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

  • Parents often want changes in kids' shots schedule

    By Andrew M. Seaman

    (Reuters Health) - Many parents ask doctors to spread out toddlers' vaccines instead of following the recommended immunization schedule, according to a new study.

    Most doctors comply with the request, even though they believe the delays put the children at risk for preventable diseases and make the experience more painful, the researchers report in the journal Pediatrics.

    Only about 2 to 3 percent of parents actually refuse vaccines, said study leader Dr. Allison Kempe. But, she added, "there is an increasing number of parents asking to deviate from the schedule in other ways."

    Kempe, from the University of Colorado School of Medicine and Children's Hospital Colorado, had expected that most doctors would get such requests from parents, but not this often.

    "I was surprised by over 20 percent of doctors saying 10 percent or more of their families (had asked) to spread out vaccines," she said.

    The U.S. Centers for Disease Control and Prevention (CDC) recommends several shots during the first years of life to protect against diseases (PDF link: http://1.usa.gov/1EDPWBP). The schedule is backed by the American Academy of Family Physicians and the American Academy of Pediatrics (AAP), which publishes Pediatrics.

    The AAP says the vaccine schedule is designed to work best with children's immune systems while protecting them from diseases as soon as possible.

    The new report comes as the U.S. battles a large measles outbreak that had infected 154 people from 17 states and Washington, D.C. as of February 20, according to the CDC. The outbreak is tied to Disneyland in Anaheim, California.

    For the study, Kempe and colleagues, in collaboration with the CDC, sent surveys to 815 pediatricians and family doctors across the U.S. in 2012. They received 534 completed surveys.

    Overall, 93 percent of doctors reported at least one parental request to space out the immunizations of a child younger than two years old. And 21 percent of those doctors said at least 10 percent of families made the request.

    The doctors said parents had a variety of reasons for deviating from the recommended schedule, including concerns about complications and a belief that their children won't get a vaccine-preventable disease.

    Most doctors responding to the survey felt it's not in the child's best interest to space out vaccines, but most comply with the parents' wishes at least sometimes.

    The percentage of doctors who often or always agree to spread out vaccines more than doubled from 13 percent in a similar 2009 survey to 37 percent in the current report.

    Doctors said they tried to educate parents on the importance of following the recommended vaccine schedule, but few felt they had any effective approaches.

    "A lot of them feel what they're doing isn't making a difference," Kempe said, adding that organizations like the AAP have recommended techniques for discussing vaccines.

    "I am not convinced that we have the right methods to counter this," she said.

    She said several techniques need to be combined, including education during pregnancy, more responsible reporting by the media, limiting the use of philosophical exemptions, and better collaboration between the public and health department.

    "It can't all fall on the primary care doctors' backs," Kempe said. "It's too big and too time consuming of an issue."

    SOURCE: http://bit.ly/uFc4g2 Pediatrics, online March 2, 2015.

  • CORRECTED-Terminal cancer care should do more to treat depression

    ((In paragraphs 1 and 7, clarifies that the doctors surveyed for the study were in The Netherlands, not Norway).)

    By Janice Neumann

    (Reuters Health) - Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better - and earlier - psychological help, according to a large study in The Netherlands.

    Although it's challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.

    "Health care providers may think this is a normal part of the dying process," said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.

    "However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life," Janberidze told Reuters Health in an email.

    Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2 percent to 56 percent, she and her colleagues write in the journal BMJ Supportive and Palliative Care.

    Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.

    They used data from a 2005 nationwide Dutch survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.

    After accounting for symptoms of the individuals' illness, the researchers found that overall 37 percent of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.

    Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.

    Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.

    Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.

    "The study is novel in that it evaluates retrospectively the depressive symptom severity of patients within 24 hours of death," Prigerson said in an e-mail to Reuters Health. "I'm unaware of any other study that has attempted this."

    But Prigerson also noted some of the study's limitations, such as trying to assess patients who could be unconscious or delirious, have multiple organ failure and difficulty communicating their emotions.

    Physicians also need to distinguish physical and psychological symptoms and might not always have enough information on a patient's psychological state when they are dying or might not have enough training to diagnose their "psychological distress," she said.

    "It is also difficult to draw conclusions regarding the clinical implications of the study," Prigerson said. "Given patients are actively dying, it is doubtful that a psychosocial intervention or administration of an antidepressant will effectively improve the patients' quality of death.

    "Psychosocial interventions and care in the months and weeks leading up to the death can have a profound impact on patients' quality of life prior to death, however," Prigerson said.

