Coordinating Care for Patients with Kidney Cancer by Chuck Green
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KIDNEY CANCER Coordinating Care for Patients With Kidney Cancer BY CHUCK GREEN bout 63,990 new cases of kidney cancer (40,610 in men and 23,380 in women) will occur, according to most re- cent estimates for kidney cancer in the U.S. for 2017, ac- cording to the American Cancer Society (ACS). About A14,400 people (9,470 men and 4,930 women) will succumb to the disease. These numbers include all types of kidney and renal pelvis cancers. Most people with kidney cancer are older. The average age of peo- ple when they are diagnosed is 64. Kidney cancer is very uncommon in people younger than age 45. Kidney cancer is among the 10 most common cancers in both men and women. Overall, the lifetime risk of developing kidney cancer is about one in 63 (1.6%). This risk is higher in men than in women. For reasons that are somewhat unclear, the rate of new kidney can- cers has been rising since the 1990s, although this seems to have leveled off in the past few years, stated the ACS. Part of this rise was probably due to the use of newer imaging tests such as CT scans, which picked up some cancers that might never have been found otherwise. The death rates for these cancers have gone down slightly since the middle of the 1990s. Approximately 65 percent of people are diagnosed when the cancer is only located in the kidney, reported cancer.net. For this group, the 5-year survival rate is 93 percent. If kidney cancer has spread to sur- iStock rounding tissues, organs, and/or the regional lymph nodes, the 5-year “Very often, cancer patients need to see more than one type of spe- survival rate is 66 percent. If the cancer has spread to a distant part of cialist. It’s very challenging and stressful for patients with a new cancer the body, the 5-year survival rate is 12 percent. diagnosis to coordinate and move between multiple specialists, even when they’re in the same treatment network,” stated Tykodi, also an Guiding Patients Through Care Associate Member at the Fred Hutchinson Cancer Research Center in Following a metastatic kidney cancer diagnosis, patients sometimes Seattle. are forced to wait weeks and sometimes months for appointments “There’s time wasted” waiting to schedule appointments to see with perhaps a battery of medical specialists, according to experts. multiple specialists and the anxiety from waiting for weeks, some- In the meantime, coordination of care could become lopsided and times stretching into months for a treatment plan can be daunting. confusing. By contrast, the SCCA devises an overall game plan, the goal of which is comprehensive treatment planning in one setting in a single after- noon visit, which helps circumvent delays, he explained. “[Patients] “Very often, cancer patients need to know exactly what we’d recommend and what should come next for patient care.” see more than one type of specialist. Physicians meet as a group to review new patients’ medical history It’s very challenging and stressful for and diagnostic tests, including all pathology and radiology data, then meet with patients individually for up to two hours each to discuss a patients with a new cancer diagnosis treatment plan. What’s more, a nurse coordinator basically serves as a traffic cop to coordinate and move between for the system. “[They’re] someone who’s going to track patients multiple specialists.” and ensure there’s follow through on scheduling. [The coordina- tor] is a great resource for patients with questions. They know the overall treatment plan and help them navigate the process,” Tykodi However, it’s a far different story at institutions like the Seattle explained. Cancer Alliance (SCCA), where the Kidney Cancer Multispecialty The SCCA clinic operates 2 half days a month, serving 6-8 patients. Clinic was launched in April. A team evaluation is conducted with Based on interest and patient volumes, extended hours are possible. a urologic oncologist, medical oncologist, radiation oncologist, pa- “We’re starting a little conservatively with how many clinics we run,” thologist, radiologist, and resident doctor or fellow—all of whom Tykodi said. are UW Medicine doctors who specialize in kidney cancer. The multispecialty approach, explained oncologist Scott Tykodi, MD, Multidisciplinary Care PhD, Associate Professor in the Division of Medical Oncology at A similar approach for the treatment of the disease is practiced at the University of Washington, provides patients the opportunity to the University of Illinois at Chicago, where kidney cancer is treated discuss all aspects of their proposed treatment plan on the same day in the UI Health Cancer Center, a multidisciplinary collaborative