Kadlec Tri-Cities Cancer Center

By: Carl Berkowitz, TCCC Volunteer

In 1993, the Tri-Cities Cancer Center (TCCC) Foundation was founded, followed in 1994 by the opening of the Cancer Center thanks to the hard work and dollars raised by many Tri-City individuals and organizations. There was a need in eastern Washington not only for a radiation oncology treatment center, but an organization that could provide ancillary support for patients and community educational programs. The tradition of giving that started the Center continues today through the work of the TCCC Foundation, a non-profit 501(c)3 organization that works to help provide these and other services at no cost to individuals and families who are affected by cancer.

Presiding over the TCCC Foundation Board this year is Julia Hamrick, who is both president of the Foundation and a volunteer at the Cancer Center. As a former project manager, Julia brings many skills to her responsibilities as a Board member and a volunteer.

Julia was introduced to the Cancer Center via Cindy Caldwell, with whom she was creating necklaces, earrings and other bead art sold at fund raisers for charitable organizations in our community. One event Cindy wanted her to participate in was the Cancer Center’s ‘Autumn Affair’ (note: this year’s Autumn Affair will be held November 9th). Of her introduction, Julia says “I immediately liked the people putting this event together, but didn’t see myself becoming more involved at first.” She later bumped into Cindy at Walmart, who then asked if she’d like to join the Foundation Board.

Julia just couldn’t say no, and she now says she’s glad she didn’t. “Being somewhat of an introvert, I was initially taken back by the fundraising aspect of the Foundation.” But she became increasingly supportive of this and other activities as she learned more about the services they support. Julia notes frankly that fundraising is not for everyone, but it’s critical to the success of the Foundation and many of the Cancer Center activities. She feels that fundraising has nothing to do with ‘me’ and that it’s all for the Cancer Center. And as long as she’s asking for something she believes in (the Cancer Center), she’s OK with it, saying that “fundraising has nothing to do with you and everything to do with what touches people’s hearts.”

Julia pointed out that there is more to Foundation activities than fundraising. Through the Foundation’s Guild and the Men’s Club, members provide physical support for many of the Cancer Center activities including manning booths, helping with parking or displays at public events and decorating the Center for holidays. There are also a number of ad hoc committees for special activities. A key role played by every Foundation member is serving as TCCC ambassadors to the rest of the community. Today, after several years of participating in Foundation activities, Julia feels the Foundation sets a gold standard for charitable organizations in the Tri-Cities, citing the integrity of the organization, how they operate, and the support the Foundation receives from the community.

One of Julia’s desires is to expand the area served by the Cancer Center. In particular, she’d like to see screening activities, educational programs and other resources offered to a larger geographic area than is now the case “While radiation treatment of course has to be done on the campus, many of our other activities might be expanded to individuals living further out.” And as a Board member, she’s always looking for future Foundation Board members who have needed skills in areas including finance, communications and who are just generally plugged into other community organizations that can support Foundation activities. While the officers define long term goals and strategies, Julia is quick to note that “We can’t have all ‘vision people’ or all ‘worker-bee’ people. We need a mix of both.”

Since retiring five years ago, Julia has found time to participate in a number of other non-presidential activities throughout the community. She still does hands-on work with the Cancer Center’s Autumn Affair Auction, is a Monday morning volunteer at the TCCC Resource Center, and helps at the Kennewick Food Bank. Asked during our February interview if any special non-presidential, non-volunteer, non-TCCC events are coming up in her own life, she shared the excitement of an upcoming trip to Israel and Jordan with husband Doug and fellow church members, after which she and Doug plan to explore warm, sunny Sicily.

To learn more about Foundation activities, contact Julia Hamrick, Foundation Board President by calling the TCCC Foundation office, (509) 737-3413, or foundation@tccancer.org

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC

A healthy diet can help prevent against colon disorders. Risk factors for colon cancer include obesity, physical inactivity, heavy alcohol consumption, and a high intake of red and processed meats. The American Cancer Society reports that the links between diet, weight, exercise and colorectal cancer risk are some of the strongest for any type of cancer. In fact, an estimated 50 to 75 percent of colorectal cancer can be prevented through lifestyle changes according to the Colon Cancer Foundation. Colorectal cancer can be prevented, and here are the top six gut-healthy habits to get you started!

