Archives for 2014

Green Bay Healthcare Decisions Day Proclamation

WHEREAS,  Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for health care decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important health care decisions; and

WHEREAS,  in Green Bay, WI the Patient Self-Determination Act provides the specifics of our advance directives law and offers a model form for patient use; and

WHEREAS, it is estimated that only about 20 percent of people in Green Bay, WI have executed an advance directive.  Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive; and

WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives; and

WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a State-wide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Green Bay, WI citizens with advance directives; and

WHEREAS,  Heartland Home Health Care & Hospice along with Green Bay Oncology and other organizations throughout Wisconsin have endorsed this event and are committed to educating the public about the importance of discussing health care choices and executing advance directives; and

WHEREAS, as a result of April 16, 2014, being recognized as Healthcare Decisions Day in Green Bay, WI, more citizens will have conversations about their health care decisions; more citizens will execute Advance Directives to make their wishes known; and fewer families and health care providers will have to struggle with making difficult health care decisions in the absence of guidance from the patient;

NOW, THEREFORE, I, Mayor Jim Schmitt, do hereby recognize April 16, 2014, as HEALTHCARE DECISIONS DAY in Green Bay, WI and I call this observance to the attention of all our citizens.

Some of the best cancer care in the nation is now at Schoolcraft Memorial Hospital.

One of the strongest cancer teams in the nation is proud to make cancer treatment in Schoolcraft stronger too.

Green Bay Oncology is delighted to be partnering with Schoolcraft Memorial Hospital (SMH) to provide the community and surrounding areas with one of the best cancer care providers in the nation.

Green Bay Oncology is relentless in fighting cancer. Relentless in beating it. For decades, we have been known for giving patients across Northeast Wisconsin and Upper Michigan access to the highest quality, innovative cancer care.

Green Bay Oncology is proud to announce as we move forward with groundbreaking treatments, we’re also partnering with Schoolcraft Memorial Hospital to provide cancer care to our patients.

Now, area patients can benefit from Green Bay Oncology’s unwavering drive and unmatched expertise.

Green Bay Oncology specialists will be treating both adult Oncology and Hematology patients. Some of these treatments include: Chemotherapy, Biotherapy, treatments for all Anemia types,  Blood Disorders and Bone Marrow Biopsies.

For a second opinion or to schedule an appointment, call toll-free at
(866) 884-3135.

Schoolcraft Memorial Hospital Address: 7870W US Hwy 2, Manistique, Michigan 49854

Matthew L. Ryan, M.D.  and  Jules H. Blank, M.D.

Presently, the state Senate is considering passing the bill on oral chemotherapy. The state Assembly last week passed the bill which would cap the amount of co-payment at $100 per month for the cost of oral chemotherapy. Currently, there is a very large disparity in the coverage for intravenous versus oral chemotherapy. The payments for some patients may exceed $3,000 per month for all oral chemotherapy as opposed to only $150 for intravenous chemotherapy.

There are a variety of newer oral chemotherapy agents available in the last ten years which are very active and are the preferred agents for the treatment of certain malignancies. An example is in the treatment for chronic myelogenous leukemia or CML – one of the cancers of the blood. The disease can usually is diagnosed in people in their 50s and 60s but occasionally can be discovered as young as the early 20s. It is characterized as elevated blood counts. It was uniformly fatal with life expectancies of only 3-4 years once diagnosed. The initial effective treatment was a bone marrow transplant which required a donor. A bone marrow transplant can be complicated and is a very difficult procedure for some patients due to their other medical problems and age. Through intensive research, a unique chromosome translocation called the Philadelphia chromosome was discovered and found to be the cause of CML.

Medications have been developed which can block the abnormal protein which the Philadelphia chromosome produces and can halt the growth of the abnormal cells. The first of these medications developed is called imatinib. This drug, when used in CML, can completely halt the growth of the CML cells and prolong a patient’s life. Unfortunately, it appears that imatinib will need to be continued for the rest of the patient’s life. Taking the pill form can be a more convenient process for patients vs having traditional infusion chemotherapy. When patients are taking imatinib, their lives can return to normal with limited side-effects and their life-expectancy can return to normal versus only 3-4 years without imatinib. The cost for oral imatinib is approximately $9,000 per month or $108,000 per year.  By passing the proposed bill, patients would be subject to markedly less costs subject to deductible, out-of-pocket maximums and a $100 per month copayment only.

