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Rosalie C. carries an iPad with a message that she sees each time it awakens, helping inspire her through the good times and the bad: "Life isn't about waiting for the storm to pass. It's about learning to dance in the rain."

She isn't sure what her future holds â€" it's in God's hands â€" but she can tell you confidently now her immediate plans: Dance in the rain every day.

Rosalie and her husband, Larry, will leave Florida soon, returning to their farm outside Ft. Wayne, Ind., to start planting spring crops, fully expecting to return again to the Sunshine State after the late-fall harvest.

Her diagnosis of malignant pleural mesothelioma in 2011 may have altered their retirement strategy, but it hasn't stopped them from living life on their terms.

"You know that song by Tim McGraw, 'Live Like You Were Dying?'" she asked from their new winter home on Florida's west coast. "Well, we decided to just live like you are living. And I think that's a pretty good way to be."

Once childhood sweethearts, the couple celebrates their 50th wedding anniversary this fall. Rosalie and Larry, whose last name is being withheld because of privacy concerns, are still inseparable and still so much in love, determined to fight this disease together, holding hands, and encouraging each other like they always have. She was 16 when they met and 17 when they married. She turns 67 in April.

"We have been together forever," she said.

Driving Cross Country to See Sugarbaker

Just days after her original diagnosis â€" in the midst of the fall harvest â€" he left the farm suddenly and drove her 850 miles to Boston to see renowned mesothelioma specialist David Sugarbaker, M.D., whose schedule had a last-minute opening.

They returned to Boston three weeks later for the aggressive extrapleural pneumonectomy surgery that left her with one lung, a rebuilt thoracic cavity, and a long road to recovery â€" needing Larry more than ever before.

Larry became her primary caregiver, learning to do things he never thought he could do. He was nurse, housekeeper and cook all rolled into one. He hasn't missed many chemotherapy sessions, either.

He grows emotional when speaking about her illness. She takes the phone and finishes. She worries more about him, than she worries about herself. They both know the odds are long. But after 50 years together, anything is possible.

"I really believe if we had stayed in Indiana, where they really didn't know how to treat this disease, and not gone to Boston, I wouldn't be here today," Rosalie said. "I've been so lucky through this. We've had unbelievable support, from friends, family and church. I've never really been scared, because I know it is in God's hands. And I know where I'm going if something happens."

They See a Future in Florida

They bought their winter villa in Florida last summer after renting for several years, deciding the time was right because she was feeling so much better. The past few months have been wonderful, adding memories to the life they have shared.

While their Indiana home has been buried in snow, they have basked in the Florida sunshine together â€" 1,100 miles away.

They walk on the beach. They walk the dog together. She weaves her baskets that will become Christmas gifts this winter. She shops. They talk regularly by phone to the children and grandchildren back home.

"We're having a great time right now. Everything seems perfect. You never know when the bubble is going to burst, but you just can't live being a pessimist," she said. "I've been so fortunate in so many ways."

She is thankful for registered nurse Karen Selby at The Mesothelioma Center. Selby originally recommended they call Sugarbaker, who assisted them early in the process.

Rosalie raves about the way she was treated at the Brigham and Women's Hospital in Boston, from Sugarbaker in surgery and the doctor who brought her Halloween candy, to the nurse who got soaked helping her in the shower and the way others treated her whole family.

Life Is Good Again

While the first year and a half after diagnosis was a struggle â€" follow-up surgery was needed, traces of cancer returned, chemotherapy was tough â€" the last year has been considerably better.

"Things are going so well now that I almost feel guilty, but I also know it can change at any time," she said. "I remember telling Dr. Sugarbaker I was going to be one of his long-term survivors. And I still feel that way. I know now you can live with one lung. When I'm sitting in a chair, I don't feel any different than I ever did. I'm limited a little, but I'm doing just fine."

She is looking forward to springtime in Indiana, seeing the corn and the soybeans growing again on the family-run farm. She'll see it from a distance, watching the grandkids swimming in the pond out back, enjoying the day.

