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The Personal Touch in Treating Cancer

Frank Young, left, and Dr. Natasha Dhawan discuss treatment in one of the Bronson Cancer Center’s infusion rooms overlooking downtown Kalamazoo.
From technology to support and communication, advances are improving cancer treatment

Cancer is a sometimes-fatal disease in which abnormal cells divide uncontrollably and can destroy healthy surrounding body tissue, which is why being diagnosed with cancer — The Big C — is a heart-wrenching, mind-jarring, life-altering experience.

“It’s an understatement to say that patients are scared when diagnosed with cancer,” says Dr. Mazen Mislmani, oncologist and division chief of radiation oncology for the West Michigan Cancer Center. “The most prominent fear is the unknown. ‘Am I going to die? When? Are we talking three months or five years? What kind of treatments are awaiting me? What are the side effects?’ A thousand questions run through a patient’s head, and that’s overwhelming.”

But in addition to fear is the sense of losing control over one’s life, notes Mislmani. “Loss of control is an underrated factor,” he says. “If you’re undergoing treatments, you can’t plan on being there for your granddaughter’s graduation next year. All of a sudden, your life revolves around this diagnosis and treatments, and that takes away your control over what your day-to-day life looks like. It affects your short-term, your intermediate and your long-term plans.”

But there is good news that can help allay those fears. There have been considerable innovations, not only in the technologies and treatments for the disease, but also in supportive services, communication, and treatment practices, based on patient preferences and quality of life.

These innovations start at the beginning, often before there is even a cancer diagnosis. Genetic testing can now be used as a cancer preventative and guide for treatment.

“We can test for many, many genes relatively cheaply,” says Rebecca Jones, a nurse practitioner at Ascension Borgess. “We can identify people (who might be prone to cancer) and let them know they need certain screenings so that if they do develop cancer, it’s caught at an earlier stage. That’s a big change.”

Other types of improved technology have also helped to catch cancer earlier. For example, in comparison to the standard 2D mammograms used to screen for breast cancer, 3D mammograms, introduced in 2011, have been found to be more successful in finding cancers earlier and in reducing the number of women who have to be called back in for additional screening., according to the National Institutes for Health.

Early detection is key, says Mislmani. “If you’re old enough to get a mammogram or get a PSA blood draw or a colonoscopy, do it. The earlier you diagnose cancer, the higher the likelihood that you can cure the cancer.”

Better treatments

Once a cancer diagnosis is received, treatment options have traditionally fallen into three primary categories: surgery, chemotherapy, and radiation, any or all of which a patient might experience, depending on the type of cancer and its stage of growth. Each of these treatment options has benefited from innovations over the years.

Take surgery, for instance. “Years ago surgery was extensive and very aggressive. Now we view surgery as just another arm in a patient’s treatment options,” says Dr. Gitonga Munene, division chief of surgical oncology at the West Michigan Cancer Center.

For centuries, surgery involved a major incision of the skin and hands-on intrusion to reach a body’s internal organs. Thanks to the development of laparoscopy, arthroscopy and robotics, today’s surgeries often involve smaller incisions, greatly reduced pain and shorter healing times.

Robot-assisted surgery increases surgical precision and aids surgical visualization. Robots such as those used at Bronson Methodist and Ascension Borgess hospitals have multiple arms that a surgeon manipulates through a control console located next to the patient in the operating room. “These have made it possible to do more complicated operations with minimal invasion,” Munene says.

Dr. Anna Hoekstra, division chief of gynecological oncology at the West Michigan Cancer Center, notes that another innovation is surgical anesthesia that can enable a patient “to have a local anesthetic, a nerve block that targets the nerves around where the incision is going to be and numbs that nerve for up to three days, which is the time when the pain is most severe.”

In these cases, says Hoekstra, the patient can wake up from the procedure more quickly and go home the same day, taking just Motrin and Tylenol for pain relief. “That decreases the narcotic requirements, especially in a day and age when we’re trying to decrease opioid prescriptions and opioid dependence,” she says. “This is a huge, huge move in the right direction.

Radiation therapy, the second primary treatment modality for cancer, also has evolved. In 1898, physicist and chemist Madame Marie Curie discovered radium, a soft, shiny, radioactive metal that is used in radiation therapy. Back then, people saw it as a novelty, infusing it into water, bread, toiletries, soap and shoe polish, but we’ve since learned that radiation can be damaging to healthy tissue.

To minimize that damage, today’s radiation treatments use complicated software and mathematical precision to design a beam of radiation to be directed into a patient’s body that exactly matches the shape of a tumor from all angles. “This allows us to design a radiation plan for each individual patient, using beam angles, shapes and intensity that maximize the dose that strikes the tumor and minimizes the impact on the surrounding healthy tissue,” explains Mislmani.

Chemotherapy, the third primary treatment, uses powerful chemicals to kill or slow the growth of cancer cells. It can be used on patients with any stage of cancer, from minute tumors to metastasized tumors — tumors that have spread from their point of origin to another part of the body. Chemotherapy is commonly administered through an intravenous needle in a process called infusion, but the chemicals can also enter the body as a pill, capsule, oral liquid, or topical cream. Chemotherapy treatments may be prescribed for a few hours or extended over multiple days or weeks.

It’s well-known that chemotherapy can cause severe side effects such as nausea, skin sensitivity and hair loss. And despite the new drugs that cause fewer side effects or that can mitigate them, the dread of these debilitating side effects often exacerbates a cancer patient’s fear and some choose to forego this form of treatment.

That’s one of the reasons why many cancer professionals are excited about a newly developed option, immunotherapy, a treatment that activates a patient’s immune system to recognize, attack and destroy cancerous cells.

