The Good Fight

They could not do it alone, of course. Chances are if someone is stricken within the New York tri-state area, they look to Manhattan’s Memorial Sloan-Kettering Cancer Center for an opinion, be it first, second or beyond. Most are on a first-name basis with the hospital, and “Sloan” has become a home away from home to those who have the misfortune to know better.
Two of the doctors devoted to helping cancer become less welcome are Dr. Eileen M. O’Reilly and Dr. Richard O’Reilly. Besides sharing a name (they are not related), the two doctors share with their colleagues at MSKCC the same devotion to eradicating cancer. It is a tall order, but this is where the best go to take on the worst.
At MSKCC, that challenge is met by a hope that science will indeed prevail. Along with a staff that devotes much of its time to research and using the facilities of two hospitals that combined in 1960, doctors and specialists are able to arm themselves well for the battle.
Dr. Eileen O’Reilly arrived from Dublin in 1995 ready for the challenge. A fellowship with MSKCC held the promise of an unrivaled experience in her chosen field.
Having received her M.D. from Trinity College, she gained work experience during a residency at Dublin’s St. Vincent’s Hospital. After her fellowship with MSKCC, she was made a full-time staff member in 1997 as a medical oncologist. She now she splits her time between seeing patients and doing research with clinical trials.
It was not until she looked after malignancy patients that she wanted to go into the field of oncology. Under the tutelage of Dublin doctors Peter Daly and John Crown, who, she said, “helped enormously,” she found her passion in treating patients with gastrointestinal cancers, and now is deeply involved fighting pancreatic cancer.
The numbers are grim. According to the American Cancer Society, this year about 31,860 people in the U.S. will be found to have pancreatic cancer and about 31,270 will die of the disease. It is gaining more attention because of its inability to cure.
“It is a particularly difficult cancer to diagnose and treat,” she said. “There is a desperate need for particularly different kinds of treatment.”
MSKCC sees about 500 pancreatic cancer patients a year, and Dr. Patricia O’Reilly sees three to six of those patients a week. It is here that she is able to put a face to the disease while working at one of the largest referral centers in the country for this type of cancer.
“For a rare disease, it is common enough,” she quipped.
The picture is bleak for many those diagnosed, and the numbers even more so. The survival rate is about 4 percent, according to National Institutes of Health, and it is the fourth leading cause of cancer deaths in men and women.
The fatality rate is high because pancreatic cancer is usually late in its presentation, when it is either advanced or had spread.
“There is no good way to screen at this time,” she said. “If we could pick out what to screen for, we could change things, but the current screening processes are relatively crude.”
She said that new focus has been placed on clues, like heredity, and while genetic testing is under way, methods being developed through clinical trials and other research.
There is a lot of hope vested in the work of Dr. Richard O’Reilly as well. As chairman of the Department of Pediatrics and chief of the Bone Marrow Transplant Service that he created at MSKCC more than 30 years ago, he deals with the tiniest of people with the largest of possibilities.
The Brooklyn native notes that “there has been a demonstrable increase” in the instance of cancer in children, though he notes that it may be in part attributable to improved screening techniques and cancer having something of a high profile.
MSKCC sees a large number of children and, luckily, the doctor said, cure rates for them are fairly good.
After receiving his M.D. from New York’s University of Rochester, Dr. Richard O’Reilly went on to residencies at the University of Minnesota Hospitals and Children’s Hospital Medical Center in Boston, where he found his stride working with children.
He arrived at MSKCC in fall of 1973 and claims “never in my fondest nightmares” did he think we would still be there.
Since beginning the marrow transplant program, which is used in both adults and children, it has become one of his major accomplishments. The doctor, who has clinical expertise in many areas of pediatric oncology, is especially concerned about hematological diseases.
While working at MSKCC, he has implemented new techniques to bone marrow transplants, making them one of the most effective treatments for such cancers. These include using unrelated donors, as well as a mix of conventional therapies and specialized ones to help eradicate cancerous cells while upping the chance that there will be no graft-versus-host rejection or disease during the process or recovery.
These types of approaches have been promising, and enable him to look back as the progress made.
“It is a very different time from when I began as a resident,” he said. “I was told it was unethical to believe a child could be cured of leukemia,” he recalled, noting how today it is one of the most curable of childhood cancers.
“Still, it’s tough slogging,” he admitted.