As the above illustrates, it is imperative that the state legislature and our governor work diligently on passing legislation that will help bring the cost of these medications down for people of Wisconsin.

I wanted to use today’s blog to thank our employees. About 2 years ago they came to us with the idea of starting a Saturday clinic. They gave up their personal time on the weekend because they saw how it could give better care to our patients. Saturday clinic offers time for treatments for those that are unable to take off time during the work week. It also allows an extra day for patients not feeling well to be evaluated and to have symptoms managed, instead of long waits in the ER.  This often helps avoid admissions to the hospital. My thanks to each of them.

The US Food and Drug Administration (FDA) approved ibrutininb in November 2013 for the treatment of relapsed mantle cell lymphoma. Ibrutinib is a new drug which was developed to specifically block a particular enzyme called the Bruton’s tyrosine kinase which goes by the acronym, BTK. This enzyme, BTK, is over-active in many types of malignancies to include mantle cell lymphoma and chronic lymphocytic leukemia, CLL. Recent research has demonstrated remarkable response rates in patients with mantle cell lymphoma and CLL.

The exciting part of ibrutinib is that it is an oral medication with moderate side-effects. The clinical trial which lead to the approval was a multi-center, international study with 111 patients that had relapsed mantle cell lymphoma. The study demonstrated that the overall response rate was 66% with the average duration of response of 17.5 months. The most common toxicities were low blood counts, increased bruising, diarrhea, fatigue, muscle pain and rash. Only 9% of patients encountered a side-effect that lead to discontinuation of ibrutinib.

The enzyme, BTK, is a recently identified protein that was discovered in a variety of malignant cells that are derived from the B-cells. B-cells are a specific type of blood cell which normally produces antibodies to help the body fight infections. The B-cells can develop into cancer through a variety of mutations which cause the cells to grow more rapidly and survive longer than normally. The malignancies which may have a B-cell derivation include CLL, Non-Hodgkin lymphoma and Waldenstrom macroglobulinemia.

Bruton’s tyrosine kinase was first discovered in 1993 and is named after Ogden Bruton who first described a disordered called Bruton’s agammaglobulinemia. When the enzyme is not presnt the B-cells are not able to produce the antibodies needed to help the body fight off infections. If the B-cells become malignant, then by blocking or inhibiting this enzyme, BTK, the growth of the malignant cells can be halted.

There are many clinical studies which are ongoing that will define the role ibrutinib will have in early stages of CLL, Non-Hodgkin lymphoma and mantle cell lymphoma. It is hoped that by adding ibrutinib to current treatments available for these malignancies that improved responses and prolongation of survival of patients will be seen. This is a very promising drug and we at Green Bay Oncology are very excited to bring this news to you. Please feel free to give us a call for further information.

A few hundred years ago, medicine would adopt any new treatment that seemed like a good idea-no testing required.  Unfortunately, the treatments weren’t always (or often) effective or safe. Worse still, once doctors got set in their ways it took generations to convince them that bleeding and blistering patients did more harm than good.

In the last century, medicine began requiring solid evidence before adopting new treatments. And though no system is perfect, modern treatments are much safer and more effective as a result of this more deliberate process. But it does mean that new treatments take a long time to develop. And sometimes doctors are unfairly criticized as being closed-minded grumps rather than healthy skeptics.

Doctors have long been skeptical about the possible benefits of vitamin supplements. A great many people accept vitamin supplements as a cure-all, despite a lack of clear evidence to support this. Vitamin C supplementation, for instance, hasn’t been endorsed as a treatment for anything except severe  deficiency.  But that may be about to change.

Last week, the University of Kansas Medical Center reported on a study of 27 ovarian cancer patients who received IV vitamin C in addition to standard chemotherapy.  The trial suggested a boosted cancer-killing effect with the combination. Also, patients seemed to have fewer side effects than usual. The article appears in the February 5^th edition of the journal Science Translational Medicine.

