Head and Neck Cancer Care in the Community

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers with
00:08 --> 00:10your host, Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the latest
00:12 --> 00:15information on cancer care by welcoming
00:15 --> 00:17oncologists and specialists who are on the
00:17 --> 00:20forefront of the battle to fight cancer.
00:20 --> 00:21This week, it's a conversation about
00:21 --> 00:23the care of head and neck cancer
00:23 --> 00:25patients with Doctor Benjamin Newton.
00:25 --> 00:27Doctor Newton is an assistant professor
00:27 --> 00:29of clinical medicine and medical
00:29 --> 00:31oncology at the Yale School of Medicine,
00:32 --> 00:33where Doctor Chagpar is a
00:33 --> 00:35professor of surgical oncology.
00:37 --> 00:39Ben, maybe we can start off by you
00:39 --> 00:41telling us a little bit more about
00:41 --> 00:43yourself and what it is that you do.
00:44 --> 00:46I'm trained as a hematologist and a
00:46 --> 00:47medical oncologist.
00:47 --> 00:49I take care of patients with
00:49 --> 00:51a wide variety of oncology
00:51 --> 00:52problems in my community,
00:52 --> 00:54and I'm particularly interested
00:54 --> 00:55in the care of patients
00:55 --> 00:57with head and neck cancers.
00:58 --> 01:01So you know head and neck cancers is kind
01:01 --> 01:05of like this really broad bucket, right?
01:05 --> 01:07I mean when we think about
01:07 --> 01:09head and neck. I mean, geez,
01:09 --> 01:11there's a million things in there.
01:11 --> 01:13So can you break down for us what
01:13 --> 01:15you're really talking about when you're
01:15 --> 01:17talking about head and neck cancers?
01:17 --> 01:20Of course, when we talk about head and
01:20 --> 01:22neck cancer, we're really describing
01:22 --> 01:24a number of cancers that can develop
01:24 --> 01:27in or around the nose and sinuses,
01:27 --> 01:29the mouth, the throat, and the voice.
01:29 --> 01:32Blocks, and while these are distinct cancers,
01:32 --> 01:35often with distinct treatment approaches,
01:35 --> 01:37they're they're kind of brought
01:37 --> 01:39together together as a.
01:39 --> 01:41As a group, because they form what we
01:41 --> 01:43call the upper aerodigestive tract,
01:43 --> 01:46which has a surface layer
01:46 --> 01:47of flat squamous cells.
01:47 --> 01:50And most of these cancers form when
01:50 --> 01:51previously healthy squamous cells
01:51 --> 01:53change and grow out of control.
01:55 --> 01:57So you know, when we think about
01:57 --> 01:59these squamous cells that grow
01:59 --> 02:01and kind of get out of control,
02:01 --> 02:03are there other things that kind
02:03 --> 02:04of link all of these together,
02:04 --> 02:06certain risk factors,
02:06 --> 02:08family history, other traits?
02:09 --> 02:13I would say that the most important
02:13 --> 02:16known risk factor is tobacco use.
02:16 --> 02:19There are some evidence for a genetic
02:19 --> 02:21predisposition to the cancer causing
02:21 --> 02:25effects of tobacco and in addition tobacco.
02:25 --> 02:27And alcohol consumption together
02:27 --> 02:29can have a synergistic effect.
02:29 --> 02:31That means that they conspire
02:31 --> 02:34together to make things even worse,
02:34 --> 02:36and that repeated exposure of the
02:36 --> 02:38lining of the upper aerodigestive
02:38 --> 02:42tract to the cancer causing effects of
02:42 --> 02:45tobacco and alcohol can cause cancer.
02:45 --> 02:47And then we're also seeing that
02:47 --> 02:50there is a significant rise in recent
02:50 --> 02:52decades of HPV related cancers as well.
02:53 --> 02:56Now when we talk about HPV, most people
02:56 --> 02:58think about cervical cancer, right?
02:58 --> 03:00That's true, but there are several
03:00 --> 03:02cancer types that are caused by HPV,
03:02 --> 03:04including cervical, vaginal,
03:04 --> 03:07vulvar cancers in women,
03:07 --> 03:09anal cancers, HPV, associated head,
03:09 --> 03:11neck, cancers, of course,
03:11 --> 03:12and then also, it causes genital
03:12 --> 03:14warts in both men and women.
03:15 --> 03:18And so you know when we think about head,
03:18 --> 03:21neck cancers and we think
03:21 --> 03:23about these risk factors.
03:23 --> 03:26So certainly one thing that we can
03:26 --> 03:29do in terms of primary prevention
03:29 --> 03:32to reduce our risk is don't smoke,
03:32 --> 03:35don't drink, don't do both of them
03:35 --> 03:38together because they are synergistic.
