Oncology Services

Specializing Institutions

Oncology is a branch of medicine that deals with tumors (cancer), from screening, diagnosis, therapy and surgery. The most important diagnostic tools in oncology are biopsies, endoscopies, X-rays, MRI scanning and blood tests. Interventions depend on the nature of the tumor. Often, surgery is attempted to remove a tumor entirely. Chemotherapy and radiation therapy are used as first-line radical treatments. Since cancer can occur in so many of the body’s systems, many doctors choose to specialize in a particular branch of oncology, such as bone cancer or blood diseases. Oncology also involves the research into cancer, its causes and possible cures. Lung cancer is by far the most fatal cancer in men, followed by prostate and colon. In women, lung and breast cancer are the leading sites of cancer death.

The South Texas Medical Center is home to the only academic treatment and research center in the South Texas Region. Patients can benefit by gaining access to new drugs that are unavailable in other cancer centers. We are also home to an internationally recognized Phase I clinical drug program.

Oncology services at the South Texas Medical Center extend the sophistication of radiation therapy. Our oncologists and researchers practice and pioneer innovative techniques to treat patients using advanced radiation systems such as the TomoTherapy® Hi Art® unit. The unit, one of only three available in Texas, integrates optimized planning, image guidance, and continuous 360° delivery for precise radiation therapy from all angles around the patient. Other cancer therapies and services that patients can find at the South Texas Medical Center include Intensity Modulated Radiation Therapy (IMRT), High Dose Rate (HDR) brachytherapy and Novalis Tx Radiosurgery.

Patients and their families can receive non-medical oncology services at the South Texas Medical Center. These services include lectures, support groups, nutrition advice, psychological and emotional assistance, social services and more.

The National Cancer Institute has recognized one of our institutions for its excellence in cancer treatment and patient service, making the South Texas Medical Center a source of hope for many and a hub of oncology research and innovation.

Pediatric Oncology Services

Pediatric Oncology is a branch of medicine concerned with the diagnoses and treatment of cancer in children. It is considered one of the most challenging specialties because of its high mortality rate. Pediatric Oncologists take a slightly different course in their education compared to regular oncologists. Some of them, for instance, become pediatricians after completing medical school and later specialize further in oncology. Cancer affects about 14 of every 100,000 children in the United States each year. The most common cancers in children are leukemia, lymphoma and brain cancer. Typically, factors that trigger cancer in kids differ from those that cause cancer in adults, such as smoking or exposure to environmental toxins. Rarely, there may be an increased risk of cancer in kids who have a genetic condition, such as Down syndrome. Childhood cancers can occur suddenly, without early symptoms.

The South Texas Medical Center features one of the most specialized children’s cancer research centers in the nation. The research center is organized around our major programs and is comprised of an interdisciplinary group of faculty and field experts. The center’s mission is to advance scientific knowledge relevant to childhood cancer and to accelerate the translation of knowledge into novel therapies.

Oncology Articles

  • Better education on breast reconstruction may be needed after cancer

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - When it comes to deciding to have breast reconstruction after surgery for breast cancer, most women are generally satisfied with the decision-making process, a new study suggests.

    "Our findings generally were good news - women who wanted reconstruction got it, those who didn't were generally satisfied with the decision process," said Dr. Monica Morrow, the study's lead author from Memorial Sloan Kettering Cancer Center in New York City.

    The study findings also revealed misunderstandings on the part of some patients. For example, some women who didn't undergo breast reconstruction said they worried that the implants would interfere with cancer screenings later on, or that they feared the implants.

    "Our study points to specific topics doctors can address with patients - safety of implants, lack of interference with cancer detection by reconstruction that are of concern to patients," Morrow wrote in an email.

    She said that the study also indicates that many patients are focused on their cancer treatment at the time of diagnosis and not interested in reconstruction. That's fine, she said, as long as they are aware of the possibility of reconstruction later on.

    "There is no 'correct' rate of reconstruction," she added.

    Morrow and her colleagues write in JAMA Surgery that in the U.S., since passage of the Women's Health and Cancer Rights Act of 1998, women receive universal coverage for breast reconstruction after they have a breast removed.

    Despite the coverage for breast reconstruction, only about 25 to 35 percent of women opt for the procedure, they add.

    Some people, who are not patients or breast cancer doctors, have said this rate of reconstruction is low, Morrow said.

    To ensure that breast cancer patients understood their options, New York State passed a law in 2010 mandating that surgeons discuss breast reconstruction with them and provide information on insurance and availability.

    "The purpose of our study was to understand whether patients felt that they were adequately informed about reconstruction and to understand the reasons they chose not to undergo the procedure," she added. "Without such understanding, it is not possible to devise strategies to address the problem (if there actually is a problem)."

