Where Cancer Meets Its Match
Christina Hamlett
October 27, 2006
Earlier this year, he was one of thirty physicians in the United States – and the only one from California – to be named a Fellow of the American College of Radiation Oncology, an award he graciously added to prior accolades including the President’s Award for Academic Excellence and lists recognizing “America’s Top Physicians” and “Best Doctor in America”.
It was really Madame Curie who got the ball rolling,” he begins my impromptu tour of the Helen and Jim Gamble Radiation Oncology Center at Huntington Hospital. “A century ago, she stuck some radioactive radon into the tongue of a man who had been diagnosed with tongue cancer. Obviously we don’t know how much she used – and unfortunately she had no concept of what constituted a ‘safe’ dose - but that was basically the birth of what we do today in brachytherapy.”
He proceeds to demonstrate how the quality of high-tech imaging can allow physicians to use treatment planning software that determines where the radiation should go and how to put it exactly into the prostate gland.
This treatment,” he explains, “was started 25 years ago by the Seattle Prostate Institute and enables us to see where the prostate cancer is through an ultrasound. Once we know its whereabouts, we implant dozens of radioactive ‘seeds’ into the targeted area that will release the correct dose of radiation over the course of several months to a year. By the time the radiation has been used up, the cancer will be gone. This not only eliminates the older methods of cutting away the cancer, it also eliminates having radiation coming from outside the body and hitting a lot of stuff before it does its job.”
He facetiously makes the analogy of a heat-seeking missile. “People don’t realize that the prostate gland doesn’t just sit in one place all the time. Depending on what you had for dinner last night, it can move around and shift position. But if you have the radiation inside the target, the dose of radiation will still be able to seek it out.”
It’s a procedure, Lam says, that takes about 40 minutes and is done on an outpatient basis. “I have patients who are out on the golf course the very next day and telling their friends, ‘I’m getting treatment for prostate cancer, but look! I didn’t have to skip my tee time!’ The patients I’m currently treating are still working 60 hours a week and playing 5 days of golf.”
He shares the anecdote of a man he recently treated who plays golf 3 or 5 times a week. “He’s about 79 and shoots his age half the time. I told him that with the radiation treatment he might get a little tired and it might affect his golf game. About halfway through his treatment, he came in and said ‘I missed three shots today and I came back with a 75’. The point here is that patients’ lives don’t come to a standstill. In fact, of the 230,000 men diagnosed with prostate cancer, less than 10 percent will die from it. We’re seeing patients coming back in 5 or 10 years disease-free and, in studying statistics, are discovering that there are more people today who are cancer survivors than will die from it.”
In addition, he points out, patients don’t have to worry about bleeding because there’s no cutting, nor do they have to stress out about the radiation wandering off into other parts of their body and damaging other organs. “Technology has allowed us to get extremely precise at imaging. Blood tests, too, can identify if there’s a change in some enzyme in the blood that may be an early marker that something is going on.”
Lam relates that the Seattle Prostate Institute has now published 15-year data to establish that failure in the arena of brachytherapy treatments is rare.
Twenty-five years ago,” Lam illustrates, “was a totally different story. Cancer was thought of as an impending death sentence. Most people said, ‘Okay I have cancer. I’m going to die. I better get my affairs in order’. Twenty five years ago, if you had cancer – The Big C – no one was supposed to talk about it, even within the immediate family.”
Things began to change when presidents’ wives, movie stars and celebrities with breast cancer started stepping into the spotlight to encourage funding for research to find a cure.
Overnight, it seemed to become a politically correct cause to draw attention to the plight of women who were undergoing radical mastectomies. Cancer is a popular disease to get on board with because there is always the hope that each day comes closer to discovering a cure. The irony, however, was that prostate cancer was going on at the same time – the discovery being made in the 80’s that as men got older, many were getting diagnosed with it - but the men weren’t being quite as vocal about their own disease and its side effects of impotence and incontinence.”
A quarter century ago, he continues, the general thinking was that the only way to deal with any kind of cancer was to cut it out. “With breast cancer this meant that male surgeons were telling women that radical mastectomies were no big deal – ‘you’ll heal up in two weeks’.” Lam shakes his head gravely. “What they forgot to tell them was that the emotional healing was not two weeks or two months. In fact, the feelings of devastation and loss of self esteem might last all the way til you die.”
All of the money and publicity in the 1980’s gave rise to clinical trials which led physicians to start comparing various forms of treatment with the idea of using less surgery and less radiation. “As a result of this research, most women today go through a mammogram and, if something is detected, end up going through radiation and not having a mastectomy.”
No sooner did national interest in breast cancer start to taper off in the 1990’s,” Lam goes on, “there was a rise in the number of prostate cancer cases being reported. Coincidentally, it brought forth a number of high-profile males such as Vice President Bob Dole, General Norman Schwartzkoff, CEO Andy Grove of INTEL, and New York Mayor Rudy Gulliani who wanted to hold press conferences and tell their stories.” Grove is specifically lauded by Lam as having published “the only worthwhile reading on the subject in Fortune Magazine and challenging the whole thinking of treatment regarding prostate cancer”.
