Dr Eric Whitman of Atlantic Health System On The 5 Things Everyone Needs To Know About Cancer
An Interview With Savio P. Clemente
All cancers are different — Finally, all cancers are different and all patients are different. I’ve had people tell me, “My wife had breast cancer and I saw what she went through with chemotherapy and radiation and I don’t want to go through that. I don’t want any treatment.” People need to remember that cancers are different and treatments are different. And beyond that, patients are different.
Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?
In this series called “The Five Things Everyone Needs to Know About Cancer,” I had the pleasure of interviewing Dr. Eric Whitman, M.D., Medical Director at Atlantic Health System Cancer Care, a nationally-recognized cancer treatment program in New Jersey. Dr. Whitman has been known throughout the industry, as an innovator committed to improving quality of care and efficiencies, as well as expanding the depth and breadth of oncology services.
Although cancer is among the leading causes of death worldwide, understanding the complex disease can be difficult since cancer is not one, but a collection of diseases that can occur anywhere in the body. This year alone there will be around 1.9 million new cancer cases and 609,360 cancer deaths in the United States, according to the American Cancer Society. What does every person need to know to better understand cancer?
How did your interest in medicine come about?
I knew fairly early on in high school that I wanted to be a physician, but I didn’t focus on cancer care until I was training as a surgeon. Early in my career, I began to focus on specific cancers, including melanoma and advanced skin cancer. Now I’m very specialized in these areas; they are my areas of authority. Although I grew up outside Philadelphia, I have family in northern New Jersey, which is what brought me to Atlantic Health System, which is based in Morristown.
What or who inspired you to pursue your career?
While I was a fellow at the National Institutes of Health, the head of the division I was working in was a professor named Dr. Steven A. Rosenberg. Dr. Rosenberg gave a lecture on how the immune system was one day going to cure cancer, and I felt like it was a pep talk. My first thought was, “Sign me up! How can I help you?” That lecture is what inspired me to pursue my career path.
This is not easy work. What is the primary motivator behind the work you do?
I am personally invested in helping people battle and defeat cancer. I get a lot of personal satisfaction from helping people. really doing a great job and availing them of my expertise. I’ve seen so many people now with these sorts of cancers that I really have a feel for it. I’m way beyond the textbook, and I think people appreciate that, which is personally very rewarding for both myself and my patients.
Why are you considered an authority on skin cancer?
I’ve treated thousands of people with melanomas and advanced skin cancers. I’ve been involved in a lot of clinical research trials that have advanced the art and have helped save lives, and I’m continuing my work in that. In addition to being a surgeon, I also have the ability, due to my experience and my involvement in clinical trials, to treat patients when the cancer goes beyond surgery. If people need surgery, I can help them with that; and if the cancer has metastasized, I can help them with that too.
What are some of the most exciting projects you are working on now? How do you think they might help people?
Atlantic Health System is part of a breakthrough oncology accelerator program in partnership with the Translational Genomics Research Institute (TGen), which gives us access to some of the most exciting drugs that are now under development for cancer. What’s really exciting for us right now is seeing drugs that scientifically are so far beyond anything we’ve ever seen for cancer care before, and having access to them for our patients through the clinical trials we participate in. Participating in clinical trials of new investigational drugs that may have enormous therapeutic potential is really exciting for me — and for the patients too. They really get into it.
What is cancer, exactly?
This is a hard question to answer because there are a lot of ways to look at it, some more scientific and some less so. I would say that cancer is a growth in the body in which the normal cells have changed in such a way that they no longer obey the usual rules. They keep growing, they grow in areas where they’re not supposed to and they don’t slow down, thereby endangering their host, the patient.
What causes cancer?
In a lot of cases, we don’t know. Some causes are fairly straightforward. For example, people who have had a lot of sunburns are more likely to get skin cancer, but it’s not absolute. Other cancers are associated with certain diseases or with other lifestyle factors. For example, lung cancer is associated with smoking, but people who don’t smoke also get it. So a lot of the time we can’t pinpoint for sure what the cause is.
What are the differences among different forms of cancer?
Most of the difference is the tissue of origin: skin cancer is intrinsically different from pancreatic cancer, which is intrinsically different from lung cancer. Tissue of origin plays a large role because, even when cells become cancerous and are no longer obeying the usual rules, they still retain some of the qualities of the organ they came from. For instance, certain skin cancers, even though they’re cancerous, are very similar to normal skin in the ways they grow and their microscopic and clinical features. It takes an experienced dermatologist to know that ‘Point A’ is worrisome and should be biopsied, and ‘Point B’ is not. That’s why, when people go to the dermatologist with a concern about something on their left arm, the dermatologist may tell them, “That’s nothing, but that thing on your belly — now that’s something I’m worried about.”
How can cancer be prevented?
There are some things we know, but we need more research, not only in terms of preventing cancer, but also in terms of reversing early forms of cancer before they become truly malignant. As we learn more about how cancers develop genetically and mechanistically, this knowledge could potentially be used against cancer to reverse the process. But in terms of prevention, we’ve learned a lot over time about lifestyle and dietary measures that can be helpful. For instance, sunscreens can help prevent skin cancer and stopping smoking can help prevent other cancers, especially lung cancer. Drinking too much is another risk factor: alcoholics have a higher incidence of some upper gastrointestinal and pancreatic cancers, and certainly of liver cancer. We also know that certain diets can increase the risk of colon cancer — for instance, those that are high in smoked meats.
