The Nebraska Medical Center Cancer Center Blog

Doctor Values Life Lesson Learned from Breast Cancer Patients

Fall is my favorite season of the year. I love the chill in the air and the beautiful colors. However, October is always a little overwhelming to me. It is breast cancer month and as a breast cancer doctor I am assailed by feelings of pride, sadness, trepidation and gratitude. I literally know hundreds and hundreds of women who have been diagnosed, bravely walked through treatment and are now living their lives to the fullest. I have seen women from their 20s to their 80s in every circumstance of life gather their resources and do whatever was necessary to overcome the beast. They then turn and lend a hand to the sister who is following behind. I am proud to share the same xx chromosome pattern that finds the fight to be there for yourself and family, makes you gather information and actively participate in treatment decisions rather than passively agree with the pundits and spurs action that may spare others from the disease.

I am so very grateful to my patients for teaching me what is important in life. The patient with breast cancer knows what is important to fight for: namely family, community, the future and self worth.

Sadly, some patients are not cured and die of breast cancer. There is never a survivor day or a fundraiser that I don’t see the husbands, siblings and children that have been left behind. They usually are doing well, following marching orders organized and dispatched by their departed love one. It is overwhelming when I think of all the truly gifted, funny sweet friends that I have found and lost due to this one disease. My understanding as to why medicine fails some women while curing others has improved over the years but is still woefully inadequate. I hope to live to see the day where the interaction of the cancer and the patient is understood and the right treatment is known for everyone.

It would be even better if we understood the cause of breast cancer and could prevent the disease. Breast cancer that is estrogen receptor positive has decreased in the United States when it was discovered that hormone replacement with a combination of estrogen and progesterone increased the risk for breast cancer. The prescriptions for these drugs abruptly dropped and a few years later the incidence of breast cancer dropped. Unfortunately, the incidence of breast cancer in China and India is on a trajectory that was present in the United States a few decades ago. Earlier menses, pregnancies at an older age, less breast feeding, increased body mass, changes in dietary patterns and increased consumption of alcohol particularly at a younger age may be the perfect storm that promotes breast cancer. I fear that worldwide, breast cancer will become an even bigger problem. I feel confident that the collective maternal power of the world will play a huge role in teaching the future generations about the essential role of exercise and the need for moderation in food and alcohol.

I am so very grateful to my patients for teaching me what is important in life. The patient with breast cancer knows what is important to fight for: namely family, community, the future and self worth. Often, if I am bogged down in the details of life which can seem important, a patient will say or do something that lets me refocus on the truly important things in life. I am also incredibly thankful that there is so much data that informs me how to best treat breast cancer. That is not the case with most cancers. The reason it is true of breast cancer is that thousands and thousands of women have participated in clinical trials that have informed us as to the best treatment of breast cancer. Breast cancer patients have left an invaluable legacy with their participation in research and the pressure they have exerted for better understanding of the disease.

So, I leave October and enter November with profound thanksgiving for the gifts of wisdom, bravery, humor, optimism and friendship I have received from my patients. Thank you to each and every one of you.

Elizabeth Reed, MD
Hematologist/Oncologist
The Nebraska Medical Center

Professor of Internal Medicine, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Elizabeth Reed. For clinic location and hours use the Find a Physician link.

Pain Management Should be the Standard of Care for Cancer

Many patients with cancer have multiple symptoms which may be related to their diagnosis. One common symptom is pain. As if having cancer isn’t enough to deal with, the pain caused by cancer can start to affect other areas of patients' lives from appetite, mood, work and sleep to putting strain on relationships with friends and family. As cancer pain sets in, enjoying life can become a challenge for most patients.

Each particular cancer has pain associated with it. Abdominal pain is usually present when cancer is in the pancreas, stomach, liver, colon or rectum. Pain in the wall of the chest may be experienced by patients with lung or breast cancers. Patients who have been diagnosed with multiple myeloma or have metastases from other cancers such as prostate, lung, renal, or breast often experience lower back pain. And after radiation treatment, muscle pain is a reality for most.

Finding a cure and treating a disease is what every physician wants for their patient. In addition to opioids or narcotics and adjuvants such as antiepileptic drugs, there are many interventional procedures that may help patients with poor pain control. These procedures are geared to help patients feel better, take less oral medications, improve nausea, sleep and appetite. Pain control may be achieved in most patients without compromising their need for chemotherapy, radiation or surgery.

