Feeding the Hungry this Holiday Season

Our series of articles titled Business is Everyone’s Business has focused so far on various employers, both large and small, and their economic or employment impact in the region. In this season of Thanksgiving and Christmas, we must also remember that our local non-profits are everyone’s business as well.

The Thanksgiving holidays saw a great outpouring of giving through the Community Food Drive, originally started by our own “saint” Rev. Bettie Kennedy and now ably overseen by Bruce Love. On November 21, 2015, two thousand boxes of food were quickly packed and distributed throughout the community. Hundreds of volunteers, young and old, black and white, rich and poor came together for a common purpose and in one accord. That singular, annual event has great impact. Do you ever wonder how that need is met throughout the year?

The Christian Information & Service Center is an amazing organization that provides food for our hungry day in and day out. CISC, a 501 (c)(3) organization led by the indomitable Yulonda Richard, has a mission to be a Christian witness and minister to those in need specifically by feeding the hungry within Angelina County. It is a volunteer-supported organization that exists because of donations given in love by individuals and local churches. These donations allow CISC to operate locally in Lufkin to provide food out of the East Texas Food Bank in Tyler.

The need is significant. One in seven Americans will visit a food bank this year. 465,000 East Texans are at risk of hunger. Every year, CISC hands out over 2M pounds of food to around 200,000 people on a budget of $347,000. Though the primary assistance to the community is free food for low-income residents within Angelina County, CISC also offers various programs throughout the year, such as the "BackPack Buddies" after-school feeding program, the "Senior Food Box" senior citizen program which feeds over 2,600 seniors per year, and the "21-Day Meal Program," which aims at feeding children who are on summer vacation. There is also an avenue for assistance with gas vouchers, sleeping bags, bus tickets or utility assistance.

According to Yulonda Richard, the recent layoffs in Angelina County have led to an increase in the number of clients seeking help at CISC. Previous statistics showed that forty-nine percent of the households served have at least one employed adult, and the rest are mostly children and seniors on fixed incomes. It is, to a large extent, the working poor who really need a helping hand.

If you have ever driven by CISC in the morning, you know there are people there at 6:30 AM waiting, even though the doors don’t open until 9:30 AM. Fresh fruits, vegetables, meats, dairy, bread, everything you find in the grocery store CISC delivers. The majority of the donations come from right here in Angelina County: money, food, church support.

How can you help? Come to the Believe in Christmas! musical this Sunday, December 6, 2015 at 6 PM at Lufkin’s First Baptist Church. First Baptist and New Beginnings Baptist are uniting for the second year to celebrate unity, worship together, and support CISC. Admission is free, but bring canned goods or even a monetary donation for CISC when you come. As Yulonda Richard says, “It doesn’t matter what we give, God always expands it. As long as you are giving from the heart, God will increase it.”

CISC may not be the most glamorous non-profit in town, but they just might be the most impactful. As we move through this holiday season, remember that supporting local non-profits like CISC is everyone’s business.

PineCrest has Far-reaching Economic Impact

Mayor Bob Brown, City Manager Keith Wright, Chamber CEO Jim Johnson and other local government and business leaders recently launched a series titled Business is Everyone’s Business. The purpose of this initiative is to highlight local businesses and remind us not only of their economic impact but also the importance of our community support.

I recently asked the Texas Comptroller of Public Accounts office to provide me with updated statistics on the contribution of the healthcare sector to our local economy, and I was startled at the findings. Employment in the healthcare industry in Angelina County grew from 7,091 FTEs in 2005 to 8,411 in 2014. In 2014, 23 percent of all jobs in Angelina County were in the healthcare industry (up from 20 percent in 2013). In 2013, the healthcare industry accounted for $401,447,145 or 13 percent of the gross regional product in Angelina County. Angelina County truly is the healthcare hub of our deep East Texas region.

Within the healthcare industry, there are the major employers we all know about, like CHI St. Luke’s Health Memorial (1200 employees), Woodland Heights Medical Center (580 employees) and the Burke Center (400 employees throughout East Texas). There are myriad small businesses providing pharmacy, home health, hospice, and various diagnostic and therapeutic services to our region. We also have a number of nursing, rehabilitation and long term care facilities, one of which I want to feature today.

PineCrest, part of Methodist Retirement Communities, is a not-for-profit continuing care retirement community offering independent living, assisted living, memory support, skilled nursing and home health. Open since 1992 and located on 55 acres, PineCrest employs 220 people with an annual payroll of $6 million (mostly to Angelina County residents) and an additional spend of $3 million going to physical plant operations, utilities, contractors, and others.

