Eastern Iowa hospitals say tackling cancer has become more complex

Behind a 5,466-pound lead door at the Physicians' Clinic of Iowa medical pavilion in Cedar Rapids sits a brand-new linear accelerator — a device used for radiation treatments for cancer patients.

The machine, delivered by a semi in July, is encased in concrete room with walls three feet, nine inches thick. It delivers a high dose of radiation to the tumor while limiting radiation to nearby tissue and organs, giving cancer patients an effective treatment in less than five minutes.

It's the reason UnityPoint Health-St. Luke's built a new 10,000-square-foot radiation center, complete with five exam rooms, two patient consulting rooms and a conference room for oncologists to meet and discuss a patient's treatment.

The addition of radiation treatment, which has been in the works since May 2014 and will open in late October, fills a gap in UnityPoint Health-St. Luke's cancer care, said Kimberly Ivester, cancer care and Nassif Community Cancer Center director.

'Before the center being here, if you were diagnosed and received surgery here, you would have to go elsewhere for radiation services,' she said. 'It was hugely disruptive.'

The new tools and location of the center — across the hall from the medical oncology department, so physicians can easily go between practices to talk about patient care — illustrate an evolving understanding of cancer and cancer care.

The Gazette spoke with oncologists at Mercy Medical Center, PCI and St. Luke's about changes in care over the past 15 years and new technology that allows for higher survival rates and better quality of life.

More Targeted Approach

Drugs are now more effective, radiation therapy is more precise and surgery is more minimal.

'One person's lung cancer is completely different from another's,' said Dr. Deb Wilbur, a medical oncologist at Mercy's Hall-Perrine Cancer Center.

Tumors have different mutations, which require different drugs that specifically target that mutation, she said. For example, a specific gene found in one woman's breast cancer might be similar to a common gene in kidney cancer, which makes a kidney cancer drug more effective than other breast cancer medications, Wilbur added.

'We used to use chemotherapy primarily,' said Dr. Rasa Buntinas, a medical oncologist at PCI. But now drugs and targeted therapy have increased treatment options, which she said 'translate into better outcomes.'

'Even if you're diagnosed with a disease, you're generally living longer than 20 years ago,' she added. 'Quality of life is there as well. Yes, there are side effects, but they aren't as harsh.'

Surgeries are not as invasive, noted Dr. Vincent Reid, a surgical oncologist and medical director of Hall-Perrine. He cited cases in which surgeons once may have had to perform a mastectomy now can cut around the rim of tissue surrounding the cancer.

'We have a better understanding of which nodes to take,' he said.

New tools also can cut down on re-excision rates for breast cancer patients — or the number of women who need a second surgery after a lumpectomy — conserving more of the breast.

'Thirty years ago, the philosophy was to cut as much out as you can,' said Dr. Bobby Koneru, a UnityPoint-Health radiation oncologist. 'For instance, with breast cancer, you'd remove the entire breast. But this is a big surgery and a radical procedure. ...

We can now do things non-invasively.'

Koneru said a small surgery and radiation treatment is just as effective.

'Radiation is surgery without the scalpel,' he said. Physicians can deliver high doses of radiation and precisely target tumors.

Oncologists now can deliver higher doses on radiation, which means fewer treatments for patients, said Dr. Janet Merfeld, a radiation oncologist at Mercy.

'Treatment for an early stage lung cancer, we can do five large, very focused precise treatments versus doing daily, Monday through Friday treatments for six to seven weeks.'

Team-based Care

More dialogue now occurs among physicians — Mercy has set up multidisciplinary clinics in which patients meet with all of their doctors in one visit; St. Luke's chose to build its radiation center across the hall from PCI's medical oncology department; and oncologists regularly meet with one another to discuss a patient's treatment.

'The largest impact on cancer care is that coordinated care, the strength of having more than one opinion,' said Dr. David Cowden, a pulmonologist at Respiratory and Critical Care Associates.

Cowden said physicians meet in a weekly thoracic oncology conference for a roundtable-like discussion about their patients.

'Each patient is presented before undergoing treatment,' he said. 'There is a behind-the-scene debate.'

Mercy now has multidisciplinary clinics for thyroid, gastrointestinal, lung and breast cancers. Patients meet with all their doctors individually — medical, surgical and radiation oncologists — on the first visit. Physicians then discuss the patient's case and he or she leaves with a comprehensive, firm care plan in place, Wilbur explained.

It used to be, Reid said, that 'You could have at least three visits spread out over two to three weeks. There's anxiety before you're aware of what the treatment plan is.'

There's also been a push in recent years to add 'softer services,' Merfeld said, such as a dietitian, massage therapists and social workers to help patients recovery. Mercy even has a specialist that explains what cancer is to a child whose parent is ill.

'It's not enough to eradicate the cancer' in the patients, she said. 'You have to restore them, too.'