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Military Hospitals and Clinics, San Antonio
Military doctors have more tools in their kit in the fight against cancer. One area showing good results is interventional oncology that focuses in the treatment of various cancers.
“Interventional oncology brings a minimally-invasive, imaging-guided, tumor-focused option to cancer care,” said Army Maj. Nicolas Cahanding with Brooke Army Medical Center in San Antonio, Texas. “These procedures are often performed in a shorter amount of time (approximately 1-2 hours), bring shorter recovery times (often hours to days), and less patient complications and adverse reactions compared to more traditional surgical and chemotherapy options.”
Cahanding said different techniques are used to deliver the cancer treatments. One method, ablation, uses a small probe inserted through the skin and into the tumor to destroy tissues using thermal or other energy. Another method, embolization, uses the patients’ own blood vessels to deposit small particles into tumors in order to starve them of blood and other nutrients, thus, killing the tumor.
At Brooke Army Medical Center, a more technical hybrid procedure, radioembolization, delivers radioactive isotopes into tumors through a patients’ blood vessels. It’s currently used just in the treatment of liver cancers, such as hepatocellular carcinomas, cholangiocarcinomas and others. It is an accepted and growing method to augment more mainstream therapies. Due to the nature of the treatment (the nuclear medicine element, the large investment in resources of time, money and expertise for this treatment, and a needed large population eligible for this procedure, among other factors), BAMC is the only facility in the Department of Defense currently performing the procedure. It's available to all beneficiaries who meet the medical requirements. Cahanding sees these newer treatment options as promising complements to conventional cancer therapies, such as surgery or chemotherapy.
“A patient with overall poor health might better tolerate the less-invasive radioembolization procedure over a more-invasive open liver surgery,” said Cahanding. “However, a healthier patient able to tolerate the more invasive treatment might want to seek surgery in hopes of a definitive cure.”
Cahanding said that an individual could receive the newer treatments and traditional surgery and chemotherapy in combination, depending on the patient’s overall health status and disease course.
“The actual success rate depends on whether the treatment is designed to eliminate disease, stop disease progression or palliate symptoms,” said Cahanding, emphasizing the main benefit lies in how it is less invasive, and thus, shortens recovery times, as compared to the more common treatments.
Doctors and other providers can practice with new therapies at Brooke Army Medical Center’s state-of-the-art simulation center.
“A doctor is able to refine various skills, build confidence and recognize potential limitations before working with an actual patient,” said Cahanding.
Interventional oncology is part of the Military Health System’s (MHS) larger commitment to the White House-led initiative known as the Cancer Moonshot. That effort looks to make 10 years of progress against cancer in just five years by bringing together resources from the government and private sectors.
“This is a concerted effort of the nation with the ultimate goal to do what we normally would do in active research in just half the time,” said Dr. David Smith, deputy assistant secretary of Defense for Health Affairs, Health Readiness Policy and Oversight and one of two DoD principals in this summer’s Cancer Moonshot Summit hosted by Vice President Joe Biden.
The fight against cancer is a priority for the MHS. More than 1,000 active-duty service members are diagnosed with cancer each year, in addition to the many retirees and family members affected. The information MHS handles on the disease could one day help find cures to many forms of cancers.
“We have a significant presence in research in this area,” said Smith. “That investment in effort also means we have a significant cancer registry, one of the best in the world, of samples, tissues, etc., supported by our electronic health records helping us match data.”
Cahanding said treating various cancers allows military medicine providers to maintain ownership of service members’, retirees’, and other beneficiaries’ care, particularly in difficult times. He added they must keep up on new techniques, such as interventional oncology.
“Given the broad knowledge base and quickly evolving information on cancer-related disease, it is a reminder that military physicians must stay current in the literature and perform at levels comparable to, if not better, than our civilian medicine counterparts,” said Cahanding.