1. Limit red meat consumption to no more than two 4-oz portions each week, and limit processed meats to an occasional treat.

2. Decrease added sugars in your diet to less than 10% of total daily calories (around 25 g for women and 38 g for men per day) to help keep yourself at a healthy weight.

3. Increase your fiber intake to 25-35 g per day by increasing your intake of fiber-rich fruits and vegetables, whole grains, and legumes. Fiber aids colon health by preventing constipation. This can lower your risk of developing hemorrhoids and small pouches in your colon that can lead to diverticular disease.

4. Drink your milk! Studies show calcium and vitamin D may decrease risk of colon cancer. Other dietary sources of calcium include spinach, kale, and collard greens. Try to get between 1000-1200 mg calcium per day. Vitamin D can be found in fatty fish, cheese, and egg yolks as well as from the sun. Many foods like orange juice, cereal, bread, and some yogurt brands are also fortified with vitamin D.

5. Make at least half of your daily grains whole grains. Some readily available whole grains include barley, quinoa, whole wheat flour, wild and brown rice and oatmeal. These foods contain more vitamins, minerals, fiber, essential fatty acids, antioxidants and phytochemicals than refined white grains.

6. Limit alcohol consumption. Minimize alcohol intake to one drink per day or less.

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC

A common theme in cancer care is the earlier we can find it, the better our chance of curing it. Colorectal cancer is no exception. Unfortunately, early stage colon or rectal cancer has no symptoms. Therefore, we have to use some simple tests to find it. When you consider it is the second leading cause of cancer-related deaths in the United States, it appears those 50,000+ deaths annually were avoidable if we could have diagnosed earlier.

Who needs to be screened for colon or rectal cancer? Everyone who identifies with any of the following:
√ Age 50 years to age 75 years
√ Close relative with colorectal cancer
√ Personal history of colorectal adenomas, Crohn’s Disease or ulcerative colitis
√ Personal history of ovarian cancer
√ Familial adenomatous polyposis

All of these risk factors increase if you add excessive alcohol, smoking or obesity. Not only will these three elements increase your risk of getting colorectal cancer, if diagnosed they will decrease your chance of cure.

The Centers for Disease Control and Prevention recommends the following for adults age of
50 to 75 without any of the other risk factors:
√ A high-sensitivity guaiac Fecal Occult Blood Test (gFOBT) or Fecal Immunochemical Test (FIT) every year or a FIT DNA every 3 years
√ Flexible sigmoidoscopy every 5 years and a high-sensitivity gFOBT every 3 years
√ CT colonography (virtual colonoscopy) every 5 years
√ A colonoscopy every 10 years or a flexible sigmoidoscopy every 10 years with an annual FIT

If you are over 50 and you have additional risk factors, colonoscopy is the best path. The gFOBT can determine if you have a cancerous lesion with relative certainty, but its ability to identify a pre-cancerous lesion is much lower. The National Cancer Institute estimates a 60% reduction in death rates of colorectal cancer could be achieved by the use of colonoscopy when indicated.

The American Cancer Society lists the following as signs or symptoms of colorectal cancer:
√ A change in bowel habits lasting more than a few days
√ A feeling that you need to have a bowel movement that is not relieved by doing so
√ Rectal bleeding
√ Blood in the stool, which may cause the stool to look dark
√ Cramping or abdominal (belly) pain
√ Weakness and fatigue
√ Unintended weight loss

While there may be reasons other than colorectal cancer for these symptoms, any one of them should be discussed with your family physician. For those of you approaching 50, be sure to discuss this with your family physician at your next visit. If you do not have a family physician, please reach out to Trios Health, Lourdes Health or Kadlec to establish care. For those of you with a family history of colon or rectal cancer, ask your family physician when you should begin your own screening program.

For more information about colorectal cancer, visit the National Cancer Institute’s website.
http://www.cancer.gov/cancertopics/pdq/screening/colorectal/HealthProfessional/page3

For colorectal cancer information in Spanish:
http://www.cancer.gov/espanol/recursos/pdq

By: Carl Berkowitz, TCCC Volunteer

The prostate is a small organ located underneath the bladder and in front of the rectum in men that produces seminal fluid. It is also the site of one of the most common cancers among men. Approximately 160,000 men will be diagnosed with prostate cancer in the United States in a year, and 30,000 men will unfortunately succumb to their disease. The good news is that many cases of prostate cancer are curable if caught early.

