Redefining Cancer Care (Continued from page 1 )
general oncology program. “As survival rates improve, patients have desires or concerns that go beyond strict oncologic considerations because they want a fulfill- ing life after cancer. And we have also learned that non-oncologic care often works in concert with cancer care to produce a better outcome.” sophisticated understanding of how can- cer and cancer therapies interact with the body has enabled clinicians to re- duce side effects. “For example, every cancer patient is at risk of thrombosis, and probably close to 10% are affected,” said Michael Kroll, M.D., a professor in the Department of Pulmonary Medicine and chief of M. D. Anderson’s new Be- nign Hematology section. “Cancer itself triggers things that lead to hypercoagu- lability, which in turn leads to deep vein thrombosis and pulmonary embolism. However, chemotherapy often leads to Benign hematology In some instances, the increasingly thrombocytopenia, which creates a bleeding risk that is worsened by anti- coagulants given for thrombosis. So we have to balance the risk of bleeding ver- sus the risk of thrombosis, and by work-
Over the long haul, our most important mission is to improve the standard of care for cancer patients who develop benign hematologic diseases.” – Dr. Michael Kroll, chief of the Benign Hematology section
ing with the patient’s oncologist, we try to find the right balance.” The section of Benign Hematology is among M. D. Anderson’s more recent expansions into the non-oncologic as- pects of cancer care. Launched this year, Benign Hematology provides clinical care for cancer patients with hypercoag- ulability, thrombosis, bleeding, and ab- normal platelets, red blood cells, and white blood cells. The section also per- forms laboratory research on such con- ditions. “Over the long haul, our most important mission is to improve the standard of care for cancer patients who develop benign hematologic dis- eases,” said Dr. Kroll, who leads the effort with research director Vahid Afshar-Kharghan, M.D., an associate
professor in Pulmonary Medicine. Both are oncologists, as well. For now, the section is focused pri- marily on improving the diagnosis and management of thrombosis. One type of thrombosis, stem cell transplant throm- botic microangiopathy (SCT-TMA), is especially vexing. SCT-TMA is the occlu- sion of small arteries by platelets following a stem cell transplant; at M. D. Anderson, about 50 cases occur each year, Dr. Kroll said. SCT-TMA can lead to kidney fail- ure, and up to 80% of patients who devel- op SCT-TMA die within 3 years. “Diagnostic guidelines exist, but they are somewhat vague, and effective thera- py for SCT-TMA has been elusive,” Dr. Kroll said. “We understand very little about the basic science of the syndrome, and optimal prevention and treatment strategies need to be identified and elu- cidated. That’s what we hope to accom- plish through our clinical and laboratory efforts in collaboration with members of the Department of Stem Cell Trans- plantation and Cellular Therapy.” In addition to developing prevention and treatment strategies for SCT-TMA, the section’s goals include implementing institutional guidelines for the use of anticoagulants; developing continuing medical education programs on manag- ing thrombosis in cancer patients; and building research programs aimed at un- derstanding the complex relationship between cancer and thrombosis. Gastroenterology and hepatology In the Department of Gastroenterol- ogy, Hepatology and Nutrition, cancer patients are routinely screened and treated for Barrett’s esophagus. This pre- cancerous condition caused by gastro- esophageal reflux disease may go un- detected for years, sometimes until can- cer develops. Fortunately, many patients
Broadening Care
C ertainly, supportive care has been an essential component of cancer care for decades. Such tasks as manage- ment of cardiotoxicity, treatment of opportunistic infections, and even re- constructive surgery have long been staples of oncology. But the sheer variety of interven- tions now provided before, during, and after cancer treatment suggests that the term “cancer care” is broader than ever. A few examples of the non-onco- logic services provided at M. D. An- derson illustrate how far cancer care has evolved from treating only the malignancy: • The institution’s Brain and Spine Center specialists diagnose and manage neurologic disorders associ- ated with systemic malignancy (so- called paraneoplastic syndromes) and manage brain and spinal radia-
tion necrosis, a late-occurring com- plication of radiation therapy for central nervous system cancers. They also perform surgery to relieve carpal tunnel syndrome and other peripheral nerve entrapments re- sulting from the toxicity of chemo- therapy. • Department of Urology specialists treat M. D. Anderson patients for urine voiding dysfunction, inconti- nence, and erectile dysfunction re- sulting from prostate or bladder cancer surgery. They also treat dis- orders such as blood in the urine resulting from chemotherapy or radiation and obstruction of the ureters resulting from tumors. • Physical rehabilitation and psy- chosocial counseling are provided on-site to help patients deal with the physical, mental, and emotional toll of cancer and its treatments. ●
2 OncoLog • January 2009
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