Ep. 19 | Leslie Holmes, MD, Radiation Oncologist, SGMC Health

Transcript

---

- Welcome to another episode of What Brings You in today.

- I'm Erika Bennett. And I'm Taylor Fisher. And we just wanna thank all of our listeners for tuning in and if you haven't already, please subscribe and like our podcast so that you can stay up to date with all of our new episodes.

- Yes. And if you have any questions or topics you would like to submit, you can do so at sgmc.org/podcast.

- Alright, well today we have Dr. Leslie Holmes, radiation oncologist at SGMC Health's, Pearlman Cancer Center with us. So Dr. Holmes, what brings you in today?

- I'm here to talk about the fabulous things that radiation oncology can offer our patients.

- Alright, so let's just hit the first question. What is radiation oncology for the average listener that knows nothing? Okay.

- Radiation therapy uses the power of radiation therapy and a big word would be photons. But basically that's, we remember the, the cells and the nucleus and the protons and electrons.

- I don't remember them very well, but I do remember the names.

- But what we do is we take electrons, which is part of a a cell, and we accelerate them and make them move really, really fast down a tube. And then we smash them into a specific target and we create photons. And those photons are way stronger. You could think of them as sun ray, but they're a million times more stronger than that and we use that ability to treat cancer cells.

- Wow, that's so fascinating. I had no idea that that's what that was. Me neither. I'm like, okay, I know we do radiation oncology, I have no idea what that means, but

- Dr. Holmes, can you tell us a little bit about you, now that we know what radiation oncology is, can you tell us about your background and how you got to SGMC Health?

- Well, I'm from New Jersey originally. I'm a graduate of Howard University and then I was accepted to Morehouse School of Medicine, which is in the great town of Atlanta, Georgia. And one of the premises of our school was to help the underserved and I've dedicated my career to doing so and this was a perfect opportunity for me to come here. Also, one of the mantras of our school is they would like us to serve the area unto which they graduated from. And so that's what brought me back to Georgia. And so I'd like to serve this community and I found it a great place to be and it's been a wonderful experience thus far.

- And all the different specialties as you're going through medical school that you can choose to, you know, focus on and become what you, you know, your career and your life's work. What drive you to radiation oncology?

- Well, it started in my undergraduate matriculation. I'm a radiation therapist. I was the one that was delivering the actual treatment that the physician prescribed. But while I was in that role and I was learning how to be a therapist, I had some great mentors around me, the physicians, and I saw how they interacted with the patients, how much joy they brought the patients, how the outcomes were, how thankful the patients were. They were thankful at the therapist level as well. But I wanted to be more involved with the care and decision making upon their care. And so that promoted me to go to medical school to become a physician so that I could be a radiation oncologist. Wow.

- Wow. I wouldn't have thought of that even as a specialty I guess whenever I was deciding. No, no. But I mean, we're so glad that we have radiation oncologist. What's the most

- Type of cancer that you treat in your specialty?

- The majority of the cancers that we treat are breast, lung cancer and prostate cancer. Those are the top three and those are the main ones we focus on. We do a lot of GI cancers as well. We treat a lot of esophageal cancer, pancreatic, anal and rectal cancers as well.

- Let's talk about breast cancer because that, I mean that one's huge, widely advertised, promoted as far as screenings and making sure you're, you know, how important is it that they get a mammogram and get it recognized early?

- Yes. The whole premise of screening tests and we don't have that many, we'll focus on breasts mainly when we talk, but there are only a few screening tests out there. We have the mammogram for breast cancer, we have the pap smear for cervical cancer and we have the colonoscopy for colon cancer and we have the low dose CT screening for lung cancer. And that's about it. That's what we have. And so we encourage patients to talk with their primary care physician and really undergo those screening tests so that disease can be identified early and it can be identified in an early stage. The earlier the stage, the better the treatments that we have for them, the more control. And that helps to contribute to one's survival with, with controlled disease or obliterating the disease completely.