One common treatment option is ‘external beam radiation therapy’ (EBRT), in which beams of radiation are focused on the prostate gland and surrounding areas from outside the body. While already effective and reasonably well tolerated, a relatively new technology has increased the safety of EBRT and can decrease long-term side effects.

Tri-Cities Cancer Center radiation oncologist Dr. Juno Choe says, “If I was going to have external beam radiation therapy for my prostate, I’d want to have the SpaceOAR gel placed prior to radiation”. He described SpaceOAR as a relatively new technology that physically separates the rectum and prostate gland during radiation therapy. This results in significantly lower radiation doses along the rectum, and this results in a decrease in associated side effects.

Images showing spacing between prostate and rectum with SpaceOAR gel. From https://www.spaceoar.com/physicians/

Results from a multi-clinic, randomized study of 222 men concluded the SpaceOAR technique was “…associated with low toxicity rates and a reduction in patients experiencing declines in bowel and urinary quality of life.” In fact, patients who received the SpaceOAR hydrogel product had declines in bowel, urinary, and sexual quality of life at a rate that were one-eighth of the amount in the control group. To which Dr. Choe notes that “Anybody getting external beam radiation should strongly consider the SpaceOAR hydrogel product as a supplement to their treatment.”

TCCC has all of the special equipment needed for this procedure. SpaceOAR can be inserted under local anesthesia, and it takes about 20 minutes to place. “We’ve found the gel insertion procedure to be relatively straightforward and painless” Dr. Choe says, and that the worse part of the procedure for his patients is a pinprick sensation that lasts for a couple of seconds as a numbing agent is injected. His patients then describe a short-lived sensation of pressure in the rectum as the gel is inserted which he explains “…results from a gentle pressure on the rectum. Our patients say this sensation of pressure usually dissipates almost immediately but may last a couple of days.”

Dr. Choe notes that “we’ve done a number of SpaceOAR insertions at the Center, and we have been pleased with both the relative ease of the insertion procedure and the separation achieved between the prostate gland and rectum. Patients have been very  happy with their radiation treatments with the use of the SpaceOAR hydrogel, and we have seen a very favorable side effect profile afterwards. ”

1 Int J Radiation Oncol Biol Phys, Vol. 92, No. 5, pp. 971 – 977, 2015

By: Carl Berkowitz, TCCC Volunteer

The Gleason Score
There was concern in 2012 when Terry Warnick’s Prostate-Specific Antigen (PSA) levels went slightly above the ‘normal’ value of 4.0 ng/mL. But then his count went down. Then back up. Then down. This up-down cycle continued through 2015 when his PSA levels not only went up but stayed up followed by a biopsy to understand what was going on. The pathologist who examined the biopsied samples looked for two types of cell patterns known to be associated with prostate cancer, giving Terry a ‘Gleason Score’ of 3+3. Because the sum of these two numbers was less than seven, it was recommended that a watch-and-wait protocol be followed, with Terry’s PSA levels to be closely monitored on a regular basis.

Eventually Terry’s PSA levels climbed up to nine, well above the normal value, and another (his third) biopsy was done in 2017. This time Terry had a Gleason Score of 3+4, at which time Kadlec Clinic urologist Dr. Patrick Gavin said ‘let’s take action.’

The action started with Terry meeting Tri-Cities Cancer Center oncologist Dr. Juno Choe to learn what treatment options were best suited to his specific case. There were many options, but Terry says “Dr. Choe gave me a full hour of his time, educating me about what therapies were available, and clearly describing the pros and cons of each one.” They settled on radiation therapy, but with a new twist.

SpaceOAR enters the discussion…
Treatments of prostate cancer had come a long way since Terry’s father was treated with multiple implants of radioactive seeds during his last 15 to 20 years of life (he passed away from another condition). Dr. Choe told Terry that a new technology, ‘SpaceOAR’ had recently been introduced as a state-of-the-art treatment and he’d found that this supplement to radiation treatment greatly reduced the discomfort commonly associated with radiation therapy of the prostate. As Dr. Choe explained it to Terry, the SpaceOAR gel acts as a spacer, pushing the rectum (which is the ‘Organ At Risk’ in ‘SpaceOAR’) away from the prostate. This added space greatly reduces the exposure of the rectum to radiation as the prostate is treated, with a corresponding reduction in undesirable side effects.

