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Cancer-Related Infections

Feb 3, 2013|

The Roswell Team discusses prevention and treatment of cancer-related infections.

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Automatically Generated Transcript (may not be 100% accurate)

This is Roswell. Rookie by Roswell Park Cancer Institute. Your team opinion or your total options. Your host -- -- welcome back to Roswell is so continuing conversation about all aspects of cancer care diagnosis treatment and research from a comprehensive source Roswell park. Cancer institute here in Buffalo, New York. Good morning I'm Tim Wenger and today talking about prevention and treatment of cancer related infections. And what you need to know about that. Doctor -- Siegel is here today he is the chief of infectious diseases and professor of oncology. In associate member of the department of immunology you know blood titles there. Yeah -- hey I think I probably have been an honor to more but we'll -- is -- room and the door I mean I think. Are eight and Kimberly Hinckley is with us today she's a senior infection prevention and control coordinator. He's selling the police to me exactly -- they -- you for being here appreciate it. What are what is it that we need to be concerned about this is you know we spent a lot of time talking about. Cancer the disease. But. You know cancer treatment opens up someone's. You know in abilities are at their immunological. And abilities I guess to to do to ward off. Certain diseases. So doctor -- coming. Well one of the things that some. Or is set to -- people with cancer from the standpoint of risk of infections are really quite variable. So for example you might have some patients with cancer. Who have very little increased risk of infection compared to people of a similar age. And then on the other spectrum you might have people with course severely -- you know compromise. So it's not just one category meaning you have cancer therefore you are substantial risk for infection. It really the risk of infection and we spent a lot of time thinking about this when we see patients. Is going to be copper and by that type of cancer that they can't and the type of therapies that we are giving. Why can our patience. Here at Roswell or it -- in in you know that are undergoing cancer treatment more susceptible. To. You know it being infected and in some -- you perform. -- -- sic a planet some that's based on their cancer diagnosis. In their treatments their level of chemotherapy radiation treatments. And whatnot. Increased our level I'm immune suppression. Tell me about the department how do you doubt you guys work this department. Well I can also just expand on that a little bit with some broad general strokes so for example. There are. There are people for example getting chemotherapy. For acute leukemia. And these are people who are going to be in you know compromise based on the disease itself because leukemia. Will affect the ability of the -- to make normal white cells that fight infection. And then the chemotherapy. Is very intensive. When we look at other cancers. Different cancers are treated with different chemotherapy. And in general the general rule of thumb. Is that the more damaging the chemotherapy is to the bone marrow which is what makes the white cells -- the other blood cells. And the longer period of time that the white cell count is low. That is going to be correlated with risk of infection. So we tailor things in that -- it in a certain way so for some people who are very high risk. Of infection we give antibiotic prophylaxis to prevent infections for other patients with cancer they don't need any. What what is the actual agreement obviously. No one that's it's healthy wants to come down with some sort of you know in infection but we're being treated for cancer obviously elevates the risk. Yes so are you in terms of precautions that can be taken for some people the minority of Brosseau -- patience. Those getting -- intensive chemotherapy. They will be for example we'll give them antibiotic prophylaxis to try to prevent infection. Another thing the oncologists might do depending. On how long. The white cell count is predicted to be low they may be giving patients may be given growth factors to accelerate recovery of the white cell count. And then the things that the patients themselves can do. They have to be especially want to win -- -- chemotherapy. And radiation therapy they have to be alert for any signs of infection. They need to call the doctor. When there is any fever. For -- for some of the pay for Pickford. Some patients. On chemotherapy were recommend that they monitor their temperature. On a regular basis and to call. With any signs of fever because this could be the first sign of infection. You want to avoid it it can be especially careful to avoid. Contact with people with respiratory illnesses because such as the flu or other. The type or are other viral infections because these can be more severe in immune compromised patients with cancer. Kim how do you spend your day. Well I think the title of my positions as a lot of it's the prevention of infections were doctors Eagles doing more of the treatment -- were working with a staff. And doing education. Just carried with arms and wash Ing. Not coming to work when -- -- And things of that nature so we spend a lot of time education and cleaning of the environment. That we're not transmitting infections you know via objects and the environment. That's a model we do during the day making sure that if patient he Sudan and isolation precaution that they are around ever -- and the staff understand. I don't think people really understand it. You don't see you come to a place like -- you go to a hospital that your your being treated for whatever you know ailment and in this case cancer. On the you're dealing with the you have to worry about these these infections I mean. That this can be a serious pretty serious concern right. This yes that concern about hospital acquired infections. Is