Act Seeks to Expand Clinical Trial Access to Patients on Medicaid

From www.curetoday.com
By Brielle Benson, Feb 20, 2020

ASCO representatives visit Capitol HillClinical trial routine care costs (including X-Rays, lab work, doctor visits and more) are not covered for people who are insured by Medicaid, leading to certain groups being underrepresented in clinical trials. However, the Clinical Treatment Act (H.R. 913) is trying to change that.

“The Treatment Act is really about ensuring accessibility for Medicaid patients for participation,” Dr. Melissa Dillmon, the Chair of the Association for Clinical Oncology’s (ASCO) Government Relations Committee said.

ASCO is one of more than 100 organizations that urged Congress this week to include the act in the upcoming “must pass” health care extenders package that is expected to be passed on May 22, 2020.

The Clinical Treatment Act would ensure that all patients on Medicaid have coverage of routine procedures and checkups associated with clinical trials. This could potentially boost the participation of minorities, who tend to be overrepresented in the Medicaid population, but underrepresented in clinical trials.

“It’s important when we look at clinical trials – especially in cancer – that we have racial and socioeconomic diversity so that it can be used in the real-world setting,” Dillmon said.

Representative Ben Ray Luján (D-NM) and Representative Gus Bilirakis (R-FL) introduced the act, which currently has 28 cosponsors representing both parties. Additionally, organizations such as the American Medical Association and the American Cancer Society Cancer Action Network have also voiced their support for the bill.

While some may be apprehensive to support H.R. 913 because they think it could increase costs, Dillmon said that is not true.

“One of the concerns is the financial part, and I hope we’re able to dispel that myth,” Dillmon added, noting that some states in the U.S. already have Medicaid coverage for clinical trial care costs, and there have been no reported increased costs there. And since the pharmaceutical company usually pays for the drug being tested, costs could even go down.

“Logically, one may think costs of care may go down. If the patient is on a clinical trial, there is no bill to Medicaid for the drug, and that’s often one of the most expensive parts of treatment,” Dillmon said.

Clinical trials are crucial to moving the field of cancer – and other serious illnesses – forward. The more patient populations they can include, the better outcomes can be for more Americans.

“Oncology has seen unprecedented successes right now in our treatment for cancer. We’ve had the single biggest improvement in the reduction in mortality. Our goal as physicians is to continue that fight and have even more survivors,” Dillmon concluded.

Cancer Care’s One-Stop Shop

From BusinessNC.com

FirstHealth of the Carolinas’ four-story, $60 million cancer center is set to break ground in early 2021 with an anticipated opening in November 2022. The new building, rendered above, will be a one-stop shop for cancer patients to get diagnoses, treatments and therapeutic support.

When Pinehurst-based FirstHealth of the Carolinas opens its one-stop shop cancer center in 2022, the 15-county medical network will have a centralized diagnosis and care center, a headquarters for its clinical trials and a check mark on the to-do list of priorities set by new CEO Mickey Foster.

Construction on the four-story, $60 million cancer center on Page Road North, near Moore Regional Hospital, will begin in 2021 following completion of a four-story parking garage. The target opening date is November 2022. Foster estimates about $30 million for the 120,000-square-foot center will be raised through a philanthropy campaign launching in January. However, people have already been donating to the project since November.

“The rates for cancer in our 15 counties is expected to grow, so we need to build a comprehensive cancer center,” says Foster, who joined FirstHealth in July after serving as president of Moses H. Cone Memorial Hospital in Greensboro. “I have had the opportunity to oversee several cancer programs in my career, and there is a need to have all the support services under one roof. It creates a one-stop shop for care for all of our cancer patients.”

Foster joined FirstHealth with three main goals: “First, we want to be the best place to work in the county. We are in the top 4% nationally [according to Hospital Consumer Assessment of Healthcare Providers and Systems], so we want to create the best culture. Second, we want to be a health system that is a zero-harm organization. There are still too many harm events in health care. We want to be a system with zero: no falls, no injuries, no infections. Third is to build a destination for cancer care.”

