A diagnosis of cancer never carries good news, but dramatic improvements in technology, drug therapies and early detection as well as promising research ventures mean developing cancer isn't the death sentence it used to be. Much progress has been made in both the research and clinical arenas to improve outcomes of cancer patients through combination therapies, treatments that are less traumatic to non-cancerous tissues and expanding knowledge about the biology of the diseases themselves. The mood is so optimistic that now, for some cancers, oncologists speak openly about "cure rates" compared to past years, where discussions involved "survival rates" of months and single-digit years.
"We really are becoming more proficient at understanding and treating cancer," says Dr. Oliver Sartor, director of the Stanley S. Scott Cancer Center at Louisiana State University Health Sciences Center. "The hope for cure is higher today than it ever has been, and the therapies we utilize are more effective and less morbid, with fewer side effects as a whole."
The subject of cancer -- in most of its forms -- has always been a poignant one for Louisianians, particularly those living in the so-called "Cancer Alley" that stretches along the industrial corridor of the Mississippi River in the southeast part of the state. To make matters worse, the American Cancer Society reports that Louisiana has the highest cancer mortality rate in the nation, with approximately 180 people dying from cancer in the state every week and incurring medical costs totaling $375 million per year. Statistics indicate one big reason for the high cancer death rate is that the disease frequently is diagnosed at late or incurable stages when, in many cases, early detection and treatment could have saved the patient. To further complicate things, patients who need to seek treatment at a National Cancer Institute (NCI)-designated cancer center, of which there are 60 in the United States, currently have to travel about 350 miles to M.D. Anderson Medical Center in Texas or the University of Alabama Medical Center in Birmingham.
To address those challenges and others, the 2002 Louisiana Legislature set up the Louisiana Cancer Research Consortium, a cooperative research and cancer treatment venture between LSU Health Sciences Center and Tulane Health Sciences Center. Lawmakers funded the concept by hiking taxes on cigarettes by 12 cents a pack and designating that five cents of that goes to the consortium with another two cents funding cancer projects at LSU in Shreveport. While both Tulane's and LSU's cancer centers will continue to operate independently, the consortium will bring researchers, physicians, equipment and resources of both universities together in a synergistic setting. The goal is to win an NCI designation for excellence, which would expand treatment options and quality for patients in Louisiana, Mississippi and Georgia and elsewhere.
"If you ask what's the most exciting thing to happen in cancer in the last decade in New Orleans, I would have to point to the consortium and the intellectual marriage of the two minds (LSU and Tulane) in the name of cancer," says Dr. Roy S. Weiner, director of the Tulane Cancer Center. "Both institutions have grown to respect the talent that's there and have grown to understand that a big investment in recruiting talent is going to be needed to give our people the level of service they deserve."
Recruiting the best and brightest researchers and doctors to the consortium will be funded through the tobacco tax, and the two schools now are discussing the types of research, clinical trials and other projects that can most benefit from the union. "We're taking the best of Tulane and the best of LSU and putting parochialism aside," Weiner says. "The challenge is no longer which institution is better on Tulane Avenue (where both health sciences centers are located); it's how can we give our population the resources it deserves. It's a total paradigm switch."
It also should represent a change in Louisiana's stature within the nation's medical industry, he says, moving the state closer toward the engine of the train that drives cancer research and treatments instead of bringing up the caboose.
The consortium also will help New Orleans and Louisiana as a whole by decreasing the burden on families who now must uproot their families to seek treatment hundreds of miles from their homes. It also promises to be a huge economic development and professional talent recruiting tool for the New Orleans area as well as the state, according to Steve Moye, director of biotechnology development for the Louisiana Department of Economic Development.
"The amount of federal grant dollars that will come into the consortium will be pretty significant," he says. "What both institutions are projecting is that in federal resources, it will bring in $25 million a year in research funds to the institution. And something in the neighborhood of $70 million would be generated from the value of jobs and taxes. It's significant."
The savings in patient lives as well as the expenses they incur seeking treatment elsewhere also are sobering. "Citizens of Louisiana are having to travel a great distance to receive treatment from an NCI-designated center," Moye says. "The cost to the state's economy is somewhere around $400 million a year from death and lost work. It's pretty staggering. The combination of that and how many citizens in the state die each week from cancer-related illnesses made it paramount to get a center here."
Economically speaking, Moye says, the consortium is a win-win situation for the state because not only will it provide better outcomes for the state's cancer patients, but it also will help diversify the state's economy and could spur new businesses based on biotechnology developed through research and clinical trials conducted at the consortium.
"One of the objectives of this center will be to put together a cancer drug discovery program, which will get technologies into the marketplace for better patient care," he says. "The revenue from the intellectual property will be big. The researchers that LSU and Tulane will be recruiting also will bring in their research dollars; they will have intellectual property and technologies they're working on. Once the technology is patented, the idea is to turn these into small companies that stay in the state."
Not all the good news is in the future, however, as medical facilities all over town have implemented new technologies, combination therapies, drug treatments and screenings that already are saving lives and easing the stress of cancer treatment. "If we look at cancer as a whole, there really is a remarkable change going on in current therapies," says LSU's Sartor. "It used to be that therapies were non-specific: surgery, radiation and chemotherapy, our triad of conventional standard treatments. That has changed. We understand both their capabilities and limitations to a greater degree. The field is going to more targeted methods of drug, radiation and chemotherapy."