Much more than a nursing home, PineCrest has 82 residential apartments, 36 patio homes, 21 assisted living apartments, 40 memory care units, and 51 skilled nursing units with 19 of those dedicated to transitional rehab. PineCrest also has on-site banking, full-service dining, a bistro, grocery store, library, chapel, beauty salons, a wellness center, and even a large auditorium to hold banquets, seminars, or private parties.

According to Amy Thomas, Executive Director at PineCrest, they currently serve around 237 residents, which include those with spouses. PineCrest is constantly reinvesting in our local community with ongoing renovations. PineCrest residents also contribute to the local economy as any of our county residents would, whether dining out, going to the grocery store, shopping, buying gas, attending Angelina Arts Alliance and Pines Theater shows, as well as with expected healthcare-related visits (hospitals, doctors, pharmacies, etc.).

PineCrest supports our broader economy in other, unexpected ways. For example, they partner with SFA as an intern site for social workers and as a clinical site for nursing students in SFA’s Bachelors nursing program. In addition, PineCrest is an intern site for SFA’s hospitality program. PineCrest also partners with Angelina College with AC’s LVN, RN, and CNA programs. These affiliations have led to numerous full time healthcare positions not only at PineCrest but at other facilities in our community.

PineCrest residents serve as volunteers at CHI St. Luke’s Health Memorial and at AC’s Adult Learning Center. And local high school students are working with PineCrest residents in a program called Wisdom for Youth with Senior Expertise (WYSE), which promotes inter-generational learning through shared experiences. An Alzheimer’s support group is also facilitated at PineCrest. Though these programs may not have a direct economic impact, their quality of life impact is significant.

PineCrest is a true community within our community, and one that is far from insular or isolated. I’m grateful for PineCrest’s economic impact as well as their influence far beyond simple employment statistics. PineCrest demonstrates that Business is Everyone’s Business!

Cattle Baron's Gala Supports Local Cancer Patients

I always look forward to the Pineywoods Cattle Baron's Gala. Not only do I have a good time, I know the money raised is going to a great cause - the American Cancer Society. Unfortunately, there has been recurrent grumbling - from what I hope is an unenlightened minority - that the money raised doesn't stay local. I understand this "local first" mindset and agree that we should expect local return on our charitable giving. The American Cancer Society delivers that in spades.

Yes, the American Cancer Society is a national organization. But did you know that the American Cancer Society has a regional office building right here in Lufkin? This office was built thanks to generous local foundation, business, and individual support. Did you know this office houses eight employees and serves a 12-15 county region? Annual payroll, benefits and overhead is about $450,000 per year. These are good local jobs that feed back into the local economy at a time when all local jobs are significant.

But it isn't just about the jobs. Every dollar raised has local impact in many more ways. Since I started practice in Lufkin nearly 23 years ago, the overall cure rate for cancer has increased from 50% to over 70%. That translates to local lives saved, not in small part due to the incredible research funded by the American Cancer Society. Statistically, an additional 120 people who come through the Temple Cancer Center every year are cured! Now, that is local impact!

Did you know that the American Cancer Society National Cancer Information Center in Austin handles close to 1 million requests for cancer information annually, including calls from Lufkin and deep East Texas? Those calls, emails and online chats provide direct, one-on-one support and information about local services for local patients, including navigation and information on how to access insurance coverage when possible. (By the way, some of these services, like rides for patients to appointments, require local drivers. You can volunteer to help!)

Did you know that every new cancer patient seen in the Temple Cancer receives accurate, specific educational material provided by the American Cancer Society? And local cancer patients have access to wigs, supplies, and support services whether they receive treatment locally or not.

Did you know that the American Cancer Society funds efforts to increase screening rates for cancer? More than 4.6 million women in need have been helped since 1991 through the national breast and cervical cancer early detection program. The latest project is to screen 80% of the eligible population for colorectal cancer by 2018. Colorectal cancer screening can find and remove polyps before they become cancerous, and that prevents colorectal cancer. And what about the incredible American Cancer Society work in the area of tobacco control? Locally, the American Cancer Society Cancer Action Network was instrumental in the passage of smoking ordinances in both Lufkin and Nacogdoches.

What about local patients who choose to travel to the Texas Medical Center for treatment? Soon they will have access to free lodging at Hope Lodge Houston provided by - guess who? - the American Cancer Society. The TLL Temple Foundation generously provided the lead gift for the Hope Lodge Houston. 