Informal talks about a centralized cancer center began four years ago but weren’t concrete until last summer.

“We have outstanding services, but they’re spread out across our campus,” says Dan Barnes, president of FirstHealth’s physicians group and vice president of oncology services. “This [new center] allows patients to be seen from diagnosis to treatment to survivorship and be patient-centered and patient-focused. It allows us to bring physicians and treatment under one roof and increase support services such as financial counseling and palliative care.”

The project received full support from the Pinehurst Village Council and the Village of Pinehurst, Foster says. Space will be reserved for meditation and support groups, as well as rooms designated for exercise. “We want to create a more healing and natural setting that will differentiate us from other places,” he says. “It’s a game changer for cancer care in this region.”

One floor will house research and clinical trials, such as those headed by pulmonary specialist Michael Pritchett, director of the Chest Center of the Carolinas at FirstHealth and an employee of Pinehurst Medical Clinic. Last April, Pritchett was the first in the world to demonstrate work with a robotic-assisted catheter-based device to collect samples for lung cancer diagnosis. Pritchett performed his first procedure last March and as of mid-November, he had seen about 60 cases.

“We have the pathologist sitting in the room, so they put it on a slide, and we get immediate feedback as to whether it’s malignant or not,” he says. “So when I wake you up, we will tell you what we found. We can biopsy multiple lesions, so it’s really a game changer for us.”

The future cancer center’s central location is imperative in reaching the 15-county area beyond the 16,000 people of Pinehurst, Pritchett says. “We don’t want them to drive past us and have to go to Duke or UNC.”

Pritchett isn’t the only one working on research at the new cancer center. On the same floor in the building, gynecologic oncologist Michael Sundborg will continue administering a Gynecologic Oncology Group Foundation trial to assess a chemo treatment for advanced cervical cancer.

Sundborg has two patients enrolled in the six-month trial designed to prompt the immune system to seek and destroy cancer. The GOG Foundation chose FirstHealth to test the therapies in a hybrid trial, meaning it’s sponsored by the National Cancer Institute and is an industry trial, so the medication is free. “We’re shooting smart missiles. We’re a sniper,” Sundborg says. “This is the evolution of cancer therapy.”

Sundborg says Moore County has seen a 7% increase in cancer diagnoses annually, compared with a national average of about 3%. It’s the leading cause of death, according to the 2018 State of the County Health Report. He attributes it to the region’s relatively older population and patients in nearby rural coastal areas without access to care. “But we’re doing something for them. We’re changing life spans.”

Both Sundborg and Pritchett have begun their research in their current roles, but the new cancer center will make “a substantial footprint” in care, Sundborg says.

Foster did not detail the number of jobs that may be created with the completion of the center but anticipates recruiting additional physicians, nurses, support staff and medical-office assistants for the new center. Health care and social assistance are listed by the N.C. Department of Commerce Labor & Economic Analysis Division as the top employers in the county with 9,457 workers, or 26.2% of the total workforce.

“I have plenty of offers all the time to go other places, and I have no desire to go anywhere,” Pritchett says. “I can do all these things, [including] publish research, right here in my own community.”

 

What is Cancer?

“What Is Cancer?” was originally published by the National Cancer Institute

image of a dividing cancer cell nci ncorp scor

A dividing breast cancer cell.
Credit: National Cancer Institute / Univ. of Pittsburgh Cancer Institute

A Collection of Related Diseases

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues.

Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.

Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemias, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In addition, as these tumors grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Benign tumors can sometimes be quite large, however. When removed, they usually don’t grow back, whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life threatening.

