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Talking About Cancer Treatment in 2012

An Interview With Dr. Shane Dormady, medical oncologist at the El Camino Hospital Cancer Center in Mountain View, California

Dr. Shane DormadyECH: Through our "50 Patients, 50 Stories" project, we've profiled many of your patients who have overcome Stage IV cancers--the most deadly kind. How often do you see patients beating the odds like this, and why is this happening?

Dormady: Although some of these patients are what we would call "outliers," it is true that a lot of them are beating the statistics here. If physicians are appropriately aggressive and make use of all the latest technology available to them, we can help some of these late-stage patients. And keep in mind there are two ways of looking at cancer statistics: Is it a 95 percent chance they will die, or a 5 percent chance they will survive? We like to look at that 5 percent--because 5 percent is not zero. So I think there is always hope. There is always something you can do for these patients.

ECH: What is your philosophy then when it comes to cancer care?

Dormady: Sometimes I think of it as, how can we squeeze a square peg into a round hole--how can we beat the odds with a patient? I guess my philosophy is that I don't give up on anyone.

ECH: Tell me about some of your recent patients, whom we profiled as part of the "50 Patients, 50 Stories" project? It seems that many of them did indeed beat the odds.

Dormady: It's true. Jean, Tom, and Tom and Linda's mother [who asked her daughter to share her story] were all told their situations were hopeless. They all had late-stage cancers. And Josephine, who is turning 90 this year, was deemed by some as "too old" to be treated. But here they are today, alive and well, despite having such a small chance at survival. We have many, many stories like this.

ECH: Some might question the need to treat a patient who is nearly 90. What are your thoughts about treatment of the very old?

Dormady: You know, it really rankles me when an older patient doesn't get the care he or she deserves. I think it's a flawed perception--that certain people can be considered too elderly to receive treatment. People may think I am aggressive because I will treat an 89-year-old patient like I would a younger patient, but here's what's important to consider: Every few months, new clinical trials open up and new medicines come out. Just last week, for example, a new treatment for kidney cancer came out. So, if you can give patients an extra six months or a year, you may extend their life long enough so that they will be alive when a promising new treatment comes on the market.

ECH: Given that many of your patients are defying the statistics when it comes to one-year and five-year survival rates, is there a problem with the numbers here? Are the statistics outdated?

Dormady: Cancer statistics aren't perfect. And, yes, some of these numbers come from an older era, before CyberKnife [a new form of targeted radiation] and other advanced treatment technologies. Later this year we will be putting together some outcomes data, and I think people will be astonished at what our outcomes have been here at the Cancer Center.

ECH: Speaking of some of these newer technologies, like CyberKnife, which is mentioned in quite a few of our "50 Patients, 50 Stories" profiles, how do you decide on a treatment plan for a patient? Can you tell us about the process?

Dormady: Early-stage cancer patients are fairly straightforward. When early-stage patients come in, we go with standard NCCN guidelines, which is the national standard of care. But with late-stage cancer patients (stage IV patients), we have to be more creative. First we have to show that a patient is responsive to systemic treatment, so it is typical to start with chemotherapy to shrink or stabilize a tumor. That helps to give the other cancer specialists we work with the confidence to move on to the next step in treatment, which might be surgery or radiofrequency ablation or CyberKnife, for instance.

ECH: And some of the new tools aren't actually all that invasive, correct?

Dormady: That's right. Patients love CyberKnife, for instance. And they get terrific care at our CyberKnife center. Our director of radiation oncology, Bob Sinha, has a style that is similar to mine and the patients really like him. We work extremely well together.

ECH: Tell me more about how your team interacts, and why patients should think about the larger treatment team involved in their care.

Dormady: Well, it's not only important to have access to all the available cancer tools, it's also important to have the right kind of specialists. In addition to Dr. Sinha (radiation oncology), I work closely with Dr. Shyamali Singhal (cancer surgeon and medical director of the Cancer Center), Dr. Fabio Komlos (interventional radiology), and Dr. Al Pisani and Dr. Dwight Chen (both gynecologic oncologists with the Palo Alto Medical Foundation). All of these doctors are available 24/7--so if I am meeting with a patient in my office, I can just pick up the phone and have a mini tumor board meeting with any of these specialists, right then and there. No waiting. I think it's important to have a team that is highly accessible.

ECH: Many patients today get second opinions when it comes to cancer care. How do you feel about that? Do you encourage it?

Dormady: Of course. In an area like Silicon Valley, where people are extremely well educated, patients naturally will do a lot of research and get a second opinion. I think it's good. We [oncologists] don't always agree with each other. In the end, I think patients have to choose a doctor whom they think will go to bat for them. I also think that, over the years, our Center has gained the reputation as one that patients love, and so more and more doctors from all over California are hearing about us. Because of that, I tend to have a very collegial relationship with doctors at other hospitals--it's easy for us to pick up the phone and talk with one another about some of the more difficult cases.

ECH: Do you see any changes in the future of cancer care at ECH?

Dormady: One thing we're doing is that we are becoming more and more specialized at El Camino Hospital. So, our patients will begin to see more specialists in areas such as head and neck cancer, thoracic cancer, breast cancer and melanoma.

ECH: Given that you give out your cell phone number to patients, and you put a lot of time into each and every patient case, does it take its toll on you personally?

Dormady: It does. But I'm passionate about taking care of my fellow human beings. There's nothing more rewarding than when a scan comes back clear. Actually, my favorite part of what I do is seeing what happens after I meet with a patient for the first time. On that first visit, a patient will walk in with a look of terror in their eyes. They've just been diagnosed, and they're understandably terrified. But then I tell them, "Don't worry. We are going to help you." And then I see the fear subside. I think we inspire hope in our patients.

ECH: Do you think being hopeful actually helps patients achieve better outcomes?

Dormady: I do. I think you have to have the mind, spirit and body moving in the same direction. People do better when they believe they will do better. I've seen it firsthand. So, patients should never give up hope.What's changed in cancer treatments video

To hear more from Dr. Shane Dormady of the El Camino Hospital Cancer Center, watch the video "What's Changed in Cancer Treatments?"

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