Technologies for delivering radiation to kill cancer cells, for instance, have improved to a point where they can be used with unprecedented precision and much less damage to healthy tissues surrounding the diseased cells. One such modality is the intensity modulated radiation therapy (IMRT).
"It allows us to vary the intensity of a radiation beam throughout the treatment area, to pinpoint the radiation on the tumor and where we want it, but to spare the healthy tissues as much as possible." says Dr. Troy Scroggins, chairman of the department of radiation oncology at Ochsner Cancer Center. "It will allow you to almost wrap your dose of radiation around a nerve in the back, for instance, without hurting the nerve or the spinal cord. It also allows us to go to a higher dose of radiation, which we hope will help with cure rates and better outcomes."
IMRT can be used to irradiate all types of tumors, but isn't always the best available treatment for a specific patient. Another targeted treatment at Ochsner is brachythreay, a radiation implant that sits next to the cancer site and emits radiation that kills the tumor.
"We were the first in New Orleans and the area to start using brachythreay for prostate cancer," Scroggins says. "With that system we take small seeds, about the size of a grain of rice, and place them inside the prostate gland and it treats the cancer. It is really useful in patients who have localized, early-stage prostate cancer." It isn't recommended, however, for patients with very aggressive tumors, high-stage cancer or an overly enlarged prostate. The implanted radiation also is used to treat breast cancer in some patients and can reduce the six weeks of daily external radiation treatments to a little as a week, he says.
A third targeted radiation treatment offered at Ochsner is stereotactic radial surgery, used to treat brain tumors and abnormalities in the head. This radiation delivery system allows doctors to pinpoint the radiation to within about 2 milimeters of the target region. The gamma knife technology, offered at other insitutions in the city, also treats brain tumors with less damage to surrounding tissues by focusing gamma rays on the tumor and avoiding conventional intrusive brain surgery.
"Using multiple angles of modulated radiation therapy (IMRT and gamma knife), we can treat patients that otherwise were not possible with less morbidity," says Sartor of LSU's cancer center. "Now they might be able to have an alternative that damages normal tissue to a less extent and controls the tumor better. Less toxicity and more specificity is where we're seeing the whole field of oncology today. We have seen the future with this targeted and controlled therapy."
Dr. Jyotsna Fuloria, a gastrointestinal oncologist at Ochsner, says researchers in her department currently are involved in clinical trials for novel therapies, such as one for lymphoma patients who have relapsed after conventional treatment. In that project, doctors remove tissue from the patient's lymphoma and have a tumor-specific vaccine made that should defeat the cancer once the vaccine is reintroduced into the patient.
Her group also is looking at new oral therapies for colon and breast cancer that seek to inhibit cancer growth and spread without the need for repeated IV treatments. Another benefit of modern medicine, Fuloria says, is that doctors now have a better regimen of medications to handle problems stemming from the treatments themselves.
"What is different today from the past is that we have a lot of good, supportive care measures available," she says. "People are able to take the same treatment with much less problems ... because of better nausea medications, more liberal use of therapies that bring up hemoglobin counts and give the patients more energy and less problems with blood counts going down and infections."
All the doctors agree that prevention, such as not smoking or consuming large amounts of alcohol, and early detection can be key to surviving cancer. Again technology is stepping up to the plate, with more sensitive and comprehensive imaging technologies and screening techniques giving doctors a jump on early treatment. Technology such as electron beam tomography, which gives doctors a three-dimensional view of organs and arteries in the torso area, and PET give oncologists reviewing the scans a view of where and how big cancer clusters are and, in some cases, whether it has spread to other parts of the body. These scanning techniques are non-invasive and could become regular health-screening tools in the future.
On the drug front, medications are being developed and tested constantly in search of alternatives and improvements to conventional treatments. Targeted therapies such as the drug Gleebec are delivered orally and, according to Sartor, have put people in complete remission for at least one type of leukemia. While these new treatments are giving doctors hope that they can save more patients, researchers are working behind the scenes to better understand the biology and pathology of the myriad cancers and ways to help the body battle diseased cells, including gene therapies that use adult stem cells to correct tendencies toward tumors.
Other treatments such as monoclonal antibodies, retinol acid therapy and others also are being found to place cancer patients in remissions. "In terms of some of the targeted therapies ... we now have a new series which are able to induce fairly dramatic remissions without the side effects of chemotherapy," Sartor says. "Some of these things would have been undreamed of two decades ago."
Equally important, doctors say, is improved early detection with kinder, gentle screening processes such as virtual colonoscopies, new techniques for finding cervical cancer, spiral CT scans to detect lung cancer and other innovations.
With the advent of the Louisiana Cancer Research Consortium, both what we know about cancer and the weapons we have to fight it will only grow.
"With both universities being able to to coordinate new therapies and foster their development, we feel we can differentiate what is being offered in New Orleans with the rest of the region.
"It's a tremendous economic opportunity not only in lives saved -- dying from cancer is very expensive -- but also in terms of the research that will garner support. It also will help to reverse our brain drain in education ... so people who are highly proficient in what they do seek out New Orleans to come and raise their families."
- Biotechnology advances are producing a range of medications to combat cancer, adding another weapon to doctors' traditional arsenal of surgery, radiation treatments and chemotherapy.