Latest / Still Caring / 02: How New Technology Is Transforming Cancer Care

Transcript

02: How New Technology Is Transforming Cancer Care · Still Caring

• 0:03
  Intro: Welcome to the Still Caring Podcast presented by Stillwater Medical.
• 0:07
  Here, community is at the heart of healthcare.
• 0:09
  Through honest conversations and shared experiences, we explore what it
• 0:13
  means to care for our health and each other, because Better health takes
• 0:16
  a village and you're part of ours.
• 0:19
  Abby Fox (Host): Hello, and welcome to Still Caring.
• 0:21
  I am Abby Fox, the PR and marketing manager here at Stillwater Medical, and
• 0:25
  today we are joined by Michael Chaco.
• 0:27
  Michael, it's good to have you in the studio today.
• 0:29
  Michael Chacko, PhD: Good to be here.
• 0:31
  Abby Fox (Host): Yes.
• 0:31
  Tell us a little bit about yourself and kind of how you
• 0:34
  made your way to Stillwater.
• 0:35
  Michael Chacko, PhD: Sure.
• 0:36
  so, little bit of my background.
• 0:37
  I grew up in the radiation therapy environment.
• 0:40
  so my father was a medical physicist and still is.
• 0:43
  So as I was growing up, I've seen the evolution of, the field.
• 0:48
  So I went to OU for my PhD in medical physics and uh, I started my career
• 0:52
  at the Oklahoma Proton Center.
• 0:54
  But over time, I've always been particularly attracted to the
• 0:57
  cutting-edge of the field, and radiation medicine is a high ceiling
• 1:01
  of what we can offer patient's.
• 1:02
  So in my lifetime, I've seen a lot of things that have improved with technology.
• 1:06
  You know, technology doesn't always make things better, but in our case it
• 1:09
  really led to better patient outcomes.
• 1:11
  So, You know, when I was working at the Proton Center, it was one
• 1:13
  of the few in the country, so I was particularly drawn to it.
• 1:16
  over time though, I started to notice how a lot of our carefully designed
• 1:21
  treatment plans started to go awry.
• 1:23
  When patient's have changes over time.
• 1:26
  And at that time what was known as adaptive radiation therapy
• 1:30
  started to be something that we, talked about in the field.
• 1:32
  So I had heard that Stillwater was planning to purchase an Mr.
• 1:36
  Linear accelerator, which is an MRI combined with a linear accelerator, which
• 1:40
  is the machine that delivers radiation.
• 1:42
  So, I mean, this was so cutting-edge that I didn't even know where
• 1:46
  the nearest machine was.
• 1:48
  So once I heard about that, I was, I knew I had to be a part of it.
• 1:52
  And I live here in Edmond with my family.
• 1:55
  And I, I knew that Ed meant and driving an hour each way, but I was, I was more
• 1:59
  than willing to make that sacrifice.
• 2:00
  'cause I really believe in what Stillwater Medical was doing.
• 2:03
  So that's a little bit of my background And what drew me to, Stillwater Medical.
• 2:07
  Abby Fox (Host): That's amazing.
• 2:08
  Thank you for sharing that with us, Michael, and I appreciate what you're
• 2:12
  talking about, but I feel like I only know a tiny bit of what that means.
• 2:17
  So can you talk to me more about what is so revolutionary about this and how is it
• 2:22
  different from other cancer treatments?
• 2:24
  Michael Chacko, PhD: Sure.
• 2:25
  if a patient decides with their doctor on a course of radiation
• 2:28
  therapy, what typically happens as a treatment plan is created.
• 2:32
  So, this allows us to program the linear accelerator, And what we're
• 2:36
  trying to do is deliver that radiation.
• 2:38
  To the target area, generally tumor and minimize the
• 2:42
  radiation dose to normal tissue.
• 2:45
  So we talk about different forms of radiation therapy, proton therapy, which
• 2:49
  is also a form of radiation therapy.
• 2:51
  What happens in that process is generally the same, But when you really
• 2:55
  sit down and think about it, right?
• 2:57
  You're delivering this treatment over a course of, a few fractions, which may
• 3:01
  take days, a couple weeks, and you think about your body from day to day.
• 3:05
  You know, a lot of things are changing over time.
• 3:08
  So as we deliver that therapy over the course of multiple days, you can imagine
• 3:11
  that that tumor, ideally starts to shrink But not only that, all sorts of
• 3:15
  changes in anatomy changes are happening macroscopically and microscopically.
