Portland Business Journal President and Publisher Candace Beeke recently moderated a roundtable discussion with folks on the forefront of cancer diagnosis, treatment and research in the Portland area. Joining her were Dr. Tris Arscott, a radiation oncologist at Compass Oncology; Dr. Eliot Edwards, a naturopathic physician at Sage Cancer Care; and Dr. Robert Strongin, PSU researcher and chemistry professor and biotech startup founder.
Candace Beeke: Tell us a little about what you do.
Dr. Tris Arscott: At Compass Oncology, we are involved in patient care from initial diagnosis and treatment or relapse or for pain palliation — managing symptoms when cancer is not responding to other treatments. Within the Portland area we are involved in the tumor boards, which is a great way of interacting with the other specialties within oncology for putting together collaborative and multidisciplinary care for patients.
Dr. Eliot Edwards: I’ve been practicing for 20 years and 14 years of that has been focused on integrative cancer care. I work alongside the medical oncologist and the radiation oncologist and use my knowledge and expertise in naturopathic medicine to support patients going through those treatments, while not interfering with the conventional treatments.
Dr. Robert Strongin: I have an academic lab at PSU; my specialty is organic chemistry. I also founded two startups — a cardiovascular-focused company, Elex Biotech, and my newer company, Captis Biotechnology, which is totally cancer focused, as is my own research. We have strong collaborations with OHSU. We’re mainly focused now on pancreatic cancer imaging, also disease progression.
Candace Beeke: What effects has the COVID-19 pandemic had on cancer treatment and research?
Arscott: The pandemic really changed our relationship with our patients and we had to find new ways to connect. Patients were scared to get tests done and about exposing themselves to COVID or family members. I’ve seen a lot of patients coming in with more advanced stages of cancer than I otherwise would have. There’s been delay in getting patients into clinic for treatment, evaluation, as well as supply chain delays for certain testing and supplies like IV contrast.
We’re figuring out how we can use the resources available and looking at how we can change our treatment paradigms. There’s been collaboration, internationally, looking at radiation regimens and pretreatment protocols and how we can safely deliver care in a shorter period of time.
Edwards: I’ve had many patients delay screening, imaging and then found things in a more advanced state. There’s a lot of fear. People ask me about zinc, melatonin and other natural things to help bolster their immune system. The supply chain is an issue. With the vaccines, there’s been a lot of lymph node enlargement, and that can be scary when you have active disease, because it may be a sign of progressing disease.Strongin: There were shutdowns where we weren’t allowed to work at all; getting supplies and chemicals is hard. Every facet of what I do was slowed down. The startup company we founded at the end of 2019 is two years behind.
Beeke: What training is involved to become a naturopathic physician? Describe the role and treatment goals.
Edwards: The doctorate in naturopathic medicine degree is gaining awareness, but it’s still a small profession. It requires candidates to have their pre-medicine undergraduate studies completed. Once they complete the program at one of the accredited naturopathic universities, they can start practicing. The training entails a minimum of four years. The first two are very similar to standard medical school. The last two years is where we diverge and focus on more holistic treatments like nutrition, diet, lifestyle. The use of nutritional supplements and herbal medicines is a big focus of our practice. However, naturopathic physicians are also trained in pharmacology. Once a student has completed graduated, then they take national board exams and apply for licensing.
Most naturopathic physicians are general medicine practitioners, family medicine or primary care. However, there has been a growth in specialties, and oncology is one of those. My role is providing evidence-informed support to improve the compliance and tolerance of patients going through conventional treatments. I try to manage side effects, support their immune system, and help maintain quality of life.
I pay very close attention to not interfering with conventional therapies. We want them to work; we don’t want them to be interfered with. I educate my patients about their disease and treatments.
Beeke: How do patients find you?
Edwards: Over 80% of patients diagnosed with cancer use some form of integrative therapy, so it’s really driven by the patient. I have a website and do online marketing and that’s ultimately how most people find me and through collaborations with oncologists.
Arscott: What’s been nice about this Portland community and working with complementary integrative medicine is it’s a space to incorporate Western medicine and Chinese medicine, naturopathy, among others.
I also have patients who haven’t really recovered from their treatment or are still undergoing hormonal treatments. That’s affecting their quality of life, their energy. Incorporating people like Dr. Edwards and naturopathy we explore ways of bringing other elements or potential treatments into their life to help get them back on track.
Beeke: How do the radiation oncologist and radiotherapy factor into a patient’s treatment plan? Any common misconceptions?
