Korst, Donald R.

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The Linacre QuarterlyVolume 32 | Number 2 Article 14May 1965Reports of Successful Research Activities: Cancerand Cancer ChemotherapyDonald R. KorstFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationKorst, Donald R. (1965) "Reports of Successful Research Activities: Cancer and Cancer Chemotherapy," The Linacre Quarterly: Vol.32 : No. 2 , Article 14.Available at: http://epublications.marquette.edu/lnq/vol32/iss2/14Reports of Success£ ul Research ACancer and Cancer Chemothe DONALD R. KORST, M.D. , F.A.C.P . vi ties: ;_)y The purpose of this report is to describe the development, the need, and the management of a cancer program in a community hospital with a large referral service and an affiliation with the University of Michigan Medical School. THE HOSPITAL The hospital is a 520-bed institu­tion with 19,000 admissions annually and an emergency service seeing 24,000 patients each year. The staff is comprised of 190 physicians rep­representing all specialties, and 35 physicians in medical and surgical specialties who have offices in the hospital and are geographically full­time to that institution, as well as a comprehensive pathology group, an x-ray department, a radioisotope service and a complete medical rec­ords section. The hospital is affili­ated with the University Medical School which provides consultation, a postgraduate training program, visiting lecturers, rotation of some residents and medical students, and many extems during free periods of the medical curriculum. Each year there are approximately 600 to 800 new cases of malignant disease diagnosed and treated at the institution. The overall staff par­ticipation in the diagnosis and treat­ment of cancer is inspected and Dr. Korst is associated with the Department of Hematology and Chemotherapy, St. Jo­seph Mercy Hospital, Ann Arbor, Michigan. 164 approved by the Cn of the American Col, supported also by College of Physician requires the full c approval of the med Committee of Surgeons, � American his program ,2ration and staff.1 THE MEDICA, TAFF The medical staf. organized under the cancer committee ar executive committee to include represer major departments. supervises the tumo tumor conference an· tion program of the ] as the cancer fund. of the cancer comn­the full time secretar. the tumor registry, �' current data, abstrac up of each patient. available at any tirr and regular meetiny, c2r committee are 11 the abstracts for con . mctions are .�ction of the nted by the the hospital i\·es of the e committee ·egistry, themcer educa· pita!, as well he secretary ee serves as ·n charge of ch maintains and follow· rhis data is to the staff, of the can· d to inspect ·leteness and accuracy. Advice i,, maintaining the tumor registry is -btained from the American Canel Society and the secretary attend, an annual workshop. Tumor conferences c1 re held each month as one of se ('ral combined 1American College of Surgeons' pamphlet on · Cancer Programs in Hospitals, Manual fo1 Cancer Programs. American Coll�e ? Surgeons, 40 E. Erie St., Chicago, Ilhnois, January, 1961. LINACRE QUARTERLY conferences on the trai�ing sc�ed-1 Wl·th lectures on specific sub1ects u� C d and visiting speakers. ance_r e u-cational booklets and material are also provided to the school of nur.:­ing as needed. A cancer fun� is maintained from personal donations and support of the local chapter _ of the American Cancer Society, which provides a means to contin�e treat­ment in near indigent patients or hardship cases . THE CANCER CHEMOTHERAPY PROGRAM During a 15-year period, the i�­portance of cancer c_hemot�erapeu_tic control of many patients with malig­nant disease has increased. There are currently available to all physi­cians a number of proven helpful drugs. The knowledge of the indi­cation, the usefulness, and the tox­icity of these drugs is important for every physician to know and equall Y important is the clinical decision as to which patient should be selected for cancer chemotherapy and when the treatment sh0uld be started. By definition, cancer chemotherapy in its present state is the ora�, _intra�e­nous or intra-arterial admm1strat10n of chemicals and drugs to patients with regional or disseminated ma­lignant disease in order to produce remission or palliation. Five year re­missions or possible cures have been induced in an occasional woman with choriocarcinoma or a child with acute leukemia or Wilm's tumor.2 � R., Cancer Chemotherapy: The Importance Of Selection Of The Patien!. At.-cepted for publication, Michigan Medi­cine, September, 1964. MAY, 1965 Perhaps as many as one-third of the patients seen today at the_ time of diagnosis of cancer are candidatesfor chemotherapy. This has m�a�t a great deal to patients and physi­cians in managing what a few yearsago was considered � compl�tely hopeless situation with patients turned away from the hospital. These patients are no longer relegated to the false cancer cures or to the high cost of dubious treatments. The management of the patient receiving cancer chemotherap�u�ic drugs by various routes of a��mms­tration requires close supervJS1on of nursing and house staff. Manage­ment can be augmented consider�bly b having the service an efficient s?mi-intensive specialized care ar�a. Centralization improves staff train­ing and is particularly adva�tag�ous during the use of catheter 1�fus10ns . by pumps and slow mtrave-grven . nous drips, which often are mai�­tained on an around-the-clock basis. Morale of the patients, or of thestaff, on this type of ward has not been a problem; in fact, the oppo­site is true. Our patients request re-admission to this area and are quite disappointed if the beds a:e filled. An additional advantage . m this type of service is a close pro�im­ity of the doctors' offices, outpatie.nt examining rooms, and