- No, I feel like most people are not, you know, a majority of people would just be scared to find out, you know, like what you don't know, you can't, it can't bother you. And so you just kind of live without knowing what,

- But that's the thought process of patience.

- Right.

- Okay, if it's not broke, don't fix it. But we have the ability to have screenings And if you know what you have, you can deal with it early on. And yes, it is a little difficult to obtain that diagnosis and to be taught about that diagnosis and to be told that you have a diagnosis of cancer. But here at SGMC Health, you have a whole cancer center and everyone there is dedicated to helping you fight your disease process. And everyone there involved, no matter what level from the valet person at the, that accepts you at the front door with a warm greeting from your, from the receptionist to all the physicians, the nursing staff, the therapists, the nurse practitioners and navigators, there's a whole team there that helps you work through your process. We have social workers, dieticians, so we look at the patient as a whole and we hold your hand because we do know that it's scary, but our passion for developing the care for you and your treatment plan will help guide you through and we give you a great support system that you can rely upon so that you can deal with that difficult news because it is difficult to deal with so that you can get well.

- I imagine that would be hard and I, I feel like I've heard some doctors speak about particular cases what that of patients that they've received that it was just so late in the diagnosis and they just wished so much, you know, that they could have like found that earlier. So I guess to that point, if you are nervous about it, you would probably feel so much worse about it if you just put it off because you were being kind of hardheaded. Exactly.

- Just kind of Exactly. Or apprehensive or you know, fear. Fear does consume, yes, it drives a lot. It does drive a lot and denial drives a lot as well and it is frightening. But that's why you go to the doctor because they are trained to help you get through your, your woes.

- So

- What are, regarding your health,

- What are the recommendations as far as screenings go? Like what age or you know, are there any other factors that you should start getting screened?

- Well you have to follow up with your primary care physician and you have to have a good relationship with them. And they're the ones that will guide you to say, Hey, it's time for your colonoscopy screening. You know, and the guidelines are changing quite frequently. You know, if you have a family history, maybe you have to start a little earlier than what the guidelines say just because you have a family history of disease process. So you really need to build that relationship with your primary care physician. And even me, I'm a radiation oncologist, but in, you may have come to me for colon cancer or rectal cancer that was found odd oddly. But then I may say to you, Hey, you know, have you ever had a mammogram? You know, you are smoker, have you ever had a low dose ct? Just because I'm a specialist and I'm treating this one site doesn't mean I don't care about you as a whole. So you, I refer patients to their primary care physician, the American Cancer Society and they can follow all of the guidelines that help you with

- Screening. I know one of the things that we've implemented pretty recently is, or just really focused on is care gaps and within our electronic health record to help our primary care doctors like see when a patient has not had, if they qualify for those certain things to make sure they're having that conversation with the patient. And it's not because we just want patients to get more things done. I mean it's because we want the patients to take care of themselves and be proactive and be exactly a advocate for their health.

- Right? I receive my hair, my healthcare in the South Georgia Medical S system and I've used that care gap system myself, you know, to say, oh hey, I gotta make an appointment, you know, I have to do this, I have to get an eye exam, I have to. And those prompts are very, very helpful in one's health care

- Just hold you accountable. So the MyChart, so any, if you're a patient anywhere within our system, you know, you get access to MyChart which is I think one of the leading electronic health records in the nation. But, so there's so many people using it that are always, you know, advancing it, making it be, you know,

- Refining it to get better. Yes,

- Refining it to meet all the patient's needs. But it's really cool because not only can you get like your lab results before the doctor even gets into the room, which can be good or bad, but I mean you do get those reminders and I think that does help you if you have that mindset like, I'm gonna be proactive, I'm gonna go to my primary every year, I'm gonna get, you know, whatever I'm supposed to be getting just to hold you, be your little reminder.

- Right? But it's a great reminder. And healthcare, I tell patients all the time, healthcare is a two way street, so didn't call you with a result, it's up to you to pick up the phone because the health staff that they get busy and it's not that they forget about you, but you have to take care of you and you are the most in person for yourself and you need to be an advocate for yourself. So if you don't hear something or if you have a question, no question is too small, no question is stupid, pick up the phone and ask and the team here really helps you.