What about the various treatments we recommend for cancer patients? Those treatments very well may have been developed from research supported by none other than the American Cancer Society. The American Cancer Society has funded an incredible $4 billion in research grants since 1946. In Texas alone, this year nearly $36 million is currently invested in research.

Website presence? The American Cancer Society's website, cancer.org, is the most trusted website available when it comes to cancer information, with 61 million hits logged in 2014.

The suggestion that funds raised by American Cancer Society events don’t stay local (or don’t benefit our local community) simply can't be supported by facts. Not only that, it misses the point that we can accomplish so much more together than what we can by ourselves. Isn't that our community spirit anyway?

Join me this Saturday night, October 10th, at the Moore Farm for the 2015 Pineywoods Cattle Baron's Gala in support of the American Cancer Society’s lifesaving cancer research, education, and truly local services. Call (936) 634-2940 for ticket information.

Jimmy Carter's Cancer Revelation

When a current or former President of the United States has a major health problem, it is international news. And when a former president has cancer, we all take in a collective gasp. Especially when that former President is 90 years old. On August 12, 2015, Jimmy Carter announced that he had cancer.

As an oncologist, I read such announcements with particular interest. I look for certain words or phrases that carry a lot of meaning. According to the New York Times coverage that day, Mr. Carter has a diagnosis of “a spreading cancer that was detected by recent liver surgery.” Already, my antennae went up. No cancer in a 90 year old is good news, but a few are potentially more benign acting – not likely to be fatal – than others. For example, prostate cancer in the elderly may not even need to be treated. But just about any cancer in the liver is extremely serious, no matter what one’s age. The New York Times goes on to say that “a small mass” was removed, as if “small” is any more comforting.

But the next statement attributed to the former president’s office blew me away: “(T)he prognosis is excellent for a full recovery.” Full recovery, in my mind, means cure. What sort of propaganda is this, I wondered.

The Times noted that Mr. Carter has a strong family history of pancreatic cancer; his father and three siblings all died of pancreatic cancer, and his mother had it as well. If he had pancreatic cancer that spread to his liver, prognosis is likely months, with a chance for “full recovery” being zero. Most other metastatic cancers also have a poor prognosis, although time frames can vary. How could I reconcile what I presume medically to be a near zero chance of “full recovery” to a press release predicting an excellent prognosis?

What bothered me in the early discussion was not so much that the news media refused to speculate; that is understandable. But Mr. Carter’s team did a disservice to those who have cancer – and to those of us who treat cancer – by overly reassuring and misleading the public about his condition rather than owning up to it.

Thankfully, that misdirection did not last long. It was announced on August 20, 2015 that Mr. Carter, in fact, had metastatic melanoma. Surely that was known on August 12 (the liver surgery was August 3, after all). At a videotaped news conference on August 20, Mr. Carter explained that the melanoma in his liver had been completely removed, but that four small tumors were found in his brain. He started radiation treatment that afternoon and famously taught his Sunday School class three days later.

To Mr. Carter’s credit, he admitted on August 20 that his cancer is “likely to show up other places” in the future. And being the man of faith that he is, he is quoted as saying that his life was in God’s hands and that he was perfectly at ease with whatever comes. It was reported that when he first learned that the cancer was in his brain, he believed he “had just a few weeks left.” After radiation, he will pursue several courses of a brand new drug pembrolizumab – also known as Keytruda – over a period of several months, depending on how he is doing.

Regardless of how Mr. Carter responds to treatment or how long he lives, what started as obfuscation on the part of a press machine ultimately turned into an amazingly vulnerable self-revelation by a man of deep faith. I hope and pray President Carter responds well to treatment. I also hope that as he confronts treatment and end of life decisions he will spark an honest and open discussion of the role of palliative (comfort) care and hospice care. That would be as great a humanitarian legacy as any he has yet left behind.

A New Generation of Leaders

A new generation of leadership is emerging in Lufkin.

For those of us who have volunteered for various organizations over the years, there has been a hunger to see young adults step into volunteer leadership roles in the community as well as a desire to see our churches, schools, and governmental organizations mentor and raise up a new generation of leaders.

