A Message from Our CEO: Fighting for Our Practice Partners’ Financial Survival in 2022

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As the sun sets on another year dominated by an evolving and unprecedented global pandemic, we find ourselves on the threshold of what promises to be another year of familiar challenges. To address them, American Oncology Network (AON) will leverage the many lessons learned from our experiences clearing the hurdles presented by 2021 while maintaining focus on our primary mission of ensuring our partner practices can continue providing patients with top-quality care.

In fact, despite the ongoing challenges of COVID-19 and the changes it has necessitated to the practice of oncology and the healthcare industry, AON realized several milestones over the past year. We’ve grown to more than 100 physicians in 16 states and expanded both the clinical trials underway within AON sites and the volume of non-oncology infusion services offered by many of our practice partners.

These are just a few of the ways AON is continuing to help keep community oncology viable so that patients have access to affordable yet high-quality care close to home – a commitment that takes on greater significance as we gear up for another battle against a round of cuts to Medicare physician reimbursements that will take place in the spring without additional action by Congress.

Cuts Delayed, But Not Gone

While recent action by Congress has given providers a reprieve from what would have been financially devastating reimbursement cuts totaling 9.75%, it could be short-lived. That’s because the legislation passed in mid-December only extends until April a moratorium on the 2% Medicare sequestration relief originally mandated by the Budget Control Act of 2011 and in effect since 2013 – cuts that had already been delayed three times due to the pandemic. A 1% sequestration cut (which will impact both Traditional and Managed Medicare) will be in effect from April thru June 2022 with 2% going into effect the remainder of the calendar year.

The package, which is now with President Biden, also prevents a 4% cut due to statutory budget rules known as “PAYGO,” which require Congress to pass legislation in a deficit-neutral manner or automatic sequestration is triggered at the end of the year. It also offsets a rate cut finalized in the Medicare Physician Fee Schedule final rule from November that was originally slated to happen due to the expiration of a temporary across-the-board increase previously authorized to partially offset cuts triggered by the 2021 MPFS Final Rule.

It’s important to note that the fight is not limited to the pay cuts. Should the temporary rate increase to lessen the blow of the 2021 MPFS Final Rule be allowed to expire, the Centers for Medicare and Medicaid Services (CMS) will factor that into the conversion factor as outlined in the 2022 MPFS proposed rule lowering reimbursement by 3.75%. Further, the 2022 Medicare Hospital Outpatient Payment System and Ambulatory Surgical Center Payments Systems (HOPPS) proposed rule included the mandatory Radiation Oncology Model (ROM) would lower physician reimbursement rates and create uncertainties that will negatively impact providers and patients.

A Voice for Community Oncology

While the current delay is certainly reason to celebrate, the fight is far from over. AON will continue to do everything in our power to ensure the voice of community oncology is heard in the push for Congress to take action to prevent what will be a devastating 9.75% cut in Medicare physician pay from taking effect in April.

We encourage practice leaders, physicians, and the entire AON provider network to join us by contacting their senators and requesting that the necessary action be taken to protect reimbursement rates. Addresses and phone numbers can be found here.

Winning this fight will protect community practices from a potentially devastating financial blow that could have long-term implications for the scope of care they’re able to provide to their patients.

Celebrating Veterans Day: An Interview with Dr. Jonathan Sharrett

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November 11 is Veterans Day, celebrating America’s military veterans, their service and the contributions they’ve made to the nation’s well-being and ensuring its freedom. According to the United States Census Bureau, there are currently about 18 million veterans in the US, with service experience ranging from World War II to Afghanistan.

In honor of the holiday and to help celebrate the nation’s veterans, we spoke with Jonathan Sharrett, DO, a Board-certified radiation oncologist with Summit Cancer Centers, an American Oncology Network partner, and Spokane CyberKnife. A military veteran, Dr. Sharrett enlisted into the US Armed Forces after high school and served from 2002 through 2008. He deployed twice to the Middle East in support of Operations Enduring Freedom and Iraqi Freedom, was a member of the Honor Guard and a military fitness instructor. 

During his service, Dr. Sharrett’s grandmother lost a courageous battle with Stage IV breast cancer and his mother beat Stage IV Burkitt-Like Lymphoma. These events shaped the trajectory of his life, as his purpose and mission quickly evolved into a career in medicine.