We’re now seeing the kind of momentum that changed the thinking in treating breast cancer. The U.S. Congress, two years ago, passed House Resolution No. 669 that requires doctors to give their patients information on all available forms of treatments so as to determine which will yield the best outcome at the least sacrifice to the quality of one’s life. The truth is that doctors simply don’t know what the best treatment is for every patient. For instance, I should not assume from past frames of reference that a patient who is 70 years old has a particular lifestyle. I can’t tell a patient who is 50 that erectile dysfunction is important or not important. That’s because there’s a lot more to his life than the disease. The doctor’s role is to empower patients to explore all of their treatment choices – surgery, radiation, brachytherapy, chemotherapy, homeopathy, and a very important option called no treatment.”
He pauses a moment to reflect on a movie several years ago called “Patch Adams” starring Robin Williams. “It contained the most profound statement that if you treat the disease, you’ll either win or lose. If you treat the patient, you will never lose. As doctors, we have a responsibility to treat their emotions, their beliefs, their fears, their depression, and their dealing with the side effects that we cost them through treatment. What I see a lot of times with cancer patients is that they’re either over-treated or under-treated because of the doctor’s thinking or bias. It’s no longer a matter of ‘cut, fry, poison’ and then send them home. Cancer patients go through denial, anger, fear, and withdrawal and need to be able to draw on the resources of psychotherapy, psychology, and support groups to help them cope.”
Lam has not shortage of praise for Huntington Hospital’s reputation as the destination of choice for patients facing cancer. “The reason why Huntington Hospital is so successful is not because of marketing; it’s because of word of mouth. For instance, about 3-4 years ago there was a man who was diagnosed with prostate cancer in Madrid. He’s very wealthy and talked to a friend of his who lives in Lima, Peru. When he told him he had just been diagnosed with prostate cancer and asked where should he go, the friend immediately told him Pasadena. ‘Pasadena?’ the man said. ‘Where’s Pasadena?’ Word of mouth is powerful stuff!”
On another occasion, he recalls two men who both came to Huntington at the same time from opposite ends of the country – one from New Jersey and the other from Hawaii. Lam’s reputation, it seems, is the stuff of legend.
He’s also quick to explain what drew him to become director of the Cancer Center seven years ago. “They extended the invitation to come in and take over the entire cancer program and I knew this hospital was passionately committed to cancer care.” He grins. “And you can’t beat the commute – it’s only 2 Starbucks and 8 minutes away from my house!”
Huntington Hospital, he continues, is not only a non-profit facility but is also a teaching venue.” A cancer patient will typically want a second opinion from the City of Hope, a third opinion from USC Norris, and maybe a fourth opinion from UCLA John Wayne. For the last seven years what I have done is to now have in place at Huntington a core of doctors from these facilities so that patients won’t have to be calling all over town to get those second, third and fourth opinions. His or her case can be presented in a single room with the expertise of the top cancer facilities in the area. This happens every week. You don’t get that kind of attention at any other hospital in California.”
If his mother had possessed a strong say, Lam quips, he might have found himself in the obstetrics wing instead of distinguishing himself at the forefront of cancer research and treatment. “I grew up in a medical family. My father was an obstetrician and my grandfather was a doctor. I also have a brother who’s an obstetrician. In my grandfather’s day there were no specialists. Doctors took care of everybody. My mother was in medical school with my father and was one year shy of graduating when World War II broke out. After medical school, I started with one year in OB and decided I didn’t want to spend the rest of my life there. Why? Because I’m not sure there’s a lot of exciting new things that can happen with delivering babies.” Outside the U.S., he interjects in reminder, most people deliver without doctors, a comment that leads him to add, “I think the human race has done pretty well with this.”
His mother, he shares, never understood why he went from OB – which almost always meant dealing with happy outcomes – to what she felt was the end of life.
I got involved with prostate cancer because I saw that that’s where the excitement, timing and opportunity were going to be in the future. Where there’s excitement, there is always money to follow and the more money there is for research, the quicker we come to solutions. Cancer treatment, cancer research – what could be more exciting than the adventure of knowing each day was bringing you closer to the discovery of a cure? Besides that, I also like to sleep. And what I’ve seen of babies, they’re always coming at a bad time or constantly waking you up after you bring them home!”
His own babies – three daughters - were each born at Huntington and went through San Marino schools. “My first daughter is passionate about dance. My second daughter started the San Marino High School girls golf team.” He divulges with pride that it had an 11-1 season this year.
So if his philosophy of life and spiritual balance were emblazoned on a t-shirt, what would it say? “Good health is a blessing,” Lam replies. “Enjoy it.”
He’s unabashed in his enthusiasm for what the next 25 years might bring. “I think tomorrow’s treatment,” he predicts, “will be why do we have to actively cut out a cancer or to kill a cancer cell by poisoning it with radiation. Maybe all we want to do is to stop that cancer cell from dividing and multiplying. If the cancer cell cannot divide, it can’t spread and will, thus, go through an aging process and die. Cancer then becomes a chronic illness and a treatable disease.”
He closes by encouraging men who reach the age of 40 to get regular checkups. In addition, individuals who have a family history of prostate cancer should tell their primary care physician so that expeditious screening can ensure prompt attention and treatment.
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