In recent years, there has been an oft-repeated lament that we've lost a generation of leaders - the Kurth, Temple, Trout and Henderson families jump to mind, among others - individuals who could pick up the phone and make a call and things got done. Though there certainly were instances where that was true, I think nostalgia glosses over the very real hard work and elbow grease that often went on behind the scenes. And the problem with that type of nostalgia is that it discourages current and future leaders from jumping in and getting their feet wet. "Oh, we can never accomplish what those guys did," we surmise. But we can.

Bettie Kennedy, whose life was celebrated this last weekend, didn't just pick up a phone to get something done; she got in the trenches and worked hard. Day after day, year after year. Rev. Kennedy proved you can have influence through servant leadership. Lufkin is a better place and a stronger community because of her.

My church, First Baptist, has been without a full-time pastor and music minister for some time now, and the church (which is the people, after all) has had to step up and be the church they were meant to be. This is the church fulfilling its mission.

In the same way, our community - especially our young adult population - is demonstrating we can step up and be the community we want and need to be! Each generation must reach the point where they take that mantle and lead. It is incumbant on both the current leadership to pass that mantle down and the next generation to take up that mantle and lead us forward.

I had the privilege over the last several months of serving on two different search committees for the Angelina County area and region. The first committee was to recommend a new president for Angelina College. The second was to select a new President and CEO of the Lufkin/Angelina County Chamber of Commerce. Both committees engaged search firms and conducted nationwide searches. Several things were remarkable about each process. Both committees were intent on seeking the input of a broad range of our community, as these were community leadership positions. And both committees were willing to consider, and in the end choose, young leaders.

Starting this month, Angelina College is under the leadership of Michael Simon, and the Lufkin/Angelina County Chamber of Commerce will be led by Jim Johnson. Both leaders come from a younger generation than their predecessors and symbolize the passing of the mantle I already mentioned. At Jim Johnson's press conference announcing his hiring, he was accompanied by his wife, Jasmine, and preschool son, William, who played with his toy car, cheerfully oblivious to the importance of the occasion. How refreshing!

And look at just some of the young leaders we already have! People like Trent Ashby, Mark Hicks, Tara Watson-Watkins, Hall Henderson, Martha Hernandez, Hilary Haglund Walker, Monique Nunn, They are accomplishing amazing things! There are many more in those ranks just starting to get involved.

I am proud of Lufkin and Angelina County. We have always demonstrated a greater degree of leadership, volunteerism and charity than any other place I know. My unsolicited advice to potential young leaders is this: Take the servant approach. Give of your time and talent first and foremost. As you have treasure to give, do so in a generous fashion. Lead by example, like Bettie Kennedy. You will gain credibility which will open doors and allow you to accomplish far more than you can imagine. But the first step of leadership is to step out of your office and get involved. You'll never regret it!

Doctors Are From Another Planet

Jupiter and Venus aligned recently in what was called a Bethlehem Star event. The next time the two planets appear this close together will be in 2023. The rarity of planetary conversions reminded me of the 1993 bestseller from PhD counselor Dr. John Gray, titled Men Are from Mars, Women Are from Venus. If you haven’t read it, apparently there are more than 50 million copies floating around.

The basic premise of the book is that men and women are naturally different in the way they think and communicate. We all know that an underlying lack of communication in a relationship keeps that relationship from maturing or even kills it. The success of the book is rooted in the knowledge it imparts (in very humorous ways) about how our spouses think and, therefore, how we need to relate to one another.

Communication among doctors is equally important, but what may die in this physician-physician communication desert is you, the patient.

Everyone knows the phrase from the 1967 Paul Newman movie, Cool Hand Luke, “What we have here is a failure to communicate.” A scholarly article in the Journal of the American Medical Association in 2007 noted that direct communication between inpatient physicians and primary care physicians happened in less than 1 in 5 hospitalizations. It is just as bad inside our hospitals.

Physicians are notorious for expecting others to communicate for them. Part of that is time crunch, but mostly it is laziness. It is easier to write an order for a nurse to contact another physician to see a patient rather than to make the call yourself. Although, with cumbersome electronic medical records and CPOE – computerized physician order entry – it is getting easier again just to pick up the phone and call.

Consulting physicians are busy, too, and getting one on the phone can be a challenge. But if I am asking another physician see my patient, I’m the one who knows best why I am making that request and what I want from that consultant. I shouldn’t delegate critical communication to others. That gets back to one of my golden rules: take the time and do what’s right.

