Q&A: Oncologist’s colorectal cancer diagnosis ‘changed the way I interact with patients’
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A cancer diagnosis can be terrifying for any patient, but when a colorectal cancer researcher is diagnosed with the same disease that they spent years studying, it also transforms how they practice medicine and how they relate to patients.
Diagnosed with rectal cancer just as he was about to begin a faculty research position at University of Wisconsin Health, Dustin A. Deming, MD, noted that his diagnosis came as a shock, especially since “I had already dedicated my future career and research focus to treating patients with colon and rectal cancer.”
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“To be honest, I did not get what it meant to hear the word cancer,” Deming, associate professor in the division of hematology, medical oncology and palliative care at the University of Wisconsin School of Medicine and Public Health, told Healio. “I did not understand the impact of a cancer diagnosis on people’s lives, how they slept at night, how they interacted with family members and what this was going to do to their work or potential future opportunities that they had. Obviously, I knew cancer was bad, but the day-to-day impact is much different when you experience it yourself.”
In an interview with Healio, Deming discussed how his own patient journey with rectal cancer has continued to fuel his research and provided him with a unique perspective on how to care for patients with CRC.
Healio: How has your personal experience with CRC affected your work as a clinician and researcher?
Deming: When I was seeing patients initially as a fellow, I would talk to the patients about the stage of their disease, about the science behind the treatments that we were going to do and what we understood about the biology of CRC.
My diagnosis has given me a lot more empathy with patients and changed the way I interact with patients. Before we even dive into what we are going to do and the science behind everything, I ask them: How are you sleeping at night? How is your mood? How did hearing the word ‘cancer’ change things for you?
Healio: What advice would you give gastroenterologists who are caring for patients with CRC?
Deming: We can all get caught up in the day-to-day rush of things, but as we are interacting with patients, especially with a new diagnosis of cancer, we need to take that deep breath and understand how the information we are going to be giving these patients is really going to impact their life.
Gastroenterologists are, unfortunately, often the ones who have to break the initial news to patients about the new diagnosis of cancer in the rectum or colon. It is important that they understand how this is going to impact the patient. What that patient really wants to hear is what do we do next and how do we potentially get rid of this cancer?
In addition to the empathy around the diagnosis and sharing information with the patient, doing whatever you can to help expedite the plan and the interaction with a surgery team, medical or radiation oncology team is important. It is also important for the medical oncology team to work with our gastroenterology partners to try to get those patients in as soon as possible and help narrow that gap between diagnosis and development of a treatment plan.
Healio: Can you expand on the importance of gastroenterologists and oncology teams working together to treat CRC?
Deming: Gastroenterologists can have a great impact on the development of colorectal cancer by removing adenomas before they ever turn into cancers. For those patients who do develop cancer, the earlier we find it, the better the outcomes will be for that patient.
Additionally, the time between being diagnosed and a treatment plan being established is often the hardest part of dealing with a new cancer diagnosis. Making the transition between a gastroenterologist and the surgical or medical oncology teams as seamless as possible can significantly decrease the emotional and mental burden of the diagnosis for patients.
The collaborations between gastroenterologists and oncology teams are only going to increase, especially with better therapies resulting in nonoperative treatment options for some patients. These patients will require serial endoscopic evaluations over time to make sure their cancers do not recur, and if they do, they are dealt with in a timely manner.
Healio: Can you discuss your latest research?
Deming: One of the exciting things about being a medical oncologist studying CRC is that the research field has expanded so dramatically over the last 5 years.
When I first started my career, I received a grant from the V Foundation, which really helped us establish a lab to work on developing new models for CRC that would allow us to specifically study subtypes of colorectal cancer. Prior to our work, the models we could use to study cancer in the lab were very crude and did not really represent the cancers we see in patients in clinic.
Through the work I completed as part of a V Foundation grant, we were able to develop new models that recapitulate the mutations and the histology of what cancers look like in patients. This has afforded us multiple opportunities now to develop new treatments.
We are also using some of our organoid cultures, which is a 3-D culture system to predict how patients are going to respond with two different therapies. Just like we do for infections, we can prescreen patients with a test to see which chemotherapies they are most likely to respond to.
Additionally, our work has now expanded to the clinic, where we are targeting subtypes of colon and rectal cancers. Specifically, we are interested in two subtypes of CRC, one that has a PIK3CA mutation. In a recent publication of the MATCH trial [in the Journal of Clinical Oncology], we show that a subset of patients with PIK3CA mutations can respond to copanlisib (Aliqopa, Bayer), a new FDA-approved phosphoinositide 3-kinase inhibitor.
We are excited about the colorectal cancers that have no mutations in KRAS, RAS or BRAF and are very sensitive to anti-epidermal growth factor receptor (EGFR) therapies. These anti-EGFR therapies are known to induce responses in patients, but these cancers can evolve to become resistant by acquiring mutations or metabolic changes. Excitingly, we are seeing that those changes actually change over time.
We can now reuse the anti-EGFR therapies for patients as long as they have had an intervening therapy and it has been at least 4 months since the last time they had that therapy. For that population of patients, we are able to expand the opportunities for different treatments for those patients, because we can reuse therapies that we used previously.
We also have an ongoing clinical trial where we are starting with the single agent anti-EGFR therapy and cycling between that therapy and different types of chemotherapy to double the number of treatment options we have for those patients. So far, we have seen some exciting results.
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