Transcription:

Melanie Cole (Host): A team at the UVA Cancer Center streamlining treatments for patients with tumors that have spread to the bone from weeks to a single day. My guest is Dr. Paul Read. He’s a board certified radiation oncologist at the UVA Cancer Center who specializes in working to develop more effective cancer treatments with fewer side effects. Welcome to the show, Dr. Read. Tell us, describe for us how your team’s approach is different for treating cancer that had spread to the bone.

Dr. Paul Read (Guest): All right. We recognize that this is a very painful condition for patients and that anything that we could do make this process simpler for them and more efficient would be of great value to the patient, and their families, who have to bring patients, sometimes from a long distances, to get treatment. We analyze the entire workflow of treating somebody who has spread of cancer to the bone and came up with a strategy that included making sure that all of the people who need to perform a specific task knew exactly when we’re going to treat them, when they needed to do their part, their role. Instead of doing a kind of one day then the next day, then the next day, we were going to do it over very short time period, and also developed whole new systems for doing quality assurance for patients to make sure that the treatments are safe. And when we combined these approaches, we came up with a strategy to treat patients in actually less than a single day. We’re actually looking at patients in under three hours. So they come in and have a consultation with the radiation oncologist, and they have a CT scan. And then we draw on that CT scan the area where the tumor is and what we want to treat, and then we develop a treatment plan and we do the quality assurance, and then we give the patient the treatment, all within about three hours. In most places in the country, when patients go to get treated for spread of cancer to the bone, it’s over a five to ten treatment course. So you can imagine driving back and forth if you live 50 miles from UVA with painful bone cancer, how much better and more efficient this would be for patients.

Melanie: Dr. Read, that’s amazing. Tell us how that multidisciplinary approach, how do you get everybody on the team together for that one day? Aren’t people running in all different directions and busy with different other things? How do you get them all together for that one patient?

Dr. Read: Well, I think the people who are involved include the physicians. People call dosimetrists; who do the radiation planning, CT technologists; physicists, who check the safety of the plan; and then radiation therapist, who actually deliver the treatment. And in addition, the nurse will see the patient to make sure that they have adequate pain management during this process. Redesigning workflows isn’t that hard. All this work has to be done regardless, as long as we basically have built a system where we have email that get sent out to everybody and we also discuss things, that we have a patient that’s coming in two days and this is how it’s -- when we’re going to do this, start the treatment, and this is when the process we anticipate ending it, and we just make sure that everyone knows to adjust their schedule accordingly so that they can do their part. It’d be like if you went to a restaurant for dinner, and all you got the first day was salad, and then you went to the second day and you got your main course, and then you went your third day and you got your dessert. That’s how it currently is in many places. But if you can coordinate it so that you go once and have the entire process, it’s just much easier for patients.

Melanie: I think it’s amazing for patients. So which patients may benefit from this treatment option?

Dr. Read: We’re treating patients who have spread of cancer to bones, for the most part. That’s where we’ve started this procedure. We may ultimately extend it to other types of cancer patients, but right now, we have a clinical trial that’s open, and we have funding from Medicare to develop this process, this new type of workflow process for patients. We’re focusing on patients that have pain from spread of cancer to bone and one to three places on this trial.

Melanie: So, what other changes to cancer treatment are you examining there?

Dr. Read: Well, I’m working with several palliative care physicians within our department, which is a very unique situation. There’s been a lot of publications recently and discussion at national-level meetings and organizations that have really recognized the value of having palliative care physicians who focus on the patients’ wellbeing and their quality of life during their cancer treatments. We have palliative care physicians who work in our department. We work very closely with them, and we’re pioneering a new strategy called patient-reported outcomes. In this strategy, when patients come to the cancer center, particularly patients who have advanced cancer with a lot of symptoms, we have them fill out a very simple questionnaire on an iPad. It asks them questions like how much pain do you have and questions about whether or not they have anxiety or depression and how their bowels are functioning and so forth. All of this goes into the computer and it’s tracked over time. So instead of the electronic medical record just having numbers of blood values and things that physicians or nurses say, this is a place for the patients’ voice of how they’ve felt during this process, whether they’re feeling better or worse. And in just a couple of weeks, we’re going to automate this to have automatic triggers so that if a patient tells us that their anxiety or depression or pain has gone way up or has gone beyond the threshold, it’s going to have a big flag alert when you open up their chart that this patient needs to have this addressed. This is a distressing problem for them. We actually have a group from Duke who’s coming up to visit us to kind of see exactly what we’re doing because it’s very pioneering type approach. It sounds simple, but actually making it happen with large groups of people, making sure that everyone understands how the process works takes some time. But we think that this is really going to benefit patients. Another thing that we’re doing within our department that I’m not directly related with but that is very exciting is breast intraoperative radiation therapy. And Dr. Kim [Shaw-Walter] is the radiation oncologist at UVA, and the breast surgeons are actually doing lumpectomies of the breast, removing tumorous tissues and normal tissue around it, and then doing the radiation all at one time while the patient’s under anesthesia so that they can have their surgery and a full course of radiation all at one time. They don’t have to come back and forth for radiation after the surgery. And this is also being done on a clinical trial. So, very exciting, I think.

Melanie: It’s so important that patients have a voice, and how wonderful that they get it there. So, why should cancer patients come to UVA Cancer Center for their care, Dr. Read?

Dr. Read: Well, it’s unusual if you live in a rural location like Charlottesville to have a resource like this with as many nationally recognized experts as we have and specialists in so many areas who really focus on what your particular problem might be. So you can come and have really nationally recognized experts take care of you and give recommendations. I think it’s very important that patients consider coming to UVA even if they have been seen by their local oncologists for consideration of getting a second opinion to make sure that there’s not options that haven’t been fully described to them that may be available to them. We also have very advanced technology, and there’s a real emphasis on teamwork and quality right now that I think is just terrific, and I think it’s just going to make the care better and better.

Melanie: That’s wonderful, Dr. Read. And in just the last minute that we have left, really give us your best advice for how patients benefit from this streamlined cancer care.

Dr. Read: Well, first of all, the treatment itself is highly targeted to the tumor, so the radiation is targeted really just to the area where the bone metastasis is as best as we can so that we spare the normal tissues around these high doses of radiation to minimize toxicity. We have shown that patients really get very rapid pain relief because we give a fairly high dose of radiation with this. On this clinical trial, we’re giving what would be a week or two weeks’ worth of radiation in a single setting. So it’s fairly high dose radiation. And patients get rapid relief within a week and can start taking this pain medication. It’s a cost-effective approach. If the patient have has significant co-pays, perhaps this would benefit them. And it’s obviously very convenient for patients and their family. So, cancer really affects not just the patient but their family. If somebody has a painful disease, frequently a family member has to bring them and take off from work. And if you can provide a service to patients like this in such a convenient setting where we frequently try and organize it so that it’s around another visit with another physician even at the cancer center so that they can come, have this done, perhaps see another physician for another reason, that’s just, I think, a win-win for the patient and their family.

Melanie: Thank you so much, Dr. Paul Read. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.