Posts Tagged ‘cancer care’

Dr. Pandey, Hematologist and Oncology at St. Mary’s, Shares New Exciting Developments in Cancer Treatment

Friday, December 16th, 2011

I am Dr. Mahesh Pandey. I am a Hematologist and Oncologist at St. Mary’s. I shall be writing about the new exciting developments in cancer treatment. While cancer care remains a big challenge, new developments in diagnosis and treatment have changed the course of some diseases. Better understanding of disease mechanisms and developments of targets to treat changes that are responsible for development of a cancer has led to some breakthrough developments.

One such treatment is the medication Gleevec or Imatinib. Chronic myeloid leukemia (CML) is a cancer of the white cells in which the cells in different stages of development pack up the bone marrow and cause a high white blood cell count, enlarge the spleen, give the sensation of being full after eating small amounts of food, and weight loss. This starts as a gradual disease but untreated, goes into a rapidly progressive phase and eventually transforms into an acute leukemia.

Traditionally the only treatment known for this disease was a bone marrow transplantation, which even in healthy young adults has a death rate of 15%.  Additionally, there are longstanding complications even after a successful transplantation.  The chemotherapy that was used to treat this disease had a lot of side effects.  It was toxic and only palliated this disease for a while and eventually the disease took its course. Another treatment called hydroxyurea only controlled the white cells for a while but did not change the course of the disease at all.

In 1960, a genetic abnormality called Philadelphia chromosome was discovered by Peter Novell in the city of Philadelphia (thus the name of this chromosome) in this disease. The Philadelphia chromosome occurs when a broken piece chromosome number 9 joins with a broken piece of chromosome number 22 and causes uncontrolled proliferation of white cells.

Initially treatment of cancers was focused on treatment of the different stages of the cell cycle. As new chemotherapy agents known to target different stages of cell cycle, attempts were then made to combine chemotherapies that targeted growth of cancer cells at different stages of the cell cycle. Some rapidly growing cancers such as ALL in children, testicular cancer and some aggressive lymphomas can be treated with curative intent with a multi-agent chemotherapy regimen, and the idea was that the different chemotherapy agents each attack the cancer cells at a different stage of cell growth and were able to kill the cancer cells completely in these different diseases and we the cancer could be cured. This approach does not work in majority of cancers since in most cancers only some cells are in the actively dividing phase and most of the cancer cells are in the dormant phase, so chemotherapy is not completely effective. In lymphomas or testicular cancer vast majority of the cells are rapidly dividing so chemotherapy is highly effective.

Now, we are in a new era of targeted therapy. Even though we have known about the Philadelphia chromosome since the 60s, a drug to target the changes caused by Philadelphia chromosome wasn’t discovered until the 1990s. That drug, called Gleevec won FDA approval in 2001.  Now, patients with CML that have the Philadelphia chromosome, can be successfully treated.  Studies have shown the Gleevec not only normalizes blood count and spleen size, but the changes caused by the Philadelphia chromosome can be removed from the bone marrow (so called molecular response or cytogenetic response). With just the use of Gleevec, patients with CML are now living normal lives. At this point we do not know how long people should stay on the drug but the current standard of care is to maintain patients on Gleevec indefinitely. In terms of side effects, they include diarrhea, nausea, vomiting, mouth sores, swelling, and skin rash.  In general, Gleevec is very well tolerated and the side effects are manageable.  The only caveat is that 5% of patients with CML do not have the Philadelphia chromosome and, therefore, cannot be treated with Gleevec. 

With development of one target Gleevec, better targets against the Philadelphia chromosome have been developed such as new sister drugs Dasatanib and Nilotinib.  Now we have more targeted treatment in our arsenal against what was previously thought to be the fatal disease chronic myeloid leukemia.

Gleevec can also act against certain targets on a rare cancer called gastrointestinal stromal tumor or GIST.  GIST is known to be a fatal disease if untreated. In its localized form surgery is curative, but in high risks cases, Gleevec adds to the curative intent when used for a year after surgery.  In patients where GIST has spread, Gleevec is known to shrink the disease considerably and often completely.  Although not curative, it has provided patients with some longevity and quality of life.

Stay tuned for more exciting developments in treatment of cancer.

