institute in Nashville, which enters 1,500-plus patients into trials each year. This relationship provides an internal research structure and gives local patients access to new drugs and treatment options as much as two years before the rest of the country,” says Kudrik. “To me, a successful trial is one where we can accrue a large number of patients into a study. When a drug shows an impressive response early in the process, sometimes the drug company will move forward and present it to the FDA sooner than anticipated. There are still a lot of misconceptions about research – that it’s experimental and that patients are just being used as guinea pigs, for instance – but it actually provides more specialized care because of the strict protocols for data collection and reporting. It also allows us to identify predictors and targets to treat with the best chance of response.”
Nannette Faile, R.N., MS, is the Research Nurse Coordinator of cancer-related clinical trials at LMC. She says the clinical trial and corresponding tissue bank programs demonstrate the hospital’s ongoing commitment to cancer treatment.
“We have eight or nine trials going right now,” says Faile. “Most recent is a breast cancer trial to help doctors determine if hormone therapy alone is enough for some women (versus hormone therapy plus chemotherapy). There are many different types of breast cancer – trials like these help oncologists decide if the risk is high enough to warrant chemotherapy and can even help predict the risk of recurrence. In the past we’ve given chemo because it was the best option available. Clinical trials can be challenging to coordinate across departments, but the longterm benefits are invaluable.” Faile also oversees LMC’s Tissue Banking Program, where some 400 donors currently provide samples of normal and malignant tissue for molecular comparison.
“When patients come here for surgery to remove tumors or other abnormal tissue, that tissue is examined by a pathologist, who, with the patient’s permission, will collect and submit it to the tissue bank,” says Faile. “When surgeons remove tumor tissue, they always include a rim of normal tissue around it. Samples are literally the size of the head of a pin. A computerized analysis runs the DNA of both samples line by line to find the defect between the normal tissue and the cancer. Many of the most promising cancer drugs today are being developed from this kind of information – ‘smart drugs’ that can find that one defect, amino acid or protein and shut it down. I’m extremely proud that LMC eagerly supports this endeavor. When I started back in 1986, I never dreamed something like this would be possible. It is really changing the way we treat certain cancers.”
Tissue banks and clinical trials are also in use at Palmetto Health Children’s Center for Cancer and Blood Disorders, where Ron Neuberg, M.D., is Director of Pediatric Hematology and Oncology. Although the most common is leukemia, Neuberg says trial protocols are available for almost every type of childhood cancer through the Children’s Oncology Group. In the past five decades, through pediatric multidisciplinary trials the overall cure rate for childhood cancer has risen from below 50 percent to above 80 percent.
“We take a three-prong attack to research: epidemiology, where we identify risk factors like genetics, lifestyle and exposures to carcinogens; biology of the disease itself, which includes banking tissue for genetic research; and clinical trials, which are generally much more complex than those for adult cancers,” says Neuberg. “We see about 40 new cancer patients a year – about 85 percent will qualify for existing protocols – and offer local families the same level of treatment as anywhere in the country. Families don’t have to be disrupted in order to take their children far away; the most current treatments are available right here in the Midlands. Clinical trials require advanced support systems and cooperation among specialists. Audits every three years ensure the quality of care provided and data submitted. Even though childhood cancer is relatively rare (representing only about one percent of all cancers), we follow these kids well into adulthood to study any late effects or increased risk of second malignancy. The number of person-years saved by pediatric clinical trials warrants the amount of funding those trials receive.”
COMPREHENSIVE TREATMENTS AND SUPPORTS
No matter where or how cancer patients are treated, multiple layers of support for patients and their families are critical. Lynn Tucker, M.D., is a breast and endocrine surgeon with Lexington Surgical Associates at LMC and the first physician there to enroll a patient in a clinical trial. She says the future for noninvasive treatment is increasingly bright.
“The treatment of cancer requires a multidisciplinary approach,” says Tucker. “What we’re finding through tissue bank programs and other research is that even radiation can be tailored to shorter treatment plans and fewer treatments per patient overall. With targeted medication, we’re now able to block hormone receptors – tiny antennas coming off the tumor that pick up signals which spread the cancer. We’re also offering more hormonal and surgical research options. Mastectomies aren’t that common, but we do offer reconstructive surgery when necessary. More often, it is highly specialized treatment and not surgery that’s curing patients and improving their prognosis.”
Steven Madden, M.D., of Lexington Oncology Associates, a physician practice at Lexington Medical Center, is one of four staff oncologists in LMC’s network of physicians. The hospital system includes approximately 39 physician practices in 47 locations throughout the Midlands.
“Because our practice is centered here at the hospital, we have state-of-the-art radiation therapy capabilities, major and minimally invasive surgical capabilities, and access to the latest drugs and treatments – including Provenge, a groundbreaking infusion ‘immune-booster’ that uses the body’s own immune system to treat prostate cancer,” says Madden. “LMC’s Board and Foundation have recently approved an expansion of our outpatient facility and inpatient unit, all scheduled to be completed by the end of the year. This will double our chemotherapy capacity to approximately 50 infusion chairs and increase the size of inpatient rooms. Combined with an electronic medical record system, a full-time social worker and financial counselor, we’ll be able to provide a more seamless transition between disciplines.”
C. Gregory Cauthen, M.D., FCCP, practices with Midlands Pulmonary, Critical Care and Sleep Medicine and currently serves as chair of the South Carolina Chest Tumor Consortium at Sisters of Charity Providence Hospital, established in 2004 to provide a multidisciplinary care plan for patients with thoracic tumors. Twelve doctors from five different practices meet voluntarily every other week to review cases and determine the best method of treatment for patients requiring intervention.
