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

  • 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.

  • Prescription painkiller deaths fall in medical marijuana states

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Researchers aren't sure why, but in the 23 U.S. states where medical marijuana has been legalized, deaths from opioid overdoses have decreased by almost 25 percent, according to a new analysis.

    "Most of the discussion on medical marijuana has been about its effect on individuals in terms of reducing pain or other symptoms," said lead author Dr. Marcus Bachhuber in an email to Reuters Health. "The unique contribution of our study is the finding that medical marijuana laws and policies may have a broader impact on public health."

    California, Oregon and Washington first legalized medical marijuana before 1999, with 10 more following suit between then and 2010, the time period of the analysis. Another 10 states and Washington, D.C. adopted similar laws since 2010.

    For the study, Bachhuber, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and his colleagues used state-level death certificate data for all 50 states between 1999 and 2010.

    In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

    Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications.

    Of those who die from prescription opioid overdoses, 60 percent have a legitimate prescription from a single doctor, the CDC also reports.

    Medical marijuana, where legal, is most often approved for treating pain conditions, making it an option in addition to or instead of prescription painkillers, Bachhuber and his coauthors wrote.

    In Colorado, where recreational growth, possession and consumption of pot has been legal since 2012 and a buzzing industry for the first half of 2014, use among teens seems not to have increased (see Reuters story of July 29, 2014 here: http://reut.rs/1o040NI).

    Medical marijuana laws seem to be linked with higher rates of marijuana use among adults, Bachhuber said, but results are mixed for teens.

    But the full scope of risks, and benefits, of medical marijuana is still unknown, he said.

    "I think medical providers struggle in figuring out what conditions medical marijuana could be used for, who would benefit from it, how effective it is and who might have side effects; some doctors would even say there is no scientifically proven, valid, medical use of marijuana," Bachhuber said. "More studies about the risks and benefits of medical marijuana are needed to help guide us in clinical practice."

    Marie J. Hayes of the University of Maine in Orno co-wrote an accompanying commentary in the journal.

    "Generally healthcare providers feel very strongly that medical marijuana may not be the way to go," she told Reuters Health. "There is the risk of smoke, the worry about whether that is carcinogenic but people so far haven't been able to prove that."

    There may be a risk that legal medical marijuana will make the drug more accessible for kids and smoking may impair driving or carry other risks, she said.

    "But we're already developing Oxycontin and Vicodin and teens are getting their hands on it," she said.

    If legalizing medical marijuana does help tackle the problem of painkiller deaths, that will be very significant, she said.

    "Because opioid mortality is such a tremendously significant health crisis now, we have to do something and figure out what's going on," Hayes said.

    The efforts states currently make to combat these deaths, like prescription monitoring programs, have been relatively ineffectual, she said.

    "Everything we're doing is having no effect, except for in the states that have implemented medical marijuana laws," Hayes said.

    People who overdose on opioids likely became addicted to it and are also battling other psychological problems, she said. Marijuana, which is not itself without risks, is arguably less addictive and almost impossible to overdose on compared to opioids, Hayes said.

    Adults consuming marijuana don't show up in the emergency room with an overdose, she said. "But," she added, "we don't put it in Rite Aid because we're confused by it as a society."

    SOURCE: http://bit.ly/1pYZf8d JAMA Internal Medicine, August 25, 2014

  • Mammography false alarms linked with later tumor risk

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Women whose screening mammograms produce false alarms have a heightened risk of being diagnosed with breast cancer years later, but the reason remains mysterious, researchers say.

    An increased risk of breast cancer among women with a "false positive" mammogram has been reported before. What's new about this study is that the authors tried to figure out how much, if any, of the extra risk is simply due to doctors missing the cancer the first time they investigated the worrisome mammogram findings.

    But mistakes from doctors missing cancers explained only a small percentage of the increased risk, according to lead author My von Euler-Chelpin, an epidemiologist from the University of Copenhagen in Denmark.

    She told Reuters Health in a telephone interview that she could not explain most of the increased risk of later breast cancer in women with false-positive mammograms. (A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it.)

    Of more than 58,000 Danish women who had mammography between 1991 and 2005, her study identified 4,743 women with suspicious findings that were eventually declared negative.

    By 2008, 295 of those 4,743 women had been diagnosed with breast cancer, von Euler-Chelpin and colleagues reported in Cancer Epidemiology.

    Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent. Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.

    The risk was slightly higher in women who had surgical biopsies that turned out to be negative.

    Von Euler-Chelpin thinks a smaller percentage of American women would have an elevated risk for breast cancer after a false-positive test because the U.S. has a higher rate of false positives than Denmark. The risk of a false-positive test over 10 mammograms ranges from 58 percent to 77 percent in the U.S., while it is around 16 percent in Denmark, the study says.

