Gabby Cinnamon (Host): Medicine has changed drastically over the years and sometimes even professionals look back on the way things used to be done and can't believe that a certain procedure or treatment was done the way that it was done in the past. Cancer treatment is no different. Options for treatment and outcomes have improved greatly in recent years with a new feeling of hope for many cancer patients that may not have had it 15 to 20 years ago. Joining us today to talk about the evolution of cancer treatment is Dr. Ahsan Basha, an oncologist and hematologist at the Riverside Cancer Institute.

Welcome back to Conversations on Cancer brought to you by the Riverside Cancer Institute. As just mentioned today, I'm joined by Dr. Basha, a medical oncologist and hematologist at the Riverside Cancer Institute to talk about the evolution of cancer treatment. Thanks for coming on the podcast today, Dr. Basha.

Dr Ahsan Basha: Hi, Gabby. Nice to be here.

Host: So in case our listeners haven't listened to an episode with you, could you tell us a little bit about yourself.

Dr Ahsan Basha: So, I'm a medical oncologist. That means I help take care of cancer with the use of medications that go through the body, like chemotherapy, pills, and other stuff that we'll talk more about today. I've been with Riverside since 2011.

Host: Awesome.

Dr Ahsan Basha: And I worked both in Watseka and Bourbonnais.

Host: Very cool. Very cool. Before we kind of get into the treatment aspect of things, can you walk us through a brief timeline of when cancer was first discovered so that we can kind of get an understanding of where things began?

Dr Ahsan Basha: Yeah. And actually, to be honest, before you asked me about this, I did not know.

Host: Oh, wow. I'm very surprised.

Dr Ahsan Basha: So, actually, you know, I recommend a book that came out about three or four years ago called Cancer, Emperor of Maladies. So, it's actually about the history of cancer almost taken as a biography.

Host: Oh, wow.

Dr Ahsan Basha: So, I dwelled into that book and I found out things I did not know. So, the very first mention of a tumor per se was back in ancient Egyptian scrolls, okay? Back then, with the old pharaohs and things like that, where the reciter of the scrolls said, he found a breast mass and said, "Nothing to do about it."

Host: Oh my gosh.

Dr Ahsan Basha: And then, the next thing was actually the first "mastectomy", was an ancient Persian queen who had a breast tumor that sounds like it had been there for quite a while and she was hiding it. And finally, her surgeon did the first mastectomy, per se. And so, that's the first recognition of cancer. And it was actually the Greeks who later gave us the term cancer, because they thought those heart tumors looked like a crab shell. That's where we got the tern.

Host: Oh, okay. I did not know that.

Dr Ahsan Basha: Neither did I.

Host: The more we know. So, you mentioned treatments kind of, but you know, back in those days, you mentioned surgery, were any other things done to treat cancer?

Dr Ahsan Basha: So when the Greeks first described cancer, they believed in what are called the humors. Bile, blood, and there's one other one I can't remember. But then, cancers came from something called black bile rather than yellow bile. So, basically, they used bleeding and basically trying to pull out those bad humors from the body. And that continued on to the Middle Ages because nobody knew what caused cancer until they dealt with microscopes much later on. But really, it was just random guesses as to how things happened until like about the 1700s, 1800s, is when they first started cutting cadavers and trying to find things.

Host: Wow, I feel like I say this a lot, but I'm very glad to be alive now and not in the 1700s or 1800s. I mean, things have just come so far and it's a little bit scary sometimes to think about what was done, but they didn't know so...

Dr Ahsan Basha: Definitely. I mean, so, the first two kind of cancer treatments really started about, sounds like, around the mid-1800s once they figured out how to deal with anesthesia.

Host: Oh, yeah. Oh, gosh.

Dr Ahsan Basha: Exactly.

Host: All that going on without anesthesia.