• 3:20
  when we talk about in our field, we're delivering radiation
• 3:22
  therapy, so we're trying to be as precise as possible, right?
• 3:25
  We're trying to deliver the radiation, to the tumor, kill
• 3:29
  all the cancer cells, right?
• 3:30
  And minimize all the dose that we give to normal tissue, right?
• 3:33
  So minimize all the side effects.
• 3:36
  So we obsess over these millimeters of accuracy, right?
• 3:39
  Trying to just deliver the radiation to the part that we want.
• 3:43
  but if you really think about it when we're planning that we're
• 3:45
  doing all this work ahead of time, but we have really no idea what's
• 3:48
  going on inside the patient, we.
• 3:50
  Once we start that treatment.
• 3:52
  So we have really good imaging at the start of treatment, but we have
• 3:55
  no little to no idea what's going on, as a treatment progresses.
• 3:59
  so with an Mr.
• 4:00
  Linear accelerator, what that means is that you're combining an MRI
• 4:04
  with a linear accelerator, which is what delivers the radiation.
• 4:07
  So when you talk about an MRI, that's the best kind of soft tissue contrast that
• 4:12
  you can get on any kind of imaging device.
• 4:15
  So you're combining the best form of imaging with the best form of
• 4:19
  treatment, and that's really what an Mr.
• 4:21
  MRI Linac really provides for us.
• 4:23
  And we're the only ones in the state of Oklahoma that are able
• 4:26
  to provide that form of treatment.
• 4:28
  Abby Fox (Host): So it's kind of like you are not flying blind.
• 4:32
  It's kind of like you can see as you are administering that
• 4:35
  dose And so you know exactly.
• 4:37
  Are you adjusting it all the time too?
• 4:39
  Michael Chacko, PhD: Exactly.
• 4:40
  So what's happening is that we're adapting that treatment plan the
• 4:45
  very day that we're treating it.
• 4:46
  So if you come in for your fifth.
• 4:48
  Fraction, right?
• 4:49
  And you're laying on the table.
• 4:50
  We're looking at real-time what's going on inside of you, and we're
• 4:53
  adapting that treatment plan.
• 4:55
  all of the other radiation therapy centers in the Oklahoma, really their adaptive
• 5:00
  process is not online like ours is.
• 5:02
  We're able to take what's going on inside the patient and real-time
• 5:06
  and adapt that radiation treatment plan, right then and there.
• 5:10
  So that means less radiation dose.
• 5:13
  to your, critical organs and less side effects for you, and
• 5:17
  that's what that translates to.
• 5:19
  Abby Fox (Host): That's amazing.
• 5:19
  Now, can it also translate to fewer treatments?
• 5:23
  Michael Chacko, PhD: Yes.
• 5:23
  So one of the advantages of this form of treatment is that we're able to reduce
• 5:28
  the number of fractions and deliver the same efficacy of the treatment.
• 5:33
  over a fewer number of fractions, and that's really a game-changer
• 5:36
  for people who are driving in.
• 5:38
  we even have people who drive in from the city who are looking for treatment
• 5:42
  at Stillwater Medical, and they're able to minimize the number of visits
• 5:45
  that they're, that they have to make.
• 5:47
  So it's really, enabling that access to care to go out, further and further.
• 5:52
  Abby Fox (Host): Would it be fair to say it's a substantial number,
• 5:56
  like it's a substantial, fewer number of treatments that you would
• 5:59
  need with this kind of technology?
• 6:01
  Michael Chacko, PhD: Yes.
• 6:01
  So we're able to offer, if qualified patient's, prostate
• 6:06
  treatment that comes down to five fractions, so that's a game-changer.
• 6:10
  When you talk about in the past, as I've seen in this field,
• 6:13
  it was over 40 treatments and.
• 6:16
  It came down to near 20, but now we're able to offer it in five fractions.
• 6:21
  So that's something that's really a game-changer in our field.
• 6:24
  Abby Fox (Host): That's great.
• 6:25
  Well, and I know I've talked to one of those patient's, cause in my role.
• 6:28
  Mowing saltwater medical, I do have the opportunity to talk to them.
• 6:31
  And I think the gentleman that I was speaking with was from Ponca City.
• 6:35
  so the fact that he could come here, just over five times, you know, for five
• 6:39
  treatments versus 40, I mean, that made a big difference for his quality of life.
• 6:43
  So I can imagine you hear that from a lot of patient's, but do you interact
• 6:47
  directly with a lot of patient's, Michael?
