Tuesday, April 23, 2024

Medical: Heart and cancer care, casting a wide net

Cancer will directly affect almost 90,000 North Carolinians this year. Reducing that number requires more research, improved screening and better access to care.

The North Carolina Central Cancer Registry estimates that the disease will kill almost 22,000 people statewide this year, while about 65,000 cases are expected to be diagnosed. It’s impossible to find anyone who hasn’t been affected by cancer, whether personally or through a family member or friend.

Fighting cancer — North Carolina’s leading cause of death, according to Centers for Disease Control and Prevention — isn’t a straight-forward process. It requires finding better treatments and cures, expanding preventive screenings and offering better access to care.

The National Cancer Institute budgeted $6.9 billion for cancer research this year. It sent $2.5 million to Winston-Salem, where Wake Forest Organoid Research Center, a collaboration of Wake Forest Baptist Comprehensive Cancer Center and Wake Forest Institute for Regenerative Medicine, where a project that applies different drugs to laboratory-constructed tumor tissue, studying how the results can be used to construct treatment plans, is underway.

Wake Forest Baptist Comprehensive Cancer Center Director Konstantinos Votanopoulos and Lance Miller, associate professor in cancer biology at Wake Forest School of Medicine school, are the study’s principal investigators. “Every time cancer cells multiply, they generate the next generation of cancer cells with new properties,” Votanopoulos said in a news release. “As the cancer progresses, the patient ends up with not just a single tumor but many different tumor clones with variable biologic behavior and responses to treatment. Accurate mapping of tumor clonality, combined with response of each clone to therapy is the key for the development of personalized treatment strategies tailored to each patient separately.” They see their work sparking further research.

The American Cancer Society funneled $1.5 million toward Wake Forest Baptist Health for two cancer research projects last year. Wake Forest School of Medicine Assistant Professor Yong Lu and his team will receive $792,000 over four years to study how he specialized white blood cells that he previously discovered can be used against advanced tumors and stop drug-resistant tumors from forming. “We hope our work will shed light on the mechanisms underlying how T cells, the major type of white blood cells, prevent resistance and hopefully establish a foundation for translating that into more effective immuno-therapies in human cancers,” he said in a news release.

The grant’s balance goes to Wake Forest School of Medicine Assistant Professor David Soto-Pantoja and his team. They want to understand why some chemotherapy and immunotherapy drugs affect the heart in an effort to discover cancer treatments that are safer for patients with heart disease. When he was a National Institutes of Health fellow, his team identified a molecule that can prevent some of the damage caused by chemotherapy drugs. “The molecule enhanced the immune system to attack the tumor but protected normal tissue from the negative effects of chemo-therapy,” he said in a news release.

Research also is underway statewide to further screenings for common cancers. These efforts aren’t necessarily new, and results are being seen, particularly with pulmonary cancers. Michael Pritchett, director of the Chest Center of the Carolinas — FirstHealth in Pinehurst, has been advocating for better lung-cancer screening procedures since 2013.

The American Cancer Society says lung cancer is the deadliest cancer in the state and country. Despite its rank, Pritchett says it’s misunderstood by many people. They believe they have to smoke to get it and it can be prevented by not smoking. This can contribute to fewer early screenings. “The problem is there’s estimated to be 8 million people who qualify for lung-cancer screening, but we’re not doing a good enough job screening those people,” he says. “We’re screening about 4%. It’s difficult, but at the same time, it’s literally a matter of life and death.”

NCI says North Carolina saw a 2.6% decrease on average for lung and bronchus cancers for each year between 2013 and 2017, the most recent period that data is available. It also is when use of cone beam CT machines, which better direct treatment, began in earnest.

This work over the past decade has contributed to further research in new lung-cancer treatments, including using microwave energy to treat lung cancer and metastatic disease and a trial to study the direct injection of chemotherapy into small tumors in the lungs. Pritchett was the first U.S. researcher to do a robotic bronchoscopy with technology made by Intuitive.

Before the end of the year, Pritchett’s FirstHealth team will be leading the way in cutting edge technology again. During an upcoming clinical trial, they will be one of the first in the world to have a second robotic bronchoscopy machine, this one made by Johnson & Johnson.

Health care centers are dedicating more resources to fighting cancer. Cape Fear Valley Health, for example, is building the five-story Center for Medical Education in Fayetteville.The $31 million project will house the system’s Neuroscience Institute, which will help research, diagnose and treat brain tumors and other issues, and is expected to open next year.

Cape Fear Valley Health offers cancer care to residents of four counties from three sites: Cape Fear Valley Health Cancer Center and Health Pavilion North Cancer Center in Fayetteville and Harnett Health Cancer Center in Lillington. All use the latest technology, including linear accelerators and a CyberKnife, all of which precisely apply radiation to tumors non-invasively.

Kanwar Singh, the system’s executive corporate director of oncology services, says the centers regularly operate at capacity. That makes continued expansion necessary. Health Pavilion North, for example, is adding infusion chairs, which make treatments easier and more comfortable for cancer patients. The expansions don’t mean the disease is becoming more prevalent here than elsewhere. “The [local] rate of growth of cancer incidence is in line with national averages,” he says. Some of the increase can be attributed to better screening. “On a diagnostic end, some things have improved through education and advances. We can find certain cancers in earlier stages than previously, which correlates with improved survival outcomes.”