After leaving the military, Dr. Sharrett earned his medical degree from Edward Via College of Osteopathic Medicine and completed his residency at Cleveland Clinic before joining Summit Cancer Centers and Spokane CyberKnife. In this interview, he speaks about his path to radiation oncology, his military career, the importance of service to him and his family, and how the military has helped his medical career.

Was medicine a consideration when you joined the military?

Not one bit. I grew up in a trailer park in a small rural town in east Tennessee. No one in my immediate family worked in medicine or had more than a high school education. My family was very patriotic, though. My dad was in the Army, my brothers were in the Navy, and I had uncles who were infantrymen in the Marine Corps who served in World War II in the Pacific Theater (Iwo Jima and Saipan). I was patriotic too, so when 9/11 happened, I was all about the military. That was it; it changed everything for me.

Regarding your decision to go into medicine, specifically oncology, what factors got you here?

My grandma was diagnosed with Stage IV breast cancer when I was still in high school. Then, while I was deployed in the Middle East, I found out my mom had Stage IV aggressive lymphoma. I already had a powerful interest in fitness and nutrition and their diagnoses made me want to learn even more about the body, so I started down the healthcare path as I was on my way out of the military. I thought about being a dietitian at one point, and I was already a personal fitness instructor for military professionals and a personal trainer. But I soon realized I knew more than I thought and considered being a nutritional biochemist. Then, at some point, I said ‘you know what? I’m just going to be an oncologist.’

My dream was to be a medical oncologist. But in my third year of medical school, I met a radiation oncologist who said, ‘why don’t you come hang out with me.’ The next thing you know, I was visiting MD Anderson and Emory University in Atlanta for clinical rotations, and I found myself on the path to radiation oncology.

But first and foremost, it was driven by my family.

Did the discipline you acquired in the military help you through medical school and now in practice?

Absolutely. The military – the discipline, attention to detail, focus, and challenges you face – created an environment where nothing could faze me. The setting helped me interact well with people from different backgrounds, be rational, and maintain level-headedness. I started out training in the bomb squad (Explosive Ordnance Disposal), which meant I had to dedicate time to studying and preparing and, for obvious reasons, I had to be exceedingly disciplined. While I ultimately decided that was not the job for me, the intense training definitely set the standard for how I would approach future endeavors. The military also gave me a sense of confidence in myself that I didn’t know I had. All of that had a significant impact on my ability to stay hyper-focused through medical school and the other tough challenges I encountered along the way.

What do you love most about radiation oncology?

I love the opportunity to help people by drawing on multiple facets of my life – not just as an oncologist. For example, because of my personal experiences, I understand the patient journey. My mother had a lot of questions about her cancer that didn’t get answered, my grandmother too. Many people are confused about their care, so when I walk into the room to see a patient, I want to know how I can maximize that interaction and make a difference in their life, whether I end up treating them or not. Even if it’s not related to cancer, I enjoy going in every day and having that mindset of wanting to help make someone’s life better or help them through this process that they’re going through. This is my anchor – helping people. And that’s what I love about it.

What accomplishments are you most proud of?

Going through the whole process of getting out of the military, going back to school – especially coming from a small town – and going to a small medical school. That’s all extremely important to me. Also, going to Cleveland Clinic for training and completing the journey of becoming Board-certified were significant accomplishments and I’m proud of them. However, most importantly, I’m proud that my parents are proud of me, that they are still alive to see the success I’ve had, and I can remind them that I wouldn’t be where I am today without their love and support throughout my life. It makes me happy to know they can see the fruits of their labor.

What have been some of the main challenges in your journey from military to medicine?

The biggest challenge moving from the military to civilian life was the loss of the camaraderie and brotherhood that you have in the military. It’s not the same out in the real world. Veterans yearn for that kind of sense of belonging. Your military colleagues understand what you did, where you came from, and what you sacrificed for the country. They get the loss and understand the emptiness of not having that interaction. It’s challenging to recapture that out in the real world. It’s almost like what you might feel in highly functioning/competitive athletics or when playing on a team – the team bond – where everyone has a defined role and works hard for each other and not just their own interest to accomplish the goal at hand. That’s hard to replace. The structure the military provides in one’s life is also very important and just not the same out in the real world, although some medical settings do come close.

The closest thing I came to that so far was during my training in radiation oncology at Cleveland Clinic where just the teamwork and esprit de corps was close. It made me feel almost like the military again, because they were demanding and had high expectations like the military, but also very supportive and had your back and refused to let you fail. I think that’s one of the reasons why Cleveland Clinic is such a great place. Lack of camaraderie and structure is a challenge for many veterans as well.