• 6:49
  Or what does your role look like on the cancer team?
• 6:52
  Michael Chacko, PhD: generally I joke around that I know patient's from their
• 6:55
  insides a lot more than, their faces.
• 6:57
  'cause I'm behind the scenes so.
• 6:59
  really my role, people hear the term a physicist and they think that, you do
• 7:03
  research, but, surprisingly a hundred percent of what I do is clinical.
• 7:07
  So, my job is to make sure that the radiation dose that's prescribed
• 7:11
  by the radiation-oncologist goes to the prescribed area.
• 7:14
  And it's the right amount and it's the right location.
• 7:17
  So that means that I calibrate the radiation machine, right?
• 7:20
  not only that, but I look at every single treatment plant and decide, is this
• 7:24
  the best way to deliver this radiation?
• 7:27
  that's really my bread and butter, and that's what I do on a day-to-day basis.
• 7:31
  But one of the more fun aspects of my job is to make sure that
• 7:35
  we're on the cutting-edge.
• 7:36
  So, I'll give you an example.
• 7:37
  Recently we had a patient that had a, rather large lesion in his prostate,
• 7:42
  and I had just attended a talk on a cutting-edge approach where we treat
• 7:46
  the entire prostate, but we're able to escalate the dose to the lesion itself.
• 7:51
  So This is kind of a really new approach, and it's only possible with an Mr.
• 7:56
  Linac.
• 7:56
  You can only see.
• 7:57
  That lesion within the prostate itself on the day of treatment with an Mr.
• 8:02
  Linux.
• 8:02
  So I work with a physician with this patient's, physician And the rest of the
• 8:06
  treatment team to implement that approach.
• 8:08
  And I had not seen it done in this state at all.
• 8:11
  So that's really exciting for me and I think that's rewarding part
• 8:14
  of what I do on a day-to-day basis.
• 8:16
  Abby Fox (Host): I do hear that, like excitement for innovation, has that
• 8:20
  just always been a part of who you are or is this something that, like
• 8:24
  you've seen the progress And that gives you that fuel to keep digging in?
• 8:28
  Michael Chacko, PhD: Yeah, I, you know, my father worked in this field in the
• 8:30
  nineties and, growing up, I used to do my homework in the cancer center.
• 8:34
  So grew up doing that and I attended cancer support, sessions,
• 8:38
  and I used to really, Be so involved in all aspects of this.
• 8:43
  'cause it was my, dad's life, so, and I saw the, side effects that
• 8:47
  came with radiation therapy over time and just in my lifetime I've
• 8:51
  seen that dramatically reduced.
• 8:54
  So I always wanted to be on that cutting-edge And we able to
• 8:57
  offer that here in Stillwater.
• 8:58
  And they're just, remarkable.
• 9:00
  I mean, we'd have to go outta state really to be able to find this sort of
• 9:03
  treatment, that we're able to offer here.
• 9:06
  Abby Fox (Host): Hearing about your dad.
• 9:07
  I always love that kind of personal aspect of kind of why
• 9:10
  we got into this to begin with.
• 9:12
  What does it feel like to you to be, on the cutting-edge, but to also.
• 9:16
  So be bringing this to our community.
• 9:20
  Michael Chacko, PhD: It means a lot.
• 9:21
  we go to a lot of national meetings, our treatment team, and believe it or not,
• 9:26
  we're the smallest cancer center in the country, to offer this type of treatment.
• 9:31
  So most of our peers are from enormous universities or health systems.
• 9:36
  their professors, faculty members of.
• 9:39
  Gigantic universities and, we're a little still our cancer center,
• 9:42
  but we're offering this treatment.
• 9:44
  So a lot of people do double takes and they, they're just so astonished at the
• 9:48
  fact that we were able to do this and we're still offering this treatment.
• 9:51
  And that's just, part of the wonder and kind of the rewarding part of what I do.
• 9:55
  and I love to do that.
• 9:57
  Abby Fox (Host): kinds of cancer do you treat?
• 9:59
  Is it any kind of cancer?
• 10:01
  Can anybody, you know, get radiation from this new machine
• 10:04
  that you're talking about?
• 10:05
  Michael Chacko, PhD: So generally it really excels in deep-seated tumors,
• 10:09
  um, which is a majority of what we treat in radiation therapy anyway.
• 10:12
  So we're really good at treating prostates rectal cancer.
• 10:16
  We are second to none and treating abdominal cancers, but.
• 10:20
  You have to remember any form of radiation therapy is a form
• 10:23
  of localized treatment, right?