    Janberidze said doctors should be checking cancer patients for physical and psychological pain and integrating palliative care with their cancer management earlier in their disease. She also said family members could help monitor the patient's pain.

    "In general it is important for family members with loved ones who have advanced stage cancer to pay attention to the signs and symptoms of depression and inform healthcare providers immediately. Doctors should investigate the patient further and recommend psychological interventions as needed," Janberidze said.

    SOURCE: http://bmj.co/1LeAEoL BMJ Supportive and Palliative Care, online February 9, 2015.

  • Doctors with bad news seen as less compassionate

    By Andrew M. Seaman

    (Reuters Health) - Regardless of how they frame the discussion, doctors who deliver bad news may be viewed as less compassionate by their patients, a new study suggests.

    Patients who watched videos of fictional interactions between doctors and patients felt the doctors delivering bad news were less compassionate than those giving good news, researchers found.

    Until recently, doctors and researchers believed that doctors who delivered bad news in an empathetic tone would be seen as sincere, said Dr. Eduardo Bruera, the study's lead author from the University of Texas MD Anderson Cancer Center in Houston.

    "We wanted to test if the news itself had an impact on the way the patient saw his or her doctor," Bruera said.

    The researchers showed 100 cancer patients two videos. In one, an actor playing a patient with advanced cancer was told by a doctor that there are no more treatment options. The other video showed the same scenario with a similar-looking doctor saying there may be some treatment options.

    On a scale of 0 to 50, with 50 being the least compassionate, patients gave the doctor with good news a score of 19, compared to a score of 26 for the doctor with bad news.

    What's more, 57 patients said they preferred the doctor delivering the more optimistic message, compared to 22 who preferred the doctor delivering the less optimistic news.

    "What we found out is that the patients consistently perceived the doctor who gave the more optimistic message as more compassionate," Bruera said.

    He said the findings may help explain why doctors intuitively have a difficult time delivering bad news to their patients.

    "It's unfortunate, but it's the reality of life that when the doctor needs to give the patient bad news, the perception of that patient may be that of a less compassionate doctor," Bruera said.

    There needs to be additional research into the findings, Dr. Teresa Gilewski of Memorial Sloan Kettering Cancer Center in New York City said in an editorial accompanying the new study in JAMA Oncology.

    "For example, would the patient perception be different with an in-person interaction, a longer discussion, a personal relationship with the physician, or at a different time in the patient's illness?" wrote Gilewski.

    The researchers say future research should account for the trust patients have with their doctors, too.

    Still, they also suggest researchers should craft techniques to help doctors deliver bad news without the content affecting the patients' perceptions of their compassion.

    SOURCE: http://bit.ly/1MZitVK and http://bit.ly/1MZizgi JAMA Oncology, online February 26, 2015.

  • Younger men more bothered after prostate cancer treatment

    By Shereen Lehman

    (Reuters Health) - After treatment for localized prostate cancer, changes in quality of life will vary by age, as will men's reactions to those changes, according to a new study.

    "While older and younger men start with different baseline quality of life function, older men may be less bothered by certain declines that may affect younger patients more," Dr. Lindsay Hampson told Reuters Health in an email.

    Prostate cancer is the most common malignancy in men of all ages in the U.S. Almost 60 percent of new cases are diagnosed in men over the age of 65, and the average age is 66.

    Older men are often diagnosed with more aggressive disease and are less likely to get treatment, in part because they worry about the impact on their sexual and urinary function, Hampson and her colleagues write in European Urology.

    Determining quality of life priorities is vital to ensuring that patients make well-informed treatment decisions, said Hampson, a urologist at the University of California San Francisco.

    The researchers reviewed national data on 5,362 men diagnosed between 1999 and 2013 with aggressive prostate cancer that had not spread. The men received various treatments, including surgery, brachytherapy, external beam radiation, or androgen deprivation, or active surveillance.

    Before treatment, and again within two years later, the men filled out surveys that included quality of life questions about their urological functioning and symptoms.

    Overall, men over 70 had worse quality of life after treatment than those under 60 - except in terms of mental health - but the younger men were more bothered by quality of life declines.

    For sexual function, 40 percent of the younger men reported a decline after treatment, compared to 46 percent of the older men. But 39 percent of younger men reported worsening sexual "bother" versus just 17 percent of the older men.

    More men under 60 had declines in urinary function, with 14 percent reporting some negative change, compared to 9 percent of older men.

    It's likely that older men start out with a lower level of function, and lower expectations, and therefore are less bothered by declines, the study team writes. Or, perhaps older men have just learned to cope better with fluctuations in their functioning, they note.