global all through the world. Whether you're talking about a major teaching hospital or community hospital. There are certain infections that are more common in hospital environments. This could be that this isn't part related antibiotic use -- in part related. To the type of patients who are immune compromised and -- and are more prone. Two infections so. We at Roswell have I think even an additional responsibility. And an additional. Focus on preventing infections because. We have patients who who many of our patients are highly you know compromise. So they are at greater risk of getting infections and a greater risk of complications from infections. So -- and I and really our whole team -- we work together and I would say. Pretty seamlessly and me in my mind. My major role act as well as my clinical colleagues are taking care of patients. We take care of patients with infections we are involved. And have a leadership role at every level in terms of preventing infections including selecting patients who would be appropriate to receive. Antibiotic prophylaxis. And then we work very closely with him to look not just that the individual patients but all of the infection trance. And say do we have an increase in one vs another very specific infections that week we track very closely for example. Patients with cancer often have central lines that are used to deliver chemotherapy and blood products and fluids. These are always even with the best care they are always a potential source of infection so. We put in a lot of effort into using best practice and the best evidence available. Into a bundle. To try our best to prevent these infections. The bigger concern that it -- that the fact that someone's. Immune system is compromised by treatment or is the biggest concern. Someone coming in here with some sort of infection to begin -- or is that both. -- -- It's yeah it's it it's both but. If -- we're gonna say what is the bigger contribution. The bigger contribution. I would say is the treatment itself and that's something we have to recognize. Chemotherapy. And radiation therapy. They they can not only lowers the immune system they can also. And compromise protective barriers like our -- coastal services. And the level of chemotherapy -- -- set before the intensity of the chemotherapy. The duration of the low white count that these are major predictors of infection. -- that he can you he. We're not your head like you that I think you have something to say about all this so. Just to add to that I am. It is their treatment that's higher risk and for example we have a protected environments that we use for the patients with extremely low when it counts. Where were filtering in the air coming from the outside. Into the patient room so that's that's an example of arm are most in you know -- patients and Howard trying to protect them. Smoking comes into play tobacco use comes into play with a lot of -- you know cancer patients tobacco is that you know a huge. Force in enough a lot of you know the results you know why people end up having cancer. How does. Tobacco use affect our immune system in the in you know that the the fact that maybe he might have some sort of in inspection. Well there in the areas. -- massive incentive. To. Quit smoking. Irrespective of the infection risk let's pretend for a moment this isn't the case let's pretend for a moment. That smoking did not pose an increase infection risk. Well it increases the risk of heart disease it increases risk of lung disease it's an obvious risk factor from cancer. And growing research including research done at Roswell park. Is showing that. Smoking can even. Affect the response to cancer treatment. It may aggravate the toxicity or even affect the efficacy. So there Russell park is put -- a lot of effort into helping people stop smoking in an aspirants the infectious risk. Even if we take cancerous are people with smoking have are more likely that CO PD respiratory illnesses asthma. And that by itself can increase the risk of infection and increase their severity of respiratory infections. Now -- Russell one thing that I do you want to do want people to be. Aware of is that Russell park has a dedicated service to help its own patients. Quit smoking sometimes people feel well I have cancer so it's too late the horse has left the barn I don't need to stop smoking. The exact opposite. It's recognized. That. That smoking continues to pose a risk of complications even after the diagnosis of cancer. And I could tell my wife is a part of this surface. At Roswell park that involves helping patients with cancer to just to stop smoking. And that you don't think that the great thing about what you say. Is that it's never too late here right now that exactly that's the part that is that comes up you know softened as we have as you know discussion here. On the program this is Roswell lists and that is doctor brand. Siegel he is chief in the of infectious diseases here Russell park and professor of oncology. Also an associate member in the department of immunology at Roswell park. Kim Hinckley is with us today she is a senior infection prevention and control coordinator here. At Roswell park how do you do that and being. You know you really do I mean this this place is amazing it is you know you keep. You know a lot of people. Healthy while you're treating them for cancer and an easy task well let her answer that but I couldn't quickly say hat does she do it extremely well that's. But -- -- our territory were there at the. And I kind of eluded earlier it's being involved with the staff working with a staff. Letting them know the importance of infection prevention for a patient population. Finally monitor hand washing my staff we monitor the number of infections that we do have so that we can see do we have a rising infection rate or not. We worked very closely with the department -- health. With some of our patients. We have an alert system that lets us know right away if there's a serious infection. I'm sometimes we even -- they -- before doctor