What’s more, patients are demanding better communication among their healthcare team, and rating hospitals and physicians on whether or not they measure up. A 2011 National Academy of Medicine discussion paper noted, “Consistent and effective communication between patient and clinician has been associated in studies not only with improved patient satisfaction and safety, but also ultimately with better health outcomes, and often with lower costs.” In addition, “Breakdowns of communication, or disregard for patient understanding, context, and preferences, have been cited as contributors to health care disparities and other counterproductive variations in health care utilization rates.” In other words, when we don’t communicate, extra tests may get done and patients can get hurt.

However, communication is a two way street. You, the patient, need to know at a minimum your own medical and surgical history, what medications you are taking (and what doses), and what you are allergic to. Medical records are not perfect, and as with any electronic media, if garbage goes in, garbage comes out. If you don’t give your physician or the hospital accurate and complete information, that’s just garbage in. Can’t remember everything? Write it all down and bring in a copy.

Communication is a skill, and skill development requires practice. Yes, some physicians (and patients) need more practice than others. Let’s work together to align our communication stars and usher in a new era of patient safety, better outcomes, lower costs, and greater satisfaction.

Doing the Right Thing, One Day at a Time

As I write this column, it is Saturday morning of Memorial Day weekend. I have been at my office several hours working on patient charts and mapping out cancer treatment plans. This type of work cannot be done in the midst of a busy clinic day. Once I am done today, my radiation physicist will compute these patient plans. Then I will come back out later today or tomorrow to review and approve them so treatment can start next week.

Such is a typical Saturday morning for me. This is the tedious, mental work that requires me to be alert, focused, and very careful. Modern radiation treatment is highly precise, and the treatment is only as good as the planning process. If I don’t accurately target the cancer, it doesn’t get treated. And if I don’t carefully protect surrounding normal tissues, side effects can be worse. All of this takes dedicated, uninterrupted time. So, I am here at my office this lovely Saturday morning because, well, it is the right thing to do.

What does it mean to “do the right thing”?

A number of guiding principles come to mind. For me, the most important one is to take my time. Doing the tedious work on a Saturday morning or weekday evening. Spending adequate time with my patients. When I rush or get careless, I make mistakes. And by the way, we should acknowledge our mistakes and learn from them.

A second principle is: don’t do either more or less than required. Medically speaking. What I mean is physicians shouldn’t do procedures that are unnecessary just to pad their pocketbook. The flip side is also true: physicians should provide needed care even if they do not expect to be paid for it. Yes, there are times when this is not possible, but the concept and practice of providing charity care is part of who we are and what we profess to be as physicians.

Third, don’t be afraid to ask for help. I can provide most radiation-related cancer treatment in Lufkin, Texas, thanks to the fantastic equipment and personnel at CHI St. Luke’s Health Memorial. But there are rare or unusual cases where I don’t mind asking colleagues for assistance. It’s OK to pick up the phone and call my Houston colleagues if needed. In a similar vein, I tell my patients that I am not offended if they decide to seek treatment elsewhere. Patients need to be comfortable getting their care from me, and almost all are. Some physicians get all bent out of shape and act offended when someone wants to go elsewhere for care. They need to get over it and realize it is not about them. We are to serve our patients, not the other way around.

Fourth, treat everyone the same. What I mean by that is, each person has value, and that value is not based on their insurance plan. We shouldn’t let money dominate our decision-making.

Reimbursement for one’s work is important, but physician compensation comes with an obligation that an ever growing, younger crop of physicians seems unwilling to meet. We “old school” physicians often lament that younger doctors don’t view medicine as a profession. New medical school graduates view medicine as a job, with an employee, get-in-and-get-out, do-the-minimum mentality. Yet, they expect high salaries off the bat. What a shame! Sometimes the best payment is the heartfelt gratitude of a needy patient.

Each of us should strive to do the right thing, one day at a time, no matter what our profession or job.

A New Era of Cancer Survivorship

We are surviving cancer in greater numbers than ever!

The American Medical Association's new oncology journal, JAMA Oncology, presented encouraging statistics in their inaugural issue on how many of us survive cancer. Some cancers have seen a lot of progress over the last 20 years. For example, patients aged 50 to 64 years and diagnosed with colorectal, breast, liver, and prostate cancer from 2005 to 2009 were 39% to 68% more likely to survive than similar patients diagnosed between 1990 and 1994. The article also pointed out that certain subgroups - the elderly, and African Americans - are not seeing as much improvement. Disparities in healthcare remain one of our greatest challenges in the United States. I have addressed this previously, but for today, I want to focus on the survivors.