a s�eci�l hematology laboratory to m�mtam the needs of this group of patients. Many new drugs are evaluated on a chemotherapy service and a day­to-day flow sheet of drug dosage, ·response, weight, performance status, 165 and laboratory data is maintained, for a close continuity between the inpatient and the outpatient man­agement. In addition to evaluation of new drugs, there are new meth­ods of administration such as intra­arterial catheterization and slow infusion apparatuses that can be in­vestigated on such a service. Also under study is a hospital pharmacy control of all new drugs. These types of investigation may be in cooperation with the Cancer Chemo­therapy National Service Center of the National Institutes of Health many pharmaceutical companies, 0: cooperati\'.e medical study groups and provide means of reporting to medical meetings and the medical literature. In addition, an organized obse�vati�n on a group of patients provides improved data on survival and on the natural course of ma­lignant disease, which is a much needed type of clinical research.a Criteria of response to treatment and principles of care in cancer chemo­therapy have been obtained as a result of "the clinical investigation on our service.2 THE CLINICAL RESEARCH PROGRAM Members of the house staff in medicine and surgery are encouraged to carry out projects under super­vision of interested members of the 3Korst, D.R., Clifford, G. 0., Fowler, W. M., Louis, J., Will, J., Wilson, H. E. Multiple Myeloma II. Analysis of Cyclophosphamide Therapy in 165 Patients, /. Amer. Med. Assn., September 7, 1964. 166 attending staff. Th( ing project that ca1 in the type of hosp this report is that 1 to the problem disc at the patient's bed the discussion, an ic' this is formed into a col. The protocol is to the hospital rese& composed of intereste offer advice, approv, funds for the study. lem goes into the lau ment involving smE dogs. Following this periment is reporte · meeting and final pu L mitted. The eventu. this form of clinical application and bene patient's bedside. Th ical research and is today in the complc forms of research encc,, the broad title of med ,t stimulat­carried out lescribed in ing directly d and seen Following s born and arch proto­,1 submitted committee, embers who md provide ,t the prob­tory experi­animals or Jrk, the ex-a medical 1tion is sub­outcome of carch is the back at the 5 truly clin­uch needed and varied ,assed under I research. The clinical researd. ,oject should be kept quite sepat c from the many very basic proJ ·ts involving expensive equipment, ,1rge labora­tory staffs, and an e1 ,re approach at the cellular level. The clinical research projects can . ,' carried out by young investigator at the clini­cal level who are prin,arily partici­pating in the practice of medic ine and- surgery. For exan, pie, two such projects carried out at our institu­tion arose from clinical discussions, then carried to the lahoratory, and finally back to application resulting in changes and improvements in medical treatment as noted in ref-LIN ACRE QUARTERLY ercnces 4 and 5. Both of these proj­ects were carried out to publication and application by two members ofthe house staff. Support for projects is obtained· through the hospital research com­mittee which is supported by con­tributions from members of the staff and the community, by support from pharmaceutical firms who wish to evaluate new drugs in our institu­tion, and several grants from some local societies ( e.g., Michigan Heart Association). Our investigators are provided a small amount of funds for travel and illustration, secretar­ial help, and the major portion of the support goes to maintaining ani­mal laboratories for the projects. Support from large granting agen­cies such as National Institutes of Health has not been obtainable as most projects are small, involving a limited number of personnel that can. be carried out in one to two years, and are considered pilot projects. The magnitude of the projects carried out at our type of institu- · tion is important and provides vital spokes in a large wheel of advances in clinical research. However, each individual project is probably not of a nature to gain major support from large granting organizations. Pe.,.­haps the record of these sm::.11 proi­ects could be combined under the 4Diethrich, E. B., Campbell, D. A.. and Korst, D. R. "Tissue_ Tolerance and Syste­matic Toxicity of 5-Fluorouracil External Radiation and the Combination' of Drugs and X-ray." Accepted for publication, Sur­gery, 1964. 'Tipton J.B., Regan. W. J. Effect of 5-Flu­orouracil On The Adrenalectomized Ani­mal. Surgery, 53:49 5-499, April, 1963. Mu, 1965 general research program of the hospital which, in tum, might be supported by a granting agency on an annual basis as long as the pro­gram is productive. A program su,p­port of this type would be most feasible for our own institution where the research committee is in a position to promote and support individuals, but where one individ­ual's efforts would probably not be of suffic:ent stature or where he would not have sufficient time to devote to a project, to warrant a large individual grant. Each year it is getting more and more difficult to raise funds from the community. It has been particularly more difficult to raise funds from the pharmaceu­tical associations in the past year or two and therefore support from large organizations is going to be impera­tive to continue good clinical re­search -programs in the community hospital. Space has not been critical, but the major expense of our program has been maintaining areas in thehospital and in surrounding build­ings for such purposes. We main­tain a dog laboratory, which doubles in teaching ( e.g., dog surgery tomedical students and residents), andwe maintain a small animal labora­tory for mice, rats, etc. These areasrequire