Siegel has and we let him know what's going on. But it's a lot of work with the staff and being out there and being involved with all the departments and working as a team because we don't do the job alone there's just a few of class and several thousand employees. But you know I hit it to begin again mention your your kindly to that the police so to speak right down. I mean really it's important you think about all the the advice that we get. Just in our routine world -- washing your hands and you know making sure that you know things -- -- are are are all you know it clean and everything's is all good you've got you know an unbelievable. Responsibility in. You know making sure that. Something doesn't you know get around right and. Yes but they have they said earlier it's it's a team process we work very closely with housekeeping apartment. Tom Wheeler worked closely with dietary there's some dietary restrictions for patients. We work very closely with nursing now the -- other ancillary departments even a transfer department and how we transport equipment throughout the hospital. I'm more very involved with facilities construction because construction as a risk. For our patients so we really touch all different apartments. And as -- -- we have to work with them and they -- ethos. Because it is a team effort. How does it all relate to the treatment of cancer here. Doctor if you can just panic you know how how does -- does your role. It's a team. Relate to the actual treatment of cancer. Here Russell park and ending in -- it's important because they notice. Yeah I would view everything we do any infectious diseases division which includes the console. Service which includes infection prevention which includes all the policies that we have in place. It's all geared towards. Helping people. With cancer. To receive their treatment. And ultimately. That you know that the broad goal which we share with our oncology colleagues. Is to ultimately help the patient. Cure. Get that two to arrive -- -- care if that's in fact possible. If it's not possible. To give the best quality of life that we can to the patient. And preventing and treating infections is an integral part of that overall mission. Great interest of yours is the flu which is really interesting to me you know here we -- -- it in the cancer. Center and you know that's an incredible interest of of yours coming what -- that -- is an important. Well flu I would say is. It's one of the threats. That. That our patience. A confront our many threats I mean the major threat is a cancer itself that's without saying. Flu is want is also a threat because as I said before. Flu and other respiratory viruses. Can be can create. Much more conflict much more severe complications in people with impaired immune systems. Also many of our patients are elderly and many have preexisting. Lung problems. Many have preexisting heart problems all of these increase the risk of flu related complications. The good news about the flu is that it is not completely preventable but we do have ways. Two reduce. The risk of getting infection. And to me that that is a very positive things because he is he in some ways for example the patient is getting intensive chemotherapy. We don't have control of Wendell white and we'll come back where things of that nature. But we do have control to women to a degree. Over the risk of of of flu what are things that we can do to prevent it. We have a very aggressive policy for our staff to be immunized against the -- Because the last thing we wanted to do -- transmit flu from staff to a chatter or terror patients. We have a very aggressive. Policy that was supported fully supported by leadership. To really get our vaccination rates up to par. We strongly encourage. Patience to be immunized. Against the flu. Realizing that with impaired immune systems they may not be able to mount as an effective responses people. Who don't have cancer but against some protection is better than on. We also strongly encourage. People at home. People who are living went to get a flu shot because they to -- to avert the chance of transit transmitting to the patient. And we have aggressive respiratory. What we call respiratory etiquette policies in terms of screening any visit her -- start or staff who may have. Respiratory. Type infections that we we keep them away from our work. From our awards and are on the diagnostic level we have a very low threshold for testing for flu and putting people under precautions. Who who may have flu type illness so that they are not transmitting to others. Kim when he gets rate down to the patient -- patient's standpoint. What's what's the that that the response what it. I I would think that there are surprised. That this is a huge concern because I mean really again going back to my point earlier. You know you come here for you know very specific. You know targeted treatment for whatever cancer that you're dealing with -- and for you to be so concerned -- to be so concerned about infectious disease I think is a surprising but really impressive. Again it's a lacked the staff to a lot of education on the front and with the patients and families about infection prevention we've helped draft booklets to. -- not all patients get when they come in Iraq as well why it's so important and how to protect themselves. So we do a lot of work with that up front when they first come here. The staff you know is there is a doctor just mentioned you know the staff. You know it is rigorously encouraged to. You know undergo. Whether it's immunization words you know making sure that they think they follow protocol. What's what's the staff response to. What we try to do a lot of times is make it personal for them everybody knows somebody. That Imus after hands cancer and we say to them how would you want your family member treated. And explain the risks and then. Understanding as much greater when we do that. Doctor -- where you know where we go from here is there is their research. That is. -- you know. Under way you know as far as