Hospital brings better breast cancer treatment for women's hearts

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Louisville Courier Journal

Published 12:16 PM EDT Oct 29, 2019

The radiation room in the basement of the Cancer Care Center of Baptist Health Floyd is stark white with an imposing robotic machine placed at the center of the back wall.

It's here that breast cancer patients spend at least 30 minutes five days a week for several weeks as they undergo treatment to kill cancerous cells and prevent the life-threatening disease from returning.

The patients receiving radiation are often under stress, worrying about their families, their jobs, their health.

What they shouldn't have to worry about is their hearts. But they often do.

As doctors aim radiation at damaged breast tissue, they risk also hitting the patient's heart and lungs, potentially opening the door to new dangers such as heart failure or cardiac arrest.

That's why in the last two years, Baptist Health Floyd has invested in several pieces of modern equipment and technology to protect patients' organs and reduce their chances for unnecessary radiation.

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Hospital brings better breast cancer treatment for women's hearts

"No one signs up for (breast cancer), nor do they understand how to imagine it. It's an intruder," said Dr. John Cox, the cancer center's medical director of radiation oncology.

"We want to make sure we give them what they need and no more."

Cox came to Baptist Health Floyd from Indiana University Health Methodist Hospital in downtown Indianapolis, where he simultaneously worked as residency director for radiation oncology at the IU School of Medicine.

In New Albany, Indiana, he's made sure Baptist Health Floyd has the same technology as the larger institution — and more.

"I trained in a large institution, I led at a large institution, my family is in a small community," Cox said.

"The idea (of this technology) is it allows that level of care to happen where people live."

In 2016, more than 5,000 breast cancer patients received a form of radiation therapy at hospitals in Kentucky and Indiana — up from about 4,000 patients in 2007, according to the National Cancer Database.

Baptist Health Floyd general surgeon John McCormick said more patients are receiving the treatment as they choose breast-conserving surgeries over mastectomies, which remove the patient's entire breast instead of just pieces of it.

Surgeries such as lumpectomies are outpatient procedures that often have less recovery time and risk for complications than mastectomies, though they generally require patients to return for radiation treatment that kills remaining cancer cells, McCormick said.

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The breast-conserving surgeries are proven to have the same survival rate as mastectomies.

"It gives women the opportunity to keep their breasts and keep some of their identity," McCormick said. "And they really get the same survival benefits that they would if they were getting a mastectomy."

Baptist Health Floyd serves patients from six counties in Southern Indiana. For many, crossing the Ohio River to seek treatment at hospitals in Louisville can be a burden, especially if they need 15 or more days of radiation.

To make excellent care more accessible, Baptist Health Floyd has purchased two sets of equipment that prevent radiation from reaching the heart.

For most women with early stage breast cancer, the hospital now has a soft pink board that attaches to the radiation system, allowing patients to lie face down while receiving treatment.

The prone position causes patients' breasts to fall away from their heart and lungs so that doctors can apply radiation with less fear of hitting the other organs.

The approach has become a best practice within the last few years, but it doesn't work for all breast cancer patients, Cox said.

For patients with cancer in their lymph nodes or those who do not have much breast tissue, such as men, doctors at Baptist Health Floyd use a different technique called deep inspiration breath-hold.

The technique requires patients to lie on their back and periodically hold their breath — moving their heart away from their chest wall — while a beam shoots radiation into chest tissue or lymph nodes.

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The Baptist Health Floyd team gives patients control over the technique by incorporating a visual coaching device that shows them when to breathe in and out.

"This is the same patient," Cox said, pointing to a page with two X-rays. "From the heart to the chest wall is 2.17 centimeters (using the technique) where it was 2 millimeters."

Beth Thompson, a medical dosimetrist who works with Cox on radiation treatments, said patients who look at the X-rays know they're in the right place.

"People will drive for that, and to be able to be treated at home and not have to drive means everything," Thompson said.

"They have less time in the car, less time in the doctor's office. It's a win for us, and it's a big win for them."

Bailey Loosemore: 502-582-4646; [email protected]; Twitter: @bloosemore. Support strong local journalism by subscribing today: courier-journal.com/baileyl.