Arscott: I’m usually further down the line in terms of people a patient needs as they’re going through their cancer journey. We deliver radiation to cure cancer. That’s one of the common misconceptions. Radiation isn’t the end of the line. It’s something that’s integrated into a curative treatment plan.
There’s a fear of radiation; it’s invisible. We use photon and electron radiation, high-energy light. We discuss that there’ll be manageable side effects that usually will resolve within a few weeks. We continue to see our patients every few months, or at least once a year, usually for a few years, to be sure that if there are later side effects, we’re able to figure it out and incorporate additional treatments as needed to fully heal and recover.
Edwards: It’s nice that we’re becoming part of the whole team and not an alternative approach like we used to be. You would expect being a naturopathic physician that I would recommend alternatives, but I don’t and that’s informed from two places — one, my expertise in naturopathic medicine. We know that our medicines are gentle and not as strong as conventional therapies. They really haven’t been shown to take the place of conventional therapies. Sometimes my patients are taken aback thinking that I’m going to discourage them from conventional therapies, but I absolutely don’t do that.
I’ve seen heartbreaking cases where patients tried to treat their disease naturally, and it went from being curable to possibly not even treatable. So I educate patients and help them understand it’s the best of both worlds. I support them through the conventional treatments.
The advancement of radiation technology is wonderful, consistently delivering radiation right where it needs to be versus 15 years ago where the treatment fields were so big and there was a lot of collateral damage.
Arscott: Even 15 years ago, we didn’t use to create these customized treatment plans that have become standard practice in radiation oncology, where every patient gets a CAT scan and we recreate their anatomy in the computer 3D. We model the body and organs and define the targets in the system based on where disease is and where it spreads, like lymph nodes. Through those advancements in technology, we create more precise and focused treatment on where to deliver it, therefore sparing normal tissue.
Side effects, unfortunately, can still happen, but they’re usually more manageable, and they can recover more quickly after treatment. There are other technologies as well, like MRI-guided therapy. We can adapt the plan on the spot. That’s something that’s coming on board. Other technologies, like proton therapy and newer things like flash therapy, which is a very high dose delivery rate, are more tools to deliver the best and safest treatment.
Beeke: Dr. Strongin, how does your research on pancreatic cancer imaging add value to current technology?
Strongin: Most of my research in the diagnostics area is taking simple organic dyes. Instead of detecting protons, which is what a pH sensitive dye does, we asked, why can’t we just take molecules with color and fluorescence changes?
I started doing this about 15-20 years ago and everyone said it would never work because the human body is too complex. But we forged ahead and it does work. Basically, we have a simple, basic organic dye that selectively targets pancreatic ductal adenocarcinoma and also targets precancerous lesions.
We tested this on certified human pancreatic tissue and precancerous lesions, and it works so well. So, if we can partner to do clinical testing and have surgeons try this, perhaps during the operation, it only takes 10 minutes to stain the tissue as a frozen section. Currently, surgeons send a sample of a tissue to a pathologist and have to wait for their subjective analysis. What we have is something that could be used even potentially in the ER. It takes 10 minutes to stain and then you get a quantitative readout of the contrast between the (affected) tissue versus the more healthy tissue.
Beeke: Who are the collaborators you’re seeking? What challenges do you face?
Strongin: Definitely people who can do some clinical testing. It’s challenging to convince people that this is worthy of their time. Clinicians are extremely busy. I’m optimistic as we keep publishing and making progress we’re getting more and more attention. Cancer research is never done in a vacuum.
Beeke: Dr. Arscott, where do you see radiation oncology going? Is there a way to reduce toxicity further?
Arscott: Customized treatment plans based on the patient’s individual anatomy, where the tumor is, defining it in the computer and creating customized plans is helping to reduce toxicities and advance what we’re able to do. Prostate cancer used to be nine weeks of therapy. Now, in the right patients, we can do it in five treatments. Through understanding biology, anatomy, imaging modalities to better define disease, we’re able to change these long regimens and deliver them in a more compressed and safe fashion.
Beeke: For the future of health care as it relates to cancer, how are we doing? Are there barriers slowing progress?
Edwards: So much of my work is focused on side effect management in the realm of genomics and the ability to do a genetic profiling on the tumors to be able to identify receptors and mutations so that we can use very specific targeted treatments. The greatest advancement is, instead of having to use general systemic chemotherapies with much broader side effects, we can sometimes do targeted therapies, which are often very well tolerated and focused to the disease.