According to the American Cancer Society, nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014, not including carcinoma in situ (non-invasive cancer) of any site except urinary bladder, and not including basal cell and squamous cell skin cancers. It is estimated that by January 1, 2024, the population of cancer survivors will increase to almost 19 million: 9.3 million males and 9.6 million females.

I recently spoke at the Polk County Relay for Life Survivor's Dinner, and this weekend will speak at one for Crockett/Houston County. American Cancer Society Relayers are passionate about the fight to end cancer and remembering loved ones lost to cancer, but they are equally passionate about recognizing and honoring survivors. If nothing else, these dinners remind me that survivors are the everyman. And as such, survivors want nothing more than to live their lives with cancer in their past, not with side effects or debilities that are constant reminders of what they have been through to get where they are.

For the field of oncology - the study of cancer and how to treat it - this new focus on what happens when we cure cancer is both refreshing and eye-opening.

What does it mean to survive? Surely it means more than just to live, more than just to carry on despite the hardship or trauma of cancer. Today, when you can buy survival guides for anything from zombies and global warming to ballroom dancing and Disney queue lines, we very much risk cheapening the word. And how about the "take no prisoners" approach of the reality television Survivor series? Being the last man or woman standing is not the goal, either. Cancer survivorship is about all of us reaching the goal!

I believe that successful cancer survivorship has much to do with attitude. I see it all the time. Patients with a positive mindset suffer less! Negative patients can talk themselves into any side effect and can let the burden of cancer treatment weigh so heavily on them that they simply can't function. Having strong support systems in place can help; surviving cancer is a cooperative effort which ideally should include not only the patient and the medical team, but the family, friends, caregivers, support groups as well.

We have entered an era where it is no longer good enough to cure cancer. We must cure with the least toxicity possible, all the while staying concerned with the cost of cancer treatment both for the patient and for society. And, we must ensure that these advances are available to all patients, regardless of race, ethnicity, income.

Are you or is someone you love going through cancer treatment? Get involved in Relay for Life! Survive? Thrive! Find an event near you at relay.acsevents.org.

New Cancer Fighting Technology in Lufkin

Last week, the Temple Cancer Center treated the first patients on our new Elekta Synergy linear accelerator, the first major investment of Memorial since the CHI acquisition. To say, "We got a new piece of equipment" understates the multi-year project of visiting other cancer centers, evaluating manufacturers, specking options, removing an older treatment machine and renovating the vault that houses the linear accelerator, and determining what other hardware and software is required to make this new piece of incredible technology work to treat cancer. No small task!

All told, this project, which also included a Toshiba large bore CT scanner, Vision RT image guided radiation alignment technology and other accessories, topped out at $4.5 million. It is a recognition of the importance of exceptional cancer treatment to our region and a signal that Memorial will remain the regional hub for cancer care in deep East Texas.

So, what does this new technology bring to our deep East Texas region? For our many patients currently being treated with IMRT - intensity modulated radiation therapy - we will be able to deliver their treatment in a fraction of the time it has taken up until now, often less than five minutes per treatment! Standard treatments can go even faster. And, these treatments are often even more precise with less dose to surrounding normal tissues, which will translate to even fewer side effects.

In addition, we will be able to implement a totally new procedure to the region called SBRT - stereotactic body radiosurgery. SBRT delivers high doses or radiation over very short courses - three to five sessions, typically - and requires much finer tuning and more rapid treatment delivery than we were previously able to do. We will start using this technology for small lung cancers first, but I anticipate over time treating cancers in other locations as well. The utility of the technology for lung cancer cannot be overstated. Lung cancer is almost always related to smoking, and heavy smokers often cannot undergo surgery, because they do not have enough normal lung function to survive removal of even a small part of a lung. However, these same patients can often be cured with SBRT. With low-dose CT lung cancer screening, we anticipate finding more early lung cancer; now we have the ability to treat them even if they cannot have surgery, with equal results and less morbidity.

Another site where we plan to implement stereotactic radiosurgery technology is in the brain, where small tumors can be ablated with radiation without having to be removed neurosurgically. Treating tumors such as these in an outpatient setting without having to resort to major chest or brain surgery is a remarkable benefit of this new technology. We will not start using this new technology immediately, however, because any new procedure requires establishment of appropriate protocols, quality assurance procedures, and training, all of which will be implemented over the coming months.

