Patient Care
One surgeon’s story: From art history to medicine with no regrets
Lily Lai can still remember the personal breakthrough that reset the course of her life.
Lily Lai rerouted her career path from art history to cancer care. (Photo: Walter Urie)
Closing in on her bachelor’s degree in East Asian languages and civilizations from Harvard, she burned away her nth hour among the library stacks. Senior thesis deadlines loomed. Graduate studies in art history lay ahead.
But there was a thought she just couldn’t shake: Perhaps the ivory tower wasn’t for her.
“I realized that probably five people in the world would read anything I would write on Chinese art history,” said Lai, M.D., now an associate clinical professor of surgery at City of Hope. “It just seemed like I needed to do something that was more physically related to people — that would really help people.”
That nagging thought drove Lai to embark on a career in medicine. As a surgeon, she puts her skilled hands to work healing patients facing colorectal or breast cancer. As an oncologist, she helps patients make treatment choices that best match the priorities they hold precious. The relationships she builds with her patients comprise a key inspiration for all she does at City of Hope — and beyond, through her work in the organization’s community clinics.
Continue reading “One surgeon’s story: From art history to medicine with no regrets” »
Survivors, stem cell transplants – and a reason to celebrate
The description is simple: Blood and marrow stem cell transplants replace a person’s faulty stem cells with healthy ones.
The reality is complex: High doses of chemotherapy and radiation must be used to destroy the disease and “make room” for the new, nondiseased stem cells. The immune system is then essentially kick-started to start producing healthy cells on its own.
Survivors and family at the City of Hope “Celebration of Life” Bone Marrow Transplant Reunion
City of Hope’s numbers belie both: Physicians here have performed more than 11,000 blood and marrow stem cell transplants. Based on a 2012 report from the Center for International Blood and Marrow Transplant Research, City of Hope is the only transplant program in the country to achieve eight consecutive reporting years of “over performance” in one-year overall patient survival.
Perhaps only those who have been there – and back – can truly understand the significance of this achievement; what’s it’s like to have gotten another chance at life, to have survived not just a life-threatening cancer but the ordeal of the transplant itself. So, once a year, they get a chance to celebrate with the only others who come close to understanding – their transplant doctors, nurses and caregivers. Continue reading “Survivors, stem cell transplants – and a reason to celebrate” »
Focusing sound on metastatic bone cancer pain, tumor cells
Breast, prostate, colon and other cancers that spread to other parts of the body often take root in bone. These metastatic tumors can be very difficult to eradicate and often create terrible pain for the patient. A new technique helps alleviate that pain — and it might one day eliminate the cancer, too.
Cancer that spreads to bone can cause significant pain. Magnetic resonance guided focused ultrasound, or MRgFUS, can alleviate bone cancer pain. City of Hope researchers hope it also will destroy tumors.
When treating metastatic bone cancer pain, surgery is seldom used. Radiation is the preferred choice, but not all patients can receive it, and others choose not to have it.
So some clinicians are now turning to magnetic resonance-guided focused ultrasound, or MRgFUS (as it is inelegantly abbreviated), specifically to provide care that reduces patients’ cancer-related bone pain.
“MRgFUS is for those select patients who cannot have radiation therapy because they have previously been irradiated or they do not want it,” said Jeffrey Wong, M.D., chair of City of Hope’s Department of Radiation Oncology.
MRgFUS, which first emerged as a noninvasive way to treat uterine fibroids, uses pinpointed high-energy sound waves to heat and destroy pain-causing nerves in the membrane surrounding bone. This lowers or eliminates pain, improving the patient’s quality of life for months, according to the Food and Drug Administration, which approved MRgFUS for metastatic bone cancer in October 2012.
Wong recently treated the first patient in Southern California to receive MRgFUS for metastatic bone cancer outside of a clinical trial.
Now, he and his colleagues are working to turn MRgFUS to an even higher purpose — eradicating cancer cells altogether. Continue reading “Focusing sound on metastatic bone cancer pain, tumor cells” »
Ask the Experts: Stress, diabetes and how to manage both
In many ways, stress and diabetes feed off one another in a vicious cycle. Research has shown that stress — particularly chronic stress — leads diabetics to make poor lifestyle choices. It also causes their bodies to release hormones that can destabilize blood sugar levels.
Diabetes causes stress, which in turn makes blood sugar control more different. To take control of stress, exercise.
