Chipping away at the boulder

Providence Regional Cancer System is proud to be a member of the Northwest Community Clinical Oncology Program.

The NWCCOP is federally funded by the National Cancer Institute. In most of these studies there is no potential for a new drug to be approved. Instead, these studies are more likely to examine:

• Treatment length
• Doses
• Improving quality of life

If you think of cancer as a boulder in the middle of the road the pharmaceutical trials are the dynamite that helps to blast it apart. However, just as important are the NWCCOP trials—the guy with the chisel chipping away diligently at the rock.

So what does that look like?
Consider that we used to give extremely high doses of chemotherapy every three weeks to lung cancer patients even though they were suffering from a lot of side effects. Through a NWCCOP study we learned that we could divide up the extremely high dose every three weeks to a moderate dose every week. Not only did the patients suffer from fewer side effects they actually responded better due to the steady stream of chemotherapy they were receiving.

NWCCOP trials bring cancer studies to local communities, like ours. And the truth is, every day we make advancement, even if it’s just chipping away at the boulder, we help to affect change in the fight against cancer.

*If you are ever interested in being involved in research studies or learning more call the Providence Regional Cancer System Research Department directly at 360.412.8939.

Understanding research studies in 4 phases

Research studies are conducted in phases. A Phase III research study cannot happen unless a Phase I and Phase II research study have been completed successfully. At all times the patient’s safety is the number one priority. At Providence Regional Cancer System we participate in Phase III research studies.

Phase I: Is it safe?
Commonly called the “safety phase,” this is the first time the drug is used in people. In essence the study is determining how safe the drug is for human interaction. Most side effects are revealed during this phase as researchers determine exactly how the drug interacts with the human body. These are typically very small studies of about 20-80 people, usually with healthy participants.

Phase II: Does it work?
If a drug passes Phase I we know it’s relatively safe. What we don’t know is, does it work? Phase II begins using the drug on those individuals with the disease or condition of interest. Control groups are established, meaning one group of participants will receive the new drug (experimental group) and one group of participants will receive a placebo or the current “approved” method of treatment (control group). At the end of the study the results will be closely compared to determine if the new drug actually works. Phase II studies usually involve 100-300 people.

Phase III: Is it better?
After a drug is determined to work for it’s designed purpose it begins to be compared against the gold standard of treatment (ie: what is currently being used for treatment). Is the new drug better, worse, or the same than the current drug? Do the benefits/risks of the new drug outweigh the negative side effects? Phase III studies are fairly large, usually involving 1,000-3,000 participants from multiple sites across the nation. After a successful Phase III a drug will earn FDA approval.

Phase IV: Are there other uses?
Research studies in Phase IV are called “post-market research studies.” Researchers will continue to collect information on risks, benefits and side effects now that the drug is being used in “real-life conditions.” Phase IV will also take into consideration different dosage amounts and schedules as well as the drugs potential benefits for different stages of the disease or even different diseases altogether.

* If you are ever interested in being involved in research studies or learning more call the Providence Regional Cancer System Research Department Directly at 360.412.8939.

You might also like:

• Community Clinical Oncology Program Introduction
• "I take one blue pill and three pink pills twice a day."
• How do I contact my nurse from home?
• Part 1: Why we believe in research studies

Community Clinical Oncology Program Introduction

Since 1986 the Community Clinical Oncology Program (CCOP) has helped to bridge the gap between the research clinical trials that occur at large institutions and the local community clinics. Operating behind the belief that everyone should have access to the latest cancer-management research the CCOP has helped more than 4,000 community physicians participate in the National Institute of Cancer (NCI) clinical trials. Additionally, 50 CCOPs have been set up in 34 U.S. states, the District of Columbia and Puerto Rico to provide cancer clinical trials in 403 community-based hospitals.

