Health Source October 2011 : Page 2

T Carlos Castillo, M.D., Joanne Dragun, M.D., and M. Firdos Ziauddin, M.D. By LaNeta Crighton “The benefit to coming to a comprehensive cancer center is that it’s a much smoother transition and a very intimate process for patients.” — Joanne Dragun, M.D. he physicians and staff at 21st Century Oncology of Jacksonville know out of the estimated 207,090 women diagnosed with breast cancer each year – no two patients are the same. That’s why, at their comprehensive cancer center, every patient receives an individualized treatment plan designed to meet their specific needs. 21st Century Oncology of Jacksonville offers medical, surgical and radiation oncology care at one convenient location. That means there’s no driving from place to place or juggling appointments all over town. The multidisci-plinary team approach ensures that all physicians involved are working together toward the best possible outcome for every single patient. “The benefit to coming to a comprehensive cancer center is that it’s a much smoother transition and a very intimate process for patients,” says Joanne Dragun, M.D., radiation oncologist at 21st Century Oncology of Jacksonville. “The physicians coordinate care and brainstorm about how to best provide individual care for each patient.” Imaging services are also provided onsite, so patients requiring CT or PET scans can literally come in, have the scan and review the preliminary results with Dr. Dragun in a matter of minutes. “When you receive a diagnosis of cancer, it impacts your whole life,” says Carlos Castillo, M.D. As a medical oncolo-gist, he describes himself as a kind of quarterback of care. “Communication is one of the most important parts of can-cer care. Patients need to be able to go to one person for answers,” he says. For many patients, waiting is the worst part. Having all the services under one roof provides better access. When patients have questions about any aspect of their treatment, Dr. Castillo collaborates with the team to find the answers they need. “From day one; we incorpo-rate the concept of a whole view of the patient and their needs,” he says. “The mortality rate for breast cancer has decreased signifi-cantly over the past two decades,” says Alan Marks, M.D., a medical oncologist. The American Cancer Society attributes this decrease to earlier detection and improved treatment.

21st Century Oncology Of Jacksonville

LaNeta Crighton

The Physicians and staff at 21st Century Oncology of Jacksonville know out of the estimated 207,090 women diagnosed with breast cancer each year – no two patients are the same. That’s why, at their comprehensive cancer center, every patient receives an individualized treatment plan designed to meet their specific needs. 21st Century Oncology of Jacksonville offers medical, surgical and radiation oncology care at one convenient location. That means there’s no driving from place to place or juggling appointments all over town. The multidisciplinary team approach ensures that all physicians involved are working together toward the best possible outcome for every single patient. “The benefit to coming to a comprehensive cancer center is that it’s a much smoother transition and a very intimate process for patients,” says Joanne Dragun, M.D., radiation oncologist at 21st Century Oncology of Jacksonville. “The physicians coordinate care and brainstorm about how to best provide individual care for each patient.” Imaging services are also provided onsite, so patients requiring CT or PET scans can literally come in, have the scan and review the preliminary results with Dr. Dragun in a matter of minutes. “When you receive a diagnosis of cancer, it impacts your whole life,” says Carlos Castillo, M.D. As a medical oncologist, he describes himself as a kind of quarterback of care. “Communication is one of the most important parts of cancer care. Patients need to be able to go to one person for answers,” he says. For many patients, waiting is the worst part. Having all the services under one roof provides better access. When patients have questions about any aspect of their treatment, Dr. Castillo collaborates with the team to find the answers they need. “From day one; we incorporate the concept of a whole view of the patient and their needs,” he says. “The mortality rate for breast cancer has decreased significantly over the past two decades,” says Alan Marks, M.D., a medical oncologist. The American Cancer Society attributes this decrease to earlier detection and improved treatment. DiagnostiC FaCtors Breast cancer is now separated into types. Identifying the type and stage of cancer is important in determining which treatment will be the most effective. In some cases, therapies can be targeted to improve treatment outcomes. One example is HER2, a protein that promotes the growth of cancer cells. Caused by a genetic mutation, HER2 cancers tend to be both more aggressive and less responsive to hormone treatment. “All breast cancer is now tested for HER2, which occurs in 25 percent of cases,” says Dr. Marks. “This has allowed for targeted therapy of HER2-positive breast cancers. It has really leveled the playing field, and survival is now equal to or better than that of hormone responsive breast cancer,” he says. Treatment options “Breast cancer treatment has many components,” says surgical oncologist, M. Firdos Ziauddin, M.D., “Surgery, different types of systemic therapy and radiation may be used. Not every patient needs all three, but when there are different treatment modalities, they need to be coordinated.” For breast cancer patients requiring radiation therapy, the center uses TomoTherapy, the newest radiation treatment option available. TomoTherapy employs a unique CT scanner design to provide 360 degree delivery of tiny beamlets of radiation to the tumor site. Daily CT scanning means the tumor is precisely targeted each time, focusing treatment in the correct area and reducing damage to organs and tissue around the tumor. Surgery is performed to remove the cancer and ensure margins around it are cancerfree. But, while Dr. Ziauddin admits mastectomy may be indicated when tumors are extremely large or cancer is present in more than one quadrant of the breast, surgery doesn’t mean necessarily mean mastectomy. And, he says, studies dating back over 30 years, show mastectomy doesn’t increase the survival rate or lessen the risk of local cancer recurrence. In some cases, there are good reasons to give chemotherapy prior to surgery, one of which is to shrink the tumor and save more of the breast. “We look at tumor size to breast ratio,” says Hank C. Hill, M.D., also a surgical oncologist at 21st Century Oncology of Jacksonville. A large tumor in a small breast is different than the same size tumor in a bigger breast, and each individual tumor biologically dictates the best treatment route to take, he says. Efforts are made to save as much of the breast as possible. “The majority of breast cancer patients, probably between 60-80 percent can undergo breast conservation surgery,” says Dr. Hill. When removal of the breast is necessary, steps can be taken to prepare for reconstruction. “A skin-sparing mastectomy allows a lot of skin surface area to remain, so breast reconstruction can be done to match the opposite breast,” he adds. There are other ways to preserve breast appearance, too. Using oncoplastic techniques when necessary, Dr. Ziauddin is often able to reduce the cosmetic damage sometimes associated with breast surgery. “Oncoplastic surgery is a way to remove the cancer and rearrange the breast tissue for better cosmetic results,” he says. A LeaDer in Care Part of a nationwide network, 21st Century Oncology of Jacksonville offers the most advanced treatment options available in a locallymanaged, patient-centered setting. “We are the biggest company in the world for radiation, and as such, our resources allow us to provide top-notch therapy,” says Dr. Dragun. While some centers reserve specialized equipment for certain types of cancer, every patient at 21st Century Oncology of Jacksonville has access to the most technologically advanced equipment the center has to offer. The fellowship-trained, board-certified physicians at 21st Century Oncology of Jacksonville are committed to providing expert cancer care, delivered with compassion. As an active research facility, patients are offered the opportunity of participating in studies involving leading-edge treatment modalities. A newly formed cancer survivor support group is also available. “We try to be a place a woman with breast cancer can come and have all her management decisions made with a team of doctors who respect her, her diagnosis and her lifestyle,” says Dr. Dragun. “We want to deliver the best care we can, in the best way we can, so she can make a smooth transition back to life.” “When you receive a diagnosis of cancer, it impacts your whole life. Communication is one of the most important parts of cancer care. Patients need to be able to go to one person for answers.” — Carlos Castillo, M.D.

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