Dr Ahsan Basha: So once they learned about anesthesia, once they learned about antiseptics actually is when they first started doing true surgeries for cancer. And what was in vogue back then is what are called radical surgery, where basically they did massive surgeries when they talked about mastectomies back then. And this was the most common form of cancer surgery with mastectomies, like they literally took off not just the breast, but the muscles underneath, going all the way up into the neck, and taking out the muscles of the neck. Same thing in other parts of the body, is they go after the tumor and then everything came out with it.

But if you caught the cancer early, which they didn't know if they caught the cancer early, then people did well. But if you had any cancer that had spread to lymph nodes or anything like that, they realized later on, you had about a 70-80% chance that would progress and kill the patient within a year or two. Then, I believe the first radiation therapy was actually here in Chicago. The first person who ever thought about doing radiation therapy was a guy from the University of Chicago and treated people back in the late 1860s, pretty much caused massive burns on the body. But the cancer was treated and still people only live for like a year or less.

Host: So when would you say the tide started to change where we have kind of the treatments that we do now, some of the more common ones, chemo, immunotherapy, radiation, which you mentioned, when did things start to change for the better, would you say?

Dr Ahsan Basha: So after World War II is when we first started talking about chemotherapy. Because basically, all these surgeries, they were successful if you caught them early, same with the radiation therapy kind of thing. But once cancer spread beyond the local area, there was no treatment that they had.

Then, the first chemotherapies actually came about right after World War II. They used different chemicals. Some of the chemicals they used were actually like the nitrogen gases they'd made into like chemotherapy. And the first cancers that were treated were actually leukemias. And the reason they treated leukemias first is because these were blood cancers, leukemias and lymphomas. They were blood cancers, which surgeons couldn't cut anyway. So, that's actually how chemotherapy came about, and it's progressed since then.

Host: Wow. Can you talk a little bit about treatment options that are available now that maybe weren't available 30, 40 years ago?

Dr Ahsan Basha: There's a lot. Let me just tell you when I first got into cancer, okay? So, I was in my medical school training-- or not my medical school training-- my post graduate residency training in the late '90s at Rush University. And the last rotation I did was actually on the cancer ward, and this was about early 1990s. And so, it was the most depressing floor. It was filled with patients who were just in there for morphine drips because they were dying, or fluid hydration, trying to control their nausea. It was just kind of like everything you saw in the movies, right? So, they'd actually ask me, like, when I was done, they'd go, hey, you know, "You seem to do well here. Would you like to become an oncologist?" I said, "No way."

Host: Yeah, how could you after, seeing all that?

Dr Ahsan Basha: It was just really depressing. But then what happened is, I actually went and interned for medicine. And so, I'd send patients to the cancer doctors, and they came back. I'm like, "Oh, this works." So, what's happened really is the fact that now you have teams of doctors working together. So, that's one thing, okay? So, you have the surgeons, you have the radiation oncologist, you have the medical oncologists like myself all working together as a team, and that's made the difference instead of one doctor trying to do everything like it used to be done back in the early part of the 1900s. So, you work together as a team.

Obviously, chemotherapy has changed dramatically since we first started. Just for your listeners to know, all cancer is, is cells which have lost control of the way they divide and grow. So, they stop not growing. And they keep growing and growing and growing. So, the basic concept of chemotherapy is you try to keep cells from dividing and kill those cells from dividing. But the side effect is you kill normal cells, too. So, you're trying to find the right balance.

And for the longest time, that's all we had, was those chemotherapies. And we got pretty good at them. And we still use them, and they still have a big place in what we do now. But everything has moved on to now we know this is what's happening. These are driven by lots of mutations in cancer genes. So after the Genome Project was done in the late '90s, early 2000s, we've learned all about these genes that drive cancer. And we're detecting more and more of them. And so now, we're targeting those things. And we're also using our own body, the immune system. We talked about immunotherapy to help fight off cancer and that's made a world of difference in the part of stuff that I do.

And because of that in many ways and also obviously changes in technology, surgeons now aren't always going after the bigger and bigger surgeries. They're doing more as much less invasive surgery, smaller surgery as possible. They're using robotics to kind of minimize the surgical damage. Same thing with our radiation doctors, they don't radiate the whole tissue body at one time. They target things much more clearly. Back, I think when I was first starting out, they're still using lead blocks to manage what they're trying to protect from radiation therapy. But now, we have very fancy computer systems, and it really targets the cancer much better, so everything is less and less.

