Provider Insights

What is on Your Care Team’s Mind

A lot of progress has been made in early detection and treatment for many cancers, but it is still a frightening diagnosis. Keep reading to find out more about our passionate care team as we share some of our thoughts on cancer with you.

“Tending to my garden”

By Lori Wingerter, LIMHP

When spoken to you for the first time, these three words seem to linger in the air and then slowly begin to permeate every cell of your being. It can leave you speechless, unable to breathe or hold a thought. Before this statement, you were many things…a husband, wife, mother, father, engineer, runner…now, instantly, you are a CANCER PATIENT and your identity revolves squarely around this fact. It trumps every other role you play. As the panic, fear and denial set in, you begin to envision a future filled with treatments, illness, loss and a life frightening and foreign to you. Your anxiety rises and depression is knocking at your door.

Now…stay with me as we picture another image.

Dr. Keith Block, founder of the Block Cancer Center, paints a different scenario. He says in the face of these three horrifying words, you do not have to succumb to the terror. Rather, you DO have the option to choose a different path – a path of discovery, action and self-advocacy. Indeed, you can choose LIFE over cancer.

Dr. Donald Abrams, who works as a conventional Oncologist (as chief of oncology at San Francisco General Hospital) and as an Integrative Oncologist (as a practitioner at the Osher Center for Integrative Medicine at the University of California, San Francisco) likens the treatment of cancer to trying to get rid of a nasty weed. Typically, your treatment will eliminate the cancer weed by dousing it with chemotherapy, surgery, and radiation. Integrative Oncology Professionals view their jobs as working with traditional treatment by also “tending to the garden” in which the weed grows – making the soil rich with life and inhospitable for survival of the weed. He encourages anyone being treated for cancer to take a look at how you are fertilizing your soil: Is your lifestyle nurturing? Do you engage in regular self-care with yoga, meditation, massage, exercise? Do you follow a healthy nutrition plan? He says it is essential to manage anxiety, depression and overwhelm and recommends the support of a Psycho-Oncology Therapist who can help enrich your soil by teaching life-affirming tools such as progressive relaxation and guided imagery.

When it feels as if you have lost all control in your life, it’s critical to know you still have control over these most powerful personal tools and can focus your energy on living!

I speak on behalf of the many cancer and other disease patients I have worked with… this path is not easy. In fact, it requires a great deal of strength, self-advocacy, accountability, courage and a willing spirit. It requires every bit you can muster. It requires that you understand what brings you joy, that you know what your hopes are and you know what gives you strength.

If this is the path you choose, your path of healing begins now. I look forward to meeting you soon and am honored to walk with you.

What is Brown and White Bagging?

By Mike Brodersen, PharmD, R.P.

At Nebraska Cancer Specialists, we take your safety seriously. That is why we only prepare and inject medications we provide ourselves. When we provide medications, we ensure they are the correct drug and stored appropriately so that they are safe when it is time to give them to our patients. However, sometimes insurance companies and other payers require these injectable medications to be obtained outside of our facilities, and then deliver them to you or to your physician for administration. This is called brown bagging when the medications are delivered to patients or white bagging when they are delivered to a physician. As we cannot ensure that a drug we did not provide is the correct drug or appropriately stored and handled before it comes to our clinic, we do not feel we can responsibly administer outside medications to our patients.

If your insurance requires you to obtain medications outside of our facilities, there are several things we will do. First, we will notify you and your insurance company of this requirement and our policy, and we will explain our policy to your insurance company and to your employer. We will take every effort to convince your insurance that we need to provide the medication ourselves so that we can take care of you. If we cannot get authorization to provide your medications at our facility, then you and your insurance company will have to find an alternate facility for your medications to be administered.

Cancer Genetics – What Does It Mean?

By Dr. Margaret Block

Cancer is not one disease; it is many different diseases with different causes, characteristics, and treatments. For some, the cause is known, such as hydrocarbon induced lung cancer (usually cigarettes, but can be cooking fires ? and other hydrocarbon sources), asbestos induced mesothelioma, radiation induced leukemias and sarcomas. For others there are known risk factors that impact the incidence of those cancers, but are not the direct cause, such as association of red meat with breast, colon and prostate cancers.

Genetics, the genes you are born with, play a role in some cancers depending on the gene and the mutation. For instance, many (but not all) mutations of the BRCA 1 and BRCA 2 genes (two genes that all humans have but only a small percentage of the population have harmful mutations of these) are associated with a high risk of developing breast cancer or ovarian cancer. CHK2 mutations are associated with increased risk of breast and colon cancers. P53 mutations are associated with a large variety of different cancers as well as increased susceptibility to radiation induced cancers.

A clue to possible genetic mutations is the number and type of cancers in a family. Knowing your family history is important, including history of second degree relatives (aunts, uncles, grandparents) and more distant relatives, if possible. Other indicators of possible genetic mutation causing cancers in a person or family is age at diagnosis, having multiple cancers in one person, and certain types of cancer (such as triple negative breast cancer).

Until about 4 years ago, genetic testing was extremely expensive. Newer lab methods such as NextGen DNA sequencing, and a US Supreme Court ruling have made genetic testing much more available. In June 2013 the US Supreme Court ruled that human genes could not be patented since they are a natural human entity. Up until that time only one laboratory could test for BRCA 1&2 mutations. Following that ruling many other labs started to offer genetic testing, opening up competition and thus greater affordability ? .