"A year ago, I didn't think I'd ever make it back to see the Gulf ever again, but I turned the corner," she said. "I've never had that 'why me feeling.' I've always said, 'why not me?' This kind of thing happens to a lot of people. I'm not worried."

She looked down at her iPad and saw a Biblical passage from Matthew 6:34 that she keeps close to her heart: "So do not worry about tomorrow, for tomorrow will care for itself. Each day has enough trouble of its own."

"I don't worry about what could happen in the future," she said. "We're enjoying ourselves today."

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Dr. Stevens Wants Beaumont to Be Midwest Leader in Mesothelioma Treatment

Craig Stevens, M.D., has heard too many stories about patients with mesothelioma leaving Michigan to seek treatment elsewhere, searching for the best, specialized care they could find.

He wants to stop that exodus by making the Beaumont Cancer Institute in suburban Detroit the best regional center for mesothelioma treatment.

Stevens is the recently-appointed chairman of the Radiation Oncology Department at Beaumont. He is a pioneer in the use of Intensity Modulated Radiation Therapy (IMRT) and a specialist in the treatment of pleural mesothelioma, a rare and aggressive cancer.

He wants to build and integrate a new specialty program for this asbestos-related cancer with an already acclaimed multidisciplinary lung cancer program at Beaumont. It's one of the major reasons he left the Moffitt Cancer Center in Tampa.

"There is no real [mesothelioma] program in the state like what we're putting together," Stevens told Asbestos.com. "Everyone is enthused about this. When you think about the best mesothelioma treatment in the country now, you think about New York, Boston and Houston, but really nowhere in the Midwest. We can change that here."

Michigan Ranks High for Mesothelioma Incidence

Michigan ranks 9th among the 50 states with the most asbestos-related cancer deaths, according to data from the Centers for Disease Control and Prevention. The auto industry, once huge in the state; the shipping industry on the Great Lakes; and a past reliance on manufacturing all play a role in Michigan's prevalence of the disease.

The cancer is caused by exposure to asbestos, which was used extensively in those industries.

"There is a need in this state for a real mesothelioma program, when you think about the jobs and industry here, the number of brake pads that were produced and handled here," Stevens said. "Beaumont already is a preferred place to be treated for any number of diseases. We need this to be a place where a patient with mesothelioma can get the finest care possible."

Emphasis on Multimodality Approach

Stevens' goal at Beaumont is a center with a multimodality approach, where aggressive surgeries can be combined with state-of-the-art radiation therapy, and the latest in chemotherapy treatments. He wants to have an experienced mesothelioma specialist in each of those disciplines, meeting regularly to discuss cases. Clinical trials involving immunotherapy also will be available.

Although mesothelioma has no cure, and often still comes with a grim prognosis, some patients at the big specialty centers are living longer than ever before, reaching 2, 3, 4 and 5 years after diagnosis.

"You need to have enough experience with this disease to know how to handle it best. Patients can do well with it if managed properly," Stevens said. "If it's not treated correctly, which happens too often in many places, the results are not good."

Beaumont already has several multidisciplinary programs designed for cancer patients. They combine a comprehensive clinical, academic and research approach, delivering oncological services that are second to none.

The National Institutes of Health regularly rank Beaumont among the top cancer centers in America. The Cunnington Family Comprehensive Lung Cancer Center at Beaumont boasts renowned experts in thoracic surgery, pulmonology, nuclear medicine, and diagnostic and interventional radiology.

The radiation oncology department is known for its innovative treatment and advanced technology, a big reason they wanted Stevens to lead the staff. Beaumont helped develop high-dose brachytherapy, image-guided radiation therapy and hyperthermia therapy.

Stevens brought years of experience as a leader in the field, too, first at the University of Pennsylvania and then at M.D. Anderson Cancer Center in Texas.

Stevens a Radiology Leader

He spent almost a decade at Moffitt, where he was department chair of radiation oncology, focusing on thoracic cavity diseases. He worked on thoracic oncology, radiation oncology and experimental therapeutics programs, always looking for better ways to fight different cancers. At Moffitt, he wrote a lengthy article titled "Personalized Treatment Approaches in Radiation Oncology: The Future is Now," urging colleagues to look toward newer and better therapies.

