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Daily News: Disease

Coordinated care helps cancer patients, says Providence exec

Mail Tribune (Medford, OR)


April 09--Active, coordinated care handled by advanced medical teams can make a world of difference for cancer patients or those at risk for cancer.

Walter Urba, director of the Providence Cancer Center in Portland, told a Chamber of Medford/Jackson County Forum audience Monday that the scope of research, prevention and treatment is rapidly changing.

So is the cost.

The reality facing men is that they have a 1 in 2 chance of dealing with cancer. For women it's one in three, and according to the American Cancer Society, cancer hits more than 20,000 people in Oregon annually. It's still the most feared diagnosis by patients, Urba said.

The 1.6 million Americans -- or one-half of 1 percent of the population -- who will get cancer this year will consume 5 percent of the country's health care spending, he said.

This year, there will be 13.7 million cancer survivors with the number -- driven by baby boom demographics -- growing to 18 million in 2020.

Cancer survivors' care cost twice as much per year, and will be a major contributor to the 27 percent increase for cancer care costs by 2020.

Of the nearly 5,200 new cancer cases Providence doctors encounter each year, about 750 come through its Medford Medical Center on the average.

"We need to manage them properly," Urba said. "We need to make sure there is access for what is available locally and to special research protocol or hospital, with perhaps physicians or equipment that local hospitals don't have. We can't all have expert doctors and nurses and multimillion dollar pieces of equipment at every hospital."

Genome research has enabled better understanding of cancer in recent years, he said.

"We now know that cancer is a genetic disease," Urba said. "It doesn't mean that you're born with it necessarily, but you can be born with genes that are predisposed to cancer. We can test for what those genes are and identify the patients that are at risk."

Activity and habits also can shed light too, as genes mutate over time.

"Whether it's smoking with lung cancer or exposure to sun with melanoma, we can see the mutations that can cause mutation or cause the cells to behave in a different manner," Urba said.

Early detection of changes is what can prevent the spread of life-theatening cells at an early stage, perhaps even before a colonoscopy is needed.

Molecular biology tests of stool or urine samples, costing "a couple hundred dollars" are considerably less expensive than colonoscopies.

"But not everybody can do those studies, so we have to get the samples to the right place," he said. "If we find out too late, that's when we all pay the price."

Patients may have a disease that looks the same for all of them under a microscope, but the subtle variations can make a big difference.

"When you look at the genetics, it's different," Urba said. "You can understand why the same three drugs given to 100 people will only give you 20 percent or 15 percent response. We think it's the same disease, but it's not. We have to be prepared from the very beginning to go to lengths to understand what makes the tumor cells different."

In the area of oral, head and neck cancer, he said, Providence has coordinated its efforts with the Earle A Chiles Research Institute in Portland, Oregon Health & Science University, New York University and the University of California-San Francisco.

"It brings together doctors to give the best patient care, teaching, services to those in need and provide research for the best possible therapy," he said. "Collaboration is really crucial for all of it."


(c)2013 the Mail Tribune (Medford, Ore.)

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Copyright Mail Tribune (Medford, OR) 2013

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