Differences between Cancer Cells and Normal Cells

Cancer cells differ from normal cells in many ways that allow them to grow out of control and become invasive. One important difference is that cancer cells are less specialized than normal cells. That is, whereas normal cells mature into very distinct cell types with specific functions, cancer cells do not. This is one reason that, unlike normal cells, cancer cells continue to divide without stopping.

In addition, cancer cells are able to ignore signals that normally tell cells to stop dividing or that begin a process known as programmed cell death, or apoptosis, which the body uses to get rid of unneeded cells.

Cancer cells may be able to influence the normal cells, molecules, and blood vessels that surround and feed a tumor—an area known as the microenvironment. For instance, cancer cells can induce nearby normal cells to form blood vessels that supply tumors with oxygen and nutrients, which they need to grow. These blood vessels also remove waste products from tumors.

Cancer cells are also often able to evade the immune system, a network of organs, tissues, and specialized cells that protects the body from infections and other conditions. Although the immune system normally removes damaged or abnormal cells from the body, some cancer cells are able to “hide” from the immune system.

Tumors can also use the immune system to stay alive and grow. For example, with the help of certain immune system cells that normally prevent a runaway immune response, cancer cells can actually keep the immune system from killing cancer cells.

How Cancer Arises

Cancer is caused by certain changes to genes, the basic physical units of inheritance. Genes are arranged in long strands of tightly packed DNA called chromosomes.

Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our cells function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Cancer-causing environmental exposures include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun. (Our Cancer Causes and Prevention section has more information.)

Each person’s cancer has a unique combination of genetic changes. As the cancer continues to grow, additional changes will occur. Even within the same tumor, different cells may have different genetic changes.

In general, cancer cells have more genetic changes, such as mutations in DNA, than normal cells. Some of these changes may have nothing to do with the cancer; they may be the result of the cancer, rather than its cause.

“Drivers” of Cancer

The genetic changes that contribute to cancer tend to affect three main types of genes—proto-oncogenes, tumor suppressor genes, and DNA repair genes. These changes are sometimes called “drivers” of cancer.

Proto-oncogenes are involved in normal cell growth and division. However, when these genes are altered in certain ways or are more active than normal, they may become cancer-causing genes (or oncogenes), allowing cells to grow and survive when they should not.

Tumor suppressor genes are also involved in controlling cell growth and division. Cells with certain alterations in tumor suppressor genes may divide in an uncontrolled manner.

DNA repair genes are involved in fixing damaged DNA. Cells with mutations in these genes tend to develop additional mutations in other genes. Together, these mutations may cause the cells to become cancerous.

As scientists have learned more about the molecular changes that lead to cancer, they have found that certain mutations commonly occur in many types of cancer. Because of this, cancers are sometimes characterized by the types of genetic alterations that are believed to be driving them, not just by where they develop in the body and how the cancer cells look under the microscope.

When Cancer Spreads

In metastasis, cancer cells break away from where they first formed (primary cancer), travel through the blood or lymph system, and form new tumors (metastatic tumors) in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.

A cancer that has spread from the place where it first started to another place in the body is called metastatic cancer. The process by which cancer cells spread to other parts of the body is called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that spreads to and forms a metastatic tumor in the lung is metastatic breast cancer, not lung cancer.

Under a microscope, metastatic cancer cells generally look the same as cells of the original cancer. Moreover, metastatic cancer cells and cells of the original cancer usually have some molecular features in common, such as the presence of specific chromosome changes.

Treatment may help prolong the lives of some people with metastatic cancer. In general, though, the primary goal of treatments for metastatic cancer is to control the growth of the cancer or to relieve symptoms caused by it. Metastatic tumors can cause severe damage to how the body functions, and most people who die of cancer die of metastatic disease.

Tissue Changes that Are Not Cancer

Not every change in the body’s tissues is cancer. Some tissue changes may develop into cancer if they are not treated, however. Here are some examples of tissue changes that are not cancer but, in some cases, are monitored:

Hyperplasia occurs when cells within a tissue divide faster than normal and extra cells build up, or proliferate. However, the cells and the way the tissue is organized look normal under a microscope. Hyperplasia can be caused by several factors or conditions, including chronic irritation.

Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is also a buildup of extra cells. But the cells look abnormal and there are changes in how the tissue is organized. In general, the more abnormal the cells and tissue look, the greater the chance that cancer will form.

Some types of dysplasia may need to be monitored or treated. An example of dysplasia is an abnormal mole (called a dysplastic nevus) that forms on the skin. A dysplastic nevus can turn into melanoma, although most do not.

An even more serious condition is carcinoma in situ. Although it is sometimes called cancer, carcinoma in situ is not cancer because the abnormal cells do not spread beyond the original tissue. That is, they do not invade nearby tissue the way that cancer cells do. But, because some carcinomas in situ may become cancer, they are usually treated.

Normal cells may become cancer cells. Before cancer cells form in tissues of the body, the cells go through abnormal changes called hyperplasia and dysplasia. In hyperplasia, there is an increase in the number of cells in an organ or tissue that appear normal under a microscope. In dysplasia, the cells look abnormal under a microscope but are not cancer. Hyperplasia and dysplasia may or may not become cancer.

Types of Cancer

There are more than 100 types of cancer. Types of cancer are usually named for the organs or tissues where the cancers form. For example, lung cancer starts in cells of the lung, and brain cancer starts in cells of the brain. Cancers also may be described by the type of cell that formed them, such as an epithelial cell or a squamous cell.

You can search NCI’s website for information on specific types of cancer based on the cancer’s location in the body or by using our A to Z List of Cancers. We also have collections of information on childhood cancers and cancers in adolescents and young adults.

Here are some categories of cancers that begin in specific types of cells:

Carcinoma
Carcinomas are the most common type of cancer. They are formed by epithelial cells, which are the cells that cover the inside and outside surfaces of the body. There are many types of epithelial cells, which often have a column-like shape when viewed under a microscope.

Carcinomas that begin in different epithelial cell types have specific names:

Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids or mucus. Tissues with this type of epithelial cell are sometimes called glandular tissues. Most cancers of the breast, colon, and prostate are adenocarcinomas.

Basal cell carcinoma is a cancer that begins in the lower or basal (base) layer of the epidermis, which is a person’s outer layer of skin.

Squamous cell carcinoma is a cancer that forms in squamous cells, which are epithelial cells that lie just beneath the outer surface of the skin. Squamous cells also line many other organs, including the stomach, intestines, lungs, bladder, and kidneys. Squamous cells look flat, like fish scales, when viewed under a microscope. Squamous cell carcinomas are sometimes called epidermoid carcinomas.

Transitional cell carcinoma is a cancer that forms in a type of epithelial tissue called transitional epithelium, or urothelium. This tissue, which is made up of many layers of epithelial cells that can get bigger and smaller, is found in the linings of the bladder, ureters, and part of the kidneys (renal pelvis), and a few other organs. Some cancers of the bladder, ureters, and kidneys are transitional cell carcinomas.

Sarcoma
Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments).

Osteosarcoma is the most common cancer of bone. The most common types of soft tissue sarcoma are leiomyosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma, and dermatofibrosarcoma protuberans.

Leukemia
Cancers that begin in the blood-forming tissue of the bone marrow are called leukemias. These cancers do not form solid tumors. Instead, large numbers of abnormal white blood cells (leukemia cells and leukemic blast cells) build up in the blood and bone marrow, crowding out normal blood cells. The low level of normal blood cells can make it harder for the body to get oxygen to its tissues, control bleeding, or fight infections.

There are four common types of leukemia, which are grouped based on how quickly the disease gets worse (acute or chronic) and on the type of blood cell the cancer starts in (lymphoblastic or myeloid).

Lymphoma
Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are disease-fighting white blood cells that are part of the immune system. In lymphoma, abnormal lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the body.