    Dr. Michael Alvarado, a breast cancer surgeon from the University of California, San Francisco, agreed that the risk of being diagnosed with breast cancer after a false positive mammogram is probably lower in the U.S. than in Denmark.

    "It's hard to translate the data to the U.S. population because we have such a different screening program, we tend to biopsy everything, and we're much more aggressive," he told Reuters Health. Alvarado was not involved in the current study.

    "Is there some inherent biology of the breast that makes it suspicious and it puts you at higher risk? I don't think anyone knows what it is," he said.

    Alvarado wondered if women who get false-positive mammograms should be followed more closely by their doctors, or if false-positive patients should be screened differently.

    Von Euler-Chelpin told Reuters Health the excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women - and Dr. Karla Kerlikowske agreed.

    Kerlikowske, from the University of California, San Francisco, is developing a risk calculator app to guide women in deciding how often to get mammograms. The calculator considers a range of factors, including age, race, previous breast cancer, family history and breast density. Kerlikowske was not involved in the current study.

    Although having had a false-positive mammogram is associated with a woman's breast cancer risk, Kerlikowske points out that the actual risk of being diagnosed with breast cancer remains low.

    The average five-year breast cancer risk for a 50-year-old white woman with no prior family history of breast cancer is 1.25 percent, the calculator shows. It ranges from less than 1 percent, to 2.70 percent, depending upon breast density, for the same woman with a history of a prior breast biopsy, regardless of whether the biopsy was positive or negative.

    "The absolute risk is still small," Kerlikowske said. "To me, it just says, now you have this risk factor, and you have to consider it with other risk factors."

    Von Euler-Chelpin agrees.

    "This paper is one little step on the way of trying to identify high-risk groups," she said. "The goal is to find more personalized screening programs for women."

    The American Cancer Society recommends that women be screened for breast cancer every year they are in good health starting at age 40. But a growing number of researchers have questioned the benefits of annual mammograms, and since 2009 the government-backed United States Preventive Services Task Force has recommended that screening be done every two years and be generally restricted to women aged 50 to 74.

    Women in Denmark between the ages 50 to 69 are invited to have screening mammograms every other year, Von Euler-Chelpin said.

    Getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women ages 50 to 74, according to a study Kerlikowske published last year (see Reuters story of March 18, 2013 here: http://reut.rs/1w7CMuh).

    The recommendation to reduce the frequency and delay the start of mammography screening was based on research showing the risk of false-positive results - which needlessly expose women to the anguish of a possible breast cancer diagnosis and the ordeal of further testing - outweighed the benefits of detecting cancers earlier.

    SOURCE: http://bit.ly/1wALk81 Cancer Epidemiology, online July 14, 2014.

  • Fewer U.S. youth using sunscreen new study finds

    By David Beasley

    ATLANTA (Reuters) - Fewer U.S. teenagers are using sunscreen, even as skin cancer rates increase, a study found.

    The percentage of high school students using sunscreen dropped from 67.7% in 2001 to 56.1% in 2011, according to the study by researchers at William Paterson University in New Jersey and published August 21 in the publication Preventing Chronic Disease.

    The study analyzed survey data from high school students collected for the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System.

    The drop in sunscreen use occurred as melanoma, the most dangerous form of skin cancer, increased 1.6% annually among men from 2001 to 2010 and 1.4% among women, the study said.

    "It's alarming," said Corey Basch, assistant professor of public heath at William Paterson and one of the study's authors. "Given that the rates of skin cancer and melanoma are going up, we would have liked to have seen sun protection measures also going up."

    The CDC recommends using sunscreen and avoiding tanning beds to avoid developing skin cancer.

    Avoiding over-exposure to the sun is particularly important during childhood and adolescence, the study said.

    The findings point to the need for a greater push to inform teenagers on the dangers of sun exposure, said Basch.

    "What we really need is to change the mindset that having this artificially tanned skin is attractive," she said.

    In Australia, a massive public information campaign called "Slip Slop Slap" included handing out free sunscreen at beaches and was effective in increasing sun protection, Basch said. Television ads showed beachgoers wearing hats and shirts.

    "Over time, it really transformed how people envisioned a beach day," Basch said. "It was no longer just frying yourself, so to speak, on a beach in a string bikini."

    While the use of sunscreen by teenagers is dropping in the United States, so is the use of indoor tanning devices, the study said.

    From 2009 to 2011, the percentage of respondents using tanning devices dropped from 15.6% to 13.3%, the study said. However, the decrease was so small that it is not considered significant, Basch said.

    SOURCE: http://1.usa.gov/1nfLiOx

    Prev Chronic Dis 2014.