Abby Fox (Intro): Welcome to the Still Caring Podcast, presented by Stillwater Medical.

Joe Akin (Intro): Here, community is at the heart of healthcare.

Katon Lunsford (Intro): Through honest conversations and shared experiences

Abby Fox (Intro): we explore what it means to care for our health—

Joe Akin (Intro): and each other.

Katon Lunsford (Intro): Because better health takes a village and you're part of ours.

Abby Fox (Host): Hello, and welcome to Still Caring. I am Abby Fox, the PR and Marketing Manager here at Stillwater Medical. And today, we are joined by Michael Chacko. Michael, it's good to have you in the studio today.

Michael Chacko, PhD: Good to be here.

Host: Yes. Tell us a little bit about yourself and kind of how you made your way to Stillwater.

Michael Chacko, PhD: Sure. So, a little bit of my background. I grew up in the radiation therapy environment. So, my father was a medical physicist and still is. So as I was growing up, I've seen the evolution of the field. So, I went to OU for my PhD in Medical Physics. And I started my career at the Oklahoma Proton Center.

But over time, I've always been particularly attracted to the cutting-edge of the field, and radiation medicine is a high ceiling of what we can offer patients. So in my lifetime, I've seen a lot of things that have improved with technology. You know, technology doesn't always make things better. But in our case, it really led to better patient outcomes.

So, you know, when I was working at the Proton Center, it was one of the few in the country, so I was particularly drawn to it. Over time though, I started to notice how a lot of our carefully designed treatment plans started to go awry when patients have changes over time. And at that time, what was known as adaptive radiation therapy started to be something that we talked about in the field.

So, I had heard that Stillwater was planning to purchase an MR linear accelerator, which is an MRI combined with a linear accelerator, which is the machine that delivers radiation. So, I mean, this was so cutting-edge that I didn't even know where the nearest machine was. So once I heard about that, I knew I had to be a part of it. And I live here in Edmond with my family. And I knew that that meant and driving an hour each way, but I was more than willing to make that sacrifice, because I really believe in what Stillwater Medical was doing. So, that's a little bit of my background and what drew me to Stillwater Medical.

Host: That's amazing. Thank you for sharing that with us, Michael. And I appreciate what you're talking about, but I feel like I only know a tiny bit of what that means. So, can you talk to me more about what is so revolutionary about this and how is it different from other cancer treatments?

Michael Chacko, PhD: Sure. If a patient decides with their doctor on a course of radiation therapy, what typically happens is a treatment plan is created. So, this allows us to program the linear accelerator. And what we're trying to do is deliver that radiation to the target area, generally tumor, and minimize the radiation dose to normal tissue.

So, we talk about different forms of radiation therapy, proton therapy, which is also a form of radiation therapy. What happens in that process is generally the same. But when you really sit down and think about it, right, you're delivering this treatment over a course of a few fractions, which may take days, a couple weeks. And you think about your body from day to day, you know, a lot of things are changing over time.

So as we deliver that therapy over the course of multiple days, you can imagine that that tumor ideally starts to shrink. But not only that, all sorts of changes in anatomy changes are happening macroscopically and microscopically. When we talk about in our field, we're delivering radiation therapy, so we're trying to be as precise as possible, right? We're trying to deliver the radiation to the tumor, kill all the cancer cells, right, and minimize all the dose that we give to normal tissue, right? So, minimize all the side effects.

So, we obsess over these millimeters of accuracy, right? Trying to just deliver the radiation to the part that we want. But if you really think about it, when we're planning that, we're doing all this work ahead of time, but we have really no idea what's going on inside the patient once we start that treatment. So, we have really good imaging at the start of treatment, but we have little to no idea what's going on as a treatment progresses.

So with an MR linear accelerator, what that means is that you're combining an MRI with a linear accelerator, which is what delivers the radiation. So when you talk about an MRI, that's the best kind of soft tissue contrast that you can get on any kind of imaging device. So, you're combining the best form of imaging with the best form of treatment. And that's really what an MRI-LINAC really provides for us. And we're the only ones in the state of Oklahoma that are able to provide that form of treatment.

