Doctor’s Orders Fighting Cancer
EARLY DETECTION, EARLY CURE
BAYLOR SCOTT & WHITE HEALTH ADVANCES NEW METHODS FOR EARLY CANCER DETECTION
ON TARGET TEXAS ONCOLOGY’S PRECISION MEDICINE PROGRAM PROLONGS AND SAVES LIVES BY MANAGING CANCER
Yolanda conquered
cancer — one day at a time.
Yolanda never thought it would happen to her. She was too young, too healthy and too busy. As a mom of two young boys, a cancer diagnosis wasn’t even a thought in her mind. Especially in the height of the pandemic. In early October 2020, just a few weeks after her 31st birthday, Yolanda learned she had Stage 3 adenocarcinoma colon cancer. Two weeks later, she experienced a prolapse that led her to be airlifted from her hometown of Hochatown, Oklahoma, to Dallas. She was referred to our colon and rectal team at Baylor University Medical Center in Dallas.
It was a challenging time for Yolanda and her family. She would drive three hours to Dallas for treatment, and during the first month following her cancer diagnosis, Yolanda lost her beloved mother to COVID-19.
What got her through 12 rounds of chemo and 28 rounds of radiation was the people around her. “You need a strong foundation to get through something like this, and I’m glad I have it. If it wasn’t for my family — my husband, my siblings, my cousins — I wouldn’t have gotten through anything.”
But what really inspired Yolanda to find her power to fight was her children. “My kids are my everything. I would never want to leave them, and they’re the thing that I fought for every day,” she said tearfully.
Now that she’s cancer-free, Yolanda is inspired to explore her creative side, making keychains and pens. She revels in living in the present and is grateful for every minute she has with her husband Erik, her two
My kids are my everything ... they’re the thing that I fought for every day.
Yolanda,
sons Jax and Lukas, and their extended family. To her, the simple moments with them are the sweetest — going to the park or skipping rocks on the lake. “It sounds very cliche, but life is short. Enjoy what time you have with your loved ones and let them know how you feel.”
Yolanda hopes her story can inspire others to get to the doctor when they feel something is off. She wants them to know what she knows now — that it can get easier, and it can get better. “My mom always used to tell us, ‘Just take it one day at a time,’ and so that’s what I live by.”
Jaxon, Lukas and Yolanda
Erik, Yolanda, Jaxon and Lukas
Survivor
No one ever wants to hear the words “you have cancer” from their doctor, but it is an inevitable diagnosis for many Americans. Approximately 2 million people will be diagnosed with cancer by the end of 2023 in the United States, according to the National Cancer Institute. For those who hear those words, there is more reason than ever to hope for a good outcome.
The moment someone receives a cancer diagnosis, the fight begins. New technologies and treatments to fight cancer are continually being developed. Innovative treatments, targeted therapies, and clinical trials—administered alone or in combination—are helping people with cancer live longer. This is good news for cancer patients who are seeking up-to-theminute treatment options and determined to make it to the survivorship zone.
Intercepting Cancer
Innovative methods for early cancer detection
For decades, the message of “early detection, early cure” has been circulated by the medical community to encourage everyone to pay attention to potential warning signs of cancer and get the appropriate tests and screenings each year. Science has proven that most cancers detected and treated in their earliest stages have the best chance for a cure.
“Historically, people have been diagnosed with cancer after they present with unusual symptoms, such as unintentional weight loss, a lump, shortness of breath/cough, new onset pain/bleeding or something suspicious on the skin,” says Ronan J. Kelly, M.D., MBA, medical director of oncology on the medical staff at the Charles A. Sammons Cancer Center at Baylor University Medical Center. “In many cases, these cancers are diagnosed at a later stage because they have already progressed to the point of exhibiting concerning symptoms.”
Baylor Scott & White Health wants to change this mindset and detect cancer when it is less invasive, less advanced, and curable. “In essence, we want to bring early detection across Texas to an individual’s local clinic or even into one’s living room,” says Dr. Kelly. “We want to move the point of interaction to fit within our patients’ modern lives. This ‘care everywhere’ approach may ultimately mean at-home cancer screening and virtual navigation using smart phone technology.”
“We want to support patients at all points along their journey. That is what we are here for.”
RONAN KELLY, M.D., MBA
This could be done with blood, saliva, stool, and urine samples collected at home for people who have been determined to be at elevated risk for cancer or at a certain age. Baylor Scott & White seeks to reimagine cancer detection by using molecular tests in addition to imaging, and by creating new paradigms of cancer interception leveraging artificial intelligence, deep learning, and big data.