“Pharmaceutical companies have identified chemical receptors on the outside of cells that are unique to cancer cells, and they have developed drugs that look for these receptors. This means that we’re not killing all the normal cells along with the cancer cells, but we’re targeting specific parts of the cells,” explains Nisha Hull, pharmacist and pharmacy manager at Ascension Borgess Cancer Center. “These treatments are not as toxic, and patients have fewer side effects and an improved quality of life.”

The idea of “some people with cancer not needing chemotherapy is truly inspiring and captivating for both patients and oncologists,” says Dr. Natasha Dhawan, medical oncology physician at the Bronson Cancer Center.

And cancer treatments continue to evolve, thanks to clinical trials. Clinical trials are used to determine if experimental treatments, not yet approved by the U.S. Food and Drug Administration, will be beneficial to the general population of patients. “Clinical trials have been essential in making advancements over the last 25 years and (are essential) to continue advancements over the next 25 years,” says Dhawan.

She explains that generally clinical trials are for patients who are still relatively strong but for whom current treatments aren’t working or who might have a cancer with a specific mutation. “It’s always worth asking if the option of a clinical trial is applicable,” Dhawan says. “There might be a trial treatment that’s targeted toward that mutation.”

Treating the person

While these technological and pharma-cological innovations are impressive, great strides are also being made in providing support services for patients and their families and more personalized treatments.

Dr. Muhammad Hameed, a medical oncologist at Ascension Borgess, says he’s seen “many changes” in his 13 years of practice. “The care has become more holistic,” he says. “Now we are treating the person, not just treating the disease.”

Hameed notes that not all cancers are the same and that even within a certain type of cancer, such as lung cancer, there are variables. “This awareness wasn’t present 25 years ago,” he says. “Today we do more testing on the tumor, like molecular testing, to identify the best treatment for a patient, based not just on the cancer characteristics but also (the patient’s) other health care problems, the patient’s stage in life, and so forth. We have many more options available that we did not have before, and we keep getting more on a very frequent basis.”



“We have made the treatment space a comfortable, holistic healing space,” says Kreitner.

Attention to the more personal aspects of treatment also has practitioners taking a closer look at patients’ support systems and how those can be boosted to benefit treatment. To that end, cancer treatment today integrates the patient’s caregiving team, family members and other loved ones.

“There’s much better recognition that cancer is definitely a disease that is better managed with personal support,” says Samantha Kreitner, medical director at Ascension Borgess. “There is a high level of recognition that the spiritual and psychological portions of treatment are just as important, if not more important, than the physical aspects.”

This recognition can be seen in the design and setting of the newest of Kalamazoo’s three cancer centers, Ascension Borgess’s facility on Drake Road, located across from the Asylum Lake Preserve and set in a meadow next to woods. It opened in September 2021. Patients who receive chemotherapy there via infusion can do so in private rooms or semi-private bays with large windows through which they can see the surrounding environs, colorful plants and native vegetation, grazing deer, and birds at feeders.

In addition to the medical professionals treating them, many cancer patients may find other professionals incorporated into their treatment who can help them manage how cancer affects their day-to-day lives.

Social workers are now a major part of oncological support services. Patients and their families are encouraged to meet as often as necessary with these professionals, who provide individual counseling, case management advice, transportation and housing options, and an avenue to emotional support groups.

Other support professionals can include dietitians and nutritionists who suggest optimal eating habits, financial consultants who help mitigate the financial impact of cancer care in terms of out-of-pocket costs as well as loss of income, on-site massage therapists who help both patients and caregivers relax, and palliative care professionals who provide relief from the strain and stress of the illness.

The three cancer centers in Kalamazoo County also integrate “warm-and-fuzzy” features such as inspirational painted rocks, pet therapy, art crafted by cancer patients and caregivers, and a feel-good “victory bell” that patients ring when they have completed their treatment.

Megan Bridgeman, the clinical manager at Ascension Borgess, says this atmosphere of encouragement “is not just for patients who benefit from these services. It’s for the staff too. Seeing patients day in and day out can be draining.

“People have always cared,” she adds. “We’re just better at recognizing the mental struggles, and we have better ideas about how to offer assistance.”

And while each of the three cancer centers has oncology providers in-house, the centers work together to offer complementary services without creating redundancies in the community. Any patient might receive treatments at more than one facility, and records and treatment plans are shared via electronic communication systems, virtually eliminating the need to transport physical medical records from one place to the next.

But despite innovations, cancer is a still a serious and scary subject, and the doctors and other professionals interviewed say they approach each case with concern and dignity for all affected parties.

Gary Stafford, the chaplain at Ascension Borgess and a deacon in the Catholic Church, says new patients are initially concerned about what is happening to them physically, but when the will to live becomes a struggle, spiritual concerns often jump to the forefront, he says.

“We ask, ‘What are you feeling right now?’ We listen to their stories and their relationships with loved ones and with God,” says Stafford. “We ask about their aspirations and regrets. If they say they want to say goodbye, we meet with the family. Patients want to feel understood. They say, ‘I know I’m being treated as a person. I’m being heard. I’m being cared for. I’m being loved. Thank you. And now it’s time for me to go.’”

And when the end of life does come — as it will for all of us whether we have cancer or not — changing attitudes about hospice care are facilitating that part of the life journey. Dhawan, who is a palliative medicine physician as well as a hematologist-oncologist, says she brings the subject of hospice care into conversations with patients and their families early.

“If we’re getting to the point when we really need to start considering it, my patient isn’t surprised,” she says. “That’s because we’ve normalized talking about all types of treatment, including hospice, so that’s more of an innovation in communicating.

Robert M. Weir

Robert is a writer, author, speaker, book editor and authors’ coach. You can see more of his work at robertmweir.com.

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