CANCER CENTERS PROVIDE LEADING-EDGE TREATMENT AND RESEARCH

Cancer Treatment and Surgery Advancements Create Better Outcomes

By Becky Gillette

The University of Arkansas for Medical Science (UAMS) Winthrop P. Rockefeller Cancer Institute has undergone a “very large sea change” with the hiring of 23 new lab-based researchers since Michael Birrer, M.D., Ph.D., became vice chancellor and director of the Cancer Institute three years ago.

“This represents a radical shift in direction,” Birrer said. “We did the hiring smack in the middle of COVID but were still able to hit the ground running. We have added 30,000-square feet of lab space. We have some pretty high-profile lab resources.”

One major effort involves proteomics, the study of proteins in complex biological samples. The Cancer Institute’s cutting-edge mass spectrometers are a national resource. In addition to analyzing proteins from Arkansas, they analyze work from around the country.

“It is really a feather in our cap,” Birrer said. “We also have an equally prestigious genomic laboratory, where we do very sophisticated, highthroughput sequencing of patients looking for abnormalities in their tumors. We have the only resource like that in the state.”

Another major effort involves the Center for Research, Health and Social Justice program headed by Pebbles Fagan, Ph.D., which is looking at issues like health disparities in cancer patients across the state. This work funded by a $19-million grant that started in 2021 has a large tobacco cessation program.

“Tobacco abuse is, frankly, rampant in Arkansas,” Birrer said. “We have really experienced counselors, but it goes beyond that regarding finding out what else works to get people off cigarettes and smokeless tobacco. How do we stigmatize it? What can we do to start at an early age to prevent tobacco use?”

The Cancer Institute also has a low-dose CT scanning program that can catch lung cancer early when it can be treated more effectively. They have plans to put a CT scanner in a van and take it around the state to areas where this technology has not been accessible. They do the same thing now with mobile mammography.

The Cancer Institute has four research programs:

•Developmental Therapeutics is looking at new targets and therapeutic agents.

•DNA Repairs and Host Response is investigating how DNA repairs can be used to battle cancer.

•Cancer Biology has the largest number of researchers, including a new group of structural biologists using X-ray crystallography to look at the 3D structure of proteins in cancer cells and how that might be used to develop new therapeutic agents.

•Population Science and Cancer Prevention looks at the epidemiology of cancer in Arkansas looking at possible causes of cancer clusters from things like well water contaminants and pesticide use. This program is tied to cancer prevention by using the data to help people avoid cancer by living healthier lives.

“It is an exciting time from a research standpoint,” Birrer said.

The Cancer Institute is also adding proton beam therapy and building a new radiation oncology center that will open next summer. It has doubled the size of clinical trials. “Within a year, we will have a really wonderful portfolio of trials so people don’t have to leave the state to get into appropriate clinical trials,” Birrer said.

All of this represents efforts by UAMS Cancer Institute to be seen as a national cancer leader by achieving the status of becoming a prestigious National Cancer Institute-designated (NCI) Cancer Center. Birrer said they have essentially achieved the amount of research required and expect to have enough patients and the number of clinical trials required in another year to 18 months. Other factors include community outreach and a statewide navigation program to provide cancer education, screenings, and recommendations on treatment options. About 1,500 new jobs and a $70-million economic impact over five years is expected from NCI designation.

The UAMS Cancer Institute has about 160 members (professors in the College of Medicine) who spend some portion of their time doing cancer research. Fifty of those members are physician scientists (with both MD and Ph.D. credentials) who see patients and perform lab-based research. Quite a few are federally funded researchers with millions in grants from the National Institutes of Health and the NCI.

Carti

Arkansas’ cancer specialists since 1976, CARTI’s vision is to be “the cancer treatment destination” for residents across the state. With 18 locations and counting, including the main campus in Little Rock, the notfor-profit provider’s world-class team is committed to delivering innovative, trusted cancer care close to home.

“We have been growing aggressively and truly want to shift the dynamics of health care in Arkansas,” said CARTI President and CEO Adam Head. “We’ve added five cancer centers over the past five years to offer oncology services where our patients live and work. As a nonprofit, our goal is to reinvest in the communities we serve. Our mission is making trusted cancer care accessible for every patient through compassion, innovation and purpose.”

CARTI’s cancer centers are focused on making treatment as convenient as possible. For example, the CARTI Cancer Center in Pine Bluff opened in a 30,000-square-foot space this year. Head said CARTI saw there were significant needs in Pine Bluff. It has everything they offer at the CARTI Cancer Center in Little Rock.

One new technology that Head finds gamechanging for patients is the CyberKnife S7, a revolutionary radiation oncology treatment not found anywhere else in the state. It is focused on shorter- course treatment. Head said the system features the world’s only motion-synchronized, AI-driven, real-time treatment delivery, which means that cancer can be targeted to the exact millimeter. The technology can even follow a patient’s movement as they breathe.

“Typically, radiation oncology centers across the country provide 40 to 50 treatments,” Head said. “The CyberKnife at our main campus is particularly phenomenal for prostate cancer, one of the top five most common cancers. With the CyberKnife, for eligible individuals, we only have to do five treatments for a quicker recovery and return to everyday life.”

