Winning the War on Cancer

“I have cancer.” What is your first reaction when someone tells you that? Not the same as when you hear, “I have diabetes,” or, “I high blood pressure.” Something about cancer scares the bejesus out of us. But, should it?

Twenty-plus years ago, when I first started practice, I would quote that we cured around fifty percent of patients. People didn’t believe me then, and you may not think we cure that many today. In fact, we now cure fully two-thirds of cancer patients! We have made remarkable progress in the war on cancer, thanks in no small part to the work of the American Cancer Society. In lung cancer alone, there has been a 20% decline in cancer death, largely due to decreased rates of cigarette smoking.

We just celebrated the fiftieth anniversary of the Surgeon General’s report on smoking and health. This major report, relying on research conducted by the American Cancer Society, exposed the lies of the tobacco industry and laid to rest any doubt that smoking causes lung cancer. We still don’t cure very many lung cancers today – about 15 out of 100 – but we can prevent the vast majority of cases. Since the Surgeon General’s report, eight million lives have been saved, and almost 20 years of life have been added to those lives saved!

Unfortunately, lung cancer is a global problem. There were six trillion cigarettes consumed in 2009! Last century, tobacco killed 100 million people worldwide. This century, tobacco is projected to kill 1 billion people, mostly in the developing world.

Decreasing lung cancer death rates in the United States is just one success story. Over the last nearly 40 years, breast cancer cure rates have increased from 75% to 90%, colon and rectal cancer cure rates have risen from around 50% to two-thirds, and prostate cancer 5-year survival has gone from 68% to 100%. How did we do it?

Better yet, how did YOU do it? You got your mammograms, Pap smears, PSA blood tests, and colonoscopies. You prevented cervical cancer by taking care of precancerous lesions found on Pap smear, or by getting your HPV vaccine. You prevented colorectal cancer by having precancerous polyps removed. You caught your breast cancer or your prostate cancer early by getting a mammogram or a PSA blood test. You noticed a mole changing and had it removed. YOU took charge of your health!

But there is a new danger lurking: obesity. Predictions are, obesity will surpass tobacco as the leading cause of death in the next two decades. Like with tobacco, both cancer and heart disease risk are increased with obesity. Fighting obesity is a lifestyle change, for sure. To change up an old phrase, “An ounce of prevention… is a TON or work!” And, unlike screening tests, you have to work at the diet and exercise continually. (Funny how I preach to myself in these columns!)

Anyway, next time you hear someone say, “I have cancer,” know that they are quite likely going to beat it. The war on cancer isn’t over. We still need to support research, provide prevention and detection programs, work for access to quality healthcare programs, and advocate for smoke-free public places. Walk in Relay for Life on Friday, May 2, 2014 at 6:00 PM at Lufkin Middle School! Support the Cattle Barons Gala, which will be October 25th! The American Cancer Society is the backbone in the fight against cancer. Finally, be a friend and encourager to those with cancer. It’s all about more birthdays, after all!

A New Paradigm of Volunteerism

Last week, I had the privilege of speaking at the annual Chamber banquet as outgoing Chair. This was my charge to the 700-plus in attendance, and my hope for Lufkin and Angelina County.

I have a passion for Lufkin – for her growth, her people, her churches and volunteer organizations. We live in a city and county that lives philanthropy. We have inherited a community built and sustained by many visionary leaders who made things happen, often, so the legend goes, by simply picking up the phone. And because of that legend, we run the risk of becoming complacent.

We are guilty of two things, as I see it, and I am intentionally using hyperbole to make a point. First, we are guilty of a reductionist view that thinks all advancement centered around Arthur Temple and that circle of leaders, as influential as it was. Second, we are guilty of a pessimistic view that no one is left who can make the big things happen. Now, of course, neither is true, but we shouldn’t allow ourselves to simplify and excuse away the need for hard work.

There are four keys to our continued success, as I see it.

First, COMMUNICATION.