With integrative medicine, there’s more acceptance and awareness of naturopathic physicians and other providers.
Arscott: With personalized treatments, we have a wide array of targeted therapies we can use before going to conventional chemotherapy. We can tell some patients, “You may not need chemotherapy, maybe we can do immune therapy, or we can target your mutation.” Often, that’ll have a really good effect for a number of years.
The cost elements aren’t cheap though in terms of the impact on the economics of health care. It’s becoming more incorporated into our National Cancer Collaborative Network guidelines to do genetics on really high-risk patients, but there’s a cost. I think that probably is a worthwhile investment. Ultimately, it will allow us to create more personalized treatments or understand mutations.
Strongin: It’s so important as a community to support each other. A lot of it is financially hard to get around. If we could find further support, not just financial — there’s other ways to compensate, like by partnering — that could move us ahead competitively, maybe with other regions. It is not easy to get funding at the standard NIH level because they have so many applications and can’t fund nearly as many as are meritorious.
Beeke: Creating a startup feels like an extra layer of challenge. What advice would you have for others considering a biotech startup?
Strongin: It is an extra layer, so it’s important to build a great team of people — not just experts— who get along and where there’s going to be long-term trust and cooperation, transparency and communication. I have no business experience, but I had a business CEO from day one as a partner. But it’s really hard to find business people who will come in with an unproven startup. It’s a risk and a lot of time and energy.
But the infrastructure in Portland is great. I’ve had wonderful mentors, mostly retired or semi-retired entrepreneurs. I would urge anyone wanting to start a small biotech business to learn about opportunities for funding, local opportunities like Business Oregon, and getting grant matching funds, and to learn about mentorship opportunities.
Beeke: How do Portland, Oregon and the region fare as far as cancer ecosystems?
Edwards: It’s somewhat disease driven in my experience. Among the breast cancer treatment providers, there’s a wonderful group that gets together quarterly and welcome naturopathic doctors, as well as all of the different disciplines to review recent literature. It’s multidisciplinary, the Journal Club, and has been a wonderful avenue to get to know people and collaborate more. Compass Oncology also does a number of educational get-togethers.
Arscott: Compass has done a number of these programs to bring together providers in the community and not just oncologists, but surgeons, medical oncologists, radiation oncologists, naturopathic practitioners and primary care providers as well to provide education on how we are managing diseases. It’s a chance for interaction and collaboration.
The other part with the tumor board in terms of the environment within Portland and in Oregon is that this is probably one of the most collaborative environments I’ve been in. Our tumor boards are citywide, with all aspects of different types of treatment, from pathology, radiology, surgeons. Unfortunately, not as many of our integrative type of practitioners are there, but it allows for a multidisciplinary treatment plan and care, allows for sharing of information and clinical trials, and offers information about new trials coming on board.
Strongin: The reason I moved here and to PSU in 2007 was because it was so close to OHSU. I never dreamed I would be given a second lab at a life science building with world-renowned cancer researchers in a big space built for sharing, and also now having the new Knight cancer early detection building. Portland has a lot of uniqueness for doing this kind of work.
Edwards: At the National University of Natural Medicine, there is the Helfgott Research Institute, and they have a master’s of integrative medicine research degree. My colleagues there collaborate with OHSU, PSU and a host of other organizations. So there is a lot of research going on in the naturopathic medicine world in Portland, but elsewhere as well. A lot of the natural things are gaining more research, both in preclinical and clinical trials.
Beeke: What are the most significant challenges and opportunities in the cancer field that could be addressed by a small business?
Strongin: One place with a real lack of technology is in childhood cancers. I think that’s understudied and underdeveloped. I would love to see more businesses get involved there.
Arscott: Detection. The circulating tumor DNA is really getting developed, where you can take a blood sample, look for mutations, and potentially use those as either a screening tool for early detection or as a surveillance mechanism.
Edwards: It’s been very helpful to be able to do telemedicine. I’m hoping that that solution stays in place because it has been effective from a naturopathic perspective to help more patients who are not right in the Portland area.
Candace Beeke, Market President and Publisher, Portland Business Journal
- Dr. Tris Arscott, Radiation Oncologist, Compass Oncology
- Dr. Eliot Edwards, Naturopathic Physician, Sage Cancer Center
- Dr. Robert Strongin, PSU Researcher and Chemistry Professor and Biotech Startup Founder