The Temple Cancer Center is also excited that our social worker, Appolonia Ellis, recently completed the Harold P. Freeman Patient Navigation Program, where she learned how to better assist our patients in accessing available services and programs so that they can successfully complete treatment. Patient navigation is fairly new to cancer programs, and we are excited to have the only navigator in the area.

At a time when other industries have announced plans to cut hundreds of jobs or move out of the area altogether, CHI's long term commitment to Lufkin and the Memorial system is reassuring. They are putting their money where there mouth is, so to speak. For that, I am grateful.

A Spoonful of Sugar

I don't think I'm unique in having a family that discusses medical issues at the dinner table. But in a family with a doctor, sometimes discussions – to the dismay of my children – are more colorful than they would like. I have learned (mostly) to keep discussions from veering off track. For my family’s part, they know there is a cardinal rule that must be obeyed: you are not allowed to mention Google or Reader’s Digest when discussing medical facts. That rule was recently broken by my wife, Catherine, but in an interesting and forgivable way. Here's the story.

My wife takes a potassium pill – a common supplement – once a day. As anyone who takes this pill knows, it is a big tablet. A horse pill, some would say. And because of that, she wasn't taking it reliably. Some days she could swallow it without too much difficulty, and other days she just couldn't get it down. If she tried a couple of times without success, she just let it go. That’s where Google comes in. In a worthy attempt to educate herself, she went online, researched the medicine, and found out why she needed it. Now, she is much more compliant... to a point. She won't take it if she is alone, because she doesn't want to choke on it.

When she told this story at the dinner table, she concluded, "Isn't that interesting?" To which I replied, "What is interesting is that you didn't trust that because the doctor prescribed it for you, you needed to take it." My daughter then remarked, "That's because a lot of doctors are quacks." So much for respecting the medical profession these days.

Of course, as a doctor's wife, Catherine very much respects the profession of medicine, and I had a twinkle in my eye when I "accused" her otherwise. My daughter's sarcastic analysis, however, did sting a little. Long gone is the era of paternalistic medicine, where TV doctor Marcus Welby, MD simply told his patients what was best and they complied without question. Now patients come to our offices telling us what is best and expecting us to comply. And front line primary care doctors are so strapped for time and paid so little for each office visit that sometimes it is easier just to acquiesce. 

Physicians must resist that temptation. Historically, perhaps it was appropriate for the family doctor to be paternalistic when he knew his patient so well – both inside and outside the office – and when he took care of the medical needs of the entire family. Too often today, the primary care physician is seen simply as the source of a referral to a specialist. The gatekeeper moniker was a kind way of referring to the physician whose true role was (as far as the insurance companies were concerned) to prevent specialist referrals rather than facilitate them. That is a far cry from the position of a genuine coordinator of care who manages the various specialists’ recommendations and knows all the medications that have been prescribed. Such coordination takes a great deal of communication not only among healthcare professionals but between the primary physician and the patient as well.

All physicians – not just primary care physicians – must work harder to earn the respect and trust of their patients. We must take the time to explain the interventions we recommend and the medicines we prescribe. Those horse pills will go down a lot easier with a little sweet talk and education along the way. And our patients will be happier and healthier as a result. Now, that's good medicine!

Cancer is a Global Problem

Tomorrow is World Cancer Day. We think we have a cancer problem in the US, and we do. But other countries, especially the poorer ones, are truly suffering. Two publications by the American Cancer Society - Cancer Atlas and The Global Economic Cost of Cancer (which I quote extensively) - soberingly detail the scope of the problem.

For example, 6 out of 10 cancer patients would benefit from radiation therapy (my specialty) in the course of their cancer treatment. However, about 20 countries in Africa do not have a single radiation treatment facility. And even when radiation facilities are available, as is the case in several countries in Africa and Asia, coverage is woefully inadequate. Ethiopia, a country of around 90 million people, is served by a single radiation treatment center located in the capital city.

Similarly, although morphine to treat cancer pain is plentiful, safe, and easy to use, millions of terminally ill cancer patients in Africa and Asia die in pain because of regulatory restrictions, cultural misperceptions about pain, and concerns about addiction. Eighty-five percent of the global population lives in low- and middle-income countries, but consumes just 7% of the medicinal opioids, like morphine.          

For the first time, research has shown that cancer has the most devastating economic impact of any disease in the world. The total economic impact of premature death and disability from cancer worldwide was $895 billion in 2008, nearly 19 percent higher than heart disease. And, that figure does not include direct medical costs.