What message would you share with a student whose finishing high school and thinking about the military or medicine?

I would tell them that the military is a fantastic experience. It gives you a sense of identity, purpose, teamwork, and pride in where you’re from. It gives you opportunities to leverage what they offer to then launch into whatever you want to do in your life. It provides individuals with a lot of good structure and discipline that can benefit their lives.  I would highly recommend military service to almost anyone coming out of high school, especially those uncertain about what they want to do with the rest of their lives.

Are there any mentors that you’d like to note for having helped you through your career?

I had so many along the way! One who was most important was my calculus teacher in high school, Coach Thompson. He was a significant mentor when I was starting to excel in school. He saw that and mentored me and helped me through. We stayed in touch while I was in the military and when I would go back to Tennessee, we would go to Tennessee football games together. He gave me the sense that I was worth more than I thought. After the military, a great mentor of mine was the chairman of the Department of Radiation Oncology at Cleveland Clinic, Dr. John Suh. And, of course, my dad!

How would you like people to recognize Veterans Day?

Try to take a step back and see, from their perspective, the sacrifice veterans make for our country and what they’ve been through. A sad thing is the impact of veteran suicide and those who are on the streets and homeless. What happened? How did they get there? How can we help them, support them, and be there for them? They gave a lot for our country. They should be acknowledged and supported on more than just Veterans Day.

We should find ways to uplift them and help them feel part of society when they come out of the military. It’s a big thing, because many of these servicemembers are leaving Iraq, Afghanistan, and military service in general with understandable mental health concerns, and other physical ailments and health-related issues. How they integrate back into civilian society is so important, so being compassionate and empathetic and finding ways to help them along their journey as they transition back to everyday life is something we can all do, in some capacity, either directly or indirectly. Show them honor and respect – I’m grateful to those who already do.

Anytime I have a patient and I’m aware that they’re a veteran, I make sure that I acknowledge that. It goes a long way toward thanking them for their service to our country.

National Pharmacy Technician Day: The Integral Role of the Pharmacy Technician on the AON Care Team

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October 19 is 2021 National Pharmacy Technician Day – the ideal time to demonstrate the value these technicians bring to patients and patient care outcomes.

Pharmacy technicians play a significant role in pharmacy operations. Their contributions are numerous and allow pharmacists to stay focused on performing to their highest level possible. It’s no exaggeration to suggest that pharmacy technicians are in many ways the backbone of pharmacy operations.

The Pharmacy Tech’s Role

Pharmacy technicians can be found in many healthcare environments – retail and hospital pharmacies, practice-based pharmacies, even insurance companies and pharmacy benefits organizations – and their roles and responsibilities vary by setting.

For example, a pharmacy technician who works in the neighborhood retail pharmacy under a pharmacist’s direction will typically be dispensing medication, compounding topicals and ointments, and handling billing insurance for services. In hospital settings, technicians handle medication reconciliation, prepare and compound IV solutions, maintain and restock automated machines, dispense medicines, and conduct inventory control.

In specialty clinics like the community-based oncology practices that are part of American Oncology Network (AON), pharmacy technicians provide vital support to the clinical staff. The oncology setting is a complex ambulatory care environment where pharmacy technicians must possess the highest levels of professionalism, knowledge, and efficiency. In addition to standard pharmacy responsibilities, technicians also serve as liaison between nurses, physicians, financial counselors, and management to address drug order needs.

In addition to the tasks described above, pharmacy technicians are responsible for reviewing and performing pharmaceutical calculations for medication orders, drug admixture, inventory control, asset services, operations, education and training, informatics, quality improvement initiates, procurement, and thorough project management depending upon the setting.

AON Benefits

AON pharmacy technicians have access to Board-certified clinical pharmacists and resources that are essential to the medication preparation process, as well as support from pharmacy administrators who help guide clinic pharmacy technicians on industry best practices.

Opportunities for professional development are numerous for AON’s pharmacy technicians. For example, AON will reimburse full- and regular part-time pharmacy technicians who successfully pass the national Pharmacy Technician Certification Board Exam for the cost of the exam and recertification renewal fees.

AON also encourages its certified pharmacy technicians to pursue additional credentials through the National Pharmacy Technician Board. As the profession grows, other credentialing programs are being created, including CSPT (Certified Compounding Sterile Preparation Technician) and CPhT-Adv (Advanced Certified Pharmacy Technician).