The Joint Commission is a non-profit organization, nationally recognized for setting the standards in quality and performance standards for the health-care industry. The Joint Commission considers pain assessment to be the fifth vital sign. While cancer pain may be addressed in every institution, it may not be managed appropriately. This may be due to lack of patient or provider knowledge regarding the numerous options for cancer pain management. Additionally, most hospitals and cancer centers do not have physicians formally trained to manage cancer pain. Pain control should be implemented as part of the whole cancer treatment plan. However, this is not the standard of care in every institution.

Pain control should ideally be addressed during the time of diagnosis so that it can adequately be managed without escalating into a pain crisis. And while cancer pain management is not the standard of care at every hospital and cancer center, at The Nebraska Medical Center, cancer pain management is available to all cancer patients. I truly believe that everyone deserves to be as comfortable and functional as possible during their cancer treatment. I advocate that comfort care should be a standard part of the cancer treatment program. Pain control can improve patients' quality of life and can make the rough road of cancer treatment run a little more smoothly. I chose cancer pain management as my profession to help patients undergo treatment with good symptom control so that they may enjoy spending time with family and friends. When someone is battling cancer, he/she needs their friends, family and the ability to be able to enjoy life to the most.

Dr. Are helped Walt manage his pain caused by multiple myeloma.

Madhuri Are, MD
Cancer Pain Management
The Nebraska Medical Center

Assistant Professor, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Madhuri Are. For clinic location and hours use the Find a Physician link.

Cancer Survivorship Group Dec. 7

Location
The Nebraska Medical Center, University Tower, 3rd floor, private dining room C

Meal – 5 to 5:30 p.m.
Presentation – 5:30 to 6:30 p.m.

Presentation topic: Using Biofeedback to Heal and Manage Stress

Presenter’s name: Mary Glassman, RN, LCSW

Please call 402- 559-4420 if you plan to attend

Cancer Survivorship Group Nov. 2

Meeting location: University Tower, 3rd floor private dining room C

Meal – 5 to 5:30 p.m.
Presentation – 5:30 to 6:30 p.m.

Presentation topic: The Role of Spirituality in Coping With Cancer, by Deborah Boucher-Payne, BS, MDIV

Please call 402- 559-4420 if you plan to attend

More Lung Cancer Awareness Could Lead to Better Patient Outcomes

Lung cancer is the main cause of cancer related death in the United States and world-wide. The proportion of patients with lung cancer surviving 5 years or greater is a dismal 15 percent. This statistic has not changed substantially in the past 30 years. One of the major causes of the dismal survival seen in lung cancer today is that most patients are diagnosed when the tumor is quite advanced. Lung cancer caught in an early stage is curable with surgery, but unfortunately only a minority of patients present at an early stage. If there was a way in which more patients were detected at an early stage, then outcomes for lung cancer patients would improve dramatically.

Most patients who have early stage lung cancer are identified serendipitously on a scan performed for something completely unrelated.

While this sounds simple in theory, the fact is that we currently do not have any way to detect lung cancer in the early stages. Most patients who have early stage lung cancer are identified serendipitously on a scan performed for something completely unrelated. The tests that we have today to diagnose lung cancer, chest X-rays, sputum analysis and Computerized Axial Tomography (CT) scans are fraught with problems.

Multiple studies both in the United States and abroad performed in the 1960’s and 1970’s have shown that screening for lung cancer with a chest X-ray and sputum studies actually resulted in an increased mortality, rather than increasing survival from lung cancer. There have been a number of advances in CT scan technology in the past few decades and there has been a renewed interest in using CT scans to screen for lung cancer. Current studies from Japan, Italy and United States appear promising, but use of CT scans to screen for lung cancer is not yet ready for primetime. Clearly we need to do more in order to improve the outcomes of patients with lung cancer.

A major reason for the lack of major advances in the lung cancer field is the minimal funding for lung cancer research. One reason for this may be the absence of long-term survivors who can raise lung cancer awareness in the society and also be passionate advocates for increased funding support, much like the breast cancer survivor. Another more worrisome reason is the apathy of professional organizations and funding agencies towards lung cancer. I was at a meeting a couple of years ago, when a speaker mentioned in a very tongue in cheek manner, "Finally the American Lung Association has acknowledged the fact that lung cancer is a disease of the lung!" Increased funding for research has led to dramatic improvements in results from breast cancer and so it stands to reason that the same will be true for lung cancer as well.