Cancers of the lung, bronchus, and trachea account for the largest drain - nearly $180 billion - on the global economy. That's not surprising, given that smokers die an average of 15 years earlier than nonsmokers. Tobacco is predicted to kill seven million people annually by 2020 and eight million per year by 2030, with more than 80 percent of the deaths taking place in low- to middle-income countries. One-third of those deaths are the result of cancers. This is almost entirely preventable.

And it isn't just lung cancer. Despite the fact that most cases of cervical cancer can be prevented or treated effectively, 274,000 women die from the disease yearly. Approximately 241,000 of these deaths are among women in low- and middle-income nations. And then there's breast cancer, colorectal cancer, and on and on.

It seems like all we hear about on the global stage is HIV/AIDS and malaria (and, more recently, Ebola) - the so-called communicable diseases. But the economic loss from HIV/AIDS ($193.3 billion) TB (45.4 $billion) and malaria ($24.8 billion) combined is not even 30 percent of the economic loss of cancer.

Why should you care?

Put simply, the global cancer epidemic is huge and is set to rise, according to World Cancer Day planners. Cancer treatment and pain management for those dying of cancer are not political issues. They are global health issues which we in the United States, with our expertise and yes, wealth, can tackle better than any other country. They are also the type of moral issues which donors and politicians of every stripe can come together to address. 

This will require effort on the part of organizations like the American Cancer Society and other NGOs, but it will to an even larger degree depend on the leadership of the United States in organizations like the United Nations and the World Health Organization, whatever you think of them. And it will depend on you. Support the American Cancer Society and ACS CAN - the American Cancer Society Cancer Action Network - so that we can create a world with less cancer and more birthdays.

Recognizing Stages of Grief

My father recently passed away from pancreatic cancer at age 81. What a devastating disease! He lasted a mere two months. Thanks to attentive physicians and great hospice care, he was comfortable and at peace when he died.

For my mom, who was married to my father for nearly 60 years, grieving will be a process. In the medical field, we are taught to think about grief in five stages first described by Elisabeth Kübler-Ross in 1969: denial, anger, bargaining, depression, and acceptance. Watching my mom walk through my father’s diagnosis and death, I caught glimpses of many of these stages in her emotions and responses. It is important to note that these stages were never meant to be all-inclusive or rigidly ordered. Depending on circumstances, certain stages may be more prominent than others, or not experienced at all.

Denial is indeed often the initial response to hearing that you have (or a loved one has) a terminal disease. We just can’t believe it is happening, especially when the one with the diagnosis looks so well on the outside or doesn’t feel that bad. Unfortunately, denial can result in poor judgment. Luckily for my parents, any flashes of denial were tempered by solid medical advice and faith in their doctors.

Anger is one of those ugly emotions that can pop up at any time. But, it is one that is not difficult to understand. I typically see anger as a reaction because of dreams that will go unfulfilled. My mom was humorously a little miffed that my father didn’t make it to their 60^th anniversary in April. But anyone familiar with my mother knows she is too strong a Christian to be truly angry. Significant, unresolved anger can signal deeper emotional or spiritual needs that can affect everything from pain management to dying a peaceful death.

Bargaining is the most interesting stage to me. There is a deep desire in us to bargain as Faust did with the devil for something unattainable… in this case, a cure. Sometimes we bargain with God: “If only you would spare him, I promise I would do anything!” In the terminal cancer arena, this bargaining often takes the guise of a search for alternative, unproven “snake oil” treatments. (Mexico, anyone?) To my parents’ credit, they did not pursue futile, expensive elixirs or elusive cures.

Depression and acceptance tend to wrestle with one another, with melancholy eventually fading and acceptance gaining the upper hand. At least that is what we expect with typical grief.

My mother is a strong, confident woman. She held her head high at my father’s funeral and presided over the reception and luncheon with poise and grace. She so appreciated having her sons and relatives with her! I feared she might not do well by herself after everyone left, but she firmly informed me that she needed some time alone to grieve. For her, that was the right decision. She will cry; she will remember. But she will go on, I have no doubt.

Grief shouldn’t be buried. Tears are OK, even desired. However, debilitating, ongoing depression is not healthy. A minority of people experience a complicated grief that requires significant emotional, psychosocial, even medical support. Hospices are obligated to offer bereavement services for families of patients. What most don’t know is that you don’t have to have lost someone on hospice to join a hospice bereavement group! If you are grieving a recent loss and want to talk to someone or participate in a support group, contact your local hospice for help. You don’t have to grieve alone.