Additionally, there are certificate programs they can pursue, such as Hazardous Drug Management, Immunization Administration, Billing and Reimbursement, and Management of Controlled Substances.

At AON, we believe training is the key to success, and success is obtainable on all levels, and our programs are second-to-none.

Partners in Care

Above all else, pharmacy technicians are partners in patient care. They take pride in the role they play in achieving the best possible outcomes and approach each interaction as if it were with their own family member. AON, in turn, provides our pharmacy technicians with the support they need to practice at the highest level. This includes providing opportunities they may not have with other organizations.

Pharmacy technicians are valuable members of the care team and pharmacy operations as a whole. Which is why AON is proud to celebrate National Pharmacy Technician Day and recognize their unwavering commitment to excellence.

Cancer’s Impact on Mental Health

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Cancer is hard – physically and emotionally. The diagnosis alone can trigger fear, uncertainty, and stress, all of which can be exacerbated throughout prognosis discussions, treatment decisions, procedures and just managing the normal activities of daily living with this dark shadow lurking in the background.

Anxiety is also part of the mix, even when a patient moves out of treatment and into survivorship. Undergoing scans to monitor for possible recurrence. A health change even years after getting the “all clear.” Annual physicals with their primary care physician.  All these situations can trigger the same overwhelming emotions the patient felt throughout their initial battle with cancer.

For some, cancer feels like a life sentence that carries an enormous emotional penalty. Which is why supporting a patient’s mental health needs is an important component of a comprehensive care plan.

Mental Health Challenges

A cancer diagnosis and subsequent treatment can bring forward several mental health issues, the most common being anxiety, depression, and adjustment disorder. While patients who have struggled with these and other mental health disorders in the past are more susceptible, the cancer diagnosis and all that comes with it can trigger symptoms in any patient. It can also exacerbate disorders that had previously been controlled.

While most symptoms will fall on the mild end of the spectrum, they can evolve over time into something more severe and long-lasting. For example, though uncommon, some cancer patients find themselves with symptoms much like post-traumatic stress disorder (PTSD), usually resulting from a traumatic experience during treatment such as an adverse or unexpected surgical outcome.

Many patients also struggle with feelings of guilt related to their illness. Guilt could stem from thoughts about not being able to manage chores or tasks as well as before. They may also experience worry that they are a “burden” to someone else. Guilt is not always rational, but if left unaddressed it can cascade into anxiety, depression, and even anger.

Finally, it’s important to recognize that cancer-driven mental health issues can impact the very relationships patients rely on for emotional support. Feelings of guilt, despondence, detachment and even shame can take control of a patient’s internal dialogue and create distance between them and their loved ones. Again, the emotions aren’t always rational. But when someone is sick, or treatment has taken a toll on their appearance and/or stamina, it is easy to fall into an emotional hole that can overwhelm personal relationships.

Early Attention is Key

It is vital that mental health issues be assessed and addressed as early as possible in a patient’s care plan. Symptoms are not always obvious. The patient who is upbeat and positive at the clinic may be falling apart as soon as they are alone. Or the patient who starts treatment determined to beat their cancer can, over time, become hopeless or overwhelmed.

If patients in need are not given the resources to manage the internal dialogues pecking away at their emotional fortitude, it can have a domino effect that impacts treatment outcomes, long-term health and wellness, and the interpersonal relationships they need in the battle for their lives.

To make that happen, the patient’s clinical team can look for signs that they may be struggling. They can also integrate mental health assessments into their standard practice, approaching it in the same manner they do other health issues – straight forward and empathetic and without judgement. It can be as simple as inquiring if the patient is okay or letting them know it is normal and okay to not be okay – and that resources are available to help them manage their mental health in the same way resources are available to help them manage pain or nutritional needs.

At American Oncology Network (AON), those resources now include credentialled behavioral health therapists to whom patients can be referred for additional assessment and, if needed, a therapy program tailored to their unique needs. Therapists are currently available to practices in Arkansas and will soon be available in Iowa, Missouri, Louisiana, and Indiana. The Behavioral Health Team is growing, with the goal of having credentialled, licensed therapists available to patients in every state where AON has partner practices.

The Mind-Body Connection

Helping a patient with their mental health struggles can be as simple as having someone that is not on their medical care team or in their family or circle of friends who will listen to and reassure them that their thoughts and feelings are normal and understandable; someone who can give them the tools to cope with what they’re experiencing. In some cases, a patient may only require a few sessions for them to feel emotionally stronger. In other cases, more intense or longer-term therapy may be necessary, such as when a pre-existing disorder has been triggered by their diagnosis. What is important is getting the patient the support they need before it spirals out of control.