Host: So, it's kind of like you are not flying blind. It's kind of like you can see as you are administering that dose and so you know exactly. Are you adjusting it all the time too?

Michael Chacko, PhD: Exactly. So, what's happening is that we're adapting that treatment plan the very day that we're treating it. So if you come in for your fifth fraction, right? And you're laying on the table. We're looking at real-time what's going on inside of you, and we're adapting that treatment plan. All of the other radiation therapy centers in the Oklahoma, really their adaptive process is not online like ours is. We're able to take what's going on inside the patient and real-time and adapt that radiation treatment plan right then and there. So, that means less radiation dose to your critical organs and less side effects for you, and that's what that translates to.

Host: That's amazing. Now, can it also translate to fewer treatments?

Michael Chacko, PhD: Yes. So, one of the advantages of this form of treatment is that we're able to reduce the number of fractions and deliver the same efficacy of the treatment over a fewer number of fractions, and that's really a game-changer for people who are driving in. We even have people who drive in from the city who are looking for treatment at Stillwater Medical, and they're able to minimize the number of visits that they have to make. So, it's really enabling that access to care to go out further and further.

Host: Would it be fair to say it's a substantial number, like it's a substantial, fewer number of treatments that you would need with this kind of technology?

Michael Chacko, PhD: Yes. So, we're able to offer—if qualified patients—prostate treatment that comes down to five fractions. So, that's a game-changer. When you talk about in the past, as I've seen in this field, it was over 40 treatments. And it came down to near 20. But now, we're able to offer it in five fractions. So, that's something that's really a game-changer in our field.

Host: That's great. Well, and I know I've talked to one of those patients, because in my role promoting Stillwater medical, I do have the opportunity to talk to them. And I think the gentleman that I was speaking with was from Ponca City. So, the fact that he could come here just over five times, you know, for five treatments versus 40, I mean, that made a big difference for his quality of life. So, I can imagine you hear that from a lot of patients. But do you interact directly with a lot of patients, Michael? Or what does your role look like on the cancer team?

Michael Chacko, PhD: Generally, I joke around that I know patients from their insides a lot more than their faces, because I'm behind the scenes. So really, my role, people hear the term a physicist and they think that you do research. But surprisingly, a hundred percent of what I do is clinical. So, my job is to make sure that the radiation dose that's prescribed by the radiation-oncologist goes to the prescribed area. And it's the right amount, and it's the right location. So, that means that I calibrate the radiation machine, right? Not only that, but I look at every single treatment plan and decide, "Is this the best way to deliver this radiation?" That's really my bread and butter, and that's what I do on a day-to-day basis.

But one of the more fun aspects of my job is to make sure that we're on the cutting-edge. So, I'll give you an example. Recently, we had a patient that had a rather large lesion in his prostate, and I had just attended a talk on a cutting-edge approach where we treat the entire prostate, but we're able to escalate the dose to the lesion itself. So, this is kind of a really new approach, and it's only possible with an MR LINAC. You can only see that lesion within the prostate itself on the day of treatment with an MR LINAC. So, I work with this patient's physician and the rest of the treatment team to implement that approach. And I had not seen it done in this state at all. So, that's really exciting for me, and I think that's the rewarding part of what I do on a day-to-day basis.

Host: I do hear that, like excitement for innovation. Has that just always been a part of who you are or is this something that, like, you've seen the progress and that gives you that fuel to keep digging in?

Michael Chacko, PhD: Yeah. You know, my father worked in this field in the '90. And growing up, I used to do my homework in the cancer center. So, I grew up doing that, and I attended cancer support sessions. And I used to really be so involved in all aspects of this, because it was my dad's life. And I saw the side effects that came with radiation therapy. Over time and just in my lifetime, I've seen that dramatically reduced.

So, I always wanted to be on that cutting-edge. And we able to offer that here in Stillwater. And they're just remarkable. I mean, we'd have to go out of state really to be able to find this sort of treatment that we're able to offer here.