What is a CCOP?
In simple terms, a CCOP is formed when a group of community hospitals and physicians come together under one umbrella with the common goal of participating in NCI-sponsored cancer treatment, prevention and control clinical trials. The hospitals and physicians continually work together in a peer-reviewed environment to ensure the greatest level of clinical quality is met.

What does a CCOP do?
At first, CCOPs were created to function as a way to bring cancer-treatment clinical trials to more local communities. However, over time they have expanded to focus on cancer prevention, patient management, continuing care and rehabilitation. Some research you may already be benefiting from includes:

• Adequate treatment of pain (see Dr. Sui’s article on pain management)
• Nonhormal relief of hot flashes for patients with a history of breast cancer
• Modest success in the use of nicotine replacement therapy (patch and nasal spray), bupropion and behavioral interventions to help adults quit smoking. (see Dr. Harris’ article on quitting smoking after a cancer diagnosis)

* If you are ever interested in being involved in research studies or learning more call the Providence Regional Cancer System Research Department Directly at 360.412.8939.

Cancer and pain: It's okay to ask for help

Unfortunately, pain in cancer patients is very common and affects most aspects of an individual’s life. But would it surprise you to know that cancer pain is severely under-treated in patients?

Research shows this could be for a number of reasons:

• As doctors, we sometimes focus all our energy on treating the disease and lose sight of controlling the pain along the way
• Patients often fail to talk to their doctors about their pain, falsely believing that some amount of suffering “goes with the territory”
• Patients and doctors are often hesitant to use morphine and other opiods for pain control, fearing addiction, when in reality patients being treated for cancer rarely form such an addiction.

The good news is, we believe 90% of chronic cancer pain can be treated with drug AND non-drug therapies. Source.

First and foremost, you are the only one who knows what your pain feels like. How you communicate your pain is the single most important factor in treating it.

This means, you must work with your care team to explain what is bothering you and exactly how it is bothering you. I recommend keeping a pain journal to help track anything that may be causing your discomfort. Controlling your pain is vital in maintaining your strength, emotionally and physically.

Pain can affect:

• Your sleep quality and your ability to perform daily activities
• Your mood and coping abilities
• Your relationships with others around you, including your social support system
• Your spiritual or religious beliefs

If you experience a new onset of pain, or sudden change of your chronic pain, call or see your doctor immediately.

You might also like:

• You don't have to put up with cancer-related fatigue
• Integrative care basics and what others are saying
• What is palliative care? Life-enhancing, supportive care
• Lymphedema prevention strategies

4 pitfalls to avoid when researching on the internet

The internet is a massive resource for health information, but, it’s also the most easily edited and the least policed. Anyone can publish a “scientific study” or “scholarly journal article” online.

In fact, you could probably search for and diagnose your symptoms with google and then figure out how to operate using youtube. (We don’t recommend that by the way).

Before you fall into the overwhelming wealth of information make sure you can answer these four questions:

1. Why are you searching?
   Are you looking for facts or opinions? Information to help make your medical decision or just a familiar story to relate with?
2. Is your source credible?
   The importance of credibility ties into the first question of why you’re searching for medical information. If you’re looking for medical treatment options then you will most certainly want to make sure the information you are reading comes from a reputable institution. If you’re looking for others who may share a story similar to yours you may care less about where the information originates from, that is up to you to decide.
   Consider: The American Cancer Society, The American Cancer Institute of Research, National Cancer Institute and The American Association for Cancer Research.
3. When was the study/story published?
   In the medical field, especially specific to cancer, it seems as though news is continually changing/growing. If you are referencing a source from the 1970s you may be setting yourself up for “old information.” Be sure to check the date the study was published and if any follow-up studies have been done.
4. Are you comparing “apples to apples”?
   If you are reading an article about a new study that found success with a particular treatment make sure that the patients included in the study have your “specific type of cancer.” For more information see Dr. Whitten's recent post on "The Pathologist's role in cancer diagnosis and care"

Remember, you are your biggest patient advocate. If you find something online that you’re curious about, talk with your doctor.