There is a strong connection between the mind and body. What impacts one will almost always impact the other. For cancer patients struggling with mental health issues, helping them get to an emotionally healthy place can change their entire outlook and empower them to withstand the many challenges they will face whatever their outcome might be.

Dispelling the Myths Around Nutrition and Cancer

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Holistic cancer care is enjoying growing popularity as the body of evidence on the benefits of treating the whole patient – the physical, emotional, and socioeconomic aspects – increases. Yet nutritional support is often overlooked in otherwise comprehensive treatment plans. It’s an oversight that can exacerbate side effects, prolong or delay treatment, and complicate short- and long-term recovery.

That is why American Oncology Network (AON) has assembled a team of highly qualified and credentialed oncology dietitians to work with its community practices on ways to integrate personalized nutrition counseling into care plans. While the program is still in its infancy, early response has been positive as patients and clinicians alike see first-hand how proper nutrition and in particular prevention of malnutrition is creating a solid foundation for successful treatment.

Why Nutrition Matters

Proper nutrition plays a vital role in how well a cancer patient responds to treatment. Not only does nutrition impact energy and stamina levels, but it can help boost the body’s response to treatment and therefore the efficacy of prescribed therapies.

An important goal of oncology nutrition is preventing a patient from becoming malnourished – which is much easier than treating malnutrition. When a patient maintains a healthy nutritional status, they are typically able to handle treatment much better. They don’t need to pause treatment or change treatment plans due to weight loss or the body’s inability to tolerate the full course. Thus, the ability to maintain a base level of nutrition from the outset of treatment sets the patient up for success and helps drive better outcomes.

Maintaining healthy eating habits can also give patients an emotional boost, especially when side effects from treatment sap their appetite or make eating a struggle, for example due to appetite changes, nausea, fatigue, or changes in how things taste or smell. By reframing how they view food into something with purpose, for example as fuel to power the body through treatment rather than simply an act to be performed, can help patients overcome some of the mental challenges which can be particularly helpful when eating is the last thing someone wants to do.

Nutrition – and nutrition counseling – can also help prevent patients from developing an unhealthy relationship with food. A handful of studies have found a relationship between a cancer diagnosis and development of an eating disorder like orthorexia, which is an obsession or fixation with “proper” eating to the point it becomes unhealthy. One theory is that patients fixate on food and nutrition to regain some of the control that cancer has taken away. Others suggest that controlling food intake becomes a way of subconsciously punishing their bodies for getting sick in the first place.

Working with oncology dietitians can help maintain a healthy nutritional status by identifying the right foods to fuel patients’ bodies. It also helps them maintain a healthy relationship with food, nutrition, and their bodies as they battle cancer.

Food for Wellness

When it comes to healthy choices from both a prevention and treatment standpoint, variety is the key, as is understanding how nutritional needs evolve over time for many patients. In general, the ideal diet for optimal nutrition consists of a wide variety of nutrient dense foods. These are typically plant-based – foods that are grown and eaten in their natural state such as vegetables, whole grains, beans, nuts, and seeds. However, during treatment or recovery, food priorities may shift to focus on adequate calorie or protein intake to promote maintenance of lean body mass and/or weight.

Along with variety and flexibility, another good rule of thumb is to eat the rainbow. Consuming foods that encompass a wide range of bright colors is an easy way to ensure the body is getting a variety of antioxidants and phytochemicals. These components also work together synergistically to help support overall health and wellness.

Adding protein to the mix supports lean body mass and muscle stores and adds calories – all of which are particularly important for patients who are undergoing treatment. Nutritional needs should be assessed periodically to ensure they are being met, and adjustments made as patients transition through treatment and into recovery.

An Important Focus

AON understands the importance of proper nutrition for cancer patients. That is why every member of its nutrition team is a Board Certified Specialist in Oncology Nutrition (CSO), a credential that was developed by the Oncology Nutrition Dietetic Practice Group together with the Commission on Dietetic Registration. A recommended minimum of two years of clinical practice with documentation of 2,000 hours of practice experience in the oncology care setting is required to sit for the certification exam – which must be retaken every five years to remain certified.

CSOs and oncology nutrition are important additions to the holistic care model used by AON’s community-based practices. A cancer diagnosis is traumatic, and treatment can be grueling. But a whole-person care plan that includes nutrition counseling can put the patient on the path to the most successful outcome possible.