    For the study, she and her colleagues used data from cancer registries in Los Angeles and Detroit on 485 women who had a breast removed and were cancer free for four years.

    Overall, 222 women, or about 46 percent, eventually underwent breast reconstruction. About two-thirds of those women had it done at the same time their breast was removed; the other third had breast reconstruction later on.

    Only about 13 percent of women said they were dissatisfied with the decision process about whether or not to have breast reconstruction, the authors found.

    Black women were about three times more likely to report dissatisfaction, however.

    Women who were older, had other health problems and lower education levels were less likely to have breast reconstruction. Women who received chemotherapy as treatment were also less likely to have the surgery.

    Women without private health insurance were also less likely to have breast reconstruction, despite universal coverage.

    About half of the women who did not get reconstruction said they did not want additional surgery. About a third said reconstruction was not important and about 36 percent said they feared implants.

    About 24 percent of women were concerned the implants would interfere with future breast cancer screenings, but the researchers said past studies have not found evidence to support that concern.

    "What our study actually says is that laws such as the NY state law are addressing a non-problem," Morrow said. "Patients are informed about reconstruction, some just chose not to have it."

    She added that women who want to keep their breasts may choose lumpectomy, which removes less tissue than a complete mastectomy, and radiation instead of a total breast removal.

    "So, it is not particularly surprising that reconstruction isn't a priority for all women who chose to undergo mastectomy," she said.

    Also, Morrow said, it's difficult to educate patients in a time when they get information from many sources that may not be scientifically valid or perpetuate myths, such as implants being unsafe.

    She also said that it's worth knowing that many women in this study decided to have breast reconstruction later on.

    "During follow-up it is worth asking patients if they have developed an interest in reconstruction and want to see a plastic surgeon, and patients who choose not to have immediate reconstruction need to know that they haven't closed the door permanently," she added.

    SOURCE: http://bit.ly/1thODnx JAMA Surgery, online August 20, 2014.

  • Fears of addiction keep cancer patients from getting pain relief

    By Randi Belisomo

    NEW YORK (Reuters Health) - Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say.

    "At the end of life, we should feel comfortable providing whatever necessary to control pain," said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction, he told Reuters Health, should not prevent terminally ill patients from obtaining relief.

    Pain undertreatment is estimated to affect half of cancer patients, according to a recent report in the Journal of Clinical Oncology.

    Opioids, a type of narcotic, work in the spinal cord and brain to reduce the intensity of pain signals reaching the brain. The opioids hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Oxycontin, Percocet) are commonly prescribed painkillers. Hydrocodone is the most prescribed medication in the U.S., according to the International Narcotics Control Board.

    Opioid overuse and abuse are a widespread problem that gets lots of attention in the news media - and that may keep cancer patients and doctors from using them appropriately.

    "On one hand, we're told we overuse opioids," Hyatt said. "On the other, we're told we underuse them."

    Underuse worries Judith Paice, a pain specialist at Northwestern University Feinberg School of Medicine in Chicago. Part of the problem, she said, is that it's sometimes hard for patients to convey to doctors how severe the pain is.

    Most pain is controllable, she maintains; patients must describe symptoms, and physicians must seriously consider them.

    "All pain is real to the person experiencing it," Paice told Reuters Health. "But unlike infections we measure with blood samples, it doesn't have an objective marker."

    Doctors often ask patients to rate their pain on a 0 to 10 scale. But severity, experts say, should be described in more detail than that.

    "The zero to ten scale was a good beginning when introduced to quantify pain," said Paice. "Unfortunately, it's now a check in the box. It's another thing physicians ask, and patients feel frustrated because they don't feel doctors take it to the next step and work on their pain."

    She advises patients to elaborate. Diaries may help detail sites of pain, severity and factors prompting pain to worsen. "Whether it's when walking, coughing, sitting or lying flat, those give clues where pain comes from," she said. "What words describe it?" Adjectives could include aching, throbbing, tingling, burning, electrical or shooting.

    Narcotics are not the only option for treating pain. Patrick Fehling, a University of Colorado Hospital addiction psychiatrist, says anxiety often makes pain worse. In some cases, he told Reuters Health, pain should be treated with interdisciplinary counseling from social workers, clergy or psychologists. Research suggests complementary treatments such as massage and acupuncture may also be beneficial.

    "Patients might say, 'I have pain and would like it taken away,'" said Fehling. "But their experience might be they felt pain on a three out of ten level, and they wanted zero. That's not always realistic."

    Some populations are at particularly high risk for inadequate pain control. For example, research has shown that patients in minority care settings are three times more likely to receive undertreatment than those in non-minority settings. Sixty percent of African-American and 74 percent of Hispanic outpatients with cancer-related pain reported inadequate prescriptions.