03:38 --> 03:41Is there? Is there a threshold,
03:41 --> 03:46like a safe amount of tobacco or alcohol?
03:46 --> 03:48Is this dose dependent or is
03:48 --> 03:50it really your recommendation
03:50 --> 03:51that people abstain as much
03:51 --> 03:55as possible? So we think of tobacco
03:55 --> 03:58sort of being the main risk here,
03:58 --> 04:01and alcohol as something of a cofactor.
04:01 --> 04:04I think it's agreed that that
04:04 --> 04:06people shouldn't smoke at all,
04:06 --> 04:08and I know it's it's generally
04:08 --> 04:10very hard to stop smoking,
04:10 --> 04:12but more than three out of five
04:12 --> 04:13adults who have ever smoked
04:13 --> 04:15cigarettes in the United States have
04:15 --> 04:17been able to successfully quit.
04:17 --> 04:19I think it's harder to argue
04:19 --> 04:21that people should abstain
04:21 --> 04:22completely from alcohol use,
04:22 --> 04:24but less is definitely more when
04:24 --> 04:27it comes to this particular risk.
04:28 --> 04:32And so and then and then with regards
04:32 --> 04:36to HPV, any words of wisdom in terms
04:36 --> 04:38of preventing an HPV infection?
04:38 --> 04:45Absolutely so we are now using an
04:45 --> 04:48HPV vaccine with the thoughts.
04:48 --> 04:50Not that it, not that it only
04:50 --> 04:53reduces the risk of cervical cancer,
04:53 --> 04:56but that it can reduce the
04:56 --> 04:57risk of HPV associated.
04:57 --> 05:00Had a neck cancers as well.
05:00 --> 05:02This vaccine was developed to
05:02 --> 05:05prevent cervical cancers, of course.
05:05 --> 05:10And so now we're recommending that.
05:10 --> 05:13That children 11 to 12 boys and
05:13 --> 05:16girls get vaccinated for HPV.
05:16 --> 05:18And the Centers for Disease Control
05:18 --> 05:20also recommends HPV vaccination
05:20 --> 05:22for everyone through age 26 if
05:22 --> 05:24they're not vaccinated already.
05:25 --> 05:28So. Now if you think about the
05:28 --> 05:31epidemiology of head neck cancers,
05:31 --> 05:33these tend to occur in people as
05:33 --> 05:35they get older, is that right?
05:36 --> 05:37That's that's correct.
05:37 --> 05:40I think when we're thinking about
05:40 --> 05:42HPV associated cancers where seeing
05:42 --> 05:45this more in men and we're seeing
05:45 --> 05:48it more in in in some younger
05:48 --> 05:51patients sometimes aged 4050.
05:51 --> 05:54We think about. For that reason
05:54 --> 05:57we also sometimes will you know,
05:57 --> 05:58think about whether it might
05:58 --> 05:59make sense for some individuals,
05:59 --> 06:01perhaps older than 27,
06:01 --> 06:04to get the HPV vaccine.
06:04 --> 06:08And in fact, these days this the
06:08 --> 06:11vaccine is approved up through age 45,
06:11 --> 06:14so patients can speak with their
06:14 --> 06:17physician if they're older than age
06:17 --> 06:2027 about whether their individual
06:20 --> 06:22situation lends itself well.
06:22 --> 06:25To receiving the vaccination for HPV.
06:26 --> 06:28Why is there an age cutoff at all?
06:28 --> 06:30I mean, when we think about
06:30 --> 06:32vaccines like COVID, for example,
06:32 --> 06:34which many of us now have
06:34 --> 06:36become very familiar with,
06:36 --> 06:39we really started vaccinating people who
06:39 --> 06:43are older who were immunocompromised.
06:43 --> 06:46Why is it with HPV that it's
06:46 --> 06:48kind of the reverse.
06:48 --> 06:51We're vaccinating children and
06:51 --> 06:54really limiting vaccinations to
06:54 --> 06:57people over the age of? Of 46.
06:58 --> 07:01The reason for that is because HPV
07:01 --> 07:04vaccination is intended to prevent new
07:04 --> 07:07HIV infections, but does not really
07:07 --> 07:10treat existing infections or diseases.
07:10 --> 07:13That's why the HPV vaccine works best when
07:13 --> 07:16it's given before any exposure to HPV.
07:16 --> 07:18And the thought is that as people get older,
07:18 --> 07:20they're more likely to already
07:20 --> 07:22have been exposed to HPV.
07:22 --> 07:24But of course, even if a person has
07:24 --> 07:26been infected with one type of HPV,
07:26 --> 07:27it may not be too late.