At the same time, living and coping with diabetes is itself a long-term source of stress, especially when it involves frequent monitoring and management.
Thus, it is vital for diabetics avoid this cycle as much as possible by keeping their stress levels in check. City of Hope will be hosting an “Ask the Experts – Diabetes and Stress: What You Need to Know” event to help them do just that.Randi McAllister, Ph.D., clinical professor from the Department of Supportive Care Medicine, and Jinsun Choi, M.D., fellow from the Department of Clinical Diabetes, Endocrinology & Metabolism, will be speaking at the event.
Some tips for diabetics to manage their stress and minimize its effects include: Continue reading “Ask the Experts: Stress, diabetes and how to manage both” »
‘The Big C’ offers teachable moment about ‘fighting’ cancer
Sometimes, breakthroughs must be made not by researchers or individuals but by society. In a recent interview with the Los Angeles Times, City of Hope’s Vijay Trisal, M.D., describes a breakthrough that doesn’t seem to have occurred: widespread awareness that the outcome of a person’s cancer is not decided by how hard they fight.
Vijay Trisal, medical consultant for Showtimes’ “The Big C,” understands why some patients might not appreciate the words “fighting” or “battling.”
His response follows a question about Showtime’s “The Big C,” for which he was the medical consultant.
Reporter Mary MacVean asks: “Cathy also got really angry at one point about people using the words ‘fighting’ or ‘battling’ cancer. What do you think about those verbs?
Responds Trisal, an assistant professor in the Division of Surgical Oncology:
“I think it is a lot of pressure. The pressure is that if the patient is not getting better, they’re not trying hard enough. Look at [Lance] Armstrong. Armstrong had a cancer that has a 98 percent survival rate. … Put that with someone who has even stage 1 pancreatic cancer, and eventually has a 90 percent mortality rate … it is not based on whether they are trying hard enough, it’s based on the disease. We have this belief that death is a failure. Death is not a failure. It is inevitable. How we go is much more critical than when we go.”
In a previous interview with City of Hope’s Roberta Nichols, Trisal said that collaborations between Hollywood and physicians create the potential for “teachable moments.” For a specialist in melanoma, a show about a patient with stage 4 melanoma offered plenty of such moments. Continue reading “‘The Big C’ offers teachable moment about ‘fighting’ cancer” »
To reduce melanoma risk, learn from the Aussies (and a seagull)
Somewhere along the way, May – a harbinger of carefree summer fun – got serious. It’s now known as Melanoma/Skin Cancer Detection and Prevention Month. But as fun-sapping as that name might seem, there does appear to be a way to combine an exuberant embrace of the sun with skin protection. The Aussies have already proved it.
Don’t stop with a drop. Go for a dollop. During May, also known as Melanoma/Skin Cancer Detection and Prevention Month, it pays to learn how to use sunscreen properly. Summer is just around the corner.
The words Slip! Slop! Slap! are credited with awakening Australians to the need to protect their skin from the sun. That’s what anyone would call a breakthrough. Used as a slogan, the words were the focal point “one of the most successful health campaigns in Australia’s history.”
Of course, the Australian campaign featured Sid the seagull, an animated bird wearing board shirts.
“Slip, Slop, Slap!,” Sid sang, in a charming, and apparently persuasive, Aussie accent. “It sounds like a breeze when you say it like that … Slip, Slop, Slap! Slip on a shirt, slop on sunscreen and slap on a hat. Slip, Slop, Slap!”
There’s more, but reading the lyrics doesn’t do the bird justice. See? Fun. Continue reading “To reduce melanoma risk, learn from the Aussies (and a seagull)” »
Mammogram rates not falling for women 40 to 49, despite U.S. advice
Since 2009, the U.S. Preventive Services Task Force (USPSTF) has recommended routine mammograms only for women age 50 and older. But a study published in Cancer on April 19 found that despite those recommendations, screening rates among women age 40 to 49 have not fallen.
Mammogram rates among women ages 40 to 49 have not changed, despite recommendations against them from the US Preventive Services Task Force in 2009.
In fact, between 2008 and 2011, the screening rate for that age group has risen slightly, from 46.1 percent to 47.5 percent.
Looking at this data, the study’s authors speculated that the rate may have stayed stagnant due to conflicting screening guidelines from other professional organizations.