- I totally agree.

- Yeah, I think that's a great message because some, I mean I do, they're like, well I'm not gonna call, they'll call me or whatever and we don't want everybody to fall asleep, be overly calling, but if you have a concern or something, don't be timid about speaking up for yourself. I

- Agree.

- At your doctor's appointments or you know, if you just have something else about 'em. Exactly.

- I agree. Are there any recent advancements or any new technology as far as in the field of radiation oncology that we're seeing or being used more often now that are beneficial?

- Yes, we have the advancement of intensity modulated radiation therapy, which basically we can use tighter margins. It used to when we, when I was in training, we used large fields to treat areas and we have to be concerned about the normal tissue tolerance. Now the difference between a cancer cell and a normal cell is that a cancer cell cannot repair the radiation damage. So we use that factor of radiation to treat the cancer because the cancer cells can't repair radiation damage, but normal cells can repair radiation damage. And so what happens is we don't necessarily wanna treat too many normal cells because why do we have to put the patient through that toxicity? So what was invented was IMRT where we could treat the cancer and put a tighter margin around it and still have some normal tissue in the field, but not as much as we used to before. And now we've even made the fields tighter and smaller depending on the disease process. We can use stereotactic radiosurgery to treat a lot of the brain tumors that we receive in consultation. And we can also use that same premise and call it stereotactic body radiosurgery where we can treat tighter margins and really refine the tumor and have pencil beams specifically to the tumor for tumors that are in the body area. And then now what we're doing is we're using larger fractionation of treatment. So we give a little bit higher dose than our conventional treatment. And what that does over time, it's biologically equivalent to the longer course of treatment, but now we can deliver that same treatment in a shorter period of time because we realized that radiation therapy is usually delivered Monday through Friday. And so when I was in residency it was like eight weeks of treatment for some sites. Yeah. Seven weeks of treatments for some sites, six weeks of treatments for some sites. But now we've reduced that because we give a little higher dose in a shorter period of time, which is equivalent to giving that same dose over a longer period of time. And then what we can do is shorten the timeframe onto which the patient has to give up their life per se, to come in for treatment. Yeah. And that makes their quality of life better, right. Their overall outcome better be because they don't have to spend so much time.

- Yeah.

- In the hospital and the clinics and outpatient clinic,

- It's so refreshing just seeing this and abs, we've heard this from many specialties, from heart to neurosurgery to interventional physiatry, but everything is evolving with the patient in mind to really help with that experience. And we don't want them to have to be here unnecessarily or longer than they have to. And I think that's really cool that

- Yes,

- That we're moving that direction. And speaking of like radiation, what about the equipment, the technology that you use? We,

- We use use, we use the linear accelerator, which like I said, it basically does what it says. It's a large machine, it looks similar to a CT unit and it rotates around the patient and the patient does not have to move, they just have to lay relaxed on the treatment table. We used to have to put these big leg blocks into the head of the machine, but we no longer have to do that because in the head of the machine we have these leaves that move and they block the normal tissues out and expose the tumor. And so

- Oh that's nice.

- And it used to be a spark to happen. Exactly. You used to have to lay on the table for half an hour. Now you can get treated in like 10 minutes. Yeah, yeah. So the actual deliverance of the treatment itself, the actual beam on time is about a minute. But we do take our time seriously to make sure you are set up properly and that can take about

- 10

- Or 15 minutes, but it's not as ominous as it used to be. So the treatments are shorter. The timeframe unto which the treatment, the period of time a patient is getting treated is much shorter and it's very well tolerated. And patients do have side effects from treatment depending on the site, but they're not as severe as they used to be.