07:27 --> 07:29To help protect oneself from certain
07:29 --> 07:32cancers caused by other types of the virus.
07:32 --> 07:35Cool so we've talked a little bit
07:35 --> 07:38about primary prevention in terms of
07:38 --> 07:41minimizing the the three main risk factors
07:41 --> 07:43for getting a head and neck cancer.
07:43 --> 07:47You know, the next issue is really the
07:47 --> 07:49secondary prevention, so you know,
07:49 --> 07:53we often think about screening in terms of
07:53 --> 07:57mammograms and pap smears and colonoscopies.
07:57 --> 08:01And even low dose CT's for for lung cancer
08:01 --> 08:04screening for people who are are smokers.
08:04 --> 08:06What do we have in terms of screening
08:06 --> 08:08for head neck cancers, anything?
08:09 --> 08:11Currently there are no screening methods
08:11 --> 08:13that have been proven to increase
08:13 --> 08:16survival rates for head and neck cancers.
08:16 --> 08:18That being said, a screening physical
08:18 --> 08:21examination of the neck, the oropharynx,
08:21 --> 08:23which is that middle section of the
08:23 --> 08:26throat that includes the soft palate,
08:26 --> 08:28the base of the tongue and the tonsils.
08:28 --> 08:30As well as the mouth has been
08:30 --> 08:32pretty widely adopted as part of
08:32 --> 08:34a routine dental examination,
08:34 --> 08:36so it's very important to
08:36 --> 08:38keep current with the dentist.
08:38 --> 08:39Also over the years within our
08:39 --> 08:41community we have had head and
08:41 --> 08:43neck cancer screening health fairs
08:43 --> 08:46which are intended to catch some of
08:46 --> 08:48these cancers as early as possible,
08:48 --> 08:51and so let's suppose you haven't
08:51 --> 08:55quite made it to the dentist as yet.
08:55 --> 08:58Not saying anything but a lot
08:58 --> 09:00of people don't particularly
09:00 --> 09:02love going to the dentist.
09:02 --> 09:05What should people be looking for
09:05 --> 09:07in terms of signs and symptoms
09:07 --> 09:10that might clue them into the fact
09:10 --> 09:12that it may be time to pay a visit
09:12 --> 09:14it to get something checked out,
09:15 --> 09:18so part of the reason that we don't have.
09:20 --> 09:23Solid screening tools other screening tools
09:23 --> 09:26for head and neck cancer is that these
09:26 --> 09:29cancers often present in early stages,
09:29 --> 09:31with symptoms that themselves prompt
09:31 --> 09:34people to seek medical attention.
09:34 --> 09:36Some of the main symptoms that lead
09:36 --> 09:39to the diagnosis of a head and
09:39 --> 09:40neck cancer include swelling in the
09:40 --> 09:43mouth or sore that doesn't heal,
09:43 --> 09:45a red or a white patch in the mouth,
09:45 --> 09:47a lump in the neck area,
09:47 --> 09:49with or without pain.
09:49 --> 09:52A persistent sore throat, a voice change,
09:52 --> 09:54and sometimes even frequent nose
09:54 --> 09:57bleeds or unusual nasal discharge.
09:57 --> 10:00Now, it's tricky because we all get
10:00 --> 10:02these symptoms from time to time,
10:02 --> 10:04and it's not uncommon to see patients
10:04 --> 10:07seek medical help for these issues
10:07 --> 10:09and get prescribed antibiotics
10:09 --> 10:11or decongestant decongestants.
10:11 --> 10:13But So what I really want to tell
10:13 --> 10:15people is that if the symptoms persist,
10:15 --> 10:17say for four weeks or longer,
10:17 --> 10:19then they really should get checked
10:19 --> 10:20out by a specialist.
10:20 --> 10:21Such as an otolaryngologist,
10:21 --> 10:23also known as an ear,
10:23 --> 10:24nose and throat doctor
10:25 --> 10:27and so you know one of the things that
10:27 --> 10:30you just mentioned is that these tend
10:30 --> 10:32to present with symptoms that cause
10:32 --> 10:34people to go to the doctor and they
10:34 --> 10:36tend to be found at an early stage.
10:36 --> 10:38So does that mean that most of
10:38 --> 10:40these have a really good prognosis?
10:41 --> 10:43In general, yes.
10:43 --> 10:48So when we see. Early stage.
10:48 --> 10:51The neck cancers that are
10:51 --> 10:53associated with HPV positivity,
10:53 --> 10:54their survival is really good,
10:54 --> 10:59around 80 to 90% five years in cancers
10:59 --> 11:01that are not associated with HPV,
11:01 --> 11:03perhaps more tobacco related,
11:03 --> 11:05these cancers are generally associated
11:05 --> 11:08with a lower five year survival,
11:08 --> 11:10but it's still around 5060%.