I frequently come across the mistaken belief that genetic testing is for the benefit of a person’s children. It is actually usually of great benefit to that individual. Results of cancer genetic testing may influence the surgery that the patient chooses (e.g. prophylactic hysterectomy in persons found to have Lynch syndrome after a diagnosis of colon cancer or prophylactic oophorectomy in carriers of harmful BRCA mutations), what screening tests they undergo to detect cancers at an early stage (e.g. more frequent colonoscopies for those with CHK2 mutations). Of course siblings, children and parents may also benefit if the patient chooses to share their medical information with them as well.

Unfortunately, genetic testing does not change the risk of future metastatic disease from an already diagnosed cancer, but it can lead to more prompt and earlier diagnosis of a new cancer.

So…if you or your family have a history of cancer, talk to your physician ?‍⚕️ to see if you should consider testing for a harmful gene mutation.

Placebo Pills and Clinical Trials

By Dr. Margaret Block

Most people have heard of placebos but may not have a clear idea of exactly what is meant by this word. Placebo medications are medications with no active ingredients in them, what used to be called “sugar pills”.

Many active drugs being developed are studied and compared to placebos to verify if the new drug works and to study what side effects may happen compared to placebo. What is surprising in many of these studies is HOW STRONG the placebo effect is.

In some studies of antidepressants for example, the placebo effect was often as high as 75%, meaning that 75% of patients who took the “sugar pill” thought they were having significant benefit and reported such.

At the recent San Antonio Breast Cancer Symposium, a study of Cymbalta (duloxetine) vs placebo for treatment of muscle pain due to taking aromatase inhibitors for breast cancer treatment (such as letrozole and anastrazole), found 69% of patients reported improvement in their joint and muscle pains with Cymbalta. BUT so did 60% of patients on placebo, a difference of only 9%. Considering the side effects of the “real pill” the benefit of 9% is questionable at best.

Placebo pills can also “cause” side effects. In the study mentioned above, 70% of patients experienced side effects from the real drug but 50% had side effects from the placebo! I have a patient who started on a study (letrozole vs placebo) several years ago which was the pivotal trial leading to proof of benefit and increased length of being cancer free from breast cancer when letrozole was given for 5 years after tamoxifen. We all thought she had received the real drug as she was experiencing side effects, severe enough to drop out of the study. However, later when they released the study results, it was discovered she had actually been taking the placebo. At that point, to thank the patients who had been on placebo for being on the study, the study offered 5 years of free drug to the placebo patients since the study showed so much benefit. This patient went on to take the real drug without significant side effects for 5 years (and remains cancer free now for many years!)

The need for careful controlled placebo trials is self-evident. Without these trials, the placebo effect may be occurring and the drug or supplement may not only be ineffective but harmful. Always look for results of controlled scientific studies before deciding to take something for your health (including over the counter medications and supplements), be open to participating in trials yourself which bring new and better drugs to our cancer patients and don’t forget about the placebo effect which can be deceiving to all!

Protect Your Skin

By Kari Cunningham

Summer is here and with that comes more outdoor activities and sun exposure. I remember looking forward to hot, sunny summer days working as a lifeguard when I was younger. I would lather on baby oil, lay out for hours at a time and never used sunscreen. My goal, along with many others, was to be the darkest lifeguard by the end of the summer! I had heard about people getting skin cancer, but never thought I would be at risk because I wasn’t “pale” and I hardly ever “burned”. However, a few years after graduating from high school a former lifeguard that I had worked with was diagnosed with skin cancer. She had the same skin type as me. I honestly panicked and went in to my doctor at age 22 and had my first head to toe skin exam. My primary care doctor at the time was the first person to really educate me on skin cancer and now I try to educate others. Skin cancer is the most common form of cancer in the United States and it can happen to individuals of any skin color. It is also one of the most preventable types of cancer and easily treatable, if caught at an early stage. Staying out of the sun during the peak times (10am-4pm), using a broad spectrum sunblock, and staying out of tanning beds/tanning lights are ways to lessen you chance of getting skin cancer. If you find a suspicious area, have it checked out by a health care provider. And remember, treat your skin with respect…it is your largest organ!

Cancer Treatments: How Things Have Changed Over the Years

By Dr. Margaret Block

It’s not always easy to read the news. Lots of bad things happening near and far. But sometimes there are stories that can warm your heart. I felt that way recently when I learned that former President Carter had been successfully treated for metastatic malignant melanoma. This was a disease that almost all therapy we had didn’t work for until recently. Sure, there were occasional ‘success stories’ but few and far between. But recent advances in research with immune therapy with drugs that are stimulate the immune system have changed the world for the better for people whose melanoma has spread. All those many years of basic science research on cells and mice, research that seemed silly to many is now paying off big-time with successful drugs. Not to forget the patients who volunteered to be part of these studies when these drugs were ready to be tried in humans. But the story about Carter warms my heart for another reason as well. Carter is 91 years old. When I was in medical school the cardiac surgeons would not do bypass surgery on people over 70 because they were “too old”. Really??? No one would dream of that today. Is 91 old? Most people would say yes. But will we still think that in 20-30 years? It’s all relative. When a former president like Jimmy Carter gets treated successfully at his age he sets an example for us all: Treatments are better than yesterday and do work and, perhaps, just perhaps, I’m not as old as I (they) thought!


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