Jorge A. Rios, MD Reviews Advances in NSCLC for World Lung Cancer Day

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In an interview with Targeted Oncology, Zangmeister Cancer Center Medical Oncologist Jorge A. Rios, MD, discusses recent advances in non-small cell lung cancer and the role targeted and immune checkpoint inhibitor therapy has played in this progress. Read the article.

Indy Hematology Review Convenes Nation’s Foremost Hematologic Cancer Experts to Share Insights, Advance Outcomes

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On Aug. 21, 2021, leaders in hematology and hematology malignancies will gather in Indianapolis for what has become one of the most comprehensive educational hematology conferences in the country – the 18th Annual Indy Hematology Review. I’m honored to be chair of this year’s event, which is hosted by Indy Hematology Education, Inc. and delivers to attendees a concise and practical summary of the American Society of Hematology annual meeting, including the most current hematology research and clinical practice.

It was almost two decades ago when a group of hematologists recognized a need to promote education in hematologic disorders and malignancies in the Indianapolis area. We (I was honored to be part of this group) determined that successfully meeting the needs of our community required convening a faculty that was second-to-none – regardless of where in the world they may be based. But we also wanted to ensure those experts were able to share their knowledge in an environment that made it easy for the practitioners who would most benefit from that education to integrate it into their own clinical practice.

This ultimately led to the creation of the Indy Hematology Review, where attendees hear from speakers hailing from the top universities, cancer centers and research organizations in the world, live and in-person. And, because attendance is kept relatively small compared to other meetings of this type, those physicians, nurses, and other practitioners also have the rare opportunity to interact one-on-one with these internationally renowned experts, asking questions, sharing experiences, and gaining practical tips for putting the latest research findings and clinical tools into practice.

In addition to the main Symposium, with programming for physicians, the Indy Hematology Review features a second tandem symposium for nurses and allied providers. There is even a town hall and reception at which patients can share their own case stories and ask questions of a diverse panel of experts.

The Review also offers Continuing Education – up to 8.75 Medical Knowledge Maintenance of Certification (MOC) points in the American Board of Internal Medicine’s MOC program and up to 10 Continuing Nursing Education contact hours by the American Nurses Credentialing Center’s Commission on Accreditation. Pharmacists can also earn up to 10 contact hours from the Accreditation Council for Pharmacy Education.

Among the key highlights of the 2021 Review, which features both in-person and virtual programming options, are “State of the Art: 2021 Emerging Therapies in Hematologic Malignancies,” which provides summary of all the major updates in the field, and live case reviews during the Town Hall wrap up event.

The Review will also feature “An Evening with the Experts,” an opportunity for patients, their families, friends, and caregivers to hear from nationally esteemed physicians about new scientific knowledge and advances. Among the topics to be presented are emerging therapies for blood diseases, cancers and lymphomas, stem cell transplantation and CAR therapy, surviving cancer with art therapy, emerging therapies for lymphomas, and an overview of treatments and current research in leukemia, myeloproliferative disorders, lymphoma, Waldenström’s macroglobulinemia, and myeloma. You can access more information and register here.

More information on the 18th Annual Indy Hematology Review, including the agenda, speakers and registration, can be found here. 

Expanded Therapies Bring New Hope to Lung Cancer Patients

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On August 1, Messino Cancer Centers (MCC) and American Oncology Network (AON) join the Lung Cancer Foundation of America for World Lung Cancer Day, celebrating the researchers, clinicians, and patient advocates who exemplify what “Living with Lung Cancer” looks like. We’re also raising awareness of the need for ongoing and expanded lung cancer research to continue building upon the advances that have given greater hope to patients who receive this devastating diagnosis.

Lung cancer is the third most common cancer in the U.S. It also claims more lives – both men and women – than any other type of cancer. Yet there is room for optimism, thanks to the significant advances in early diagnosis and treatment.

It was not that long ago when chemotherapy was the only real option when it came to treating metastatic lung cancer. Now, we have a broader selection of treatment tools at our disposal, which has helped improve life expectancy for non-small cell lung cancer and small cell lung cancer.

Targeted Attacks

At MCC, my practice centers around systemic therapy, where medications are given intravenously or orally and disseminate throughout the body to target cancer wherever it lurks. While chemotherapy – which attacks rapidly dividing cells – is still used in frontline treatment, we now have additional types of treatment including targeted therapy and immunotherapy.