11:11 --> 11:14Is there a difference based
11:14 --> 11:16on the etiologic factor?
11:16 --> 11:17Do they cause different mutations
11:17 --> 11:20in these cancer cells such that
11:20 --> 11:22the cancers behave differently?
11:23 --> 11:26The in the mechanism of cellular injury
11:26 --> 11:29is different for HPV associated head
11:29 --> 11:33and neck cancers and and not a HPV
11:33 --> 11:35associated head and neck cancers.
11:35 --> 11:39When in the absence of HPV association,
11:39 --> 11:42it's generally tobacco exposure that
11:42 --> 11:46drives the process and these these
11:46 --> 11:50carcinogens in tobacco tend to impact a
11:50 --> 11:53gene called P53 which is a type of tumor.
11:53 --> 11:55Suppressor gene and when this
11:55 --> 11:57tumor suppressor gene gets mutated,
11:57 --> 12:00the result is almost genetic anarchy and
12:00 --> 12:03tumors that have a lot of mutations that
12:03 --> 12:05tend to be more resistant to treatments.
12:05 --> 12:07And that most likely explains the
12:07 --> 12:10the basis of the difference that
12:10 --> 12:12we see in outcomes over time.
12:13 --> 12:15And so let's suppose you
12:15 --> 12:17find one of these areas.
12:17 --> 12:19You find a bump in your neck that
12:19 --> 12:20stayed there for more than a month,
12:20 --> 12:23or a white plaque in your mouth.
12:23 --> 12:26Or maybe you've had persistent nosebleeds,
12:26 --> 12:28and these aren't just the usual kind of.
12:28 --> 12:30It's really dry in here. Kind of.
12:30 --> 12:32This is my usual Nosebleed.
12:32 --> 12:35But this is nosebleeds that are
12:35 --> 12:38are constant and persistent.
12:38 --> 12:40And you go and see the doctor.
12:40 --> 12:42What should you expect?
12:43 --> 12:46Well, it's likely that the doctor
12:46 --> 12:50might represent a recommend a biopsy.
12:50 --> 12:51We typically think about something
12:51 --> 12:53called a fine needle biopsy,
12:53 --> 12:55where we take some cells and
12:55 --> 12:57examine them under the microscope
12:57 --> 13:00to determine whether whether there
13:00 --> 13:01are any cancer cells present,
13:01 --> 13:04and so if that should come back
13:04 --> 13:08and render a diagnosis of cancer.
13:08 --> 13:09What happens next?
13:09 --> 13:12Do people generally get scans to see
13:12 --> 13:15whether this has spread anywhere else,
13:15 --> 13:16and and how common is it for
13:16 --> 13:18head and neck cancers to spread
13:18 --> 13:19to other parts of the body?
13:21 --> 13:23Once we've made a diagnosis
13:23 --> 13:24of head and neck cancer,
13:24 --> 13:27we generally do obtain scans and
13:27 --> 13:29then we start to get everyone
13:29 --> 13:31together to discuss what to do.
13:31 --> 13:34The care of patients with head and
13:34 --> 13:36neck cancers is highly complex,
13:36 --> 13:39so it needs to be both
13:39 --> 13:41collaborative and coordinated.
13:41 --> 13:43It requires a multidisciplinary
13:43 --> 13:45team approach that leverages the
13:45 --> 13:47combined experience of various
13:47 --> 13:49physicians and other specialists
13:49 --> 13:51to achieve the best outcomes.
13:51 --> 13:52We always talk
13:52 --> 13:53about, you know what?
13:53 --> 13:55I want you to hold that thought
13:55 --> 13:57because it does sound like it will
13:57 --> 13:59be really complex and intricate,
13:59 --> 14:01and I want to get into that
14:01 --> 14:03conversation right after we take a
14:03 --> 14:04short break for a medical minute.
14:04 --> 14:06Please stay tuned to learn
14:06 --> 14:08more about innovations in head
14:08 --> 14:10neck cancer with my guest,
14:10 --> 14:11doctor Benjamin Newton.
14:11 --> 14:13Funding for Yale Cancer Answers
14:13 --> 14:15comes from Smilow Cancer Hospital,
14:15 --> 14:18where you can view videos from their
14:18 --> 14:21survivorship team by searching for the
14:21 --> 14:24Smilow survivorship playlist on YouTube.
14:24 --> 14:27The American Cancer Society estimates that
14:27 --> 14:29over 200,000 cases of Melanoma will be
14:29 --> 14:32diagnosed in the United States this year,
14:32 --> 14:35with over 1000 patients in Connecticut alone.