“We review cases from throughout the Midlands and are usually able to respond within a week and a half,” says Cauthen. “Aside from helping each patient receive the best treatment available, we also want to remove some of the anxiety that occurs between diagnosis and treatment. Our program is modeled after similar groups at Wake Forest and Duke University and includes close contact with the referring physician. Patients love it because they don’t have to spend the time and money on travel to be advised by so many specialists, and they are comforted by the fact that doctors they’ve never seen care enough to review their case. Physicians are very appreciative of this service as well.”
SCOA also provides a comprehensive approach with diagnostics and imaging, radiology, infusion therapy, hospice and research, as well as social work, family counseling and a retail pharmacy under one roof. Led by Managing Partner Rudolph L. Wise, M.D., the staff includes 20 oncologists, oncology-certified infusion nurses, four licensed social workers, financial counselors, image consultants and more. About 800 patients per day pass through the doors of a facility designed to take them from the front desk to an exam room in about 15 minutes. Robert E. Smith, Jr., M.D., and William M, Butler, M.D., FACP, have been with SCOA since its founding in the late '90s.
“Our practice is technology driven, designed with the patient’s footprint in mind,” says Smith. “Instead of waiting several weeks for imaging results, we can usually download results within 30 minutes of a scan. All patient records are electronic, so updates are immediately accessible to everyone involved in a patient’s care. It’s a large facility but designed with a unique pod system to create a small office environment for each doctor. We often have visitors from other states and even other countries who tour the building, then go home and model our layout in their own practices. Office efficiency only enhances our excellent patient care.”
“A technology-driven practice definitely makes the practice of medicine much easier,” says Butler. “As far as cancer treatment is concerned, SCOA is one of the best-kept secrets in Columbia. Even with the volume of patients we see each day, the place works – our staff is very personable, and patients are treated compassionately and humanely instead of being rushed through. We’re very fortunate as a group, and everyone contributes to our success. What excites me most is how genetic research is changing the game. There can be 100 or 1,000 different genetic mutations in cancerous cells, but technology will soon let us choose and predict a more accurate response to therapy. There are so many good things happening now that requires a greater attention to the latest findings and newest research.”
Dottye Wodogaza, R.N., OCN, is a breast cancer nurse navigator at Palmetto Health, part of a free service provided by the hospitals to educate and support patients from diagnosis to treatment and beyond. There are nurse navigators for breast, gynecological, prostate and lung cancer patients.
“We are notified when a patient in our system is first diagnosed, and make contact quickly to discuss what happens next and what kind of decisions they’ll need to make. We provide a packet of information based on the diagnosis: types of surgery and treatments available, local resources for prosthetics, wigs and support groups – anything that will help them make informed decisions for their care,” says Wodogaza. “Sometimes a huge part of what we do is just listen or give a hug, especially at first. Women shut down when they hear that initial diagnosis of breast cancer, but we’re often able to follow that devastating news with real hope and support – I’ve heard others say we ‘talk people off the ledge.’ We work at no cost to the patient, and most of the materials provided to patients and community organizations are paid for by the Palmetto Health Foundation’s annual Walk for Life event in October.”
SmartState™ AT MUSC: THE FUTURE OF DRUG RESEARCH
Established by the S.C. General Assembly in 2002, the South Carolina SmartState™ Program creates public university-based Centers of Economic Excellence (CoEE) in research areas to advance the state’s economy. Patrick M. Woster, Ph.D., accepted a SmartState™ Endowed Chair position in March and now leads the CoEE Drug Design and Synthesis Core (DDSC) in the Drug Discovery Center at the Medical University of South Carolina (MUSC) in Charleston. Known as one of the nation’s leading cancer drug researchers, Woster transferred from Wayne State University in Detroit, where he was a faculty member since 1988.
“I was attracted to this position by the outstanding collaborative atmosphere at MUSC and the availability of techniques that were not available at my former institution,” says Woster.
“I was also intrigued by MUSC’s dedication to drug discovery and their forward thinking in the area of entrepreneurship. My primary research interest is in cancer drug discovery, although we also have a successful program in designing drugs for the treatment of malaria and other parasitic diseases. Our current interest revolves around the field of epigenetics, which refers to the study of changes in DNA expression that are caused by factors other than alterations in the primary sequence of DNA. In tumor cells, many proteins which act to suppress tumor development are not expressed, and our compounds work by reactivating the expression of these proteins.”
“Although we will continue to develop our own research areas, I view the development of a medicinal chemistry presence in South Carolina as one of my responsibilities. I’d like to lend my expertise to creating a drug discovery framework that will produce new potential cancer drugs that have the potential for commercialization,” says Woster. “My vision is to help create and maintain a state-of-the-art drug discovery environment that can be used by multiple researchers to discover new agents for the treatment of cancer, as well as other important diseases. As new intellectual property is developed, it will result in the formation of new companies that will ultimately bring economic development in the biotech arena to South Carolina.”
Visit these websites to learn more:
SOUTH CAROLINA ONCOLOGY ASSOCIATES
www.sconcology.net
LEXINGTON MEDICAL CENTER CANCER CARE
www.lexmed.com/medical-services/cancer-care
PALMETTO HEALTH CHILDREN’S CENTER FOR CANCER AND BLOOD DISORDERS
http://ch.palmettohealth.org
SOUTH CAROLINA CHEST TUMOR CONSORTIUM
www.providencetumorboard.com
PALMETTO HEALTH
www.palmettohealth.org
CANCER DRUG DISCOVERY CENTER OF ECONOMIC EXCELLENCE
www.sccoee.org/cancerdrugdiscovery.asp