- Well that's good because as cancer scary enough as it is without the actual treatment part being scary,

- The diff what's the difference? So, and I only know a little bit about this because we had to put this on our website, but when it comes to cancer care, you have like medical oncologist and radiation oncologist. Tell us maybe just high level, like what the difference is. Okay. When one might see a medical oncologist first already or do you see both and

- You can, okay, so most cancer patients are treated in a multidisciplinary approach and the three disciplines mainly that treat cancer are surgery, medical oncology and radiation oncology. And we rely very heavily on our pathologists that read the specimens and tell us exactly what we need to treat. And we also rely very heavily on our radiologists because we order a lot of scans, but the actual therapeutic treatment, the actual treatment delivery are from surgery, medical oncology and radiation oncology surgery. We all know that's with a scalpel, right? That's where we cut the, remove the disease through surgical intervention or we cut it out. Okay. And then you have medical oncology and radiation oncology. And medical oncology usually div delivers a drug chemotherapy. Okay. Or immunotherapy. And that goes through the veins and circulates the entire body. Okay. Whereby radiation therapy uses radiation and we pinpoint the treatment and it's more for local controls to decrease the chance of the cancer returning where it started. Okay. Yeah, that makes, so those

- Are the difference. That makes total sense. But I guess hadn't really thought about it, but I've definitely heard of chemo, you know, often in and radiation, but, and then do you ever have to do both?

- Lots of patients do. That's why we have tumor boards here and we present our cases in tumor boards and all of the doctors come together. We review the pathology slides, the x-rays, the cts, the MRIs, the PET scans, and then all of the colleagues come together and we confer with one another and we talk about the case and the pros and cons of delivering treatment and what's the best treatment for the patient. And we come to a consensus and that is the treatment plan for the patient and we roll that out.

- What it always fascinates me, I used to have to walk by the cancer center every day to get to my office and or just during the day. And the patients were always just, that's generally like had very good attitudes. The people in the cancer center are just like often described as angels on earth. We had a lot of positive, you know, reviews from our cancer center. But what is it like working in a space, I mean that you would think would be very emotionally draining? Like how do you deal with, deal with that? Like how do you, how do you go about your day?

- Well I try to be as optimistic as possible. You know, nobody wants to come in and have a doctor that's downtrodden and

- Yeah.

- You know, woe was me and beat down. And so my thing is if you remain optimistic, your patients will reflect that. And if you are a cheerleader for your patients, your patients will appreciate that. And I always tell patients, you know, hey, I know there's gonna be days when you're gonna cry or you're gonna think, why am I going through this? Yeah. Or why, but for the most part of it have an optimistic outlook because if you do that will help you get better and hold onto that and be prayerful as well. 'cause that helps a lot as well. Yeah,

- I think you have a great personality for that job because I just always see you in the hallway and you're smiling or you'll say, you know, cute outfit or you always,

- I know I'm always just trying to figure out what you're wearing. You're

- Always dressed. How many pairs of

- Glasses

- Do you

- Have? Quite a few because

- They're always polish. So I can see how you would be that way to your patients and positive and then they would reflect that. Yeah. Because of how you are. Thank you. And you just kind of, you glow. I appreciate that.

- Thank you. - What's the most gratifying part of your job?

- I think the most gratifying part is when a patient says thank you. Just simply thank you that they're appreciative of the services provided. They tell, they, they express their gratitude to us. We have surveys that are done on us and patients. Right. A lot of accolades not just for me but for a lot most physicians in the, in the office and the whole cancer center as a whole. And we really, really try to bring a bright place for someone that's going through a catastrophic illness. And

- What would you say to people that that don't know that we have a cancer center or the caliber of cancer center that we have here? I mean, you know, you think about those that have much higher name recognition or advertised nationally like Cancer Centers of America or something like that. But how would you compare what we are able to provide and and the importance of being able to get that treatment locally versus traveling?