14:35 --> 14:37While Melanoma accounts for only
14:37 --> 14:40about 1% of skin cancer cases,
14:40 --> 14:43it causes the most skin cancer deaths,
14:43 --> 14:44but when detected early,
14:44 --> 14:47it is easily treated and highly curable.
14:47 --> 14:49Clinical trials are currently
14:49 --> 14:50underway at federally designated
14:50 --> 14:52Comprehensive cancer centers such as
14:52 --> 14:55Yale Cancer Center and Smilow Cancer
14:55 --> 14:57Hospital to test innovative
14:57 --> 14:59new treatments for Melanoma.
14:59 --> 15:01The goal of the specialized programs
15:01 --> 15:03of research excellence in Skin
15:03 --> 15:05Cancer Grant is to better understand
15:05 --> 15:06the biology of skin cancer,
15:06 --> 15:08where the focus on discovering
15:08 --> 15:10targets that will lead to improved
15:10 --> 15:12diagnosis and treatment.
15:12 --> 15:14More information is available
15:14 --> 15:15at yalecancercenter.org.
15:15 --> 15:18You're listening to Connecticut public radio.
15:20 --> 15:22Welcome back to Yale Cancer Answers.
15:22 --> 15:24This is doctor Anees Chagpar and
15:24 --> 15:26I'm joined tonight by
15:26 --> 15:27my guest doctor Benjamin Newton.
15:27 --> 15:29We're talking about the care
15:29 --> 15:31of patients with head and neck
15:31 --> 15:33cancers and right before the break
15:33 --> 15:35Ben you were mentioning the fact
15:35 --> 15:37that this is really complex.
15:37 --> 15:39So after somebody it finds a a
15:39 --> 15:42plaque in the mouth or a Nosebleed
15:42 --> 15:44or a bump in the neck.
15:44 --> 15:46Or has you know hoarseness or any
15:46 --> 15:49one of a myriad of symptoms that
15:49 --> 15:52could be attributable to a head neck?
15:52 --> 15:55Answer once they seek medical
15:55 --> 15:58attention and has a biopsy that
15:58 --> 16:00confirms the diagnosis.
16:00 --> 16:03Some scans are done and then you
16:03 --> 16:05mentioned that this is really a
16:05 --> 16:07multidisciplinary approach where you
16:07 --> 16:10kind of get all of the specialists
16:10 --> 16:12together to think about personalizing
16:12 --> 16:15or tailoring the treatment plan
16:15 --> 16:17to an individual patient.
16:17 --> 16:19Can you tell us a little bit more about that?
16:19 --> 16:22How does that work and what are those?
16:22 --> 16:25Conversations look and sound like anyways.
16:26 --> 16:30So once the data is already gathered,
16:30 --> 16:32we always talk about treatment plans
16:32 --> 16:35and what we call a tumor board and that
16:35 --> 16:37contains medical oncologists like myself,
16:37 --> 16:40radiation oncologists head and neck
16:40 --> 16:42surgical oncologist as well as
16:42 --> 16:44pathologists and radiologists and
16:44 --> 16:47will generally end up developing
16:47 --> 16:49plans that include surgery, radiation,
16:49 --> 16:52cancer, medication therapy or some
16:52 --> 16:56sequence of these or some combination.
16:56 --> 16:58Always based on the, uh,
16:58 --> 17:01based on the published evidence that we have,
17:01 --> 17:03I think it's really important to
17:03 --> 17:05tailor therapies not only to the
17:05 --> 17:07individual patients condition and
17:07 --> 17:08their other health issues,
17:08 --> 17:11but also to their priorities and values.
17:11 --> 17:13What do you mean by that?
17:13 --> 17:16Well, we spend a lot of time
17:16 --> 17:18thinking about the impact of cancer
17:18 --> 17:20and its treatment on function.
17:20 --> 17:21For example,
17:21 --> 17:23a common scenario that occurs in
17:23 --> 17:26my office is weighing various.
17:26 --> 17:28Cancer medication therapy options with
17:28 --> 17:30an eye towards the different side
17:30 --> 17:32effects that might be experienced.
17:32 --> 17:33Of course,
17:33 --> 17:35we always want to minimize toxicity,
17:35 --> 17:38but in some cases there's more at
17:38 --> 17:41stake for one person compared to another.
17:41 --> 17:42Perhaps, for example,
17:42 --> 17:44my patient is a musician and I might
17:44 --> 17:47normally be thinking of a medication
17:47 --> 17:49that sometimes damages the part of
17:49 --> 17:51the inner ear called the cochlea,
17:51 --> 17:54which can result in loss of hearing.