Singh says the Commission on Cancer, which sets standards and pushes prevention, research and edu-cation to improve survival and quality of life for cancer patients, granted a three-year Academic Comprehensive Cancer Program accreditation to Cape Fear Valley Medical Center’s cancer program earlier this year. Earning that title means medical centers have met 34 quality care standards and undergone a rigorous evaluation.

Novant Health opened its $24 million Wallace Cancer Institute in Salisbury in August 2020. The 32,000-square-foot center has the latest radiotherapy technology and support services, including a boutique that sells scarves, protheses, special clothing and other items its patients need. Multidisciplinary research is conducted at the center, too. ■

The beat goes on

The quality and accessibility of heart care across North Carolina continues to grow stronger, grabbing national recognition.

Though cancer remains the No. 1 cause of death in North Carolina, heart disease isn’t far behind, according to the Centers for Disease Control and Prevention. Almost 20,000 North Carolinians die from heart attacks and other heart-related illnesses each year. In response, doctors, health systems and researchers statewide are improving care and access to it.

HCA Healthcare, the nation’s largest health care system, acquired Mission Health in 2019. The $1.5 billion deal brought better data collection and analysis. That has allowed William Kuehl, Mission Health chief of cardiology, and his team to enhance every step of emergency heart care, identifying issues and enacting improvements within days rather than months.

Having high-tech machines help, too. Mission Health is one of western North Carolina’s only hospitals with an extracorporeal membrane oxygenation machine, which is used for patients with heart or lung failure or after heart surgery. Similar to the heart-and-lung machine that makes bypass surgery possible, it pumps and oxygenates a patient’s blood, allowing lungs and heart to rest. Kuehl says it has been a literal lifesaver during the COVID pandemic.

Over the past year, Kuehl says many patients suffered through a heart attack at home. They delayed calling 911 until it was too late, because they were afraid of contracting COVID at the hospital. “We had a lot of people who didn’t make it to hospitals, and that’s nationwide,” he says. “It’s truly heartbreaking to see patients arrive 10 hours into their heart attack rather than 30 minutes and us not being able to do as much for them.”

Kuehl says Mission Health has increased its outreach over the past year to emphasize the importance of seeking help at the earliest sign of heart trouble. The message was taken to the communities within the 18 counties in North and South Carolina and Tennessee that the system serves. “Mission Hospital has universal masking and is a safe place to come, so don’t put off your care,” he says. He says guidelines that make the hospital a safe place have been enacted, and he encourages people to seek prompt care.

The best treatments aren’t worth much if they lack accessibility. Wake Forest Baptist Health is expanding cardiovascular care into rural parts of Wilkes County, thanks to a $1.2 million U.S. Health Resources and Services Administration grant. “The goal of this project is to improve rural health equity and outcomes for patients … ,” Simon Mahler, professor of emergency medicine at Wake Forest Baptist Health, said in a press release.

The expansion includes telehealth. Videoconferencing and other communications technology will connect Wake Forest Baptist Health experts to Wilkes County EMS paramedics and Wilkes Medical Center’s emergency department, so patients can be quickly assessed based on their EKG, vital signs and risk scores. That will drive treatment and transportation decisions. Collaborations will continue later, when some patients follow up with the county Health Department’s Public Health Community Clinic.

Atrium Health opened the HEARTest Yard Congenital Heart Center at its Levine Children’s Hospital in December. Established with financial support from recently retired NFL player and longtime Carolina Panther Greg Olsen and his wife, Kara, it better serves pediatric patients with congenital heart disease. The 25,000-square-foot center has 25 patient rooms and state-of-the-art technology, including a dedicated fetal echocardiography lab, which takes ultrasounds of an unborn baby’s heart, and the Charlotte region’s only cardiac neurodevelopmental program.

The heart-care work done at North Carolina’s hospitals, health care centers and medical schools isn’t going unnoticed. Many have been recognized nationally.

U.S. News & World Report named Cape Fear Valley Medical Center in Fayetteville the Best Regional Hospital in North Carolina for 2021-22. Its efforts for chronic obstructive pulmonary disease, heart attack and heart failure were described as high performing. “We are pleased to receive this recognition from U.S. News & World Report,” said CEO Mike Nagowski in a news release. “Providing exceptional health care for all our patients has always been our top priority. Our team of caregivers is committed to the highest standards for quality and safety, and this recognition is a result of that commitment.”

CarolinaEast Medical Center in New Bern was awarded the HeartCARE Center National Distinction of Excel-lence by the American College of Cardiology in October. It had to meet a number of criteria, including partici-pating in two ACC Accreditation Services programs, to qualify for the award. “We take extreme pride in our excellence in heart care at CarolinaEast,” said Alex Kirby, CarolinaEast Heart Center cardiologist and CarolinaEast Medical Center cardiac cath laboratory medical director, in a news release. “This accreditation is further proof that our dedicated multidisciplinary team that earnestly supports these efforts has been successful in its goal to improve patient outcomes.”

Mission Health’s Asheville Heart cardiac surgery program was given the Society of Thoracic Surgeons’ highest rating in 2020. And for the 15th year, Mission Health has been recognized as one of the nation’s top cardiovascular hospitals by Fortune and IBM Watson Health.

Kuehl says earning those awards has a lot to do with using data to improve care. “What is important to understand is for Mission Hospital to keep its ranking year after year, we not only have to meet all these metrics in terms of mortality and length of stay and others, but every year we must also improve,” he says. “If we were great last year, we have to be even better this year or our ranking would drop.” ■

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