Terry decided to give SpaceOAR and radiation therapy a try, and says he’s glad he did. “The discomfort associated with insertion of the SpaceOAR gel was nothing compared to the three biopsies I’d already had. There was a pinprick as Dr. Choe injected a numbing compound followed by a short-lived feeling of fullness as the spacer gel was inserted.” Terry’s radiation treatment started two weeks later. Post treatment, he noted some tenderness on his hip (where the beam of radiation passed through on its way to the prostate), some dryness of his skin and residual fatigue associated with most radiation therapy. But otherwise, he says he was symptom free, and he’s optimistic that a follow-up check this spring, after his PSA level settles down following his treatment, will result in a clean bill of health.

Asked if there were any surprises with the treatment, Terry noted that at the start of each radiation session the TCCC technicians would do a 3-dimensional x-ray scan to position the radiation beam and to check that he had an empty rectum and inflated bladder. The empty rectum was needed to minimize pressure on the prostate from behind, while an inflated bladder moved the front of this organ away from the prostate. Terry said the empty rectum part wasn’t too hard or too bad. But it was an ongoing challenge to get the timing and amount of the inflated bladder part right. “If I wasn’t fully ‘tanked up’ the technicians would send me back to the waiting area with instructions to start drinking.”

But he also joked that if he was fully ‘tanked up’ or, worse, ‘over tanked’… well, he only had to lie still on the radiation treatment table for a few minutes before relief was quickly sought!

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC

It is human nature to look for quick fixes that solve health problems and cancer has a lot of quick fix news on the Internet. But with more than 100 related, but separate, diseases that are called cancer, can there be a quick fix? This is a disease with no single cause, and what seems to be an infinite number of unique ways to avoid a ‘fix’. Instead of trying to fix cancer once it comes, let’s put energy into avoiding or preventing the disease!

Most of us have heard of the BRCA cancer genes that increase a woman’s chance of getting breast or ovarian cancer. But it is only an increase in risk; having those genes doesn’t mean cancer is a foregone conclusion. Less than 10% of all cancers are directly related to genetics and only 5% of women with breast cancer are carrying a BRCA gene. Many other factors must come into play and that is where we get into nature vs. nurture. Nature (genetics) may have given you a risk, but the choices you make can either increase that risk or nurture your cancer avoidance. There is strong evidence that healthier lifestyles and simple cancer risk reduction choices can prevent one third of all cancers in the United States.

Let’s start with healthier lifestyles. Physical activity is paramount to maintaining a healthy weight, good circulation and an efficient metabolism. On the other hand, obesity is directly related to seven different cancers. Recommendations for physical activity start at a brisk walk for 30 minutes five times a week. So find some time for that walk or any exercise. Not only will you be working towards a healthy weight, you will be improving circulation which can flush out toxins and possible carcinogens like free radicals.

Proper diet is the next best addition to a cancer risk reduction program. It’s true: a diet high in red meat is linked to colon cancer. Too much processed meat leads to increased risk of colorectal and stomach cancer. Too much alcohol can lead to liver cancer. The recommendations from the American Cancer Society, the National Cancer Institute, the American Institute of Cancer Research, the World Health Organization and many others are very clear: eat a variety of colorful, fresh whole foods, mostly plant-based proteins and stay away from sugary or processed foods.

Researchers in cancer and nutrition have identified many naturally occurring substances in plant foods with the power to defuse potential carcinogens. Some of these nutrients and natural plant chemicals can neutralize toxins before they can cause cell damage that may lead to cancer. Others can assist the body to make repairs at the cellular level. Still others may help stop cancer cells from reproducing. Even after a cell begins to experience damage that can lead to cancer, what you eat and drink, and how you live can help prevent the cancer process.