• 10:24
  It's not a systemic treatment like chemotherapy or immunotherapy would be.
• 10:28
  So cancer is a multidisciplinary problem, so you may get another form of
• 10:34
  treatment if you're having radiation.
• 10:35
  Most commonly you'll get some form of systemic therapy as well.
• 10:39
  So it's a multidisciplinary approach, but we really excel,
• 10:43
  at these deep-seated tumors.
• 10:45
  And the Mr.
• 10:45
  Linac really allows us to look and have the best form of imaging for those
• 10:50
  kinds of tumors and those treatments I.
• 10:52
  Abby Fox (Host): What do you see on the horizon of cancer research and
• 10:55
  kind of where the field is going?
• 10:57
  What excites you?
• 10:58
  Michael Chacko, PhD: we're on the cusp of being, more
• 11:00
  personalized in our treatments.
• 11:02
  So every person is unique and their situation is unique and
• 11:07
  their bodies are unique, so.
• 11:09
  What we're doing is we're tailoring their treatment to who they are
• 11:12
  And what their bodies, require.
• 11:15
  So that's really, something that's really come alive in the last few
• 11:18
  years and enabled by technology.
• 11:20
  sometimes technology makes things easier.
• 11:22
  Sometimes it makes things more complicated, but in this
• 11:24
  sense, it leads to direct.
• 11:26
  PPAR better patient outcomes, which is what we really want, right?
• 11:30
  We are not just chasing technology for the sake of chasing technology.
• 11:33
  We want better outcomes, And so that's, we're able to provide with this,
• 11:38
  Abby Fox (Host): For every conversation that we have in this podcast, we
• 11:41
  are ending with a challenge to care.
• 11:43
  So something that our community can do to better care for themselves or
• 11:46
  to better care for this community.
• 11:48
  What would your challenge for our listeners be today?
• 11:51
  Michael Chacko, PhD: My challenge to care, would be two parts.
• 11:55
  the first part is that one of the advantages and disadvantages
• 12:00
  of our internet connected to age is that information is just more
• 12:04
  accessible and it's just out there.
• 12:06
  that's a plus and a minus, right?
• 12:08
  you have access to information, but you're also inundated with a lot of things.
• 12:11
  So.
• 12:12
  Sometimes you may see an advertisement that makes bold claims, but my
• 12:15
  challenge, to the community is this, ask the tough questions.
• 12:19
  ask the provider, you know, what is the evidence that this
• 12:22
  treatment is better or worse?
• 12:24
  Or are the risks, worth it over another form of treatment?
• 12:27
  so that's really what, my challenge to care would be.
• 12:30
  The first part.
• 12:31
  My second challenge would be this.
• 12:33
  You are in charge of your own healthcare.
• 12:36
  you're the boss, you're in the driver's seat.
• 12:38
  I'll give you a short story.
• 12:39
  When I was in college, I started to have a lot of GI symptoms and I just
• 12:44
  ignored them for a year, over a year until I went to see a gastroenterologist.
• 12:48
  And I discovered that I had Crohn's disease, which is a form
• 12:51
  of inflammatory bowel disease.
• 12:53
  but until I took a hard look and said, I don't feel well, and I think that I
• 12:58
  need to see somebody about this, all the best medicine in the world couldn't
• 13:02
  help me until I took that first step.
• 13:05
  And my challenge is this.
• 13:06
  Don't be afraid to do that, especially in, cancer treatment.
• 13:10
  The difference between early and late detection is just so huge.
• 13:14
  it's just so more important than all the fancy technology in the world.
• 13:18
  So you're in the driver's seat, you're in charge of your own healthcare, ask
• 13:22
  tough questions, and you're the boss.
• 13:25
  you know how your body feels more than any other provider or any doctor.
• 13:30
  You know?
• 13:30
  what makes you feel good?
• 13:31
  What makes you feel like you're, achieving the goals that you
• 13:34
  have set out for you in life?
• 13:36
  So, that's my challenge to care for the community.
• 13:38
  Abby Fox (Host): That's great.
• 13:39
  Well, and it's so empowering because it's something that we can all do, is just pay
• 13:42
  attention to how we're feeling and take that next step, whatever that looks like.
• 13:46
  So thank you, Michael for joining us today.
• 13:49
  We are thrilled to have you at Stillwater Medical and just grateful
• 13:52
  for all the impact you're making here.
• 13:53
  I.
• 13:54
  Michael Chacko, PhD: So much thank.