    "This is a most vulnerable population," said Egidio Del Fabbro, a Virginia Commonwealth University palliative specialist. "To undertreat them is something we should avoid at all costs." Research cites unrelieved pain as the greatest fear among the terminally ill.

    While stigmas may be keeping doctors from prescribing adequate pain medication in certain patient populations, similar misconceptions may keep patients from seeking relief.

    "There is a stigma surrounding opioids, with morphine more than others," Paice said. Many people, she added, associate morphine with dying; they think it's only used in the final hours. In fact, she said, can be used anytime during cancer treatment to maintain mobility, appetite and quality of life.

    "Pain keeps patients from being able to enjoy whatever time they have left," Paice said.

    When time is precious, however, balancing relief and alertness is essential, Del Fabbro maintains. The sedative effects of opioids may be troubling.

    "Families want to recognize the loved one they know," he told Reuters Health. "What you get with excessive opioids is sedation, delirium, cognitive changes, and that's not the person they love. You want the best of both worlds. You want patients to be themselves and their pain controlled."

  • UK cancer drug fund gets extra 160 million pounds

    By Reuters Staff

    LONDON (Reuters) - A fund that helps patients receive cancer medicines not routinely paid for by Britain's state health service is to get an extra 160 million pounds ($265 million), although the government is also taking a tougher line on prices.

    The Cancer Drugs Fund will negotiate with the pharmaceutical industry on cost "to ensure best value" for the National Health Service (NHS) in England, the Department of Health said on Thursday.

    The fund, which was set up four years ago, is being extended to 2016 and will be increased to 280 million pounds a year from 200 million.

    The funding increase follows a number of controversial decisions by the National Institute for Health and Care Excellence (NICE), the country's cost-effectiveness watchdog, to block payment for some cancer drugs.

    Patients in England who cannot get such cancer drugs on the NHS can apply to the Cancer Drugs Fund to cover the costs.

    Alongside the injection of new funds to help patients, two new drugs have also been identified that will be added to the fund. These are Astellas and Medivation's Xtandi for prostate cancer, and Celgene's Revlimid for a new group of patients with myelodysplastic syndrome, a rare blood condition.

  • Robotic prostate removal tied to surgical changes, costs

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - The introduction of robotic surgery for prostate cancer may have led to changes in the number of surgeons performing prostate removals and in the overall cost, according to a new study.

    With the technology being used more widely, fewer doctors are performing the procedure and the overall cost of prostate removal has gone up, researchers found.

    While studies examining the benefits and potential harms of robotic surgery have produced mixed results, the researchers write in BJU International that there is little information on how the innovation influenced prostate removal in the U.S.

    "We knew by anecdotal reports as well as the scientific literature that it had become relatively widespread but we didn't know how that had been done," said Dr. Steven Chang, the study's lead author from Harvard Medical School, Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

    Robotic-assisted radical prostatectomy, which is the removal of the prostate with the help of a robot, began after U.S. regulators approved Intuitive Surgical, Inc.'s da Vinci Surgical System in 2000.

    Before that, surgeons would remove the prostate through a relatively large incision in so-called open surgery - or through a small incision with the help of a camera, in laparoscopic surgery.

    For the new study, the researchers used data on nearly 490,000 men who had their prostates removed between 2003 and 2010. Of those, 338,448 had open or laparoscopic surgery and 150,921 had robotic-assisted surgery.

    Overall, there was a dramatic increase in the number of prostate removals with the new technology. The proportion of surgeons doing at least half of their prostate removals with the robot increased from 0.7 percent in 2003 to about 42 percent by 2010.

    Surgeons who had been doing more than 24 prostate removals each year were the most likely to start using the new technology.

    The researchers also found that the number of surgeons performing prostate removals decreased during the study period from about 10,000 to 8,200.

    Chang said the finding that fewer surgeons are performing the procedure is likely because the ones who were only doing a few every year decided to stop altogether.

    "It was fairly obvious that the people who adopted this technology had a higher volume per year than people who did not adopt this technology," he said.

    "We have seen a concentration of da Vinci use among high volume surgeons, which we think is a positive for the healthcare system," said Dave Rosa, the executive vice president and chief scientific officer of Intuitive Surgical, Inc., in a statement emailed to Reuters Health.

    "Da Vinci use for radical prostatectomy has been shown to have clinical advantages over open prostatectomy in most of the dozens of comparative clinical studies published," Rosa added.

    The current study was not designed to analyze which type of surgery is safer or leads to fewer complications, Chang said.

