The Beam: Fred Hutch childhood cancer and prostate cancer providers explain the importance of research and relationships

Childhood cancers: the importance of relationships and research to our experts

Relationships

Fred Hutch radiation oncologist Ralph Ermoian, MD, specializes in treating childhood brain cancers. He recently described his work as a series of relationships with patients, families, colleagues, referring providers and partner institutions.

It’s these relationships that make his work treating patients at Fred Hutch so rewarding. 

“The conversations with parents and patients I have can be so meaningful,” he said. “Families come at times of uncertainty and stress, and their child is about to undergo a treatment that seems so foreign. And it’s for something they never imagined would happen to their child. I try to make them feel comfortable enough to ask all the questions they might have and try to anticipate those they may not know to ask.”

According to Ermoian, it takes a village to treat children with cancer.

He works closely with fellow radiation oncologists Stephanie Schaub, MD, and Lisa Ni, MD. Additionally, Layne Chapple, ARNP, plays an integral part supporting all three providers as well as the advanced practice providers at the proton therapy facility.

But there are many other relationships that are vital to providing care to patients, including social workers, child life specialists, patient navigators, nurses, radiation therapists, physicists, dosimetrists and others. Creating and nurturing these relationships within the organization results in better experiences for the children and their families and can ease the stress of being treated for cancer.

Nearly half of the children treated at the proton therapy facility come from outside of Washington. Many come from Canada, especially from British Columbia, as well as from Oregon, Hawaii and other nearby states. It takes a lot of coordination to help families come to Seattle for proton therapy.

“Taking the best care of these patients requires partnerships with providers throughout the region,” Ermoian said.  “They know they can trust us to give them an honest assessment of whether proton therapy is the best treatment choice or not. If protons are indicated, we keep in touch during and after we’ve completed treatment and answer their treatment-related questions. The care we provide does not stop once the patient goes home.”

Research

Research is an integral part of Fred Hutch’s cancer care.

Ermoian and his team participate in many nationwide clinical trials that involve radiation therapy for childhood cancers. Ermoian is particularly excited about the preliminary results of two trials.

Both trials test whether physicians can treat specific cancers — medulloblastoma and germ cell cancers — with less radiation intensity and get the same positive outcomes. Treating with less intensity can result in fewer side effects, and when protons are an option, healthy organs and tissue can be further protected from harm.

“Overall, the large majority of children treated for cancer will be cured,” Ermoian said. “So, there are two things we think about. One: what’s the right strength of treatment to beat the disease, and two: how can we ensure that our patients suffer fewer side effects in the long term, so kids can have excellent quality of life in the decades ahead?”

Protons are very effective when treating children, he said. With protons, the radiation stops just beyond the edges of the tumor, protecting the healthy tissue that would otherwise be more affected by conventional radiation. 

Many childhood cancers respond better to treatment than adult cancers and can often be completely cured. Tumors that affect children are often different from ones that affect adults on the molecular level and can be different even within the category of childhood cancers.

“Tailoring treatment to the specific variation of cancer will maximize the curative effect while minimizing negative effects," Ermoian said.  That’s why it’s important to find a specialist who treats a patient's particular type of cancer at an institution that prioritizes research toward cures.

“Staying on top of the latest research and participating in clinical trials is integral to providing the best possible care for both children and adults because treatment options are always evolving,” Ermoian said. “We are proud that here at Fred Hutch, research has led to cures being used around the world to treat cancer, and that the relationships we’ve built have led to great trust in the institution.” 

Developments in prostate cancer treatment

T. Martin Ma, MD, PhD, is one of Fred Hutch’s radiation oncologists who specializes in treating prostate cancer with both proton radiation as well as conventional, or photon, radiation. He sees patients both at the proton therapy facility and at the South Lake Union campus.

Ma values being part of a multidisciplinary care team that includes experts in all the individual aspects of cancer therapies, as well as an emphasis on research. 

“It’s important to approach cancer treatment by engaging with experts in the various treatment options, such as surgery, chemotherapy and radiation,” he said. “Discussing all the options based on the latest research is the best way to provide optimal care to patients.”

Ma, who studied Cellular and Molecular Medicine at Johns Hopkins University, said his background as a scientist helps him assess research critically so he can have a balanced discussion with patients.

In addition to his interest in the underlying science of tumors, Ma enjoys learning about his patients outside of their cancer diagnosis, getting to know them as a person. He wants to understand their values, so that he can make them as comfortable as possible with himself and with treatment.

Ma said it’s crucial that his patients not only receive the best care but also don’t suffer from long-term side effects or from the course of treatment itself.

“I live by the quote ‘A good physician treats the disease; the great physician treats the patient who has the disease,’ by Sir William Osler, father of modern medicine,” he said.

Ma is excited by some promising tools that have become available to help tailor treatment to each patient. The National Comprehensive Cancer Network (NCCN) publishes definitive guidelines for treatment of cancer types, depending on various factors such as stage, subtype and more. Hormonal therapy (androgen deprivation therapy or ADT) is recommended for some intermediate-risk and high-risk patients because it reduces testosterone levels or blocks its effects, which in turn slows the growth of cancer cells.

But new tools should help determine if and when this therapy will benefit patients. Artera AI is an artificial intelligence tool that examines the histology of the prostate tissue biopsy to predict if a patient will benefit from ADT in conjunction with radiation therapy.

“Some patients reject undergoing hormonal therapy, mostly due to concerns about side effects,” said Ma. “But NCCN guidelines recommend hormonal treatment for certain types of prostate cancer. This is where the AI tool comes in handy. It can analyze patients’ biopsies, assess risk level, predict the risk of their cancer spreading and recommend whether hormonal therapy is necessary or if we can achieve the same results without it.”

Another tool is called Decipher, a genetic biomarker test that looks at the activity of 22 genes in prostate tumors to determine the risk of developing metastases. Depending on the score a patient receives, physicians can evaluate whether ADT will be needed in treatment. Ma cautions that these tools are not a substitute for clinical judgment or shared decision making. They are new and continue to be validated and updated.

Ma is also excited about a randomized trial called PROMETHEAN (NRG-GU011) involving patients with only a few sites of metastatic prostate cancer. The study is testing whether patients do better with or without an oral hormonal therapy called Relugolix in addition to radiation. Relugolix is what Ma calls a “fast on, fast off” treatment. Patients’ testosterone levels recover more quickly on this oral hormonal drug. 

For more information on proton therapy for prostate cancer, see our dedicated webpage. We also have a page where you can learn more about hormonal treatment for prostate cancer. 

Subscribe to our monthly proton therapy newsletter

Get once-a-month updates about proton therapy, including science and medicine news, survivor stories, staff profiles and more.