When I was in medical school, one of the hardest lessons for me to learn was to pick up the phone and call someone for advice when I didn’t know the answer. There are experts out there in all fields. Maybe the Arthur Temples and Murphy Georges, the George Hendersons and Bubba Shands, the Rufus Duncans and Joe Denmans – I could go on – maybe it just seemed like they could just pick up the phone and call one another and get things done. We can, too, but we have to communicate. We are all in this together, and all have the same goal, whether city, county, Chamber, public or private sector, for-profit or non-profit. Let’s communicate!

Second, COOPERATION.

This actually dovetails with communication. Not only do we need to talk to each other, we need to work together. And we are! One thing I do believe is different today from the previous generation, perhaps, and that is rules and regulations are just more complicated. But everyone has to play by the rules, so let’s all get in there and do the work… together, and across organizational lines.

Third, CREATIVITY.

Partly because the rules of the game have changed, we need to get more creative with our solutions. I think of the discussions community leaders have had regarding Economic Development and how both the City and the Chamber have an interest, and how at an Economic Development Partnership meeting we were able to identify common interests as well as areas where either the City or the Chamber should take the lead (for example, bringing in manufacturing jobs versus business retention and retail initiatives). Let’s embrace our different approaches and creatively structure our relationships for maximum effectiveness.

Finally, CONTINUED INVOLVEMENT.

Last month, we buried Lizzie Wallace, a courageous teenager who died from a rare liver cancer. Her two-year fight with cancer didn’t stop her from working to make a difference. “Be the change you want to see” was her motto. As Lizzie saw it, we all have a responsibility to continue to use our influence in a positive way, even if – as in her case – we are near the end of our journey.

Whether you bring youth and energy to the table or the connections and influence that come with age and experience, you are needed. Get involved; stay involved! Together, we can make our dreams for Lufkin and Angelina County come true.

What a Hospital Should Be

Healthcare reform may be the most polarizing issue today. Depending on your point of view, you are either eagerly anticipating or just dreading the changes that are happening. Either way, we can all agree there is profound upheaval in the system. We are in the middle of an earthquake waiting for the ground to stop shaking.

While the focus on Obamacare has been on the individual’s access to healthcare, we need to remember that our hospitals are feeling the earth move underneath them as well. When hospitals are merely trying to survive may not the best time to consider what a hospital is and does, but I believe it is exactly when we need to take a step back and focus on mission.

A hospital is, first and foremost, an institution to take care of the sick. The Latin root for hospital is the same root for hospice and hospitality. Hospices in the Middle Ages were way stations for pilgrims who needed a place to rest/ Today, hospices are known for end-of-life care for those on their final journey. And the word hospitality denotes kindness and generosity. What a great family or words! Hospitals should provide comfort for travelers on a journey – a journey from illness to wellness. And that hospitality should be extended to all.

We, as a country, have decided that healthcare is not a universal right, in that not everyone (even under Obamacare) will have free care. Yet, we can’t seem to decide what level of individual responsibility (either in terms of healthy lifestyle choices, like smoking, for example, or huge deductibles which the average person cannot afford) goes along with whatever care we do receive. That leaves us with a broken system of inflated billing and inadequate reimbursement that continues to leave a good number of our sick not only without resources but with outrageous bills.

And, unfortunately, the government is placing more and more burden on the hospital to make sure that patients not only receive high quality care in the hospital, but are taking their medicine and seeing their doctor once they are back at home. The hospital is now supposed to be Big Brother. If a patient is readmitted to the hospital too soon after being discharged, the hospital does not get paid for that stay, even if it was because the patient was noncompliant with their own care outside the hospital. One can argue the fairness of regulations such as this, but all hospitals are required to play the same game now, and some will be better at it than others.

I would argue, some will have better results than others in the new quality outcomes paradigm because they “cherry pick” their patients based on ability to pay. That brings me to my main point: We must not let a divided system of care (non-profit versus for-profit) keep the sick from accessing care.