St. Mary’s Center for Cancer and Blood Disorders Earns a Three-Year Accreditation with Commendation

Monday, November 15th, 2010

Staff at St. Mary's Center for Cancer and Blood Disorders Front Row: L to R, Mahesh Pandey, MD, Yelena Patsiornik, MD, Evie Taylor, RN OCN, Oncology Supervisor, Joline Betsch, Director, St. Mary's Center for Cancer and Blood Disorders. Standing: Lori Wilbur-Dunham, CTR, Melanie Whited, RN , Jen Hazen, RN OCN , Kim Thistlewaite, RN, Maura Clark, LCSW, Lori Dyer, RN, Linda Merchant, RN OCN, Chris Gervais, RN OCN, Melissa Dube, Shannon Lessard.

FOR IMMEDIATE RELEASE
11.12.10

The Commission on Cancer (CoC) of the American College of Surgeons (ACoS) has granted Three-Year Accreditation with Commendation to St. Mary’s Center for Cancer and Blood Disorders. 

A facility receives a Three-Year Accreditation with Commendation following the on-site evaluation by a physician surveyor during which the facility demonstrates a Commendation level of compliance with one or more standards that represent the full scope of the cancer programs (cancer committee leadership, cancer data management, clinical services, research, community outreach, and quality improvement). In addition, a facility receives a compliance rating for all other standards. 

 Established in 1922 buy the American College of Surgeons, the CoC is a consortium of professional organizations dedicated to improving survival rates and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive, quality care.  Its membership includes Fellows of the American College of Surgeons and 42 national organizations that reflect the full spectrum of cancer care.

 The core functions of the CoC include setting standards for quality, multidisciplinary cancer patient care; surveying facilities to evaluate compliance with the 36 CoC standards; collecting standardized and quality data from accredited facilities; and using the data to develop effective educational interventions to improve cancer care outcomes at the national, state, and local level.

 The American Cancer Society (ACS) estimates that more than 1.5 million cases of cancer will be diagnosed in 2010.   There are currently more than 1,400 CoC-accredited cancer programs in the US and Puerto Rico, representing close to 25 percent of all hospitals.  This 25 percent of hospitals diagnose and/or treat 71 percent of newly diagnosed cancer patients each year.  In addition, a national network of more than 1,600 volunteer Cancer Liason Physicians provides leadership and support for the CoC Accreditation Program and other CoC activities at these local facilities. 

The Accreditation Program, a component of the CoC, sets quality-of-care standards

for cancer programs and reviews the programs to ensure they perform to those standards.  Accreditation by the CoC is given only to those facilities that have voluntarily commotted to providing the highest level of quality cancer care and that undergo a rigorous process and review of their performance.  To maintain accreditation, facilities with CoC-accredited cancer programs must undergo an on-site review every three years.

Receiving care at a CoC-accredited cancer program ensures that a patient will have access to: 

  • Comprehensive care, including a range of state-of-the-art services and equipment  
  • A multispecialty, team approach to coordinate the best treatment options 
  • Information about ongoing clinical trials and new treatment options 
  • Access to cancer-related information, education, and support 
  • A cancer registry that collects data on type and stage of cancers and treatment results and offers lifelong patient follow-up 
  • Ongoing monitoring and improvement of care  
  • Most importantly, quality care, close to home

Cancer patient data are reported by each CoC-accredited cancer program to the CoC’s National Cancer data Base (NCDB), a joint CoC/American Cancer Society program.  The NCDB currently contains patient demographics, tumor characteristics, and treatment outcomes information for more than 18 million cancer patients diagnosed and treated at hospital cancer programs in the US between 1985 and 2004.  These data account for approximately two-thirds of newly diagnosed cancer cases in the US each year. 

NCDB data is regularly used to monitor and improve the quality of patient care delivered in CoC-accredited cancer programs.  The CoC requires programs to implement quality improvement initiatives that promote the delivery of quality, multidisciplinary cancer care and lead to ongoing educational interventions with local providers in the CoC-accredited cancer programs.

Through an exclusive partnership with the American Cancer Society, the CoC provides the public with information on the resources, services, and cancer treatment experience for each CoC-accredited cancer program.  This information is shared with the public on the American Cancer Society’s web site at www.cancer.org and through the American Cancer Society’s National Cancer Information Center at 1-800-ACS-2345. 

For more information about the Commission on Cancer, visit www.facs.org/cancer/index.html.  For more information about St. Mary’s Center for Cancer and Blood Disorders visit www.stmarysmaine.com.