- Well we can do whatever the high, high powered centers or tertiary care centers can do. We can deliver that care right here in your back door and you don't have to go to a tertiary care center for everything. You don't have to go to the high powered name centers for everything. We are a community based centers but we have very well trained physicians. Everyone here is board certified and you can trust the fact that they are here to deliver first class care to you. Now that being said, if it's something that we can't deliver, we do have a relationship with all of those tertiary care centers. And so we do have that and sometimes we have, we have colleagues out there and we can call them on the back end and say, Hey, you know, let me run this by you and I just wanna double check. Yeah. And I always read the national guidelines. They're we are, they are reviewed regularly. We talk about them in tumor board and we don't go astray from those national guidelines and those tertiary care centers, they're using the same guidelines that we're using. So for the most part you can receive your care right here. You don't have to travel afar.

- Yeah. And I think when receiving care, you know, such as cancer care, you don't wanna be very far from home if you can help it. No. You wanna be near your support system.

- You do

- Because you're having to go several appointments, you know, whether it's weekly or you know, more than that. I know my father-in-law received chemo here and it was just nice. I mean I know I work here but I was able to go drop in and see him while he was getting chemo and I've just known several patients that have utilized our services and you know, they're always just raving and so grateful that they were able to get that here.

- Right. It's nice to go home at the end of the day you've had a hard day of of treatment and it's nice to go home and eat your own dinner.

- Yeah. And

- Sleep in your own bed. Well not have the added expense of like a hotel or the travel. Exactly, exactly. Because that does make one weary. Yeah. But it's right here and it's the best care and we love delivering it.

- I do have a question specifically about breast cancer because I feel like just from the people in my circle that I'm seeing more younger women.

- I'm glad you said that 'cause I was wanting to ask that too.

- Yes. That are testing positive or you know, having breast cancer like even into their twenties. I've had, you know, friends that were around my age 29, you know, and having to have all these treatments and I mean do you know anything like medically, like why that could

- Be? What would be attributing

- The so prevalent or any, any about

- That? I think that the whole diagnosing early is, is an evolution of education. I think that we are more aware of breast cancer when Susan G. Coleman came out and and American Cancer Society and then they realized, hey women are being diagnosed at late stages. We need to get on this early. And so with the education that's out there with social media that's out there with the television and the advertisements and October being breast cancer awareness month, it's advertised everywhere. And so I just think that people are more educated about the disease process. I think that we're more aware, I think that the world in general has been made comfortable to talk about

- Yeah.

- Screenings in breast cancer. And so that makes it more amenable. One of the fallacies it's screening for breast cancer is that the technology we have is good, but the, it doesn't work very well with the density of the breast. And younger women have more dense breast tissue. That's why they say start at age 40 for the screen.

- I was wondering why, like why they haven't decided to lower it just because there's been more. But I, the ones that I know that have been younger have typically found because they've felt something and Yes.

- Yes. And it's hard. The technologies that are available work better with less dense breast tissue. But hopefully on the horizon there are new, new, there's new, there's new, I think it's a three DM mammogram that's coming out now. And so that may help. And now we've incorporated the MRI, we're using ultra ultrasound much more. And then we're educating patients on doing self-breast exams. You have to do a self-breast exam. You do it once a month, you go to your clinician, they do it for you as well. And then you, you start with your screenings earlier. Yeah. But if you feel something I go get it worked up, just don't blow it off as oh I'm 20 or I'm 25 and I can't possibly have that. You know, because cancer does not follow the textbook.

- Yeah. And worse, worse comes to worse. I mean, best news is nothing and then

- You never

- Have to worry about it.

- Yes.

- Worst case it is something. But you identified it early.

- Yes. Yes. I had that case with my very best friend. Shout out Katie, we've been friends since we were kids, but she has a family history of fibroids in her breasts. So she, at 24, 25 maybe felt a lump and immediately went and had, you know, her doctor look at it, they did ultrasound, they did the, what do you call it? Biopsy. Where they biopsy test the biopsy. The biopsy, everything came back normal. It was just a fibroid. But I mean at that young, you know, you think, oh this can't be Yeah breast cancer

- But, but fibro adenomas are very common in young breast tissue. And so you just have to be aware

- Yeah.