As a non-profit institution, Memorial has a mission to provide care for all, regardless of ability to pay. In an era of declining reimbursement, for-profit institutions – who report to investors – are increasingly turning away those without insurance (except in emergency situations, where federal law requires care to be administered to stabilize a patient). All hospitals operate on a tight margin, and non-profit hospitals (especially those outside of metropolitan markets) are increasingly feeling the pinch. We in Lufkin have an ongoing obligation to provide non-profit care locally so that OUR mission of compassion in Lufkin can continue. It is what our community forefathers established. It is what hospitality demands.

Heart Disease Prevention for the Holidays

My brother just had a heart attack. He had classic chest pain and immediately went to the ER. Before he could sneeze, he was transferred from his small town to a regional center for a heart catheterization, where they found a single vessel blockage. He had a stent placed and has no significant damage. He’s doing great. He’s more upset that A&M lost to LSU.

I’m the one not handling it well.

You see, my brother is only five years older than me. He exercises regularly, jogging 3 miles at a time. He’s even been to the Cooper Clinic in Dallas for all sorts of tests. Our father will be 80 years old in a few weeks, and he has not had a heart attack. Why my brother? And, to the point of my worry, why not me?

Now, I know that we all just gorged ourselves over Thanksgiving, and Christmas is right around the corner. Any talk of diet and exercise should wait until after the first of the year, right? If you are like me, it takes awhile to get psyched up for this. Habits are hard to start and easy to break. This needs to be a lifestyle decision. Mind you, I am not a stranger to exercise… I just haven’t been very friendly with him lately.

If you are like me, there are things you just don’t really want to change. I like my morning latte from Standpipe Coffee and cookies from Confections (shout outs to Ben and Dawn!), and when I travel, I often seek out nice restaurants. At 178 lb, many would say I am not overweight. The insurance industry, however, would disagree. My BMI is right at 25, the cutoff for being “overweight”. Scary word, that one, but not as frightening as “obese”, which a significant percentage of Americans are now.

Dr. Huber, my internist, would like to see me lose 10 lb or more. He told me so last year. In one ear and out the other… Actually, I did lose weight, but gained it back. I should learn to schedule my appointments at the low end of the scale.

As a cancer physician, I preach prevention and early detection every day. The facts with cancer are irrefutable: diet, exercise, and not smoking are three very important things we can do to help lessen our risk of getting cancer. Well, those three things also happen to be the key to lowering one’s risk of heart disease, which kills even more people than cancer.

We are fortunate to have access to incredible cardiac care right here in Lufkin. Truly excellent cardiologists and cardiac surgeons practice here. I would not hesitate to have my heart cath done down the hallway from my office here at Memorial if I had to. But like my cancer patients tell me, they really didn’t want to ever see me professionally, and I’d just as soon keep my relationship with my cardiology friends a social one.

I don’t want to be a “do as I say, not as I do” role model and end up on the cardiac cath table in five years. I see Dr. Huber this month to discuss what other measures – tests? medication? – I need to take for heart disease prevention.

And, I’ve decided that December is a good time to start my diet and exercise program. Yes, I’m going to enjoy Christmas! But maybe I can limit my portion sizes some and NOT go for that second (or third) slice of pecan pie! (Or that second cookie at Confections!)

Giving Thanks!

Thanksgiving is just around the corner, but why wait! I want to send a big thank you to Debbie Jackson, my hardworking co-chair for local enrollment for the American Cancer Society’s CPS-3 study, and to all of the CPS-3 Champions who helped get 423 people enrolled in this amazing cancer prevention study. Our enrollment sites – Memorial Health System of East Texas, Power of Pink!, Lufkin Industries, First Assembly, and the C. L. Simon Recreation Center in Nacogdoches – were fantastic.

Thank you to Becca Chance (along with her powerhouse committee), whose leadership and grace under pressure – and under thunder and lightning! – resulted in another successful Cattle Barons Gala. Thank you to Yana Ogletree and Lindsey Mott with Memorial Health System of East Texas, who hosted an amazing 21^st annual Power of Pink! luncheon. Since 1990, breast cancer deaths in the U.S. have decreased by 27%. Much of that is due to education about mammograms and the importance of screening and early detection.