Host: I think too I want to go back to your comment about the team. I know that's something that you guys focus on a lot too, and I don't think people realize is it's not just oncologists, there's other people too who are involved. And I think you guys do a great job of that because you guys have dieticians, social workers, general surgeons available to all work together to create a plan for the patient. And it's not just you guys too.

Dr Ahsan Basha: Yeah. So, working together has made a big difference. We communicate with doctors, non-doctors, like you said; pathologists, they're doctors; the dietitians and all that to help us with management, physical therapy. That plays a part. The other reason we've made a big dramatic change is detection. You know, now, we do screening. Riverside offered lung cancer screening. We have mammograms. We even have them done at Watseka now.

Host: Yes. Yes. We're very excited about that.

Dr Ahsan Basha: All these things including smoking, you know, smoking cessation programs. Dramatically, I think last year, the American Cancer Society and the National Cancer Institute kind of declared that we've seen about a 30% drop in cancer death rates in the last decade, which wasn't there before. In the last 26 years, there's been a steady drop in cancer rates, and they attribute that to better screening, better smoking cessation was a huge part and then, all the newer treatments we have. And so, it's an exciting time to be an oncologist.

Host: Yeah. It sounds like it for sure. Are there any new treatments that you want to talk about that seem promising or that you hope to see in the future?

Dr Ahsan Basha: Yeah. So, again, now that we know these molecular drivers of cancer, targeted therapy is a big part of what we do. So, when a patient comes to us now, in many types of cancers, especially lung cancers right now, we check what are called next generation sequencing, we check the DNA of these cancers and look for targets that can really target what's driving the cancer and use medications that have been developed and are being developed to target those mutations and make a dramatic change in patients' lives.

And then, when I came in and we saw metastatic cancer, my former mentor when I was in training basically said, "Dr. Basha, you know, what we do is basically we're like moving the deck chairs on Titanic. It's going to sink, but you're trying to make the music last a little longer. " But now, I've actually seen patients, who I would say, a long time ago definitely will pass away within a year, they're getting three years, they're getting five years. It's a dramatic improvement.

And with more molecular treatments being developed, to be used oftentimes in conjunction with our chemotherapy, our surgery and radiation therapy, I think we're seeing better results. And there should be more of that being developed in the future. I think if people are listening about things like CRISPR, they're talking about gene editing. Sounds scary and sounds kind of malevolent, but it's actually the way they're talking about it, if they can fix those cancer genes, that would be dramatic.

Host: Yeah, yeah, for sure. One thing I want to talk ask you about is cancer treatment has become more on the outpatient side a lot Can you talk a little bit about that and when that shift started to happen? Because I think kind of like we were talking about, it used to be what you would see in a movie, everyone is in the hospital. And now, most things are outpatient.

Dr Ahsan Basha: Correct. So, again, I told you about all those patients, like I said, in the hospital. And then even when I was finishing my treatment, a lot of chemotherapy would be these continuous treatments you'd get for several days in a row in the hospital, because you know they were going to be sick or whatever. We just didn't have the technology or services to give it as an outpatient.

Now, I would say 98% of what we do is purely outpatient. It's extremely rare for us to do anything inpatient. The biggest things still are leukemias, oftentimes, but still the majority of things we can do are outpatient. And besides being able to do outpatient in our clinic, a lot of times we use what are called infusion pumps, which you come to the clinic, we connect you to a chemotherapy pump, you go home with it, you come back, and they disconnect it. And so, yeah, a lot of it is outpatient, because we've gotten so much better at things like nausea management, these side effect managements, we've gotten so much better. . Like I said, most patients, when I first was even thinking about it, were in the hospital getting nausea stuff. Now, I would say it's much more rare for patients to have to go to an emergency room or things like that for nausea control. A lot of times we can manage it either with our oral medications or within our clinic itself.

