Dr. Ronald Setzkorn
May 18, 2016
Skin cancer remains the most common malignancy diagnosed in the United States. The incidence of this appears to be greatly under-reported but it is clear that skin cancer is more common than all other cancer types combined. Basal cell cancer is most common of these cancers with squamous cell cancer being the second most common. For example, Dr. H.W. Rogers in 2006 use national representative databases and estimated the non-melanoma cancer incidence in the US that year to exceed 3.5 million cases. One should note that the reporting of non-melanoma skin cancers to Tumor Registries throughout United States is not required and this would lead to under-reporting. Fortunately, this diagnosis rarely leads to death.
As with all cancers, “an ounce of prevention is worth a pound of cure.” The development of these cancers has a direct relationship with the amount of prior sunlight exposure and years of exposure in a person’s past. This is particularly true for sunlight exposure as a child or teenager. There is a greater amount of sun exposure in countries closer to the equator where sunlight is more intense. It is also more intense at noon and at other times during the day and more intense during summer than other times of the year. Light skinned people appear to be more often affected than dark skinned. Also the frequency of prior severe burns causing peeling of skin appears to be related to the future incidence of skin cancers, for instance farmers and other people who have jobs outdoors often experience higher rates of skin cancer later in life. These factors can be reduced by limiting sunlight exposure, particularly as a child or young adult and by the use of sunscreen with a Sun Protection Factor of 15 or greater.
A close friend of mine and former partner worked in the cancer program of a large hospital in Saudi Arabia. I find it interesting that he reported virtually no cases of skin cancer in this very hot dry and sunny climate almost certainly relating the fact that it is a cultural norm for Saudi Arabian citizens to cover virtually all skin with clothing. Conversely, the incidence of skin cancer in Australia remains very high where there is no such cultural norm to cover up skin exposure.
There are also advantages to early detection and management as opposed to neglecting this group of malignancies. An area of irregular skin that is bleeding, or crusting or one which does not heal needs to be evaluated. This evaluation would include biopsy if cancer is suspected. Given the high cure rates for basal cell and squamous cell cancer, it is not clear how many lives would be saved but even under the circumstances, the morbidity of curing these cancers would be lower with early diagnosis.
Also in the setting of melanoma, the cure rate is significantly higher with early diagnosis then with a delayed diagnosis of higher stage disease. When I spent time at Massachusetts General Hospital years ago, I was informed of a program where dermatology residents were given the task of examining every surgical patient (cholecystectomy, appendectomy, etc.) for incidental skin cancers during their hospital stay and then registering their outcomes regarding melanoma. I was informed that in following these patients, they had no cases of subsequently fatal melanoma in this patient population for over 30 years. I do not know if this program is still ongoing.
For those many patients who ultimately are diagnosed with skin cancer, the goals of care would be to achieve cure with the best functional and cosmetic outcome. A diagnosis of skin cancer would involve a biopsy and generally the input of the family physician, dermatologist or surgeon. The subsequent management of skin cancer would involve dermatologists, surgeons and radiation oncologists and occasionally now medical oncologists for situations beyond the scope of standard management.
The optimal care would involve patient preference and the balancing of inconvenience, risks and benefits of each approach, the expected outcome in terms of cancer free survival and long-term appearance and function. One option is that of radiation therapy and the basic principles from which this field of medicine evolved came from the study and management of skin cancers. There has been a significant evolution in the care of skin cancer patients over these decades. For many patients, this care could now include six to ten 5 minute sessions of brachytherapy; a treatment in which a small device temporarily holding a radioactive seed is placed a short distance away from the cancer to provide these treatments and is done without the need for anesthesia or the removal of tissues.
We at Dayton Physicians Network UVMC location became the 13th facility in the US to offer the new modality of Valencia HDR care in 2005. For patients who are medically or technically inoperable, radiation linear accelerator based therapy still provides for optimal outcomes for these more difficult of circumstances but it often requires 25 or more separate brief sessions of therapy to complete this care. This inconvenience, however; is generally non-morbid and successful.
I have been blessed in being a part of many successful outcomes for patients who otherwise would have required amputation of ears or significant deformity of noses etc. In total, I have witnessed success in over 95% of cases over 30 years. Surgery however still provides the main stay of care for most patients and excision and/or Moh’s surgery remain an important part of the curative management of many of these patients.
In summary, skin cancers are surprisingly common and are rarely fatal for the majority of basal cell and squamous cell subtypes. Prevention, early detection and weighing all options for cure remain central to the care of these patients. As is well stated in the 2016 National Comprehensive Cancer Network guidelines; “The goals of primary treatment of skin cancer are the cure of the tumor and the maximum preservation of function and cosmesis. All treatment decisions should be customized the particular factors present in the individual case and for the patient’s preference.”