The goal of IMRT is delivering the maximum radiation doses to the cancer cells without hurting the healthy ones nearby, a process that works well with mesothelioma patients. He also is following closely a novel radiation delivery system being used in Toronto with surgical patients that is experiencing notable success.

"Until there is a cure for this disease, we should encourage people to try new things, be as creative as we can," he said. "We're always looking for novel ways to get better at treating this disease. That's what we want to do here."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Cerfolio Leads the Charge for Robotics in Thoracic Surgery

Just a few years ago, renowned thoracic surgeon Robert Cerfolio, M.D., was one of the biggest robotic surgery skeptics, discounting the notion that a computer-controlled system could perform a precise operation in the chest better than he could as absurd.

He is now its biggest proponent â€" taking a 180-degree turn.

Cerfolio, the chief of thoracic surgery for the University of Alabama at Birmingham Health Care System, has performed more robotic thoracic operations using the da Vinci Surgical System in the past four years than anyone in the world.

Robotic surgery involves tiny instruments attached to a robot remotely controlled by the surgeon at a computer board. While urologists and gynecologists have been using it for more than a decade, only in recent years have thoracic surgeons utilized it.

Robotics for Mesothelioma Patients

Cerfolio uses it to simplify the diagnostic and staging process, making it less invasive and more accurate for his patients.

"It's about getting the diagnosis correct and treating people with small incisions and scopes," he told Asbestos.com. "Too many surgeons will do a thoracotomy and spread the ribs of [mesothelioma] patients when they don't need to do that."

In March, Cerfolio lectured on robotics at the Fox Chase Cancer Center Advances in Thoracic Oncology Conference, which is aimed at medical professionals involved in the management of thoracic malignancies. Karen Selby, our staff nurse at The Mesothelioma Center, also attended the seminar.

Although many established surgeons remain dedicated to Video Assisted Thoracoscopic Surgery (VATS) and open chest lung surgeries, Cerfolio is determined to convert them. The da Vinci robot can be used for wedge resections, lobectomies and lung biopsies, all of which are done on mesothelioma patients.

"I'm convinced absolutely that robotics is the way to go. My initial opinions were all wrong," Cerfolio said. "I've been honest, and changed my practice. You have to be a man, and admit you were wrong. Most surgeons won't do that. They won't admit when they're wrong."

Too Many Positives to Ignore

Cerfolio, now 52, didn't do his first robotic surgery until 2010, well after others had started. He performed more than 1,000 robotic surgeries in 2013. He is known for his robotic pulmonary resection and using robotics for esophageal surgery. Making the change wasn't easy, particularly because he already was good at what he did. Yet, it was a chance to get better.

It was impossible to ignore the advantages of robotics:

• Improved visualization
• Less painful, quicker patient recovery
• Improved instrumentation
• More complete lymph node dissection
• Easier teaching tool

"Change is hard to do when it's not forced upon you. I can't tell you as a surgeon how hard or difficult that is. It's just going out of your comfort zone," he said. "It's like you're a golfer shooting 70 and winning tournaments, but now you have to go back to the driving range and learn a new grip, then shoot 80-82 for six months. The idea, though, is that eventually, you're shooting a 66."

Many thoracic surgeons have been slow to adopt the robotic platform. The equipment is complex and expensive, eliminating it as an option for many small medical centers. It requires not just a surgeon to embrace the technology, but an entire staff that must train alongside that doctor.

It Takes an Entire Team

"You're a pitcher, but you're only as good as your shortstop and second baseman," Cerfolio said. "If your nurse is having a bad day, you're a bad surgeon. If the anesthesiologist is struggling, you're a bad surgeon. It requires everyone going through the same pathway."

He believes that more study data will be released soon, providing more evidence that lung cancer patients will be better served by robotics than with VATS or open chest operations. Lymph node resections will be more complete. Survival rates will be higher. Patients will recover quicker from less painful procedures. The robotic technology is rapidly improving, too.