17:54 --> 17:56This person has more to lose in
17:56 --> 17:58terms of livelihood and general
17:58 --> 18:00quality of life and might benefit
18:00 --> 18:03from our choosing a different drug.
18:03 --> 18:05So I think that what's required as
18:05 --> 18:07we tailor treatments is that we truly
18:07 --> 18:09know our patients and engage on a
18:09 --> 18:10personal level with them in order
18:10 --> 18:12to make treatment recommendations
18:12 --> 18:14that ultimately serve them best.
18:15 --> 18:18Now the other part of personalized
18:18 --> 18:20medicine that we often talk about on
18:20 --> 18:23this show is is really looking at not
18:23 --> 18:25only the the patient and and their
18:25 --> 18:27their life and their values and and you
18:27 --> 18:30know how they earn their livelihood,
18:30 --> 18:31their social situation,
18:31 --> 18:34which is all really important but also kind
18:34 --> 18:37of the finer points of the tumor itself.
18:37 --> 18:40That particular genetic mutations.
18:40 --> 18:43Thinking about which drugs might
18:43 --> 18:46attack a particular type of cancer, or.
18:46 --> 18:49A particular mutation than others
18:49 --> 18:52does that play into, and if so, how?
18:53 --> 18:56It does we're very interested in
18:56 --> 18:58learning more about the tumor than
18:58 --> 19:00we have been able to in the past.
19:00 --> 19:04We like to learn about the
19:04 --> 19:08molecular attributes of the tumor,
19:08 --> 19:09and perhaps better understand what
19:09 --> 19:12mutations might be playing a role
19:12 --> 19:14in a particular person's cancer.
19:14 --> 19:17And there's a lot of interest in
19:17 --> 19:19developing tailored therapies that
19:19 --> 19:21are designed to address specific,
19:21 --> 19:22you know, vulnerabilities.
19:22 --> 19:25We might say when a particular
19:25 --> 19:26mutation is found.
19:28 --> 19:30You know, at the top of the show
19:30 --> 19:32we were kind of talking about the
19:32 --> 19:35fact that the head and neck is a
19:35 --> 19:37really diverse kind of region.
19:37 --> 19:39So talk a little bit more about
19:39 --> 19:42kind of the landscape of a head and
19:42 --> 19:44neck cancers and and kind of the
19:44 --> 19:47generalities or rules of thumb that
19:47 --> 19:49you kind of use or think about as
19:49 --> 19:51you're planning treatment strategies
19:51 --> 19:53in all of these different areas.
19:53 --> 19:55So it's, it's very
19:55 --> 19:57complicated and very nuanced,
19:57 --> 19:59but I think one of the things that we've.
19:59 --> 20:02Think about first is is there an
20:02 --> 20:04opportunity for surgery to eliminate
20:04 --> 20:06the disease and result in cure?
20:06 --> 20:08Sometimes there is,
20:08 --> 20:11but sometimes the consequences from a
20:11 --> 20:15function standpoint might not be desirable,
20:15 --> 20:18and so sometimes we'll think about
20:18 --> 20:21replacing surgery with radiation or
20:21 --> 20:23combination of radiation and chemotherapy.
20:23 --> 20:25Sometimes we'll use chemotherapy
20:25 --> 20:27at the very beginning to make
20:28 --> 20:30other treatments more feasible,
20:30 --> 20:32and sometimes we'll use chemotherapy
20:32 --> 20:34after some of the more definitive
20:34 --> 20:37treatments to improve the odds of cure.
20:37 --> 20:38Overtime.
20:39 --> 20:42And so, you know, as we kind of
20:42 --> 20:44think about presumably this is
20:44 --> 20:46where this tumor board really
20:46 --> 20:49comes into play, where, you know,
20:49 --> 20:51each specialist is kind of putting
20:51 --> 20:54their cards on the table as it were.
20:54 --> 20:57This is how I can help, you know,
20:57 --> 20:59in this Symphony of of instruments
20:59 --> 21:01that we have in that room with the
21:01 --> 21:03medical oncologists and the radiation
21:03 --> 21:05oncologists and the surgeons.
21:05 --> 21:07How can each instrument really help
21:07 --> 21:09the whole Symphony to sound better?
21:09 --> 21:10Is that right?
21:10 --> 21:12Is that how those decisions are made?
21:12 --> 21:14Pretty much, I think everyone wants to
21:14 --> 21:16offer the very best for the patients.
21:16 --> 21:19I think there is a, you know,
21:19 --> 21:21an exchange of ideas that allows
21:21 --> 21:24for the sort of collective consensus
21:24 --> 21:28to emerge in a way that ultimately
21:28 --> 21:30works best for the patient.
