A Holistic Approach to Cancer Treatment
Published on 17 June 2016
The following is an excerpt from "A Holistic Approach to Cancer Treatment and Research," featured in the spring 2016 issue of Script.
Understanding Cancer with a Personalized Approach
With 1,685,210 new cancer cases expected to be diagnosed in 2016, according to the American Cancer Association, the necessity to expand our knowledge of cancer biology to improve treatment is undeniable. Simply learning more about the biology of cancer is not enough; it is only one piece of the puzzle. An emphasis on interdisciplinary collaboration on cancer research and treatment has led to a more holistic understanding of every step of the cancer research and treatment process. A closer look at the current clinical practices and the discovery research that paves the way for future treatments provides a clearer view of how interdisciplinary collaboration affects cancer treatment from the beginning stages of research to the clinical manifestation of those discoveries.
As health care providers move toward a more team-based approach to cancer treatment that focuses on the patient’s physical, mental, and spiritual needs, research organizations are following suit. The National Cancer Institute has recently implemented an initiative to foster collaboration among researchers from different disciplines to attract new investigators. From interdisciplinary care and targeted drug therapies to basic research on neuron degeneration, the interdisciplinary team-based approach becomes an ever-present guiding light to treating cancer now and in the future.
Janelle Mann ’09, Pharm.D., BCOP, is the clinical oncology pharmacist for an interdisciplinary team at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. "Physicians lead the team, but there are so many additional players in the process," Mann explained. "It’s about treating not only the cancer but the patient as well." Social workers assist patients with the social and economic barriers to cancer treatment, such as answering questions relating to insurance or financial issues and addressing practical challenges within the continuum of care. Personalized care and management are addressed by the nursing staff and health care practitioners through routine visits and daily phone conversations. "I enjoy my ability to provide support to the team through medication recommendations and patient education," Mann said. “As a team, we have the patient in the front of our mind, and together we can provide enhanced patient care.”
Hitting a Moving Target
Looking at patients as a whole becomes increasingly important when other disease states are present, such as high blood pressure, heart disease, or diabetes. The potential for drug interactions makes recommending medications for cancer treatment feel like hitting "an ever-moving target," Mann said. "I need to consider the patient’s current cancer treatment recommendations along with other therapies treating their high blood pressure, diabetes, and heart disease. All of these medications need reevaluation. I also evaluate whether current maintenance medications contribute to changes in the lab work assessed prior to each treatment," explained Mann.
Recommending medication becomes a constantly evolving process. "Ongoing evaluation puts pharmacists in a good position to recommend therapies that will help reduce side effects or harmful drug interactions," Mann detailed. “Pharmacists can help coordinate care and management among their patient’s numerous specialty physicians and primary care provider. Being up to date on pharmacotherapy and disease state management, along with a knowledge of oncology pharmacology helps to bridge the specialty arena with primary care.”
With the ability to perform additional genetic testing of a patient’s tumor, the opinion on how different cancers should be treated is changing. "Traditionally, patients with lung cancer were treated one way and patients with breast cancer were treated another way," Mann described. "This approach is no longer the best direction for treatment. We need to look at the tumor itself, check the markers, and consider what the drivers are for the patient’s tumor."
A less restricted approach presents many treatment options, creating a challenge for the pharmacist. "I now have to think about the medications in terms of what mutations does it target, what disease states has it been studied in, and how to marry those two together," Mann explained.
Unlike traditional chemo treatments that affect all fast-growing cells, another class of drugs called targeted agents are being introduced into therapy regimens. "There has been encouraging advancement with new drugs in oncology, but it’s changing how you practice," Mann said. Advancements in tumor genomics continue to change the landscape of oncology and push the development of nontraditional drug therapies and treatments.
As part of an interdisciplinary team that conducts human trials for drugs coming from bench research, Mann is able to learn early on how to manage the toxicities of these new drugs. "Working with these drugs in the trial phase, and seeing them progress into the market, we’ve nearly developed a protocol to manage side effects," Mann explained.
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