Today is Election Day. I’m thankful for the right to vote! The most important issue on the ballot today is a constitutional amendment on funding the state's water plan. Voter turnout is expected to be light — below 10 percent of all registered voters — because we just don’t get too excited when actual people aren’t on the ballot. But you need to go vote for Proposition 6. The proposed amendment would authorize the Legislature to withdraw $2 billion from the Rainy Day Fund to begin funding the state’s 50-year water plan. The benefits from a long range planning and economic prosperity standpoint far outweigh and possible downside. And frankly, I think it is poetically appropriate to use a rainy day fund for water planning anyway. Be thankful you can vote, and vote YES on Prop 6.

Thursday is Salute to Healthcare, the Lufkin/Angelina County Chamber of Commerce’s awards banquet to recognize and thank outstanding leaders throughout the healthcare sector for making Lufkin and Angelina County a better place to live and work. As a physician, I have considered it my highest honor to serve as Chairman of the Chamber board this year. The healthcare sector is now one-fifth of our local economy and drives more jobs and more shopping, retail, and dining dollars than any other industry. Our community can show their support for the healthcare sector not only by coming to the banquet Thursday night, but also by “voting with your feet” when you choose where to go for healthcare. The reimbursement changes that are being implemented at a national level could easily kill what we have here locally if you don’t make the conscious decision to stay here for your healthcare needs. Like anything else, if you don’t use it, you lose it. I applaud the Chamber for starting this event several years ago and for thanking our physicians, nurses, and so many others who help care for us.

Finally, as a cancer doctor, I deal daily with the highs and lows of cancer – celebration and victory for many, but bad news and eventual death for others. I’m thankful I can “be there” for my patients, walking alongside them, no matter which path they are on. You can, too. Comfort is one of my favorite words. Its Latin roots paint a picture of coming along side with strength. Each of us needs to be a source of strength during the holiday season for those around us who are hurting, needy, and hungry. Join in helping others with Community Food Drive, Angel Tree, or other efforts with your church or in the community. And be thankful!

Choosing Wisely

My specialty society, the American Society for Radiation Oncology (ASTRO for short) is a participant of Choosing Wisely®, an effort to support and engage physicians in being better stewards of finite health care resources. The goal is to identify commonly ordered procedures or treatments that not only may not be necessary but, in fact, may be harmful. Each participating specialty provides five such procedures they believe are over-utilized or inappropriately ordered.

I was struck by two of these treatments in particular, the first because of its technological "sophistication" and the second because it points to new standard of care.

The "sophisticated" procedure is proton therapy. Unfortunately, the "new" in medicine is often assumed to be the "best". After all, technology only improves our lives, right? Sometimes investors are too cozy with equipment manufacturers who then get the federal government to reimburse a technology well before that technology has been proven to be any more effective than what is currently available.

In the case of proton therapy, investors saw a way to make a LOT of money, because proton therapy was originally being reimbursed at more than six times the rate of standard radiation therapy ($850 per daily proton treatment versus $132 for standard radiation treatment). Proton installations cost tens of millions of dollars to install. MD Anderson's cost $125 million when it was built in 2006. The Houston Police Officers' Pension System was one large backer ($10 million) expecting a sizeable return on their investment.

ASTRO, in a bold move that was sure to ruffle the feathers of some of its profit-minded members, announced last week at our meeting in Atlanta that one of its Choosing Wisely® recommendations is: "Don't routinely recommend proton beam therapy for prostate cancer outside a prospective clinical trial or registry." Their reason? After seven years of proton profit in the marketplace, "There is no clear evidence that proton beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy. Clinical trials are necessary to establish a possible advantage of this expensive therapy."

Bravo. I have bemoaned for years the grab for the money that goes on in medicine, and how that leaves the poor and under- or uninsured with even fewer healthcare resources, as these expensive technologies are, for the most part, only available to those with means to pay for them. I am proud that the House of Medicine is taking steps to control healthcare costs by pointing out our own dirty laundry. Let's hope these recommendations are taken to heart. (I'm not holding my breath.)