ef- with each individual treating doctor. Patients will receive answers to fort that boasts 97 members from 11 colleges spread across the uni- all their questions along with a specially designed plan of care, he versity, including a tumor board. The center’s dedicated to reducing continued. Continued on page 20 oncology-times.com Oncology Times 9 MUSINGS OF A CANCER DOCTOR ments. This may only represent a flawed archeologic record, or it may BEING HUMAN suggest that art and music represent something crucial about the de- continued from page 19 velopment of the modern human brain, and quite specific to Homo sapiens. I will often see patients who are artists, or patients who are musi- to supply them treats and don’t bother them too much. I find it inter- cians (and with a fairly wide range of instruments, my favorite being esting that while we can easily tell wolf and dog skeletons apart, cat the accordion). I have patients who have dogs and cats, indeed are skeletons are indistinguishable from those of African wildcats. But the passionate about them. These things are so common, so normal for passion felines generate in some humans is undeniable. I had a patient us that we fail to recognize how absolutely extraordinary they make delay potentially life-saving surgery until her cat underwent surgery. us as a species. Medical oncology is the new kid on the block, while My patient could not face the prospect of living without that cat. art, music, and our pets tap into something deeper, something more So, add “humans are the species that lives with cats and dogs” to ancient in the human psyche. Something we are designed for, if it truly Aristotle’s “Man is by nature a social animal.” They may even be the separates us from our closest ancestral cousins. same answer to the “what makes us human” question. We don’t just I once had a patient with small cell lung cancer who presented with socialize with each other, we socialize with dogs and cats. Dogs and brain metastases. The metastases were accompanied by seizures, and cats hung around for purely Darwinian reasons: today there are lots the presenting aura for the seizures was Elvis Presley’s “Blue Suede more dogs than wolves, and far more cats than African wildcats. But Shoes.” Every time he would hear the song, he would wake up a few there probably were, as well, more humans because of dogs and cats: minutes later on the floor. We radiated his brain and Elvis Presley hunt wooly mammoths more efficiently, save more wheat, and you went into hiding. We treated his cancer with systemic chemotherapy, will prosper. and the small cell responded, brilliantly but briefly, as is its wont. But the archeologic record has another interesting answer to the When the cancer recurred, so did “Blue Suede Shoes.” I find it amaz- “what makes us human” question: humans are the species that cre- ing that there is, somewhere in the human brain, a clutch of neurons ates art. We’ve been drawing pictures on cave walls for 35,000 years devoted to “Blue Suede Shoes,” but that is apparently a design func- or more, beautiful work like that found at Lascaux in France. The tion for modern humans. At least it wasn’t “You Ain’t Nothing but a first cave art we have involves hand stencils on the wall of the cave of Hound Dog.” Pettakere in Indonesia. The first figurative paintings date to 32,000 Sometimes outlandish claims are made for the dogs and cats. years ago, in the Chauvet cave in France and the Coliboaia cave in Remember the news reports a few years ago suggesting that dogs Romania. These paintings are filled with large mammals: bisons, au- could sniff out cancers in their owners? Or Oscar the cat, a Rhode rochs, horses. So perhaps another answer to the “what makes us hu- Island nursing home denizen who appears to predict impending man” question is “Humans are the species that creates symbolic art.” death, napping next to those next to pass? In both cases hand- And, at roughly the same time, musical instruments. The first mu- waving explanations (“maybe Oscar is good at smelling apoptosing sical instruments we have are flutes, made from mammoth and bird cells” or “maybe that melanoma is releasing aromatic chemicals the bones, found in the Geißenklösterle Cave in Southern Germany, and dog recognizes as malignant”) have been made. All I know for sure dating to about 42,000 years ago. Humans are the species that uses is that if Oscar ever shows up at my door it will be the last predic- tools to make music. tion he ever makes. Maybe cats and dogs are part of what makes us Again, the comparison with our Neanderthal cousins is telling. We human, but I am thoroughly unsentimental about feline diviners lack convincing evidence for Neanderthal cave art or musical instru- of death.