At Dayton Physicians Network, we’re here for you
April 26, 2016
By Robin Supinger, MBA
Jill Reese, RN, BSN,OCN recently accepted a leadership role with the Community Oncology Alliance (COA) Patient Advocacy Network (CPAN). COA is a national advocacy organization that advocates on behalf of cancer patients, physicians and preserving community oncology care. CPAN was created in recognition of the vital role patients should play in advocating for access to local affordable care for all cancer patients.
Truly inclusive on all levels, CPAN is a non-cancer type specific national network representing all members of the cancer community. CPAN members include patients in active treatment, cancer survivors, professional caregivers, family members, medical and oncology professionals, and members from the general community.
Jill is now the COA Patient Advocacy Leader for the new Dayton Physicians Network CPAN Chapter. She and Robert Baird, CEO will be hosting the launch of the Chapter and a Patient Advocacy Education event at our Greater Dayton Cancer Center. Read More
- To learn more about COA and their key initiatives, including the Cancer Experiment, visit communityoncoloy.org
- To learn more about CPAN visit coaAdvocacy.org(please note, the CPAN website is under development)
- To learn more about the event or becoming a member of our new Dayton Physicians Network CPAN chapter, email email@example.com
April 14, 2016
By Jeff Sergent, Manager of Marketing and Business Development
You’re Invited To Tour Our New Facility.
Please join us in our celebration, meet our staff and learn more about our services during the Community Open House Sunday, April 24, 2016. Open House hours are from 2:00-4:00 pm.
Atrium Medical Center
501 Atrium Drive
Franklin, Ohio 45005
April 13, 2016
By Robert Baird, CEO
Congratulations to Dr. Satheesh Kathula, Medical Oncologist at Dayton Physicians Network who was recently promoted to Clinical Professor of Internal Medicine at Wright State University’s Boonshoft School of Medicine.
Dr. Kathula has been teaching for over 15 years, with the last ten as a Clinical Associate Professor at Wright State. He has presented educational programs at Internal Medicine Resident Conferences and in India, as well as publishing medical articles.
We appreciate Dr. Kathula’s commitment to educating others, while providing top- quality care to our patients!
Satheesh Kathula, MD
Dr. Kathula attended medical school at Siddhartha Medical College, University of Health Sciences, Vijayawada, India. He completed his residency and fellowship at Wright State University and he is certified by American Board of Internal Medicine, Hematology and Oncology. He has been with Dayton Physicians Network since 2002 and is a Co-Investigator with Dayton Clinical Oncology Program.
April 13, 2016
By Robert Baird, CEO
Congratulations to Dayton Physicians Network’s Director of Pharmacy who has been appointed by Governor John Kasich to the State of Ohio Board of Pharmacy.
We appreciate Josh’s leadership and expertise in leading our Pharmacy team in this very dynamic health care environment. His commitment to serving our patients and providing the highest quality care is unmatched.
Joshua Cox, PharmD, BCPS:
Joshua Cox is a board certified Pharmacotherapy Specialist and is currently the Director of Pharmacy Services for Dayton Physicians Network. Prior to joining Dayton Physicians, he held pain and palliative care consultant and pharmacy manager positions at ProCare HospiceCare and Good Samaritan Hospital. Joshua has delivered numerous presentations, and has provided continuing education courses at multiple hospitals and universities. He has also published numerous articles on palliative care and pain management, pharmacology and oncology.
April 13, 2016
By Josh Cox, PharmD, BCPS, Director of Pharmacy Services
I am proud to announce that Dayton Physicians Network has been approved for accreditation for Specialty Pharmacy Services with a Distinction in Oncology. Our accreditation is effective through February 22, 2019.
At Dayton Physicians Network, we have the added distinction of being only one of two practices in the nation to have earned both of these accreditations.
COMMITMENT TO EXCELLENCE.
Dayton Physicians Network is accredited by Accreditation Commission for Health Care (ACHC) for compliance with a comprehensive set of standards. ACHC is a third-party accreditation organization that has developed the highest national standards that providers are measured against in order to illustrate their ability to effectively and efficiently deliver quality healthcare products and services to consumers.
WHAT DOES IT MEAN FOR YOU?
Accreditation requires healthcare organizations to demonstrate compliance with specific quality and process standards. By choosing a healthcare provider that has achieved ACHC accreditation, you can take comfort in knowing that you will receive the highest quality of care. If you have any concerns about the product or service that you receive from Dayton Physicians Network, you may contact ACHC directly at 855-937-2242.
At Dayton Physicians Network, we’re here for you.
April 8, 2016
By Robin Supinger, MBA
Join us at Greater Dayton Cancer Center on Friday, April 15th for National Health Care Decision Day-2016.
Our partners, Fidelity Health Care and Innovative Care Solutions will have advocates on hand to answer your questions and help you to complete your Advance Directives paperwork on the spot. No appointments are necessary, just stop in between 10 AM and 2 PM, Friday April 15, 2016.
Our Greater Dayton Cancer Center location is at 3120 Governor’s Place Boulevard, Kettering,Ohio 45409.