According to Dr. Kelly, the landscape of cancer care recently changed for the first time in several decades with the update of the National Cancer Plan in April 2023. The National Cancer Plan aims to end cancer as we know it by reducing the cancer death rate by 50% during the next 25 years, thus improving the lives of patients and their families. Part of this initiative is the development of more sensitive screening measures, including the multi-cancer early detection (MCED) blood tests. In the future, this could also include specimens that can be collected during routine medical appointments or even in the comfort of a patient’s own home and sent to a lab for analysis.
“Fewer than 5% of Americans participate in oncology clinical trials and everything we know about cancer comes from those 5% of patients. There is a great opportunity to learn from the other 95% which are more representative of the entire country,” explains Dr. Kelly. “We simply have to improve the diversity of our research population and remove the barriers to participation that have developed over time.”
Baylor Scott & White has created the Texas Immuno-Oncology Biorepository with the central vision of taking biospecimens and learning from every patient with cancer regardless of race, ethnicity, socio-economic background, or geographical location.
new national cancer plan asserts “everyone has a role” in the fight against cancer. At Baylor Scott & White, the team seeks to “treat every patient and learn from every patient.” The goal is to help patients along their cancer journey, and those patients can help future patients by donating biospecimens for research.
Before cancer can be detected by scans and before symptoms develop, tiny fragments of tumor DNA break off and circulate throughout the body, which is why they can be detected with new molecular detection blood tests. “Traditionally we had to wait for imaging to determine if cancer was present, but we are trying to change the paradigm of cancer detection,” Dr. Kelly says. “Some of these tests are on the market right now.”
Dr. Kelly says these biomarker tests will not replace scans and imaging for the foreseeable future. However, they will eventually become part of a new approach to care. “We want to intercept cancer by identifying abnormal cells earlier than ever before through blood and other biospecimen screenings,” Dr. Kelly says. “If cancer is identified at a less advanced stage, patients can get treatment sooner. And that will save lives.”
The idea of cancer interception extends beyond testing and includes partnering with patients to make care more convenient—available when and where they want it. If cancer is detected, patients could be referred for a followup scan using virtual or in-person navigators.
“Historically, we have asked patients diagnosed with cancer to come to the hospital and make multiple follow-up visits throughout their journey,” Dr. Kelly says. “It can be overwhelming. We want to hold their hand and support them and their family every step along the diagnostic process, through treatment, and into long-term survivorship. It’s a complete mindset change.” The goal is to move away from being reactive when it comes to cancer detection towards being preemptive, from symptom-based detection to molecular-based detection, and from requiring in-person visits towards an ‘anywhere’ mentality.
BAYLOR SCOTT & WHITE HEALTH
“These biospecimens or samples from realworld patients will become one of the crown jewels of cancer research in Texas and will provide a precious cancer research resource for generations to come,” Dr. Kelly says. The
“When someone hears the words ‘you have cancer,’ it’s almost as if they have an ability to stop time,” Dr. Kelly says. “Everything that seemed important up to that time, suddenly becomes less important. We want to support patients at all points along their journey. That is what we are here for.”
Targeting a Cure with Precision Oncology
With most cancer treatments, there is a fine line between killing the cancer cells and protecting a patient’s normal tissues. Oncologists walk this line with most every patient as they work to find the right treatment plan for their needs. Precision medicine in cancer treatment, or precision oncology, is just that—precise. When a tumor has spread beyond the confines of the original organ and becomes metastatic, the concern is how to reduce or eliminate the tumor with precise treatment while protecting the rest of the patient’s body.
“One thing I would say about cancer care today that is different from even just a decade ago is that it is becoming more of a chronic illness,” says Steven Paulson, M.D., medical oncologist, president, and chairman of the board for Texas Oncology. “The ‘hot’ area that will continue to grow and improve is targeted therapy, or precision oncology, which is taking the tumor cells and looking at the makeup of those cells to see where they are genetically different from normal cells and targeting them for treatment.”
Precision oncology is a rapidly evolving approach to cancer treatment and prevention that allows physicians to select treatments that are most likely to help patients based on a genetic understanding of their disease. Precision medicine is a type of targeted therapy that uses information about genetic changes in
the tumor, also known as the molecular profile of the tumor, to help decide which treatment will work best for someone with cancer. For example, the same cancer-causing genetic changes may be found in different types of cancer. As a result, patients with tumors that share the same genetic change receive the drug
two decades; it is continually improving its offering as more effective treatments are discovered. One of the main differences between precision medicine and more traditional treatments, such as chemotherapy, is how much better patients feel throughout their treatment, as chemotherapy can make patients feel nauseous and experience side effects, such as hair loss. “Precision medicine therapies are often better tolerated than chemotherapy regimens,” Dr. Paulson says. “In time, we think some of these agents will ultimately be curative. For now, and for the most part, they significantly suppress the underlying genetic clone of cancer cells, prolong life, and presumably improve one’s quality of life.”
that targets that change, regardless of the type of cancer.