"It doesn't take a rocket scientist to figure this out," he said. "We need to do a better job of helping our patients and learning from our mistakes. Robotics can do that. It can make better surgeons. Sometimes change gets forced upon you. And you have to evolve. That helps the patient."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Fox Chase Committing Its Best to Mesothelioma Treatment

The Fox Chase Cancer Center in Philadelphia doesn't handle as many pleural mesothelioma cases as some of the other specialty centers, but the care it provides them and outcomes it produces are second to none.

Mesothelioma cancer is a high priority.

"I don't think you can get better care anywhere else," said Walter Scott, M.D., chief of thoracic surgical oncology at Fox Chase. "We've got the experts with experience. And we've got that great support team around them."

Scott spoke at the conclusion of the sixth annual Advances in Thoracic Oncology Conference last week. The program, which included presenters from Fox Chase and other specialty centers, was aimed at medical professionals and focused on the latest advances in mesothelioma treatment. The audience included surgeons, radiation oncologists, pulmonologists, physician assistants and nurses, including Karen Selby, our nurse at The Mesothelioma Center.

Growing Hope for Mesothelioma

Prashant Shah, M.D., thoracic surgeon at Fox Chase, told Asbestos.com, "There is real reason for hope now with mesothelioma."

"We're not moving mountains, but we are making steady progress," Shah said. "There still is a long way to go, but we've come a long way, too. Attitudes [toward mesothelioma] are changing."

Shah spoke on "Strategies for Treatment of the Pleura During Surgery for MPM” (malignant pleural mesothelioma). He touched on the staging system and adjuvant therapies used at Fox; the ongoing debate on whether surgical candidates are better served by the extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D); and the future of mesothelioma treatment.

Shah and Stacey Su, M.D., handle the majority of the mesothelioma surgeries at Fox. Both trained in Boston at Brigham and Women's Hospital under renowned mesothelioma specialist David Sugarbaker.

Fox Chase, which is part of the Temple University Health System, is lauded for its multimodality treatment approach for multiple cancers, including mesothelioma. It is known as a pioneer in lung cancer treatment advances, and it's now focusing more on asbestos-related cancers.

"I think it's fair to say we've got it all here at Fox Chase," Scott said. "The care that you'll receive is better than ever. With mesothelioma, you need an experienced team that understands this disease, and we have that."

Joseph Testa, Ph.D., professor of human genetics at Fox Chase, is praised for his work in advancing the scientific understanding between mesothelioma and molecular signaling pathways, leading to immunotherapy advances currently used in several specialty centers around the country.

Conference Addresses Numerous Issues

The conference at Fox Chase also included a segment on "State of the Art: Robotic Surgery for Complex Thoracic Cases," by Robert Cerfolio, M.D., from the University of Alabama at Birmingham. He has used robotics extensively for more than a decade, though not necessarily for mesothelioma surgeries.

"Robotics is the future of surgery," Cerfolio said. "Change isn't always easy, but it's about doing what is right for our patients."

Radiation oncologist Kenneth Rosenzweig, M.D., who handles many of the mesothelioma cases at Mount Sinai Hospital in New York, spoke on "Novel Radiotherapy Approaches for MPM."

He, too, talked about the importance of experience when treating mesothelioma, a rare cancer that is diagnosed in an estimated 3,000 people annually in the U.S. It is particularly important now with the latest Intensity Modulated Radiation Therapy (IMRT), which is used in combination with both aggressive surgical options and for patients who are not surgical candidates.

IMRT â€" if delivered correctly â€" kills remaining tumor cells and reduces the risk to surrounding healthy tissue and nearby organs.

Rosenzweig also talked about the latest pre-surgery radiation done in Toronto with patients undergoing the aggressive EPP, which removes an entire lung. Neither Mount Sinai nor Fox Chase is using that radiation approach yet, but they are following it closely.

He was optimistic, yet cautious, when discussing the future of mesothelioma treatment. He is now seeing patients he first treated four, five and six years before. People are living longer than ever.

"My personal approach [to treatment], has evolved. It's tough with this disease to say we've had any big victories or that we've figured it out, but things are getting better," Rosenzweig said. "We're seeing successes."