There are two main types of lymphoma:

Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called Reed-Sternberg cells. These cells usually form from B cells.

Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The cancers can grow quickly or slowly and can form from B cells or T cells.

Multiple Myeloma
Multiple myeloma is cancer that begins in plasma cells, another type of immune cell. The abnormal plasma cells, called myeloma cells, build up in the bone marrow and form tumors in bones all through the body. Multiple myeloma is also called plasma cell myeloma and Kahler disease.

Melanoma
Melanoma is cancer that begins in cells that become melanocytes, which are specialized cells that make melanin (the pigment that gives skin its color). Most melanomas form on the skin, but melanomas can also form in other pigmented tissues, such as the eye.

Brain and Spinal Cord Tumors
There are different types of brain and spinal cord tumors. These tumors are named based on the type of cell in which they formed and where the tumor first formed in the central nervous system. For example, an astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve cells healthy. Brain tumors can be benign (not cancer) or malignant (cancer).

Other Types of Tumors

Germ Cell Tumors
Germ cell tumors are a type of tumor that begins in the cells that give rise to sperm or eggs. These tumors can occur almost anywhere in the body and can be either benign or malignant.

Neuroendocrine Tumors
Neuroendocrine tumors form from cells that release hormones into the blood in response to a signal from the nervous system. These tumors, which may make higher-than-normal amounts of hormones, can cause many different symptoms. Neuroendocrine tumors may be benign or malignant.

Carcinoid Tumors
Carcinoid tumors are a type of neuroendocrine tumor. They are slow-growing tumors that are usually found in the gastrointestinal system (most often in the rectum and small intestine). Carcinoid tumors may spread to the liver or other sites in the body, and they may secrete substances such as serotonin or prostaglandins, causing carcinoid syndrome.

Updated: February 9, 2015

Should You Join a Clinical Trial?

Watch this video from the National Cancer Institute to learn some reasons you might want to join a cancer clinical trial. Like all treatment options, clinical trials have possible benefits and risks. By looking closely at all options, including clinical trials, you are taking an active role in a decision that affects your life.

 

CarolinaEast opens doors on new SECU Comprehensive Cancer Center

From New Bern Sun Journal
By Todd Wetherington, Jan 17, 2020

SECU Cancer Center opens at CarolinaEast Medical Center in New Bern, NCCity officials, donors and members of the media got a first hand look at the new SECU Comprehensive Cancer Center at CarolinaEast Medical Center Thursday.

Located on the west side of the Medical Center’s main campus in New Bern, the three-story Cancer Center will offer radiation oncology, medical oncology, nutrition services, social worker and psychological support services, and a palliative care and survivorship program, among other services.

In November 2014, CarolinaEast Medical Center and UNC Cancer Care announced a collaboration to bring comprehensive cancer services previously available only in the Raleigh/Durham Triangle region to the eastern part of the state. Ground was broken on the 80,000 square feet, $37 million Cancer Center in January 2017. The first floor features a radiation oncology clinic and treatment areas, an infusion suite with six semi-private infusion bays and two private rooms, a specialty pharmacy, a cafe, a boutique with oncology-related supplies, group support session rooms, and palliative care. The Cancer Center’s second floor includes a medical oncology clinic with 12 exam rooms and six patient assessment bays, an infusion suite with both semi-private and private rooms, and a chemotherapy mixing pharmacy. The third floor is devoted to administration offices and an education department with classrooms and computer labs.

According to Brandy Popp, CarolinaEast Health System public relations and outreach manager, the Cancer Center will begin receiving patients on Monday, Jan. 20. Popp said an open house, ribbon cutting ceremony for the public is planned for Saturday, Jan. 25.

A new $13 million diagnostic center is also nearing completion adjacent to the Cancer Center to facilitate efficient imaging services related to cancer prevention, treatment and diagnosis. UNC Health System will collaborate to provide access to clinical trials, outreach, and telehealth.