air conditioning, daily main­tenance and constant supervision,whether or not a project is in prog­ress and thus represents the majorcost of the program. The hospitalstaff has been most cooperative in allowing use of clinical facilities for research which includes the radio­isotope laboratory, the x-ray depart-167 ment and the cardiac catheterization unit. We have not found that the program requires expensive items of equipment, but that much of the equipment used in a specialized re­ferral community hospital can dou­ble very adequately in a clinical research program. that is becoming ,, bility of the com hospital. SUMM/. The community affiliated with a un ing into a major pos ing and clinical r( The development gram serves as an , facet of this grow, the contributions to care, scientific adY the medical professic growth in research activities to the lar teaching hospitals r r ered to maintain goc 1or responsi­ity teaching ·ate hospital ,ity is grow­duate teach­,-ch activity.cancer pro· Future support of clinical research programs is necessary in order to maintain the development of good ideas in clinical medicine that bene­fit many patients. Support is also necessary to maintain an inquisitive attitude on the part of the house staff and attending staff in a large teaching program, and it is very im -portant in augmenting the training program in postgraduate medicine nple of one emphasizing di ty medical 2ment, and Support of 1d teaching community­be consid­Jrograms. 168 English-speaking missionary doctors, nurses, and medics ch-nicians and personnel from seventeen different religious c re-gations, the Papal Volunteers and Catholic Families from tfn America working in Peru and Bolivia recently met in Ch ito, Puno, Peru, to discuss their problems, exchange experiences, : . to meet those who work in the health field. This religious a, lay gathering brought together missionaries from the arid coast of 'ru, the high Andean Sierras - the "altiplano" of Peru and B,. , ia, from the dense jungle of the Peruvian Amazon and the Bo ian tropics. They work in or staff parish clinics, government ! Ith posts, public and private hospitals, and nursing schools. Several papers were read and panel discussions held. f re­sentatives from the WHO, the Peruvian health ministry, the ru­vian Red Cross, and members of the clergy spoke before the· .>up during their three-day seminar. Special emphasis was given w ,ib­lic health work, social and economic factors affecting the l, !th apostolate, nursing education, and the role of the medical w, ',crs in the missions today. A result of this meeting is the formation of an organizat, The Conference of Health Service Personnel - for the mutual ··,lu­cation, renewal and development of the apostolic spirit of its : ···m­bers; for the deepening of their understanding of the peopk for whom they labor, and for the opportunity to plan together to }rtter develop the Christian Apostolate. Due to the success of this meeting, plans are being mad,· for another in October of this year, to be held in Arequipa, Peru. Those interested in this meeting and this organization can contact: Brother Francisco P. Tanega, M.t). Hijos de Maria Av. Grau 355 Miraflores, Lima, Peru LJNACRE QUARTERLY CURRENTMedical-MoralCOMMENT*THOMAS J. O'DONNELL, S.J. * * The question of prolongation of life in terminal illness com�s u� con­stantly in the current medical litera­ture. While individual cases _are 1.1ot always easy to assess, the basic prm -ciples to be considered are reason -ably clear. In any hum_ai_i context, whether it be religious, civil or med­ical (and these are the three areas which become involved in this prob­lem) as long as the phrase ','un�er God" rises naturally to men s hp�, it is readily recognized that man is not the absolute Lord and master of human life. Man rather carries with him, both as a right and as a duty, the wise stewardship of his human life - toward the fulfillment of his human personality, his participatio� in the brotherhood of men, and his love and service of God. Out of these concepts arise the convictions that man is not free to arbitrarily terminate human life, either his own or another's; that he must, moreover, take ordinary care of his life and health; but that since ultimate dissolution on the brink of eternity is a part and parcel of our 'By arrangement with the Editor of George­town Medical Bulletin, Father O'Donnell's column in that journal appears concur­rently in THE LINACRE QUARTERLY. common clay, he need not go to extraordinary and exotic lengths. tostave off the moment of approachmg death. In our times of advancing medicaland surgical techniques the qu:stion of what is ordinary and what is �x­traordinary has become more d1ffi­cul t to decide. A hundred years ago no one doubted that a purge was a quite ordinary therapeutic procedure, and that the amputation o� a leg ( without anesthesia and with thelikelihood of lethal complications) was more than the concept of stew­ardship of one's life demanded. But with the advent of m?demmedicine, of antibiotics and mtra­venous feeding, of the iro� lung and cardiac surgery, colo�tmi:nes and home dialysis, the distmct10n_ be­tween ordinary and extraordmary becomes more difficult to discern. The modern techniques cann?t be judged as ordinary or extraordmary in themselves. They must be c�n­sidered in relation to the proport1�n between what is to be hoped for m human values and the cost in terms of human resources, both personal and material. Hence, it would _ seem that while the use of a resusc1tat?r is most vital at a critical moment, _its continued use after very extens1v_e ••Prof�r of Medical Ethics, Georgetown and irreversible brain damage IS University of Medicine. MAY, 1965 169 

Reports of Successful Research Activities: Cancer and Cancer Chemotherapy

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