With targeted therapies, we leverage the knowledge that certain types of lung cancer can have specific gene mutations, so-called driver mutations, that create hyper-activated protein products. As their name implies, these mutations drive the formation, growth, and dissemination of these cancers. Targeted therapies are designed to inhibit the production of these driver mutations. Doing so creates a catastrophic response that kills the cancer cells and shrinks the tumor.

Immunotherapies are another advancement that have completely reshaped how oncologists treat lung cancer. The idea of immunotherapy is decades-old, the premise being that our immune systems recognize cancers as foreign, but cancer cells evade attack by immune cells. Early attempts at overcoming so-called immune evasion involved deploying high dose cytokines to hyperactivate immune cells, but these are fairly toxic and have a very narrow scope of activity.

More recently, the molecular mechanisms of so-called checkpoints between tumor cells and immune cells that mediate immune evasion have been delineated by immunologists. This has directly led to the development of antibodies that block these checkpoints, allowing a patient’s immune system to bypass these checkpoints and proceed to attack and kill the cancer cells. Immunotherapies are now ubiquitously deployed in metastatic lung cancer with or without chemotherapy and tend to be more durable and less toxic than chemotherapy.

Advancing Science

When it comes to lung cancer therapies, MCC plays an active role in their advancement by participating in clinical trials to uncover the next cutting-edge treatment. In addition to an affiliation with the Southeast Clinical Oncology Research (SCOR) Consortium, our partnership with AON paved the way for us to become a strategic research site for Sarah Cannon Research Institute. These relationships help us bring clinical trial opportunities to more of our patients than would otherwise be possible as an independent community-based practice.

For example, researchers are looking at combining standard of care immunotherapies with a new investigational drug that could potentially boost their effectiveness. Participating in these kinds of clinical trials help evaluate effectiveness of drugs or treatment routines – and give our patients the opportunity to participate in approved and exploratory therapies without need for travel to an academic center.

It’s also important to point out that, in addition to novel therapies, palliative care is now established as fundamental to frontline care of lung cancer patients. The so-called Temel study – published in the New England Journal of Medicine in 2010 – found that early palliative care not only led to significant improvements in both quality of life and mood among patients with metastatic non-small-cell lung cancer, but actually prolonged survival compared to usual care. Early palliative care is now a standard of care in non-small cell lung cancer and a motivation for MCC’s recent addition of Dr. Joshua Baru, a consummate palliative physician, to our clinical team.

Progress and Hope

There is no question that, when it comes to the diagnosis and treatment of lung cancer, research has allowed us to move the needle on both survival and quality of life. A cure has yet to be found, but the dedication of oncologists, clinical researchers, patient advocates and patients themselves has resulted in life-altering advancements that mean a lung cancer diagnosis comes with a level of hope that exceeds what we’ve seen in the past.  

Men’s Health Month: Steps to Reduce Cancer Risks and Lead Healthier Lives

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June is Men’s Health Month and the perfect time for a refresher on some things men can do to improve their overall health and wellness, reduce their cancer risks, and improve the odds of catching some cancers in their earliest stages.

One of the most important steps is also the easiest:  see your doctor.

Annual physicals are essential to leading a healthy lifestyle. They ensure that appropriate health screenings are conducted and preventive vaccinations including the flu, shingles, HPV, and most likely COVID-19 are given. The physical is an ideal opportunity to identify potential issues and discuss concerns the patient or physician may have. It is also a good time to review factors, including family history, which can impact risk for cancers and other diseases and can guide screening decisions.

Preventative Maintenance

This year’s annual exam is especially important for those who put off seeing their physician during the pandemic – care delays that have driven an uptick in later-stage cancer diagnoses due to missed screenings and, in some cases, preventable advancement of the disease from delayed treatment.

One of these is colorectal cancer, which has seen a troublesome uptick among younger adults and is now the leading cause of cancer deaths in men ages 20-49. The alarming trend prompted the US Preventive Services Task Force (USPSTF) in May to change its stance and recommend screenings begin at age 45 and continue through at least age 75. Colonoscopy remains the preferred screening for colorectal cancers, particularly as any polyps that are found can be immediately removed and sent for testing. However, lab tests and other less invasive options are also available – but are likely to be followed by a colonoscopy in the case of abnormal results.