Host: Hearing about your dad. I always love that kind of personal aspect of kind of why we got into this to begin with. What does it feel like to you to be on the cutting-edge, but to also so be bringing this to our community?

Michael Chacko, PhD: It means a lot. We go to a lot of national meetings, our treatment team. And believe it or not, we're the smallest cancer center in the country to offer this type of treatment. So, most of our peers are from enormous universities or health systems. They're professors, faculty members of these gigantic universities. And we're a little Stillwater Cancer Center, but we're offering this treatment. So, a lot of people do double takes, and they're just so astonished at the fact that we were able to do this and we're still offering this treatment. And that's just part of the wonder and kind of the rewarding part of what I do. And I love to do that.

Host: What kinds of cancer do you treat? Is it any kind of cancer? Can anybody, you know, get radiation from this new machine that you're talking about?

Michael Chacko, PhD: So generally, it really excels in deep-seated tumors, which is a majority of what we treat in radiation therapy anyway. So, we're really good at treating prostates, rectal cancer—we are second to none—and treating abdominal cancers. But you have to remember any form of radiation therapy is a form of localized treatment, right? It's not a systemic treatment like chemotherapy or immunotherapy would be.

So, cancer is a multidisciplinary problem, so you may get another form of treatment if you're having radiation. Most commonly, you'll get some form of systemic therapy as well. So, it's a multidisciplinary approach, but we really excel at these deep-seated tumors. And the MR LINAC really allows us to look and have the best form of imaging for those kinds of tumors and those treatments.

Host: What do you see on the horizon of cancer research and kind of where the field is going? What excites you?

Michael Chacko, PhD: We're on the cusp of being more personalized in our treatments. So, every person is unique and their situation is unique and their bodies are unique. So, what we're doing is we're tailoring their treatment to who they are and what their bodies require. So, that's really something that's really come alive in the last few years and enabled by technology.

Sometimes technology makes things easier. Sometimes it makes things more complicated. But in this sense, it leads to direct better patient outcomes, which is what we really want, right? We are not just chasing technology for the sake of chasing technology. We want better outcomes. And so, that's we're able to provide with this.

Host: For every conversation that we have in this podcast, we are ending with a challenge to care. So, something that our community can do to better care for themselves or to better care for this community. What would your challenge for our listeners be today?

Michael Chacko, PhD: My challenge to care would be two parts. The first part is that one of the advantages and disadvantages of our internet-connected age is that information is just more accessible, and it's just out there. That's a plus and a minus, right? You have access to information, but you're also inundated with a lot of things.

So, sometimes you may see an advertisement that makes bold claims. But my challenge to the community is this, ask the tough questions, ask the provider. You know, what is the evidence that this treatment is better or worse? Or are the risks worth it over another form of treatment? So, that's really what my challenge to care would be, the first part.

My second challenge would be this, you are in charge of your own healthcare, you're the boss, you're in the driver's seat. I'll give you a short story. When I was in college, I started to have a lot of GI symptoms. And I just ignored them for a year—over a year—until I went to see a gastroenterologist. And I discovered that I had Crohn's disease, which is a form of inflammatory bowel disease. But until I took a hard look and said, "I don't feel well, and I think that I need to see somebody about this," all the best medicine in the world couldn't help me until I took that first step.

And my challenge is this, don't be afraid to do that, especially in cancer treatment. The difference between early and late detection is just so huge. It's just so more important than all the fancy technology in the world. So, you're in the driver's seat, you're in charge of your own healthcare, ask tough questions, and you're the boss. You know how your body feels more than any other provider or any doctor. You know what makes you feel good, what makes you feel like you're achieving the goals that you have set out for you in life. So, that's my challenge to care for the community.

Host: That's great. And it's so empowering because it's something that we can all do, is just pay attention to how we're feeling and take that next step, whatever that looks like.

Michael Chacko, PhD: That's right. Sure.

Host: Thank you, Michael, for joining us today. We are thrilled to have you at Stillwater Medical and just grateful for all the impact you're making here.

Michael Chacko, PhD: Thank you so much. Thank you so much.