As a lung cancer doctor, I live on optimism. Recently there has been increasing activity among patient advocacy groups, such as The National Lung Cancer Partnership and the Bonnie J. Addario Lung Cancer Foundation trying to raise awareness of lung cancer. The daughter of one of my patients, living in Omaha, Neb. recently set up an organization called "Where is The Funding for lung cancer?" She likes to call it "WTF" for effect. If these and other efforts are successful, there is no reason why we should not be able to increase the number of lung cancer survivors in the near future.

Apar Kishor Ganti, MD, FACP
Hematologist/Oncologist Specializing in lung, head and neck cancers
The Nebraska Medical Center

Assistant Professor, University of Nebraska Medical Center

Email Dr. Ganti

Breast Cancer Education and Support Group, Thursday, Oct. 28

Village Pointe Cancer Center, Conference Room
111 N. 175th St.
Omaha, Neb.

Meal and socializing at 5 p.m.
Presentation from 5:30 to 6:30 p.m.

Presentation Topic
Is your thinking foggy? Cognitive side effects of cancer treatment, presented by Ann M. Berger, PhD, RN, AOCNS, FAAN

Please call the Social Work department at 402-559-4420 if you plan to attend.

She Deserves It! Correcting Lung Cancer Misconceptions

Lung cancer is responsible for more than 1 million deaths worldwide each year, with almost 170,000 of these deaths occurring in the United States. In the past, lung cancer was a disease most commonly seen in male smokers. Over the past decade, the trend has changed and lung cancer is responsible for more deaths in women each year than breast and uterine cancer combined.

Awhile back I was attending a conference where a nurse who was 40 years old, spoke about her experience after she had been diagnosed with lung cancer. She noticed that when she spoke to friends and family and told them that she had been diagnosed with lung cancer their responses were often dismissive in nature, such as “but you smoke, right?”

Socially, there is less sympathy for a female patient diagnosed with lung cancer, than a woman who has been diagnosed with breast cancer. Many in our society will see a breast cancer patient as a victim of the disease or genetically predisposed to a condition she had no control over. Whereas a female diagnosed with lung cancer is perceived as inflicting the disease upon herself by choosing to abuse tobacco products.

Fifteen to 20 percent of female patients diagnosed with lung cancer are “never smokers.” These women have never abused tobacco products but are at risk for developing this disease through second-hand smoke or exposure to other toxins. Women who live with someone who smokes, were previously were employed in bars and restaurants where smoking was permitted or who currently work in a casino or other gambling establishment where smoking is still permitted are at an increased risk.

Fifteen to 20 percent of female patients diagnosed with lung cancer are “never smokers.”

There is a perception that those who smoke should have known better and they somehow have caused their disease by not heeding the numerous anti-smoking campaign warnings. This thought process overlooks the pressure by the tobacco companies whose main focus and marketing efforts are targeted to a younger audience. This, coupled with the fact that those in this age group perceive themselves as invincible and do not take into consideration the long-term health risks associated with smoking, contributes to the large number who continue to start smoking. Many do not even consider the addictive properties of this activity. A nicotine addiction is more difficult to break than alcohol or narcotics.

Non-smokers are a small percentage of the overall number of diagnosed lung cancers. Those who have smoked in the past and stopped continue to have an increased risk of developing lung cancer. While the risk is not as great as those who continue to smoke, it is still greater than the lifelong non-smoker. Interestingly, lifelong non-smokers and those who have quit smoking account for more cancer diagnoses than those individuals who are currently smoking.

It is estimated that there are over 2 million survivors of breast cancer, who in turn become advocates for screening and assist in raising funds for research grants, while lung cancer survivors number only a few hundred thousand. Minimal amounts of the tobacco settlements to the states were actually spent on tobacco related diseases or establishment of screening protocols.

Lung cancer is a disease that is curable in 90 percent of patients when found at the earliest stage. Currently, only a small percentage of patients are being diagnosed with these early stage tumors. Recommendations for lung cancer screening are currently being considered. Active and former smokers should discuss with their primary health-care providers the risks and benefits of lung cancer screening.

Rudy P. Lackner, MD
Thoracic Surgical Oncologist
The Nebraska Medical Center 

Associate Professor of Surgery, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Rudy Lackner. For clinic location and hours use the Find a Physician link.