infectious disease with regard to treatment of cancer. Yes say the globally there's a very large research effort to. -- and -- to come up with better therapies that. Are tailored towards. Patients with cancer and -- very you know compromise. People as well. At Roswell we also aren't just infectious disease division itself has a very active. Research. Effort. Any specific research that's. Yeah so what I can tell you about my own -- my own lab research so we study. Inflammation. We studied basic mechanisms. Of inflammation. And injuries he might say well how is that related to to cancer right. Well it it is because one of the things that's really interesting is that how're. If you think of -- of what shapes and and our immune system from. The standpoint of evolution right. In evolution. Most of the cancers that we have now are really not threatening to hunter gatherer. What's threatening to -- hunter gatherer well freezing to death starving to death trauma. Infection. And one of the things that we is so we we study inflammation in that context really understand on a very basic level how inflammation is a regulated. But then if we say how is that relevant to cancer well. The inflammatory. Environment that surrounds tumor. Can have a major effect sometimes positive and sometimes deleterious. -- tumor progression. So for example even though I'm an infectious disease doctor one of the things that we study in the lab. Is ovarian cancer we don't have any expertise on the tumor itself. But what about I do happen background in innate immunity. Great Indy in inflammation. And one of the things are really want to learn is how the inflammatory. Environments around the tumor what's called the tumor micro environment. Can actually. Affect tumor growth and how it might even peace exploited their politically. I too intense therapy. Kim you know -- you know right back to the base. What we're talking about here. You know it's he I've often heard in this studio in in when I've spoken with with medical professionals like you. That the informed patient be educated patient. Is that better patient and the patient that may have a better outcome because of that knowledge. Sounds to me like. Every bit as important maybe more -- or any hope of that patient right. Absolutely. Absolutely and empowering the patient that we have a policy here we assignments. That allows patients to ask their providers their staff coming there have you washed your hands. It's putting the power. With them and I'm being their own advocated -- What would you do. Doctor want to. Leave the show making sure someone knows who molest him too but what is it about what you do and you know your area of expertise that you think the public needs to know. That they -- not. Well 11 thing to be aware of is that infections are important complications of cancer and chemotherapy and and really working with the patient and working with my colleagues with my physician colleagues nursing. -- support services that patients themselves. Is a joint effort that that really. Is designed to achieve that the ultimate goal of making the therapy work better for them. Work better for the patient. And at the least possible toxicity. So I would like people to know that Russell park infectious disease division is a part of that team. It's a part of that team if -- patients undergoing surgery there could be surgery related fractious affair. Undergoing chemotherapy. Stem cell transplantation radiation therapy. There are risks associated with infection. And we -- we are partners. -- will with with the oncologist who provide the direct service. To do our best to prevent infections to diagnose them early and and to treat. Kim you know every day we all we all under jobs -- and we walk away we. You know I wish someone do something the you know that was really important what I do in Hawaii what they do is so important what is that what what would you tell people. Do either on research and and ask questions of their providers. Don't take everything on the Internet as being under percent true but educating yourself. In being part of that team here a part of a team and knowing. How -- your risks are. And I'm having that frank conversation with your providers I think is really really important there's a lot of information out there about infection prevention. There's a lot of research that's being done a lot more is known. And I think that's really important. It really is a team that you have here. You know that's kind of you know below the surface -- I'll say -- that there is operating here Roswell park. That that I think most of the public doctors not aware of. Thinks OK any any even even. Some he even the patients themselves they may not realize that the time of diagnosis. That they become educated later on but they may not realize offhand that. In and that there is an increase infection risk that varies with the type of cancer and the chemotherapy. We won't -- meaning. Collectively we the primary and college of surgeons. Our group. That's one of the things that is important for education so that they learn what they can do to prevent infections. Well I had my Solutia OK so that's a gold star from both of you and you can visit our patient carrying an. Brandon and if you vote Avian flu stick it to you and I and everything if you ever go -- my hands on the action that that that topic here thank you both I appreciate it Ari Fleischer scenario that is doctor brand Siegel he's. Chief of infectious diseases here in a professor of oncology and an associate member in the department of immunology at Roswell park doctor Siegel thanks so much pride and pleasure. And -- Kimberly Hinckley. Senior infection prevention and control coordinator here big job at Roswell park. Kim thanks so much I appreciate it thank you are if you wanna know more you can always visit the -- web site at Roswell park. Listen to Roswell this Sunday mornings at 630 young WB yeah. -- by Roswell Park Cancer Institute -- team opinion for your total options on line at Roswell this god of war. Me and and do you. Then.