Prostate cancer is the second leading cause of cancer death (behind lung cancer) and the second most common cancer (behind skin cancer) in men. To promote early identification of prostate issues, the USPSTF recommends that men between the age of 55 and 69 decide about prostate-specific-antigen (PSA) testing in consultation with their physician. It also recommends against PSA testing in men aged 70 and over. Those who are at a higher risk of prostate cancer, including African-American men and men whose father or brother had the disease, should speak with their doctors about earlier screenings—in some cases by age 45. Currently, Medicare and many private insurance plans provide coverage for an annual PSA test for all Medicare-eligible men aged 50 and older.

Though uncommon, breast cancer should not be overlooked as about 1 in every 100 cases occurs in a man. The risk goes up for those with a family history or inherited mutations in certain genes such as BRCA1 and BRCA2. Age, a history of radiation or hormone therapy, liver disease, and conditions that affect the testicles (e.g., injury to, swelling in or surgical removal) can all increase the risk of breast cancer, as can being overweight or obese.

Small Steps with Big Impacts

Screenings and annual exams are important steps, but there are other steps men can take to improve their overall health and reduce their cancer risks. Maintaining a healthy weight through proper nutrition and exercise is a big one, as are limiting alcohol, getting plenty of rest and other steps that strengthen the immune system.

But all these actions pale in comparison to the impact of quitting smoking.

Smoking is the leading cause of premature, preventable death, causing about 480,000 premature deaths each year in the U.S. It harms nearly every bodily organ and organ system and is associated with innumerable malignancies – cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia.

Smoking also causes heart disease, stroke, aortic aneurysm, chronic obstructive pulmonary disease (COPD), diabetes, osteoporosis, rheumatoid arthritis, age-related macular degeneration, and cataracts, and worsens asthma symptoms in adults. And smokers are at higher risk for pneumonia, tuberculosis, and other airway infections. It also causes inflammation and impairs immune function.

Make it Happen

Simply put, the message every man should take from Men’s Health Month is to carve out just an hour each year to have that annual physical. For smokers, the primary message is equally concise: quit.

Both actions can, quite literally, save a life.  

The Benefits of Clinical Trials at Community Practices

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Clinical trials are essential to advancements in treating — and ultimately eradicating — cancer. And patient participation is key to ensuring their efficacy and accuracy.

However, patients aren’t as willing to enroll in trials as they have been in the past. One study conducted in 2020 found that 49% of respondents were willing to participate in trials, which was down from 85% in 2019. One reason could be patient education; that same study showed 36% of those polled didn’t understand clinical research very well or at all. That number was at 10% in 2019.

The best way to make patients feel more comfortable enrolling in trials is participation by community oncology practices, which allows them to take part in trials close to home and alongside nurses and physicians who they already know and trust.

Getting Trials into the Communities

About 90% of cancer patients are treated at community practices — yet most clinical trials are performed at academic institutions, where they can be accessed by only about 10% of patients. This not only limits the number of patients who can enroll, but it puts the additional burden of travel on those who do participate, especially those who live in rural areas.

By administering trials at community oncology practices such as those that comprise the American Oncology Network (AON), pharmaceutical companies can provide patients with access to cutting-edge and innovative therapies and medications in the comfort and familiarity of their local clinic.

This benefits scientists and oncologists too, as they can get a clearer picture of the efficacy of a certain medication or therapy when a large number of patients enrolls in a trial.

Addressing Patient Concerns

Before enrolling in a clinical trial, patients are put through a rigorous screening process to make sure it is safe for them to participate.

Once patients are cleared, scientists, oncologists and nurses outline the process, explaining why the design of a certain drug fits their particular case and how it may aid in their treatment. If a patient has any concerns — for example, many fear they will be placed in a placebo group — it is covered in that discussion.

Once those conversations take place and their fears fully addressed, patients are typically very willing and engaged in the trials — especially when they realize that their participation can help millions of others who are also fighting cancer.

Partnering with a Network can Benefit Trials

Some local clinics may not have the manpower, time or resources necessary to participate in clinical trials, especially clinics located in rural areas. Partnering with a network such as AON can alleviate those issues.

Whether it’s financial support or assistance recruiting the necessary personnel, AON can help lay the groundwork for a community practice to start administering trials. The network can also assist with laboratory or tech support and the implementation of any hardware or software.

Clinical research is another way community oncology practices can take better care of their patients while contributing to the body of scientific knowledge. Through these trials, oncologists can continue to learn new and innovative ways to treat cancer and provide more optimistic and successful outcomes for their patients.