Another groundbreaking development is the addition of the CARTI Surgery Center, a 57,000-square-foot facility at its Little Rock campus.

“It’s going to change outcomes for cancer patients,” Head said. “The vast majority of cancer surgeries can be in this type of facility. The CARTI Surgery Center is the first of its kind in Arkansas and the South. We learned through COVID that many patients don’t want to go to a hospital for surgeries. The vast majority can be done in a non-hospital setting. We are leveraging innovative technology options, including two DaVinci robots, and offering extended stay capabilities, if needed.”

Head said it is extraordinary to see patients responding to what CARTI is doing.

“We are strategically adding specialties and treatment centers in response to what patients need and want,” he said. “Improving the patient experience and their outcomes are behind our decisions to build the surgery center and additional full-service cancer centers.”

In general, health care is difficult these days when reimbursements often fall short of meeting expenses. No matter what, Head said CARTI will continue to invest in people and services.

“We provide what we believe is critical for successful cancer treatment,” Head said. “For services not reimbursed, we count on our generous donors and partners who support the CARTI Foundation. Their contributions fund our pa- tient assistance program, which can help cover the cost of accommodations, transportation and more, in addition to new innovative treatments and technologies.”

A few years ago, CARTI expanded its food services, including opening The Hope Bistro in Little Rock. Healthy food is essential to everyone, but it is a little more complex for cancer patients. Sometimes patients find that the food they used to enjoy is now completely unappealing.

“We have to be sensitive to that,” Head said. “Health care food can get a bad rap. We try to flip that on its head with a certified chef and dedicated team who provide healthy options as well as comfort food. And, we have in-house dieticians who work with physicians around the state to help coach patients.”

Additional expansions are likely in CARTI’s future. “If it aligns with our mission and will make a difference for patients walking the cancer journey, then we will continue to lean into that,” Head said.

UAMS Baptist Health North Little Rock (NLR) Cancer Center

One of the newest cancer centers in the state, the UAMS Baptist Health NLR Cancer Center, is allowing patients to get treated closer to home, said Director Sunny Singh, MD, who is a hematologist and oncologist.

“Since we opened in July of 2021, the clinic has really picked up,” Singh said. “We provide rapid diagnosis of patients and general hematology and oncology services, so patients can have everything they need in that clinic. A lot of patients appreciate that we can provide those services locally, so they don’t have to drive across the bridge to Little Rock. A lot of patients are older people who are afraid to navigate the city. We provide most of the same services as UAMS in Little Rock. Having said that, for now we do have to send patients to Little Rock for PET scans, but Baptist is planning to hook one up on the NLR campus soon.”

The third floor of the facility offers all that is needed to deliver hematology and medical oncology treatment. The first floor provides radiation oncology.

“Radiation and medical oncologists work handin-hand,” Singh said. “We try to consolidate all care. We partner with Baptist Health and local physicians in North Little Rock to offer most services in North Little Rock. The other advantage is that we also screen patients for clinical trials. If someone is a good candidate for a clinical trial in Little Rock, patients can make informed decisions about pursuing that.”

Singh said major advancements in cancer treatments over the past 10 to 20 years have resulted in higher survival rates. Surgery has become more precise and less extensive, which helps patients to preserve a lot of function. Radiation techniques have been refined to minimize side effects. Most advances have been seen in medical oncology including molecularly targeted agents, immunotherapy and cancer-fighting oral medications.

“Also, we now have immunotherapy that is a game changer especially with skin and lung cancers, which are very common cancers,” Singh said. “Giving the high incidence of smoking in Arkansas, we see a lot of lung cancer. We have clear guidelines in how we should screen for lung cancer. Anyone who has smoked cigarettes could be eligible for CT scan as part of lung cancer screening. Colonoscopy, mammograms, pap screens and prostate cancer screening have been able to improve cancer detection, which improves treatment and outcomes. I encourage people to discuss this with their primary care providers.”

Singh said there has also been progress in terms of knowing what side effects to anticipate from their treatments, and oncologists have medications that can prevent some of them. For example, there are several medications to prevent chemotherapyinduced nausea and vomiting.

“Additionally, many of our drugs may suppress immunity, but we now have improved guidelines regarding preventing and treating infections in this scenario,” Singh said.

A concerning trend that has been well reported lately is people getting cancer at younger and younger ages. Singh said a small part of it could be because of better detection, but there are also lifestyle, diet and environmental factors at play.

“There is strong evidence suggesting that eating processed meat and other highly processed foods cause inflammation in the body, and this may lead to different types of cancer,” Singh said. “Research also shows air pollution and exposure to certain types of chemicals increase the risk of different types of cancer. A lot of patients we see are from farming communities where people had exposure to herbicides and pesticides early in their lives.”

Also, obesity is strongly linked to breast, colon and other types of cancer.

“I would strongly advise people to eat fresh organic food — greens, other vegetables and fruit — that is not processed,” Singh said. “That is the type of food which is not inflammatory, and really improves your gut health. We know that a healthy gut is linked to a lot of good things for people’s minds and bodies. When it comes to cancer, we are seeing evidence suggesting patients who respond better to immunotherapy are the ones with better gut health.”

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