- Of that. And like I said, education is key, but going to the doctor, figuring out what it is, being early on helps. No, and you'd rather, I'd rather pay and find out it's nothing. Didn't have a monstrosity. Right. Just, yeah. And find out that it's something later on.

- Well and because the treatment is so much less, if you can catch it earlier.

- Right, exactly. The tools that you have to utilize benefits. Yes. Oh, you asked earlier another advancement for breast cancer. You know, we're doing more breast conserving therapy now. Now what they're doing is they are just removing the mass more and they're taking a little tissue around that. And then you follow that up with radiation therapy. Okay.

- As as opposed to like a total mastectomy or

- It says to versus doing a mastectomy. The convention now is to try to save the native breast tissue if you can. And what the beauty of that is is having breast conserving therapy, that's what it's called, breast conserving therapy has the exact same outcome as a mastectomy. But when you, you don't have to go through the big major surgery. Yeah. And even though you get a mastectomy and you think, oh I'll just have my breast removed and I won't get this, you can't remove all the breast tissue. When you do a mastectomy, you remove the majority of it. But remember it only takes one cancer

- Cell. Yeah.

- One breast cell to change to wreak havoc. So, but the outcomes of having a mastectomy is exactly the same as having, we call it a lumpectomy or a partial mastectomy or removing the tumor with a little normal tissue around it and adding radiation therapy onto that. You have the exact same outcome as you would.

- Well that's good to know because I had no idea. I've seen women just, you know, I'll just get them completely removed. Yeah. Because you think that it can't happen again. But I didn't know that that was still possible. It is

- Possible. Well I know Derek and also depending on what they find out, pathologically doesn't negate the fact that you might not need radiation if you had a mastectomy as well. So you just have to be, be patient with yourself.

- Well and that's what having a team such as yourself on it, you're not expected to know everything as the patient. That's what your team is there for to help guide you through that. And that definitely gives confidence to the patient to know that we have a whole team of providers that are really focused on the best outcomes for them. Yes. We have, we do every year patient testimonials during breast cancer awareness month where we'll take like four usually and share one every week. But I'm always in awe of those patients, like their stories and just their strength and mental fortitude that they have going through that. I mean it always just like almost brings me, brings me to tears some of their stories because nobody wants to have to go through that. But they always come out just like so strong and just so, just with so much power. Anyways, I don't know, I just think that's really cool. So if you have not heard or if you want to read some of those stories, we always have those on our website. But I would also echo that you probably you it just for inspiration if you are going through breast cancer diagnosis or you know, wanna kind of hear from others and get that support group. Because I feel like that's probably equally important is having a good support group.

- Very good.

- And we do have cancer support groups at our cancer center. We have that information on our website under our events as well. So thank you Dr. Holmes for joining us today. Thank you for having me. I have one last question. I know we need to wrap up 'cause we're getting close to our time. But I wanted to ask, what is your favorite meal to eat here? Either in the spice or the cafeteria?

- They got rid of my favorite meal.

- Oh, no, no. Well, hey, they might bring it back. Tell us what it was. We have pool around here. We know who comes up with the

- Menu. I, it's very bad, but it was my guilty pleasure and it was a grilled hot dog.

- Oh, did they just get rid of hot dogs all together?

- They kept the corn dogs, but

- Oh, okay. We might that happen. We'll have to talk to somebody about, I think we can figure that out. I think we can probably make that happen. But

- It was my guilty pleasure. I'm not supposed to have it, but I, but I Do you have a

- Backup now? Do you have another can? Grilled cheese with bacon grill. That's my

- Other.

- Nice, nice. That's good. You gonna have some good comfort back. If you're stressed out, you can go over there, can get you something to help at the

- Spice.

- Yes. Yes, yes.

- Well thank you again for joining us. Thank you everyone for listening. And if you like the show and you wanna hear more, please like and subscribe so you can get those episodes downloaded and stay up to date with what's going on with us.

- Yeah, and if you need more information about the Pearlman Cancer Center or Dr. Holmes, we will provide her information below so that you can learn more. Thank you.

- Thank you.