Brain cancer is relatively rare. But depending on the type of that disease and the patient, the survival rate can be low.
Most often, brain cancer occurs when cells spread from cancer in another part of the body. Medical experts say timely care decisions for the patients can be critical. The Froedtert and Medical College of Wisconsin Cancer Network says a new smartphone app, designed by UW-Milwaukee, is leading to faster treatment.
Who’s a brain cancer patient?
Menomonee Falls resident Jim Garrity was diagnosed with an advanced form of melanoma about six years ago. He says imaging tests showed the cancer had settled into his brain and upper torso.
"They're green dots on the scans that they do. I looked like a Christmas tree from my waist up. It was everywhere," Garrity said.
He says many radiation treatments helped put the cancer into remission. But Garrity says he believes the radiation came with a price.
"Problems with short-term memory. I'm dealing right now with trying to fight through that. Also, my balance. I was a very active runner, and I can't even run now because of my stability going. I just fall forward," Garrity said.
Still, Garrity says it's obviously better than potentially losing his life to cancer. He praises the work of his doctors. One of them is Joseph Bovi, a radiation oncologist at the Medical College of Wisconsin. Bovi is co-leading an effort by the college and Froedtert Hospital to launch a multidisciplinary way to care for people whose cancer has spread, or metastasized, through the bloodstream into the brain.
Most often, it's lung cancer that spreads to the brain. But so can other cancers, including that of the breast, skin and kidney. Bovi says the brain can be fertile ground for cancer cells. Tumor markers — those are proteins, gene mutations or other changes — are involved.
"The markers on the surfaces of these cells actually have a predilection for the blood vessels that line the brain. And they can actually then preferentially attach to those blood vessels, and subsequently move out of those blood vessels and into the brain tissue, which subsequently lends itself to brain metastases," Bovi said.
Bovi also says the number of brain cancer metastases is up, partly because of medical success with other cancers.
"We never used to see brain metastases — kidney cancer being one of those examples. We never used to see a high incidence of kidney cancer spread to the brain. Why? Patients weren't living long enough to demonstrate disease there. But now, as we're keeping their systemic diseases, or disease outside the brain, under better control, we're recognizing that the brain is becoming that hiding spot where we see disease spread, " Bovi said.
Treating brain cancer
There are several ways to treat brain cancer. Bovi says immuno-therapy — things like drugs, cell transfers and anti-bodies — are starting to be used, along with longtime options like radiation and surgery.
At Froedtert and the Medical College, a brain tumor board, made up of oncologists and other specialists, meets weekly to plan the most effective treatment for about two dozen people. But Bovi says sometimes, the patient needs fast help at a hospital.
"A patient could present with seizure activity, and in the neuro-ICU, be incredibly sick. And it's those patients that would need immediate access to our expertise, our multi-disciplinary expertise, in order to come up with an immediate care plan for those patients," Bovi said.
Bovi says quick treatment has always been a goal, but often included phone calls and the possibility of communication delays. Now, Froedtert, the Medical College and UW-Milwaukee have developed an app that Bovi says streamlines the process.
The app is called NIMBLE, which is short for: Network for the Integrated Management of Brain Metastasis Linking Experts. It will be available for medical personnel, but not the general public.
"The ability for us to have a protected, end-to-end encrypted discussion to come up with a consensus statement for how best to manage these patients' metastases that have been referred to us for management," Bovi said.
Dustin Hahn helped oversee a team of students that created the app at UW-Milwaukee's App Brewery, an innovation lab. In these days of sophisticated hacking and other computer problems, Hahn says NIMBLE has extra security.
"Our process is, you first register, then you have to be validated by an administrator. And then, there are other steps that you need to take to make sure we're ensuring the safety of the information for the patient and the practitioner," Hahn said.
Bovi says he hopes NIMBLE, and the broader effort addressing cancer that's spread to the brain, will reduce hospital time for patients and improve their quality of life. But, given the challenge of taking on metastasized brain cancer, Bovi says it's difficult to say survival will improve.
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