What are the odds of surviving cancer today?
Because different cancers require different medicines, it depends on the type of cancer and how early it’s caught. A general misunderstanding about cancer is that the word “cancer” is taken as a global definition for all types of cancer. However, it isn’t that simple because different types of cancer are unique — pancreatic cancer is different from lung cancer and melanoma is different from breast cancer.
Can you share some new cutting-edge treatments for cancer that have recently emerged?
The cutting-edge treatments that are most exciting to me revolve around therapies we will either call immunotherapy or targeted therapy. Immunotherapy involves stimulating the immune system to go out and kill the cancer. Chemotherapy kills cancer cells directly, but immunotherapy tweaks, or modifies, the immune system so that a cancer can no longer hide from it. In theory, the immune system should be able to figure out that a cancer is abnormal and that it needs to be killed or stopped. And a lot of the time this probably happens, but obviously when a cancer truly forms and starts spreading and hurting the person who has it, the immune system has failed. A lot of the most exciting research that is going on now is around CAR T-cell therapy, which uses white blood cells from the patient that have been genetically modified outside of the body in order to better find, attack and kill cancer cells.
The other exciting new therapy is targeted therapy, which refers to the ability to genetically test the cancer and identify mutations specific to cancer cells that could potentially be blocked by medicines. In a genetic analysis of a given patient’s cancer, you will probably see 30 to 50 genetic mutations, regardless of the type of cancer. Unfortunately, we will probably only have medicines to attack one or two of these. When such medicines are available, however, they can be very effective. A lot of current research is therefore focused on designing drugs that attack specific mutations.
Healing usually takes place between doctor visits. What measures have you found to be most beneficial in assisting a patient to heal?
It’s the little things that make a big difference: eating right, getting enough sleep, getting enough exercise, figuring out ways to reduce stress that work for you. Patients who are healthier going into treatment do better across the board. Cancer doctors call this “performance status.” If you’re healthier going into it, you just do better.
From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?
When you are supporting someone who has cancer, it’s very important to listen to them. What I mean by that is that everyone has presuppositions or biases about cancer: what it means, how you should treat it and how you should think about it mentally. But until you actually have cancer, I don’t think it’s right to assume that your friend or loved one or family member is going to feel the same way about it as you. I’ve seen families get into fights over this. For instance, a family member may question a decision not to pursue treatment by a patient who is older or has multiple illnesses or has strong religious beliefs. The family member may think the patient should be more of a fighter. I don’t think it’s said often enough that you really have to listen to people and try to support what they want to do — not what you think they should want to do.
What have you learned from treating patients with cancer?
One of the things I’ve learned, especially from treating patients with specific types of cancer, is that sometimes you don’t know what’s going to come next. Sometimes you may be going down one path, and the patient responds in an unexpected way and you have to totally change gears. So you have to pay attention, and you have to be flexible. Sometimes you end up doing exactly what you originally said you wouldn’t.
What are a few of the biggest misconceptions and myths about cancer that you would like to dispel?
That cancer is a death sentence. Cancer doesn’t necessarily mean that. I would say that this is the biggest myth around this disease. Another myth is that there is one type of cancer. All cancers are different: the term is a big umbrella. Some cancers are much more aggressive than others. Medicine still has much to learn about the different types of cancers, and their diagnosis and treatment.
Based on your experience and knowledge, what are the “Five Things Everyone Needs to Know About Cancer”?
- The earlier, the better — The earlier the diagnosis, the better off the patient will be. Almost universally, the patient does better if the cancer is diagnosed at an earlier stage, when it’s more curable. That’s why it’s important to follow cancer screening guidelines.
- Cancer may not hurt — The second is to understand that cancers often don’t cause pain. People think that if a condition doesn’t hurt, then it can’t be such a bad thing. So it’s important not to ignore any symptoms you may have and to talk with your physician about any concerns.
- Consult a specialist — Seeing a physician who specializes in the type of cancer you have may have life-saving benefits. Specialists’ insight may extend way beyond the literature or the textbook. Because of their experience, specialists can pick up on subtle clues to guide the best treatment that may be overlooked by others.
- Consider immune-based therapy — Immune-based therapy is becoming more important. Even as recently as five years ago, more than 90 percent of patients in a cancer treatment center would have been getting some form of chemotherapy; today, more than 50 percent are probably getting immune-based therapy. Because the side effects may be a lot more manageable, it’s important to ask if an immune-based therapy is an option.
- All cancers are different — Finally, all cancers are different and all patients are different. I’ve had people tell me, “My wife had breast cancer and I saw what she went through with chemotherapy and radiation and I don’t want to go through that. I don’t want any treatment.” People need to remember that cancers are different and treatments are different. And beyond that, patients are different.
If you could encourage people to take an action that would bring the most amount of good to the greatest number of people, what would that be?
The first action would be — if you can — to do something you’re passionate about on a professional level, something in which you can truly believe that you’re helping to change the world and helping to make it a better place. The second, for those who are in senior positions, would be to recognize that the people around you — both those you work with and your patients — are watching, listening and taking their cues from you. It’s therefore important to constantly remind yourself that how you act can affect the mood of those around you.
How can our readers further follow your work online?
Thank you so much for sharing these important insights. We wish you continued success and good health!