Conferences like the one at Fox Chase, where novel therapies and recent advancements are discussed, are helping the cause. There also were presentations on immunotherapy, molecular testing and palliative care, all designed to help medical professionals help their patients.

"There still is a long fight ahead," Shah said. "But we're moving in the right direction."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Japan Study Finds Standard Chemotherapy Still Best Hope for Mesothelioma

The long-standing chemotherapy combination of cisplatin and pemetrexed will remain the front-line treatment regimen for mesothelioma patients in the foreseeable future, despite recent efforts to develop newer and more effective drugs.

Nothing better has emerged.

Researchers at the Shizuoka Cancer Center and Juntendo University in Japan recently concluded that the cisplatin/pemetrexed (Alimta) combination remains the best choice.

"It should continue to be the standard, front-line chemotherapeutic regimen for inoperable MPM (malignant pleural mesothelioma)," wrote the authors of the March study, published in Respiratory Investigation.

The medications are most effective with asbestos-related cancer when used in conjunction with surgery and radiation, but more often they are used alone with patients who are not surgical candidates because the cancer already has metastasized.

Although Alimta was not approved by the U.S. Food and Drug Administration (FDA) until 2004, it has been used since the mid-1990s after it was granted an early compassionate-use exception. It was the first medication specifically approved for the treatment of mesothelioma. It has been used for almost two decades in combination with cisplatin, and both drugs increase the effectiveness of the other.

Study Compares Chemotherapy Combinations

Gemcitabine, carboplatin, doxorubicin and vinorelbine are other chemotherapy drugs used, but often found to be less successful. More are being tested in clinical trials.

The recent study in Japan compared the combination of gemcitabine (Gemzar) and cisplatin with the combination of pemetrexed (Alimta) and cisplatin. Both Gemzar and Alimta, the two most widely used drugs, are marketed by Eli Lilly and Company and used with a variety of cancers.

The study included 30 MPM patients between 2002 and 2011, including 17 with the cisplatin/Alimta combination, and 13 with the Gemzar/cisplatin combination. Doctors analyzed the patients' medical charts for antitumor efficacy and drug toxicity.

The response rate for cisplatin/Alimta was 35 percent, but only 15 percent for Gemzar/cisplatin. The progression-free survival rate was 215 days for Alimta and 142 days for Gemzar. The median overall survival rate was 597 days for Alimta patients and 306 days for Gemzar patients.

Researchers found hematological toxicities, particularly neutropenia and thrombocytopenia, were more severe and more frequent with those in the Gemzar/cisplatin group.

Powerful Drugs

The study was in response to previous trials that showed an improvement in both response and survival rates when cisplatin (approved by the FDA in 1978) was supplemented by either Alimta or Gemzar. The study was the first to compare the two separate combinations.

Cisplatin has been used for a wide variety of cancers, both as a single-agent treatment and in conjunction with other chemotherapy drugs. As a single agent for mesothelioma, the response rate has been less than 15 percent.

Chemotherapy has been the most widely used category of drugs for mesothelioma patients, but others are growing in use as doctors and patients seek more effective treatment options.

Immunotherapy, targeted therapy, photosensitizing and anti-angiogenesis drugs also are used on various levels. Chemotherapy agents are powerful, but they attack both cancer and healthy cells, causing a variety of side effects.

Targeted therapy drugs, such as NGR-hTNF, are designed to target specific molecular alternations in cancer cells. Immunotherapy drugs are designed to help the body's immune system better recognize and attack the cancer cells. Photosensitizing drugs are constructed to make the cancer cells easier targets for particular beams of light to destroy. Anti-angiogenesis drugs help starve cancer cells and prevent them from multiplying. The newer categories of drugs are less toxic.

While the newer types of drugs have shown considerable promise, they remain in clinical trial phases, out of reach to many doctors and patients.

Researchers in Japan concede the limitations of their retrospective study â€" particularly the limited number of patients â€" but do assert the cisplatin/Alimta combination remains the best option available today.

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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