The American Cancer Society and the National Comprehensive Cancer Network both recommend annual mammograms for women starting at age 40. But the USPSTF suggested that women between 40 and 49 talk with their doctors about the benefits and risks of mammograms, and personal risk factors — such as a genetic mutation or a family history of breast cancer — that may warrant earlier, more frequent screenings.
In making its recomendation, the USPSTF evaluated breast cancer screening, incidence and mortality data. The task force considered the lower incidence of breast cancer in young women and the negative impact of earlier, more frequent screenings, particularly “false positives” that can result in unnecessary costs, additional tests and emotional burden. Continue reading “Mammogram rates not falling for women 40 to 49, despite U.S. advice” »
‘My cancer diagnosis: What I wish I’d known’ – James Neustice
One in a series of stories asking former patients to reflect upon their experience …
James Neustice fought bone cancer with everything he had and came out the other side a survivor. (Credit: James Neustice)
For James Neustice, what began as severe back pain at the age of 23 quickly spun into a whirlwind of blood tests and doctors’ visits — and ultimately led to a life-threatening diagnosis: a kind of bone cancer known as chondroblastic osteogenic sarcoma. That diagnosis was the beginning of seven hard-fought years of treatment.
Good thing he had City of Hope on his side. Now cancer-free more than a decade after his diagnosis, Neustice wants to share what he learned with others who must confront cancer. He has his own records from the time to draw upon.
“Through it all, I have made lists, lists upon lists and even more lists,” he said. “Lists about what to eat, what to drink, what I will stand up for, what I am doing after this chemo treatment, what I am doing during that chemo treatment.”
We asked Neustice to look back at the time of his diagnosis and to ask himself what he knows now that he wishes he’d known then. What wisdom, soothing words, practical tips or just old-fashioned advice would he give his newly diagnosed self?
Continue reading “‘My cancer diagnosis: What I wish I’d known’ – James Neustice” »
Breast cancer: Task force may recommend drugs for high-risk women
Currently, the official guidelines to reduce breast cancer risk are primarily a set of lifestyle habits such as eating a healthier diet, exercising regularly and getting the recommended screenings. But what if the prescription to prevent breast cancer included actual drugs?
Women at an elevated risk of developing breast cancer should be offered drugs such as tamoxifen or raloxifene to reduce that risk, the U.S. Preventive Services Task Force suggests.
That just might be the case for some women, specifically those at an elevated risk of breast cancer, according to a draft recommendation made by the United States Preventive Services Task Force (USPSTF).
The report, which is still being developed and open for public comment until May 13, recommends: “For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications such as tamoxifen or raloxifene.”
Both drugs work by blocking estrogen’s effect on breast tissue, and approximately 75 percent of breast cancers are fueled by estrogen.
However, these drugs also have serious side effects, such as increasing the risk of blood clots, strokes and, for tamoxifen, cataracts and endometrial cancers. Thus, the USPSTF report also notes that “women who are not at increased risk for breast cancer should not use tamoxifen or raloxifene to reduce their risk for breast cancer.” Continue reading “Breast cancer: Task force may recommend drugs for high-risk women” »
Minority Cancer Awareness Week: End disparities now
Cancer knows no boundaries: It affects men and women, the young and the old, the rich and the poor, and people from all ethnic backgrounds. But, in the U.S., cancer has a disproportionate impact on minorities.
Among men, the rate of new cancer cases – and death rates – are highest among black men, says the federal Centers for Disease Control and Prevention. Among women, although the rate of new cancer cases is highest among white women, death rates are higher among black women.
To improve the health of minorities will require a partnership, one that starts in the community.
Although Hispanics have lower incidence rates for all cancers, combined, when compared to whites, they have higher rates of cancers linked to infections, such as uterine, cervix, liver, gallbladder and stomach cancers, says the American Cancer Society in providing an overview by ethnic group. Further, breast cancer is generally diagnosed in Hispanic women at a later age than in other groups.
Such cancer disparities can be attributed to a combination of factors: a lack of early detection, insufficient attention to healthy lifestyles and poor access to health care. But each factor must be targeted to eliminate inequalities in cancer outcomes.
These disparities are likely to get widespread attention this week, designated as National Minority Cancer Awareness Week, but they’re the focus of Kimlin Tam Ashing-Giwa, Ph.D., every day. Continue reading “Minority Cancer Awareness Week: End disparities now” »