“Extraordinary place”
Dr. Eileen O’Reilly said it was that challenge of dealing with a difficult disease that led her to take advantage of working with MSKCC’s “cutting-edge science and genetics, as well as the opportunity to look out for patients.”
What makes the care at MSKCC possible is due in no small part to the facilities available.
“We’re lucky here,” said Dr. Richard O’Reilly. “It is a very extraordinary place to be, and amazing in that it is focused on getting rid of cancer.”
He talked about the importance of the team effort that anyone who works in the building contributes to.
“A lot of people here are doing more than a vocation,” he said. “These people strive for that which is better.”
For Dr. Eileen O’Reilly, dealing with a largely fatal cancer makes her research even more pertinent. For the last decade, cases of pancreatic cancer have increased slightly, though most likely due to people being more aware of the disease.
As a medical oncologist, she treats patients, but also devotes about half of her time to research. And because there is no FDA-approved treatment in place yet, everything her colleagues do is experimental.
While trials and tests are being played out in the labs, the public can benefit from advocacy on the part of those in the public eye.
Former President Jimmy Carter has had numerous family members with pancreatic cancer and has been a leading voice for testing and donations, as has Marc Lustgarten, a former Cablevision executive who had a foundation set up in his name before he died.
The public perception is still spotty, however, and Dr. Eileen O’Reilly hopes good comes out of her research of clinical drug trials, which are increasingly becoming a source of potential treatment.
Doctors are studying trials in all phases of completion to tell the best drug dosing, the schedule, and how beneficial they are.

Stem cells
One hot-button issue that could have a potential affect on cancer treatment is stem cells. Because cancer affects such a large number of people, there is little surprise that the heated debate has become an issue for those treating it. Ethics and science have clashed long before the advent of modern medicine, and just last month a County Down mother announced to be carrying a so-called “designer baby.” The child was conceived to donate stem cells after it was found to be a match for a sick sibling, in this case, one with a rare blood disorder.
The controversial embryo screening process that determines this is legal in the UK, but not in the U.S., yet councils have been set up be different states as well as the federal government to explore such options for treating diseases.
Dr. Richard O’Reilly implements adult stem cells in his work today, a new technique in which stem cells are obtained from a patient’s blood and used in bone marrow transplantation.
He feels there is room for the more controversial end of embryonic stem cell testing to be explored, having seen the success with adult donations.
“The primary focus is on cells that can produce all types of blood and cells,” he said.
While Dr. Eileen O’Reilly does not foresee stem cell research implemented in her work with gastrointestinal cancers, she predicts that things will change.
“It is hard to see what can happen now,” she said, “and it seems that it might be more tangible in hematological cancers.”
In other words, the work that Dr. Richard O’Reilly does.
“There are a lot of animal models that tell of the potential,” he said. “There is a lot to be learned.”
He said there is potential to see how early fetal cells can affect cancer growth, but time will have to tell.
“We have to learn the language of controls,” he said. “But we are in the position to affect severe diseases.”
The tough road of treatment often involves more than medicine, however. Ask any doctor, and the essence of his or her work is often the connection that patient and doctor develop over time while fighting a difficult disease.
Dr. Richard O’Reilly gives his small charges a lot of credit.
“Children are a generally optimistic crowd,” he said. “I am always amazed at how smart they are, and how they respond to a different approach. They are generally pretty wise.”
As can be expected with most goals worth aiming for, the good breaks can be very good, and the bad ones, very bad.
“Good things do happen and the small breaks are great,” according to Dr. Eileen O’Reilly. “It is why I love looking after patients. It may seem hard at times, but is well worth it.”
“Adults will say less about themselves,” added Dr. Richard O’Reilly. “But kids’ communication skills are amazing, how they get pieces of information.”
There are, of course, the unhappy endings. To Dr. Richard O’Reilly, to lose a patient is a sad affair, but, he said, “you get to see the parent and child relationship, and it is amazing how much love children can engender.
“You can feel pretty low,” he admitted, but added that, as doctors, “we get a chance to see a level of humanity, between child and parent, that is extraordinary.” For him, it is all the encouragement and demand to do better that one needs.
Dr. Eileen O’Reilly pointed out how it is rare in an instance of cancer that as a physician you are dealing with one sufferer.
“You are never just treating a patient, but their entire family,” she said.
Concurred her colleague, “If you’ve dealt with a patient for a long time, there is always a fair amount of sharing.”