    Hampson said quality of life is a very important consideration when contemplating treatment for prostate cancer, and physicians can help patients make appropriate decisions.

    "The first critical question is whether the cancer needs treatment because many prostate cancers can be safely followed with active surveillance," she said.

    "Treatment should not be deferred for older men just because of quality of life concerns, just as younger men also need to be counseled about potential changes in quality of life after treatment," Hampson said.

    Sexual and urinary problems are the most common problems after prostate cancer treatment, said Katrina Balter, a researcher at Karolinska Institute in Stockholm, Sweden, who was not involved in the study.

    "It is important to discuss potential side effects associated with different treatment options," Balter said. "If a man is sexually active, he might prioritize treatments with less risk of side effects or go for 'watchful waiting' (i.e. no treatment) whereas others may prioritize local treatment and potentially improved survival," she told Reuters Health by email.

    SOURCE: http://bit.ly/1COp3ZE European Urology, online February 2, 2015.

  • Healthy diet linked to lung health

    By Roxanne Nelson

    (Reuters Health) - Among its many rewards, eating a healthy diet might help protect against the development of chronic obstructive pulmonary disease, or COPD, according to a new study.

    Based on more than 120,000 men and women followed for more than a decade, researchers calculate that those who ate a diet highest in whole grains, vegetables and nuts, and lowest in red meats and sugars were up to a third less likely to develop COPD - even if they smoked - than those who ate the worst diet.

    "I think that we need to emphasize the role of diet in respiratory diseases, which is largely unknown by the general audience," lead author Dr. Raphaëlle Varraso, from the French National Institute of Health and Medical Research in Villejuif, told Reuters Health in an email.

    "Respiratory health and lung function strongly predict general health status and all-cause mortality," she said.

    COPD is an umbrella term for a group of progressive lung diseases that block the flow of air and cause breathing problems. They include emphysema, chronic bronchitis and some types of asthma.

    According to the Centers for Disease Control and Prevention (CDC), about 15 million Americans have been diagnosed with COPD and it is the third leading cause of death in the U.S.

    "The predominant risk factor for COPD in the developed world is cigarette smoking, but up to one-third of COPD patients have never smoked, thus suggesting that other factors are involved," Varraso said.

    But relatively little attention has been paid to modifiable factors, aside from smoking, that might reduce the risk of developing COPD, including diet, she noted.

    "As the lungs exist in a high-oxygen environment, it is reasonable to hypothesize that certain exposures can increase the burden of oxidants further," she added.

    Varraso and her team used U.S. data on 73,000 women and 43,000 men who were part of long-term studies that tracked their lifestyles and medical histories between 1984 and 2000.

    The researchers rated the participants' eating habits based on the Alternate Healthy Eating Index 2010 (AHEI-2010), which is a measure of dietary quality based on current scientific evidence about the effects of nutrients on health risks. High scores on this index - developed at the Harvard School of Public Health as an alternative to the U.S. Department of Agriculture's "food pyramid" - have been shown to be associated with a lower risk of major chronic diseases.

    A better score also generally represents a diet that is high in vegetables, whole grains, polyunsaturated fats, nuts and omega-3 fatty acids, low in red and processed meats, refined grains and sugary drinks, and includes moderate alcohol consumption.

    Those with the highest AHEI-2010 scores were 33 percent less likely to develop COPD than participants with the lowest diet scores, the study team reports in the journal BMJ.

    The results held up even after the researchers accounted for other factors, such as tobacco use, exposure to second-hand smoke, weight, age and exercise habits.

    The study does not prove cause and effect, however, said Dr. Norman H. Edelman, senior consultant for scientific affairs at the American Lung Association. "It only suggests that there may be a link."

    Edelman, who was not involved in the study, added, "There has been evidence of this before, that one way to ameliorate lung disease is to eat a diet high in antioxidants. This study used a large database and suggests that diet may play a substantial role in lowering the risk."

    But the most important preventive action for lung health is still smoking cessation, Edelman emphasized. "This study doesn't change that message," he said.

    For those who would like to lower their risk of major chronic diseases, including COPD, Varraso pointed out that the AHEI guideline (http://bit.ly/RysZuA) is "quite easy" to follow.

    But for people who already have COPD, the role of diet may be different, she noted. "In our study we only investigated the role of a healthy diet on the risk of COPD."

    Varraso added that these study results should encourage clinicians to consider the potential role of the combined effect of foods in a healthy diet in promoting lung health.

    SOURCE: http://bmj.co/1Atp1In BMJ, online February 3, 2015.