As you work to improve the amount of fresh fruits and vegetables in your diet, the question of organic vs non-organic selections may come up. We hope you can choose well but if buying organic is a challenge please consider The Shopper’s Guide to Pesticides in Produce™ published by The Environmental Working Group. The guide lists certain foods they call the “dirty dozen plus two” (non-organic fruits and vegetables with the highest amount of pesticides) and the “clean fifteen” (non-organic fruits and vegetables with the least amount of pesticides). The EWG’s Guide is available at http://www.ewg.org/foodnews/summary.php

Next on the list of cancer risk reduction is to simply avoid carcinogens. Too much exposure to UVA & UVB rays causes skin cancer so wear your sunscreen or cover up. Tobacco products are carcinogens so quit smoking or chewing and avoid second hand smoke. Some viruses cause cancer so consider vaccinations (HPV and HepB).

Finally, stay current on the screenings used to detect cancer. Without exception, cancer is most treatable (and curable) in the early stages. Your Tri-Cities Cancer Center offers multiple free or low cost screenings every year for breast cancer, cervical cancer, skin cancer and lung cancer. We also offer free fecal immunochemical tests for colorectal cancer- just stop in and ask! It’s a do-it-yourself kit for those who aren’t ready for a colonoscopy. For a quick look at cancer screening guidelines go to: https://www.cdc.gov/cancer/dcpc/prevention/screening.html

For more on the link between diet, physical activity, weight management and cancer we recommend information from the American Institute of Cancer Research (www.aicr.org). There you will find interactive tools to assess what you can do to reduce your cancer risk of occurrence or re-occurrence.

To see if you are at a healthy weight, check your body mass index (BMI). See what your BMI is and other ways to evaluate healthy weight at: https://www.cdc.gov/healthyweight/assessing/bmi/index.html

By: Lindsey Josephson, Naturopathic Physician, TCCC

According to a recent survey by U.S. News & World Report, 80% of New Year’s resolutions are abandoned by February. There are a number of reasons for this staggering statistic, but here are a couple strategies to help you beat the odds this January:

1. Small changes sustained over a lifetime will have far more impact on your life and well-being than a mad rush to do everything “perfectly” for the duration of January.
2. If you fail to plan, you plan to fail. This means breaking down your goal into actionable steps you can take every day.
3. Make your goal specific. This allows you to know if you are on track to achieving that goal. One of the most common goals every new year is to “get healthier”. While everyone wants to be healthier this is a goal you can never achieve. If you get more specific, however, you can achieve it. So a goal like “quit smoking”, or “eat fish twice per week” will make you healthier if you follow through on it.

With those things in mind, I would like to propose some small, measurable goals that can go a long way to improving your health with little or very little effort. Also, remember that while the New Year is a very popular time to enact new positive changes you can actually adopt positive lifestyle habits at any time of year, so once you have gotten into the habit of one of these changes you can start another or make a new change that’s all your own.

1. Increase your vegetable intake by one serving every day.
2. Increase your water consumption by 8oz (1 cup) every day.
3. Take three deep, calming breaths every day.
4. Go for a five minute walk after lunch every day. If you already exercise regularly, try increasing your exercise by five minutes every day.

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC and Ambassador, American Cancer Society Mission: HPV Cancer Free

As some of you may have heard, a three dose regimen of the HPV vaccine has been approved by the FDA for adults from 27-45 years of age in October 2018. Prior to this, the vaccine in a two dose regimen was approved for children from ages 9-14 and a three dose regimen for those from age 15 through 26. So what does this mean? Should every adult under the age of 45 who has not had the HPV vaccine run out and get it?

The FDA approval was based on a 3.5 year study of 3200 women ages 27-45. The study showed the vaccine was 88 percent effective in the prevention of HPV infection and the various disease states related to the virus such as genital warts and precancerous cervical lesions. But FDA approval is a far cry from a public policy or medical professional recommendation.

According to the CDC, every year about 14 million Americans become infected with HPV; about 12,000 women are diagnosed with, and about 4,000 women die from, cervical cancer caused by certain HPV viruses. Additionally, we know HPV viruses are related to several other forms of cancer affecting men and women. Thus, a vaccine that can prevent an infection that could someday lead to a cancer is a good thing, but it may not be a necessity for every adult over the age of 26.

We await the recommendations for this vaccine from the Centers for Disease Control, the American Cancer Society and the United States Preventative Services Task Force. At this time, any decision regarding the use of this vaccine in the adult population should begin with a discussion with your family physician. Some people may find it would be prudent, others may find it unnecessary. In all cases, it may not yet be covered by insurance and will be an out-of-pocket expense. We recommend in this case, a conversation with your health care provider.