21:30 --> 21:32And that's what really matters.
21:32 --> 21:33With these, you know,
21:33 --> 21:36with these discussions is that we ultimately
21:36 --> 21:38find what's going to be most helpful.
21:38 --> 21:40But yes, I think we all kind of start.
21:40 --> 21:41With what's what's our angle
21:41 --> 21:42and how can it help the most?
21:44 --> 21:46So the the other thing that you
21:46 --> 21:49mentioned was that each of these
21:49 --> 21:51modalities while it has its its
21:51 --> 21:54strengths to bring to the treatment
21:54 --> 21:57plan in terms of either making other
21:57 --> 21:59therapies more feasible in the case of
21:59 --> 22:02medical oncology or trying to remove
22:02 --> 22:04as much disease as possible in in
22:04 --> 22:08the in the area of surgery and so on.
22:08 --> 22:11Each of them also has toxicities
22:11 --> 22:14and I can imagine that.
22:14 --> 22:16While you know to your point when
22:16 --> 22:17you were speaking about the musician,
22:17 --> 22:20each of these toxicities may affect
22:20 --> 22:22a given patient more or less.
22:22 --> 22:25But all of these toxicities may really affect
22:25 --> 22:28patients in terms of you know their hearing,
22:28 --> 22:30their sense of smell.
22:30 --> 22:33You know how much they can chew or
22:33 --> 22:35swallow their speech, and so on.
22:35 --> 22:37Can you talk a little bit about how
22:37 --> 22:39you can help patients with all of
22:39 --> 22:41those side effects of treatment?
22:42 --> 22:45So I think we have to acknowledge that
22:45 --> 22:48we have a lot of people helping our
22:48 --> 22:51patients get through their treatments.
22:51 --> 22:53It's important for any.
22:53 --> 22:56Any head and neck cancer group
22:56 --> 22:59to have a wide range of support
22:59 --> 23:01services available to help people.
23:01 --> 23:03For example, speech and
23:03 --> 23:04language pathologists.
23:04 --> 23:07They help in so many ways they look
23:07 --> 23:08primarily at communication and
23:08 --> 23:10swallowing related issues relating
23:10 --> 23:12to the cancer and its treatment,
23:12 --> 23:14so it's always important to involve
23:14 --> 23:16these specialists early so that
23:16 --> 23:18guidance can be provided to help
23:18 --> 23:19limit the impacts of cancer.
23:19 --> 23:22Treatments on swallowing functions.
23:22 --> 23:25Social work is also incredibly important.
23:25 --> 23:26Of course,
23:26 --> 23:28receiving a diagnosis of cancer
23:28 --> 23:29and getting cancer treatment
23:29 --> 23:31can be incredibly stressful,
23:31 --> 23:33and people arrive at this moment
23:33 --> 23:35with different needs in their lives.
23:35 --> 23:36And sometimes unmet needs
23:36 --> 23:38can impact outcomes, too.
23:38 --> 23:40Whether there's housing instability or
23:40 --> 23:43a person doesn't have a car but needs to
23:43 --> 23:45come for their treatments nonetheless.
23:45 --> 23:47Sometimes extra services
23:47 --> 23:49and coordination are needed,
23:49 --> 23:52and dietitians are also a very
23:52 --> 23:54important part of the team.
23:54 --> 23:56They make sure that patients have adequate.
23:56 --> 23:58Nourishment during their treatment,
23:58 --> 24:01they help to assess patient needs and
24:01 --> 24:04adapt the treatment plan to ensure
24:04 --> 24:06that adequate nutrition is available
24:06 --> 24:09through and following their treatments.
24:10 --> 24:12Important to think about all of
24:12 --> 24:14these other players that are also
24:14 --> 24:16really important members of the team.
24:16 --> 24:18Not just the physicians who who
24:18 --> 24:21are trying to treat the cancer,
24:21 --> 24:24but but all of these other people
24:24 --> 24:27who make that treatment palatable or
24:27 --> 24:31at least a little bit more feasible.
24:31 --> 24:35Talk a little bit about what's new in head,
24:35 --> 24:37neck cancers and and clinical
24:37 --> 24:40trials that might be going on that
24:40 --> 24:42help to move the field forward.
24:42 --> 24:43What's on the horizon?
24:43 --> 24:44What can we expect?
24:45 --> 24:49Well, I think one of the things that is.
24:49 --> 24:52Very exciting and head and neck cancer
24:52 --> 24:55is an evolving understanding of the sort
24:55 --> 24:59of the differential outcomes that we see
24:59 --> 25:02in patients with HPV associated cancers.