The second recommendation is far more positive, and will be a game changer in my specialty: "Don't initiate whole breast radiotherapy as a part of breast conservation therapy in women age >50 with early stage invasive breast cancer without considering shorter treatment schedules." A just-released important study concluded that a particular treatment schedule common in Europe is equivalent to a longer schedule of treatment that we use in the US, and that long term side effects are less! The benefit for women is that a typical course of treatment will be reduced from 5-6 1/2 weeks down to 3-4 weeks. For women who have to travel longer distances to get in for treatment, this can be significant. In addition, it is less expensive. Again, Bravo.

Healthcare is, indeed changing. I have given you two examples of change - one negative, one positive. Educate yourself, and choose wisely.

For information on Choosing Wisely® and recommendations across medical specialties, visit www.choosingwisely.org. Do your part to help cure cancer; enroll in CPS-3 at www.CancerStudyTX.org. 

Your Role in Cancer Prevention

Cancer. Got your attention now? I live and breathe cancer. It's my job. Who knows, I may die with cancer. But my odds are improved because of some choices that I make. First of all, I do not smoke. Ninety eight percent of the patients I see with lung cancer either smoke or have smoked, and lung cancer remains the most preventable cause of cancer death. I try not to get too much sun exposure. That's not easy living in Texas (and driving a convertible). I also exercise regularly and strive to maintain a healthy weight. Finally, once I turned 50, I had my first screening colonoscopy in case there were any polyps that needed to be removed. Removal of polyps can prevent colorectal cancer. My wife, for her part, has regular mammograms (to detect breast cancer early when it is highly curable) and Pap smears (again, to detect changes that could lead to cervical cancer).

Of course, that does not guarantee that I won't get cancer. But the good news is that we cure two-thirds of cancers today. That's right... cure. Most people mistakenly think of cancer as a death sentence. Of course, if you get lung cancer, your chance of cure may only be about 15%. Terrible. Especially since it is almost always preventable. But if you detect breast, prostate, or colorectal cancer early - some of our most common cancers - cure rates run 80-90% or greater. Fantastic!

What are you doing to improve your cancer risk? Do you smoke? Quit! Are you overweight and inactive? Diet and exercise! Are you getting your mammograms, Pap smears, screening colonoscopies, checking your skin for irregular or changing moles? Take charge of the risks that you can.

It is not enough to cure cancer or just diagnose cancer earlier. We want to prevent cancer altogether. What can YOU do to help us win this fight?

Participate in CPS3 - Cancer Prevention Study 3! The American Cancer Society has undertaken a huge, nationwide, multiyear study to better understand the lifestyle, environmental and genetic factors that cause or prevent cancer. If you are between the ages of 30 and 65 years old and have never been diagnosed with cancer, you are eligible to enroll.

Participating is easy and involves the following:

1. Read and sign an informed consent form.

2. Complete a survey packet which will ask for detailed information on lifestyle, behavioral, and other factors related to your health.

3. Be measured for waist circumference.

4. Give a small blood sample (similar to a doctor’s visit). The blood sample is drawn by a trained, certified phlebotomist.

5. Completing a mailed survey every few years over the next 20-30 years

All personal information and any individual results of blood analyses that may be performed will be kept strictly confidential by CPS-3 research staff. There will be no cost to you to participate.

Enrollment will be available at the following locations, your choice:

Tuesday, October 15th (7:30am–11:00am) - Memorial Health System of East Texas, Lufkin

Tuesday, October 15th (4:00pm–7:30pm) - C. L. Simon Recreational Center, Nacogdoches

Thursday, October 17th (1:30pm–5:00pm) - After Power of Pink! at Lufkin Convention Center

Saturday, October 19th (9:00am–12:30pm) - Lufkin Industries

Sunday, October 20th (9:30am–1:00pm) - Lufkin First Assembly of God Church

We need 500 people locally to enroll, and we need ALL racial and ethnic groups to participate. To sign up, go to cancerstudytx.org or call toll-free 1.888.604.5888. Do it for your friends or loved ones who have had cancer. With your help, we can finish this fight!