Blood cancer oncologist shares insights about our program

Facing a blood cancer diagnosis starts with finding the right team to guide you through your healing journey. At Tennessee Oncology and Ascension Saint Thomas in Nashville, Tenn. we provide cancer care every step of the way using innovative therapies and giving our patients access to live-saving clinical trials. Michael Byrne, MD, medical oncologist at Tennessee Oncology shares more about our blood cancer program and what you can expect when starting your cancer care journey with us.

Q: For those who might be new to the diagnosis, how would you explain what a hematologist does in simple terms?

We take care of people who have blood cancers. Often these people present with blood counts that are too high or too low. We guide those patients through the initial stages of the testing. We talk to them about treatment options and then we are the ones that manage those treatment options. I think a lot of the effort that we have is in supporting people after we give the treatment, whether it's controlling nausea, managing the toxicity from side effects. Supporting people after we start treatment is I think just as important as giving the treatment itself.

It's a very unique kind of relationship. They get to know us and our teams pretty well.

Q: There are many places a patient can go for care. In your opinion, what makes our blood cancer program unique?

Many people believe they have to travel to a massive university medical center to get the most advanced cancer care. Our program is unique because we provide that exact same level of expertise, including clinical trials, genetic specialists and expert pathologists, but we do it right here in your community.

We offer a 'brain trust' approach where every patient benefits from a team of specialists, called a Tumor Board, reviewing their case. We are a Center of Excellence, our team has deep knowledge in even the rarest blood cancers. Essentially, you get world-class science in a setting that is more accessible, more efficient and much more patient-friendly.

Q: Blood cancer is complex. How does your team approach a new patient's case differently than a standard general oncology practice might?

We try to understand the problem. In some cases it's easy to understand, in some cases it takes a little bit of thinking. Some of our patients have unique features that have important implications for how you manage their care and picking the right treatment is obviously an important part of getting the best possible outcome for people.

We have subject matter expertise in a particular area and this is all we do every day. We're pretty good at understanding the subtle differences that maybe some of our colleagues who see everything, who don't have that similar subject depth, might not fully appreciate or may not know what to go looking for.

Q: Walk us through the first step when a patient comes in for their initial consultation. What happens?

We take care of our patients in our clinic. They either come to us through referral from their primary care doctors or as a current patient with an abnormality that we evaluate. They also come to us with a diagnosis that we then have to come up with a treatment plan for. The process involves gathering information to make the right diagnosis, ensuring the patient is healthy enough for treatment and then discussing treatment options, including clinical trials.

We have a good clinical trial portfolio and we try to put people on trials as much as possible. We think there's always an opportunity to improve safety, improve success or both. If there's none then we have chemotherapy regimens that we can give in our clinic. Once we have the diagnosis and once we've discussed the plan with the patient, we get them started on treatment.

Q: Who else is in the room or behind the scenes caring for blood cancer patients?

The physicians, at the end of the day, are there for just a small part of that patient's care. We have case managers who can help with the paperwork, to find a place that's close to their home where they can recover. We have a nurse navigator who makes sure the medications are done and looks at a number of their other social needs. We have a chaplain who comes and rounds with us. We have a pharmacist who makes sure that the doses are correct. The pathologists are the experts behind the scenes who study the cell samples to confirm the exact diagnosis.

Recently we've been working with our hospitalist colleagues to co-manage patients so that we are able to focus more on their hematologic problem while they make sure that their heart disease, their blood pressure, their cholesterol and all of those things are being managed. Then the last part of the care team is hopefully the team that our patients will never see, and that's the ICU team and the kidney sub-specialists that are sort of the safety net for these patients.

Q: Medicine is changing so fast. What are some of the most exciting advancements in blood cancer treatment that we are offering right now?

We are now seeing advanced, targeted treatments become the first step for patients with blood cancer. That's important for a couple reasons. One is that they're very effective therapies, so we're seeing patients' response rates improve. Another exciting thing is that cancer therapies are replacing chemotherapy in some instances, so people are getting less chemotherapy or people are getting chemo-free treatments that are at least as effective if not more effective than the traditional cytotoxic chemotherapy.

Another advancement is cellular therapy, and it is huge right now. It's a growing field between T-cell engagers and CAR T-cells and we're seeing products that are getting more effective. The safety profile of the second generations of these products are very exciting. The future developments of these products are getting safer and safer. Hopefully, fewer and fewer patients will actually need to spend time in the hospital.

Q: How do we use precision medicine or genetic testing to help patients get better outcomes?

Genetic testing is an important part of understanding the disease, the complexity of the disease and the risk of the disease. It's also important because we have a lot of directed therapies now. We have therapies that work better in people that have X mutation or Y mutation. Everybody that comes in gets genetic testing when they're first diagnosed with blood cancer and then at critical parts of their care journey, like when they relapse, to see if there are different ways to target a certain genetic mutation or a certain pathway to treat them. 

Q: How are you making it easier for patients with aggressive blood cancers to get advanced treatments without leaving their community?

Within the last year, we've started our own cell therapy program that's allowed us to deliver complex therapies to our patients in the community. We've had a big push to decentralize the care at a facility or hospital setting and allow people to stay at home to receive care for as much as possible during their cancer journey.

Q: Many patients are hesitant about clinical trials. Why should a patient consider a clinical trial?

Patients should consider clinical trials because they offer early access to medications that are on track to become the new standard for treatment. I’ve seen countless cases where a patient participated in a study, only to find that their trial is now the top recommended therapy for blood cancer. It’s a wonderful opportunity to get access to 'the winners' of the future, today.

Our team of experts carefully selects every trial we offer. We ensure each study is scientifically proven and of the highest quality. In fact, we only choose treatments that we would trust for our own family members."

Q: What gives you the most hope right now regarding the future of blood cancer treatment?

The most exciting thing is the progress in cellular therapies (treatments that use your own immune system to fight cancer). Over the last few years, official study results have been released showing that these treatments are more successful and safer than ever. We are seeing success rates for patients whose cancer has returned that we simply never thought possible before.

Q: If you could give one piece of advice to a family or patient who has just received a diagnosis, what would it be?

I would say be patient during this process. Understand that the diagnosis is step one. More information may come back that helps develop a good treatment plan. Take each day as it comes, and trust the system to get it right. Pick a provider, pick a team that you trust and then put your trust in them to support you and get you through it. Come to your appointments, and let us guide you through the process.

You don’t have to navigate a blood cancer diagnosis alone. Meet the team ready to support you every step of the way. Learn more about our blood cancer program. 

This blog is intended for general informational use. Any health-related information shared is not meant to provide or replace professional medical advice and does not establish a patient-provider relationship. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room.