Someone in my family survived lung cancer six years ago. The treatment didn’t include radiation or chemotherapy, and the tumor was removed neatly by an excellent surgeon. But the surgery scar still interferes with his normal muscle function, and the possibility that the cancer might come back is part of our family’s collective consciousness – and worry.

My family member is just one of the 12 million Americans who have had cancer, and the Centers for Disease Control and Prevention released a survey last week describing some of the issues and health challenges facing these patients. In sum (and as a colleague discussed in a recent Stanford Medicine article), survivors may be cancer-free, but their bodies and minds are forever marked by their encounter with the disease.

With that in mind, the Stanford Cancer Institute this week opened a survivorship clinic in its Clinical Care Center. As I wrote today in a release:

The clinic, which will focus initially on gynecologic cancer survivors, joins a small but growing number of such clinics, where all care is focused on wellness post-cancer treatment.  “There’s a whole body of knowledge, and more importantly, a whole collection of needs that cancer survivors have,” said Douglas Blayney, MD, the Cancer Center’s medical director. “Some are common across tumor types and some are unique to various tumor types. We are trying to meet those needs and serve those patients.”

At the clinic, patients will be given access to resources through Stanford’s Cancer Supportive Care Program and will likely be seen by a nurse practitioner who was there during the course of initial treatment. Jonathan Berek, MD, director of the Stanford Women’s Cancer Center, emphasized, though, that being seen at the clinic isn’t in lieu of being followed up by one’s oncologist. The service, he said, is an adjunct to patients’ care and something that offers “someone who can spend more time with them, go over tests, get them involved in support groups they haven’t been involved with and pay more attention to those needs not related to a cancer recurrence.”

“The goal is to return to wellness, as defined by each individual,” clinic manager Kelly Bugos, RN, NP, told me.

Previously: Cancer’s next stage: A report from Stanford Medicine magazine, Unique challenges face young women with breast cancer, A call for rehab services for cancer survivors, Fear of recurrence an issue for some cancer survivors and A look at how best to care for America’s growing population of cancer survivors
Photo by Norbert von der Groeben

One of the first things we learn about bodies is, of course, that women and men are different – that awareness is undoubtedly prehistoric. What remains remarkable is just how far we still have to go in our understanding of those differences, whether it’s pain or heart disease.

This month, the Women’s Heart Health program at Stanford celebrates the fifth anniversary of its pursuit toward a more delineated picture of heart disease in women. Interventional cardiologist Jennifer Tremmel, MD, is its founding clinical director. While she and other researchers in the field have uncovered some notable gender distinctions in heart health, their work hasn’t led to a full understanding among all physicians of the unique symptoms and issues facing women. As Tremmel explained to me in a recent Health Notes story:

For years, the standard medical treatment for women with heart disease was based on what we know about heart disease in men. That’s really confounded things.  In the past 30 years, we’ve learned a lot about how women differ from men, but there’s a lot we still don’t know.  Just getting physicians to have a broader concept of symptoms, and what constitutes coronary artery disease in women, is a challenge.

In the same article I tell the story of one Stanford patient: a thirtysomething woman with chest pain whose doctors couldn’t find anything wrong with her. “I intuitively knew something wasn’t right,” Reyna Robles said, and she was correct: As you’ll see in the video above, she eventually saw Tremmel and was diagnosed with and treated for a myocardial bridge.

Previously: Understanding and preventing women’s heart disease and Gap exists in women’s knowledge of heart disease

There’s lots of talk these days about teaching medical students how to be compassionate practitioners; Stanford’s School of Medicine has even introduced patient-role players into its admissions process. What some might say is equally important is making sure that doctors and other clinicians have outlets to talk about their feelings. Stanford is doing something about that, too. A story I wrote in this week’s Inside Stanford Medicine shows just how much they have to say, when given the chance, and how important it is to their own health:

“In some ways, feelings have taken second place to the illness and the technology,” said Douglas Blayney, MD, the Ann & John Doerr Medical Director of the cancer institute. “Patients often have a support network. We in the profession don’t often have an opportunity to share with one another, to know what our colleagues are feeling and how they are coping.”

Just like every other woman, I’ve read the statistics about breast cancer. I’m now in that age group where I could be the one in 29 who develop the disease, so I’m paying a lot more attention to what my treatment choices might be.

So when Broderick was herself diagnosed with breast cancer, she thought her treatment would mimic what she’d seen with her family members. But she was pleasantly surprised when her Stanford oncologist, Kate Horst, MD, told her she was a good candidate for a new abbreviated form of radiation therapy that would take just five days instead of five weeks. “The thought of going every day, five days a week for seven weeks was just overwhelming,” Broderick told me for an article in Stanford Hospital Health Notes. ”When I was presented with this shorter option, I just grabbed at it… When Dr. Horst explained it to me, it made a lot of sense.”

