Preventing, detecting, treating and healing
May 25, 2018 08:31AM ● Published by J. Chambless
Dr. Manuj Agarwal, with the linear accelerator, a device most commonly used for external beam radiation treatments for patients with cancer.
Hearing the “C word” is a life-shattering shock that forces people to make major decisions under immense pressure.
During cancer treatment, proximity to home and family is a major concern. Manuj Agarwal, M.D., knows this, and that’s why he is so enthusiastic about one of the strongest advantages to cancer treatment at Union Hospital.
Agarwal, an assistant professor of radiation oncology at the University of Maryland School of Medicine, is the medical director at the University of Maryland Radiation Oncology Center at Union Hospital. “We keep Cecil in Cecil,” Agarwal said, meaning that patients can be treated from start to finish at Union, with the whole process taking place within the county.
“We can keep about 96 percent of Cecil County cancer patients in Cecil County, which is good because previously, a lot of cases left because there wasn’t enough technology here to keep them,” he said. The few patients who require additional technology can also stay in the system. “What’s nice about that,” Agarwal explained, “is that on each of our community sites, we have one person who is credentialed to do the advanced radiation modalities.” That would include heat therapy and proton therapy, among others. “So if I see a patient here who needs something a little special, I’ll still be their treating doctor, as opposed to referring them out and having things lost in translation,” Agarwal said.
The aforementioned proton therapy was the chosen alternative for Bob Rowe, who was diagnosed with esophageal cancer brought on by acid reflux. In Rowe’s case, a weak heart ruled out surgery as an option. “We were able to do something special for him,” Agarwal said. “I saw him for his three- or four-month follow-up and he’s doing great.”
Agarwal is especially proud of the state-of the-art equipment at Union. “We have the latest and greatest here. It’s called a true-beam linear accelerator. It’s the best you can get on the market, and essentially it can do every single function you can think of.”
In describing his areas of expertise, Agarwal said, “I kind of work at both ends of the body … head and neck, and prostate and GYN cancers as well. I also do brachytherapy, a type of therapy that puts radiation near or inside a tumor. Union’s been doing that for prostate cancer, where we put radiation directly inside the prostate. At other places we can also do the same for cervical cancer, uterine cancer, etc. Most radiation is done by x-ray, and most places will have a unit that uses x-ray therapy. That therapy has advanced in recent years and is very fine-tuned, very precise.”
Medical expertise and technological advancements are of huge importance in cancer services, but just as critical to successful treatment is the ability to relate to the patient in a personal way. “Being able to do that is what separates the good from the great,” said Agarwal. “So if you’re able to connect with someone in addition to properly treating them, it’s exponential healing, not just taking care of a cancer.”
Jodi Goane, operations manager of the radiation oncology center at Union, has witnessed the effect that such attention can have. “When the patients come in, they know he’s listening,” Goane said of Agarwal. “And if they leave and call back in an hour, he will talk to them. It’s not like they’re number 100 of the day and he's not going to see you again for three months. People can call or come back anytime.”
What oncology patients have in common, Agarwal added, is vulnerability. “They’re scared, apprehensive, concerned, and they want help. So you’re in this unique position where you can offer help. The patient is not just a housing that has a tumor. It’s the whole body -- experience and taking care of the emotional component and the spiritual component some patients bring.”
Providing hope must necessarily be balanced with honesty. “In the environment of healing, you must also be realistic. It doesn’t just come from me; it comes from the entire team,” Agarwal said. “Patients tell me, 'Doc, you have such a great team, and everyone is so kind … you have a winning team.' And that’s because we only hire winners. We want that feeling to happen as soon as they walk in and not end when they walk out. They have that feeling that this is a place of healing and things will get better by coming here.”
“The majority of patients come here five days a week, so they get to know these girls and they tell us everything, whether we want to hear it or not,” Goane explained. “They usually connect with our people. They see the therapists and the nurses every day. You’re lying on this table, alone, not knowing what this machine does, and how it works. They trust us that we’re operating this thing and not making any mistakes.”
Both Agarwal and Goane agree that good people skills are essential in oncology. “I think somehow, we’ve all chosen this path,” Goane said, “with our innate ability to help people. You have to know how to listen.”
There are plenty of reasons to be optimistic about positive outcomes. “The majority of patients we see here,” Agarwal said, “are treated for cure purposes. Patients are presenting earlier and earlier stage diseases because they’re choosing to get screened to bring attention to their symptoms, and on top of getting things earlier, our technology is improving, along with medications. Our cure rates are improving. People are given realistic expectations, but also know that things can evolve and get better over time.”
Another encouraging aspect of this difficult process is financial help. “There are a lot of resources in Cecil County for underinsured patients,” Goane said. “Union has a community assistance plan. The cancer program raises thousands of dollars to help people with prescriptions and other expenses.”
Goane said some people in Cecil County are reluctant to schedule check-ups, missing the chance of early detection. “Our goal is to make people aware and get screened early and come here for your test. Our marketing goal is to bring awareness to this community, young and old. There are options here now.”
There are three primary caregivers involved in the process of treating cancer: The surgeon, the medical oncologist and the radiation oncologist. Where Dr. Agarwal is a radiation oncologist, Dr. Fahd Rahman is a medical oncologist. Rahman also works in the hematology (blood-related disorders) center. Rahman, who trained at the National Institutes of Health in Bethesda, Md., said, “That research background is very helpful. We can essentially open any clinical trial here for patients. Almost all of the new medicines come through clinical trials. So if a patient is sick and there are no good treatment options, they can be enrolled in clinical trials and they could have access to a medicine that is not an approved medicine, but it may be the best thing under the sun.”
Rahman agreed with Agarwal in his assessment of patient cancer concerns and the attention given to them by the Union staff. “It’s anxiety about something you haven’t done before,” Rahman said. “So when you inform people and educate them better, it makes it a lot easier. That’s what happens in the infusion center, where you get your treatments. Those nurses specialize in providing cancer care. So they spend time with the patients and go over what to expect.”
Fifteen years ago, Rahman wasn’t particularly interested in oncology. Then, things got personal. “My mother was diagnosed with cancer. So that kind of helped me learn about it. My perception was when you get it, you’re just done. Well, my mother has been disease-free for almost 18 years. She had breast cancer; she got chemotherapy and she’s doing awesome.”
That kind of private experience led to Rahman’s dedication to cancer treatment as a member of the Union Hospital team.
When Rahman came to Union Hospital three years ago, that’s when the medical oncology center was started. Then the second phase was the radiation unit. “The cancer center has a lot more moving parts to it than just the medical oncologist – receptionist, medical assistants, to our social workers to our palliative care team. There are so many pieces,” Rahman said. That’s the kind of comprehensive care that enables patients to stay close to home for the entire process.
The three most prevalent cancer types for men are lung, colon and prostate. For women, it’s breast, lung and colon. Historically, lung cancer hasn’t had effective screening, so when it was discovered, it was usually at an advanced stage. However, that has changed for the better. Union Hospital has screening CAT scans to detect lung cancer, and these annual screenings have led to an increase in surgery that removes the problem and cures the cancer.
Despite the fact that cancer is still a scary proposition, Rahman, Agarwal, Goane and the other members of the team are very optimistic about recent advancements and future possibilities. “Science has advanced a lot and, in the next 15 or 20 years, I think it’s going to go by leaps and bounds. Cancer is going to be a very manageable problem. Not all of it, but the majority of it,” Rahman said.