25:02 --> 25:07It it gives us the opportunity to think
25:07 --> 25:10about how now and in the future we might
25:10 --> 25:13fine-tuned therapies just to give the
25:13 --> 25:17people just the right amount of treatment
25:17 --> 25:19and perhaps avoiding unnecessary.
25:19 --> 25:20Side effects.
25:20 --> 25:23So that's incredibly exciting and
25:23 --> 25:26another area that's very exciting
25:26 --> 25:29is the the the role of immunotherapy
25:29 --> 25:32in the treatment of advanced head
25:32 --> 25:36and neck cancers we are.
25:36 --> 25:40Now able to look at a tumor and
25:40 --> 25:42assess something called a biomarker
25:42 --> 25:46that helps us determine what the
25:46 --> 25:48vulnerability of immunotherapy to
25:48 --> 25:52immunotherapy that a cancer might have.
25:52 --> 25:55These drugs basically work by.
25:55 --> 25:58Invigorating the immune system and
25:58 --> 26:01having the immune system doing the
26:01 --> 26:04work of killing the cancer cell.
26:05 --> 26:08Well, so always exciting
26:08 --> 26:10things on the horizon.
26:10 --> 26:12When we think about that team
26:12 --> 26:13that you were mentioning,
26:13 --> 26:15I would imagine that people involved
26:15 --> 26:17in research are part of that team
26:17 --> 26:19and that there may be opportunities
26:19 --> 26:21for patients to get involved in
26:21 --> 26:23clinical research and and helping
26:23 --> 26:26to kind of move the field forward.
26:26 --> 26:28Have you noticed that patients
26:28 --> 26:30are really enthusiastic about
26:30 --> 26:32that or are they a little bit
26:32 --> 26:33more apprehensive thinking,
26:33 --> 26:36you know, I'll stick to what's
26:36 --> 26:38known rather than what's unknown,
26:39 --> 26:40of course, clinical trials?
26:40 --> 26:43Are an incredibly important way of
26:43 --> 26:45improving cancer treatments over time.
26:45 --> 26:47You know, it's important to remember
26:47 --> 26:49that patient that today's treatments were
26:49 --> 26:51once tested in a clinical trial setting.
26:51 --> 26:54So what we're really trying to do when
26:54 --> 26:56patients enroll in clinical trials is
26:56 --> 26:59to define tomorrow's treatments today.
26:59 --> 27:01And and you're right, I think it can
27:01 --> 27:04sometimes sound scary to a patient,
27:04 --> 27:06the prospect of participating in a trial,
27:06 --> 27:08especially when there are,
27:08 --> 27:12as it were tried and true options.
27:12 --> 27:15But that bravery and that generosity
27:15 --> 27:18of spirit really is a key to progress.
27:18 --> 27:21And I think it's also important to have
27:21 --> 27:23clinical trials available to patients
27:23 --> 27:25who get care in community settings.
27:25 --> 27:28We want these trial results to determine
27:28 --> 27:30our management to be meaningful
27:30 --> 27:32for the patients in our Community.
27:32 --> 27:36And plus patients tend to do well on trials.
27:36 --> 27:39Care on a clinical trial is excellent care.
27:39 --> 27:41And of course we want to extend
27:41 --> 27:42these opportunities equitably.
27:42 --> 27:43All patients.
27:44 --> 27:46Yeah, that's one thing that a lot of
27:46 --> 27:48people may not realize is that in general,
27:48 --> 27:50if you look at people who
27:50 --> 27:51participate in clinical trials,
27:51 --> 27:54they tend to do better than people who don't,
27:54 --> 27:56in part because, as you say, Ben,
27:56 --> 27:59you know we're we're trying to
27:59 --> 28:00develop tomorrow's therapies today,
28:00 --> 28:04and so sometimes the only way to get
28:04 --> 28:06those therapies is on a clinical trial.
28:06 --> 28:08Now. One other question that
28:08 --> 28:11many people might have is if my
28:11 --> 28:14doctor offers me a clinical trial.
28:14 --> 28:15Does that mean that there is no option?
28:15 --> 28:17Does it mean like there is no
28:17 --> 28:19other choice that I'm kind of
28:19 --> 28:21at the end and there's no,
28:21 --> 28:23there's no other tools in the toolbox?
28:23 --> 28:25Not necessarily. Frontline clinical trials
28:25 --> 28:29are very important so that we can lead
28:29 --> 28:31out with better treatments in the future.
28:31 --> 28:33Doctor Benjamin Newton is an
28:33 --> 28:35assistant professor of clinical
28:35 --> 28:36medicine and medical oncology
28:36 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:44and past editions of the program.
28:44 --> 28:47Are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Head and Neck Cancer Care in the Community August 21, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095