The study gives fascinating background on the lab experiments showing direct cancer-killing effects of vitamin C. It also references the previous failed vitamin C trials, and suggests that the failure may have stemmed from oral (rather than IV) dosing. It’s also interesting that the direct cancer-killing effect seems the result of direct oxidative damage, rather than the antioxidant effect most popular proponents of vitamin C endorse.

Keep in mind: this small study demonstrates the need for more testing. It isn’t yet time to start giving IV vitamin C along with standard chemotherapy for ovarian cancer. But I for one am intrigued, and will be anxiously following further developments.

Here is the press release  and the scientific abstract.

Over the last fifteen years, the number of new cases of colorectal cancer has gone down by 2 to 3 percent per year. There are a number of factors that still result in over 140,000 new cases of colorectal cancer being diagnosed each year.  The following is an overview of these factors.

The incidence of colon cancer appears to increase with age although more recently,  a growing number of new cases have been diagnosed between the ages of 40 to 44.

The risk for colon cancer is higher in men and in patients of African-American descent.

There are genetic conditions associated with a very high risk of colon cancer, often at a young age, such as familial adenomatous polyposis (FAP) and its variants; MUTYH-associated polyposis and Lynch syndrome.

Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) carries an increased risk of colorectal cancer; particularly if there are ongoing inflammatory changes in the bowel wall over an extended period of time.

Evidence exists that adult survivors of childhood cancer who received abdominal radiation are at a higher risk for developing colorectal cancer.

Acromegaly, a condition which is caused by excess growth hormone in  the body, carries an increased risk as well.

Kidney transplant patients appear to have a significantly increased risk of colon cancer.

Patients with prostate cancer who had been on androgen-blocking therapy have increased colorectal cancer risk which appears to increase with longer duration of the therapy.

Diabetes mellitus results in a higher risk of colorectal cancer; even in studies which controlled for smoking, obesity and physical activity.

Obesity itself is associated with a higher risk of colorectal cancer – more in men than in women – and the risk appears to increase the higher the body mass index(BMI).

There appears to be a slightly increased risk of cancer of the right side of the colon in patients who had undergone a cholecystectomy (removal of the gallbladder).

The risk of colorectal cancer increases with alcohol consumption in a number of studies, even when evaluating  light drinkers.

Cigarette smoking, which is a risk factor for a number of cancers – most notably cancer of the lung, is also associated with an increased risk of colorectal  cancer.

Long-term consumption of  red and processed meats appears to increase the risk of colorectal cancer, particularly in the left side of colon and in the rectum.

This concludes my brief review. There are many elements that contribute to a colorectal cancer diagnosis.  There are also a number of preventive measures which I will look at in my next blog entry.

We know it’s important to remove breast cancers before they can spread. But is it helpful to remove the initial dominant tumor (also called the primary tumor) in cases where the cancer has already spread? Does leaving primary cancer in place pose a significant danger, or is removing it a case of “closing the barn door after the horse has already escaped?”

Until recently, no good data existed to answer the question one way or the other. A review of the collected histories of patients with breast cancer seemed to indicate benefit. It was thought that perhaps the primary tumor secreted chemicals or hormones that helped the distant metastatic tumors grow. Or perhaps the primary tumor, usually the largest single clump of cancer cells, might be the biggest source of metastases (and removing might slow down the appearance of new metastases).

But last month at the San Antonio Breast Conference, two separate randomized controlled trials (one 350-patient trial from India, the second a 325-patient trial from Turkey) showed no benefit from removing the primary tumor in patients who presented to the doctor with widespread disease. The same issue is the subject of an ongoing study in the United States through the Eastern Cooperative Oncology Group(ECOG) (it’s just under halfway completed, having accrued 152 of its targeted 368 patients).  Most experts at the San Antonio Conference agreed that the studies from India and Turkey are very relevant to patients in the United States.

I’ll be curious to see if this news affects the ECOG trial in progress, given the declining enthusiasm for the idea.