Host: I think too, just talking with different patients when we've done stories and, you know, with all of you guys, there's so many different options too for treatment. Whereas, when someone's diagnosed, I think a lot of fear is, "Oh my gosh, I'm going to be sick all the time. I'm going to lose my hair," for example, that's a different side effect. But I think that in reality, that's not always the case for everyone and you have other options if something isn't working.

Dr Ahsan Basha: It's not always the case, but I will say, there's still treatments we do where you go bald. So, we try to be upfront with that and warn you. And in the majority of cases, most of those side effects are limited to when you're getting treatment. And once you're done, hopefully with it, things grow back. And again, with our social workers that we have in the hospital, in our clinics who help us, the dietitians, they do an amazing job, and our nurses, of providing support.

Host: Oh, yeah. For sure.

Dr Ahsan Basha: So, patients are able to get through a lot better than they could in the past.

Host: So, Riverside Cancer Institute is an outpatient treatment center. What kinds of treatments do you guys offer there?

Dr Ahsan Basha: Probably it's easier to say what we don't offer.

Host: Yeah. You guys do a lot.

Dr Ahsan Basha: So as long as it's FDA approved and been clinically proven, we pretty much can do just about all the stuff you hear about, immunotherapy, chemotherapies, oral medication we manage through our clinics. Riverside even has its own specialty pharmacy now where we dispense our medicines. And then, going back to that radiation thing, you know, we just installed last year this new linear beam accelerator, which the radiation doctor can talk to you about. But it's actually quite amazing what they can do and minimize the side effects and things with our surgeons.

Really, the only thing we tend not to do here is aggressive leukemias, which require inpatient hospital stays. There are leukemias which we can treat in our office, actually, by the way. But the ones which require aggressive treatment and in-hospital stays, we do send them up to academic centers. And then, that's also where they'll do things like bone marrow transplants.

Host: Yeah, yeah.

Dr Ahsan Basha: But everything else we can manage. And then, we have our connections. Like I said, some of the bigger oncology surgeries, we work with surgeons that we're affiliated with to provide oncology care that our general surgeons, they don't necessarily do.

Host: I think, yeah, it's always good to remind people that you guys do all these things. People are sometimes surprised, I think, to find out that they can get all of this care without going to a big city. Of course, like you said, there are some things that you may need to go up north for, but there's so much that you guys can do right here, which is amazing.

Dr Ahsan Basha: We really can. I mean, there's a lot we can offer. It's actually very uncommon that we can't offer anything here. And what I would suggest to the patients who are thinking about it is even if we can't offer, we're kind of your go-to person, in a way. We're the primary care of cancer, in a way. So, if we need help, we'll send you to places where you need to, or even if you want a second opinion, we help arrange that. So, we want you to feel comfortable that you're getting the best care possible.

Host: Right, right. That's extremely important. Is there anything else you would like to add before we go today?

Dr Ahsan Basha: No. Actually, I appreciate you asking me to do this. Like I said, I've actually learned more.

Host: Oh, it's been great. Yeah, history and, you know, I think overall what we can kind of take away from this is there's such a sense of hope. And there's so many exciting things that are going to continue to be developed as far as treatments go.

Dr Ahsan Basha: Yeah, really, what I got out of it was by reading about the history of cancer, sometimes you get caught up in treating everything. You forget about the history and what's been built upon, over these last generations of physicians. I mean, I'm reading about people who, "Hey, that procedure's been named after that person, that procedure has been named after that person." Wow, okay, now I understand it all. So, it was actually kind of nice, so I appreciate you asking me.

Host: Yeah, thank you so much for coming on the podcast today, Dr. Basha.

Dr Ahsan Basha: Thank you so much for asking me, Gabby.

Host: And thank you listeners for tuning in to Conversations on Cancer, brought to you by the Riverside Cancer Institute. For more information about cancer treatment at Riverside, visit riversidehealthcare.org/cancer. Also, make sure to rate and leave a review for Conversations on Cancer on Apple, Spotify, or wherever you listen to our show.