As more and more medical treatment moves from large incisions to small and, in some cases, no incision at all, radiation has been moving along the same path. With machines like the CyberKnife, developed by a Stanford physician, radiation is no longer like taking a long soaking bath, but more like a quick dip. As I explain in my story:

One approach, which takes place during surgery, is called intraoperative radiotherapy. Another method uses external radiation therapy after surgery.  Both approaches focus radiation beams only on the margins of the lumpectomy cavity, instead of the whole breast.

It’s a technique, Horst said, that’s allows patients “to continue to be physically active, to keep working and to take care of their families.”

Stanford was one of the first medical centers to offer these newer forms of radiation therapy, which have shown great promise but are still in their early days. “Physicians knew it was out there,” Frederick Dirbas, MD, who leads the breast disease management group at the Stanford Women’s Cancer Center. “Most said it’s been tried and didn’t work. We decided we were going to do this in a way that would make it work.”

As for Broderick, except for the week of her radiation, she worked throughout her treatment. Seven years after her treatment, she remains free of cancer.

Previously: Partial breast irradiation could sidestep side effects of traditional radiation therapy
Photo of Broderick by Norbert von der Groben

Michelle Phillips came to Stanford Hospital with all other options exhausted. In 2002, the Sunnyvale mother of two had been diagnosed with a very rare, and malignant, brain tumor. Two surgeries and radiation treatments removed it, but five years later, new tumors appeared in her liver and lungs: thirty in her liver alone. Inoperable, her physicians told her. And they didn’t have any other recommendations.

After long hours of research, Philips and her husband found (.pdf) Stanford’s Daniel Sze, MD, PhD, an interventional radiologist. Sze and his colleagues had made Stanford among a few dozen U.S. hospitals offering patients like Philips a very new form of treatment: microscopic, radiation-loaded spheres sent through the bloodstream to the arteries that feed tumors.

Now, in a new paper in the Journal of Vascular and Interventional Radiology, Sze and his team share the results of their work with 201 patients treated this way between 2004 and 2010.  In two separate studies, the team looked at how to deliver the microspheres most effectively. In some patients, tumors had recruited blood vessels from outside the liver to feed them. The Stanford group wanted to see what would happen if they closed off those vessels first before delivering the microspheres. In a second group of patients, the physicians blocked off extra arteries found in almost half the population and used the liver’s own network of vessels to deliver the microspheres.

“Results of these two new studies may be beneficial to patients with liver tumors that cannot be surgically removed,” Sze said in a release (.pdf). “These studies address methods to modify the blood vessels of the liver in order to maximize delivery of tumor-killing material to the targets and to make treatment simpler and safer.”

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The day I turned 60, I hiked up to a place in Yosemite called Cloud’s Rest. It’s nearly 10,000 feet tall, with some very big boulders to boot. I was grateful that all that time I spent in the gym and on local trails prepared me for the 15 miles I trod that day. My aging feet were safely supported in well-cushioned hiking boots.

Back in the real world, professional attire does not allow comfy hiking boots to substitute for the youthful fatty padding my vintage bones have lost through nature’s wear and tear. When I read recently about some new, biomechanically-engineered, arthritis-assuaging shoes designed by Tom Andriacchi, PhD, at Stanford’s BioMotion Lab – and available at retail stores – I stood up and cheered. Another option to maintain my mobility!

Andriacchi, a world-class expert on gait and osteoarthritis, was persuaded by Laura Carstensen, PhD, founding director of the Stanford Center on Longevity, to apply his knowledge and creativity to the challenge of therapeutic footwear. She saw the opportunity to break out of the classic thinktank syndrome with a breakthrough bench-to-bedside project. She explains:

This is the poster child for us. There are an awful lot of important ideas that academics generate and then sit back and hope someone adopts. Most researchers are not trained to move ideas past the conceptual stage. What we do at the center is to show how and where those ideas can be useful. We help to move practical ideas, based on science, forward to a place where they can positively affect peoples’ lives.

On behalf of my age group and up, I am grateful for that thought.

Previously: Exercise may alleviate symptoms of arthritis regardless of weight loss

Sculptor Auguste Rodin was one of the great observers of human anatomy, and he did so not to advance scientific knowledge but to better exploit the human body’s innate expressiveness. Out of stone and clay, he prised riveting animation of the human body in form and spirit, inspiring generations of artists and admirers. His skill was such that some in his day accused him of using molds made directly from his models.

Today Stanford’s Cantor Arts Center opens a 132-work show that displays Rodin’s clear influence on artists like Georgia O’Keeffe, Gaston Lachaise, Edward Steichen, Gutzon Borglum, Malvina Hoffman, Charles Demuth and Man Ray. The show includes the work of 42 artists, loaned by museums, foundations and private collections.

If you visit, don’t expect to see absolute anatomical accuracy. Rodin didn’t hesitate to manipulate real proportions and musculoskeletal capabilities to achieve his artistic goals. And we know this definitively because a Stanford medical student and two Stanford physicians took the time to take a very scientific look at Rodin’s work.

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