With the rapid evolution in technology, genetic changes in the tumor are being identified in tumor samples (tissue biopsy) and in blood samples (liquid biopsy) of individuals with cancer. Special labs with equipment to sequence the DNA perform genomic testing, molecular profiling, or tumor profiling. While all genetic changes that can cause cancer to develop, grow, and spread have not yet been discovered, significant progress is being made. As specific genetic changes are discovered, new drugs are being developed and treatments are being designed to target these genetic changes in tumors. Many new precision cancer treatments include biomarker inclusion/exclusion criteria, as do many clinical trials.
Texas Oncology has been offering precision medical treatments for more than
In recent years, Texas Oncology has committed to developing a precision medicine program with the understanding that it would be a significant part of cancer management. “We have invested in a creating a program wherein all our patients with advanced cancers have molecular profiles performed on them, and Texas Oncology has relationships with multiple labs to provide this service; those relationships allow us to get that data back through an electronic database,” Dr. Paulson says. “In a space of about five minutes, we can find every single patient in Texas Oncology that has a particular mutation and notify their physicians if there is a new therapy or clinical trial that can be used to treat that patient.”
One concern patients and their physicians have had about this testing is cost. Texas Oncology has advocated for patients on this front, too, by requiring that lab partners validate out-of-pockets costs for Texas Oncology patients and reveal what test failure rates are for full transparency. “We hold our labs to a fairly high standard and require minimal or no cost to our patients; the average outof-pocket cost for this testing is usually less than $100,” Dr. Paulson says. “Cancer is never a word you want to hear in same conversation with your doctor. Regardless of the type of cancer diagnosis, we have become substantially better at treating cancer. There are more therapeutic options, side effects are reduced, and life expectancy has dramatically improved.”
Ask The Expert
PROTON THERAPY EXPERT
By Andrew K. Lee, M.D.,
WHAT IS PROTON THERAPY?
Proton therapy delivers targeted radiation to tumors, guided by the center’s advanced, accurate imaging equipment. Texas Center for Proton Therapy uses a 30-foot-tall, 110-ton machine that rotates 360 degrees to enable precise positioning of the proton beams on a patient’s tumor. Physicists and engineers have meticulously calibrated the proton beam equipment to extreme accuracy. A 220-ton cyclotron is the centerpiece of this proton beam equipment. This machine accelerates protons to two-thirds the speed of light extracted from hydrogen atoms. It then creates a proton beam line traveling nearly half the length of a football field with accuracy within 1 millimeter. The protons delivered to the tumor destroy cancerous cells, while minimizing damage to the surrounding healthy tissue.
WHERE IS PROTON THERAPY FOR THE TREATMENT OF CANCER OFFERED IN NORTH TEXAS?
For eight years, North Texas has had an advantage in the fight against cancer by having Texas Center for Proton Therapy in its own backyard. It’s the first and only proton therapy center in Dallas-Fort Worth and the most technologically advanced cancer treatment option in the region. The 63,000-square-foot facility, located in Irving/ Las Colinas, is one of approximately 42 proton therapy treatment centers in operation in the United States and is the first stand-alone LEED-Certified proton therapy center in the country. We have accomplished one of our goals, which was to improve the overall level of cancer care for Dallas-Fort Worth patients, and we have done this through a combination
of technological advances, hard work, and gaining expertise on how to better utilize the technology we have. For instance, the center has three pencil-beam scanning proton machines and the ability to do volumetric on-board cone-beam CT imaging when a patient is on the treatment table. We use an ultra-fine proton beam with pencil-point precision across each layer of the tumor. Essentially, we delicately paint the tumor with radiation. It’s the ideal technology for irregularly shaped tumors near sensitive areas. Additionally, pencil beams of protons can be combined to treat large tumors as well. There is a significant advantage of pencil beam proton therapy for larger tumors.
WHAT TYPES OF CANCER CAN BE TREATED WITH PROTON THERAPY?
As of fall 2023, the center has treated more than 4,000 new patients, and about 16 percent of those have been pediatric patients. Any solid tumor that requires radiation as a treatment component could likely be treated with proton therapy—brain, head and neck, lung, prostate as well as other gastrointestinal and genitourinary cancers. We also treat breast cancer, whether it’s part of breast conservation therapy or after a mastectomy and we need to irradiate the chest wall. Proton therapy is also a good option for patients in need of treatment for adjacent lymph nodes. Any patient who has been told that they need radiation therapy should look into proton therapy as an option for primary treatment or in combination with other therapies. A doctor’s referral is not needed to schedule a consultation at Texas Center for Proton Therapy.
Andrew K. Lee, M.D., MPH, is the medical director for Texas Center for Proton Therapy.
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