    "I don't think anyone really knows that answer and I don't know if that study will ever be done," Dr. Jeff Karnes, who was not involved with the new study, told Reuters Health.

    When it comes to prostate removal, the surgeon's experience is likely more important than whether it's done with or without a robot, said Karnes, an urologist from the Mayo Clinic in Rochester, Minnesota.

    Chang and his colleagues also found that the introduction of the new technology was tied to an increase in overall U.S. spending on prostate removals.

    They write that the increase in cost is likely related to an increased number of prostate removals and increased cost for each procedure.

    Robotic-assisted prostate removals cost more than open surgeries throughout the study but the researchers found that the cost of the older surgical methods also increased toward the end of the study.

    They can't say, based on their data, why the cost of open or laparoscopic surgeries began to increase, but they suggest it may be due to slower surgeons continuing to use open surgeon or innovations in open surgery that drove the price up.

    Alternatively, Karnes said it could also be a result of riskier prostate removals, which take more time, needing open surgery.

    Intuitive Surgical, Inc.'s Rosa said a thorough study would take into account overall societal costs in an economic analysis. Those costs include how the patients faired after the procedure.

    "Costs can be calculated very differently in economic studies depending on the methodology used," he said.

    Chang said a goal in the future would be to do a more thorough cost analysis that includes more indirect costs.

    Overall, Karnes said he is not surprised by the results of the study.

    "We know that when a hospital acquires the technology the number of robot procedures go up in that hospital," he said.

    For patients faced with prostate removal, he said it's likely best to make a decision on open or robotic-assisted surgery based on the surgeon's experience and performance.

    SOURCE: http://bit.ly/1luyDMz BJU International, online August 26, 2014.

  • Medicaid payouts for office visits may influence cancer screening: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study.

    "States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others," said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International at Washington, D.C.

    Medicaid, a health insurance program for low-income individuals, is jointly funded by the federal government and the individual states. Each state establishes its own coverage and reimbursement policies.

    Unexpectedly, states' reimbursement rates for specific screening tests weren't always associated with an increase in screening rates, Halpern and his team found.

    There is no reason to believe that reimbursing more for a certain test would lead to that test being used less, so there's probably something else going on to explain that relationship, which was specifically true for Pap tests, Halpern told Reuters Health by email.

    Researchers analyzed Medicaid data from 2007 for 46 states and the District of Columbia.

    In states with higher payments for office visits, cancer screenings were more common. But higher payments for the screenings themselves did not always mean the screenings were performed more often, according to results published in the journal Cancer.

    Nationwide, the median Medicaid reimbursement for an office visit is $37. (In other words, half the states pay doctors less than that.) The median Medicaid reimbursement was $24 for a Pap test, which can detect early cervical cancer, and $271 for a colonoscopy.

    These tests are all recommended for the age group of the people in the study, but since some of the tests are not recommended yearly and the study only includes data from 2007, it was not clear whether the Medicaid beneficiaries were receiving guideline-based screening, Halpern said.

    State by state, when screening test reimbursement rose by 20 percent, the odds of receiving a colonoscopy increased by 1.6 percent, the odds of getting a Pap test decreased by 0.8 percent, and a mammogram might be more or less likely depending on the type and location of the screening order.

    But when reimbursement for an office visit rose by 20 percent, so did screening rates, by 2 to 8 percent.

    "Many primary care physicians do not accept Medicaid patients or are able to provide care only to limited numbers of Medicaid beneficiaries, potentially due to low reimbursements for office visits," Halpern said. "By increasing Medicaid reimbursements for primary care physician office visits, more physicians may be able to provide care for Medicaid beneficiaries, thus increasing their likelihood of receive cancer screenings."

    For screenings like colonoscopy and mammography, the primary care doctor refers the patient to another provider for those tests, so the amount Medicaid reimburses for the tests generally doesn't have a financial benefit for the referring physician, he said.

    "The finding with higher Medicaid office fees is noteworthy, because it means that higher fees open physicians' doors to Medicaid patients and that is the first step to getting patients the care they need," said Stephen Zuckerman, senior fellow and co-director of the Health Policy Center of the Urban Institute. "Cancer screening is only on part of that."

    Doctors' time is limited, and economic incentives matter to them, Zuckerman told Reuters Health by email.

    "In a system with many payers, that means that it makes sense for physicians to see patients for whom they receive better compensation before they see other patients," he said.

    Fees are not the only incentives in scheduling patients, but they do play an important role, he said.

    "Since office visit fees have the most consistent relationship to receipt of cancer screening, it would be important to make sure those fees are sufficient to get Medicaid patients appropriate access to primary care services," Zuckerman said.

    SOURCE: http://bit.ly/1tOc4l9 Cancer, online August 25, 2014.