Remembering Famed Film Critic Roger Ebert 10 Years After Passing From Cancer: The Incredible Advancements in Head And Neck Cancer Treatment

In addition to being named an honorary life member of the Directors’ Guild of America, Ebert has written over 20 books and worked as a Lecturer on Film for the University of Chicago extension program from 1970 until 2006, according to his website.

Ebert, who was married to his wife Chaz Hammelsmith from 1992 until his death in 2013, was first diagnosed with thyroid cancer back in 2002.

Then, one year later, he was diagnosed with salivary gland cancer. He eventually lost the ability to speak, eat, and drink in 2006 after undergoing jaw cancer surgery, where he lost a significant portion of his right jaw, according to History.com.

Despite his health struggles Ebert continued working, writing, and blogging for his own website all while maintaining a positive outlook on life.

In an interview with The Guardian, Ebert was asked how he’s maintained such an optimistic attitude, especially in his book “Life Itself: A Memoir.”

“I nearly died and lost the ability to speak, eat and drink,” he told the news outlet. “Those points are low enough for me. But it’s true I am an optimistic person and try to deal with situations in a straightforward and positive way. It also helps that I have been lucky enough to live a generally cheerful life.”

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He also expressed how grateful he was to still be able to write, following the loss of his voice in 2006.

“I was always a writer,” he explained. “In grade school, I published a little neighborhood newspaper. I was a professional journalist on a daily paper before I was 16. It’s what I do. The fact that I can still do it is a great compensation after losing my speaking voice.”

The University of Illinois graduate, who is survived by his wife, two step-children, and two step-grandchildren, even wrote about his surgeries that affected his love of eating in a blog post.

“I was never told that after surgery I might lose the ability to eat, drink and speak. Eating and drinking were not mentioned, and it was said that after surgery I might actually be able to go back to work on television,” Ebert wrote in a blog post titled Nil by Mouth. “Success in such surgery is not unheard of. It didn’t happen that way. The second surgery was also intended to restore my speaking ability. It seemed to hold together for awhile, but then, in surgeon-speak, also ‘fell apart.'”

“A third surgery was attempted, using a different approach. It seemed to work, and in a mirror I saw myself looking familiar again,” he explained further. “But after a little more than a week, that surgery failed, too. Blood vessels intended to attach the transplanted tissue lost function, probably because they had been weakened by radiation. A fourth surgery has been proposed, but I flatly reject the idea.”

Ebert continued, “During that whole period I was Nil by Mouth. Nobody said as much in so many words, but it gradually became clear that it wouldn’t ever be right again. There wasn’t some soul-dropping moment for that realization. It just…developed. I never felt hungry, I never felt thirsty, I wasn’t angry because the doctors had done their best. But I went through a period of obsession about food and drink.”

Understanding Head and Neck Cancer

When talking about the cancers Roger Ebert battled, "head and neck cancer" is a broad term encompassing a number of different malignant tumors that develop in or around the throat, larynx, nose, sinuses and mouth, according to the American Society of Clinical Oncology (ASCO). Oral cancer is the most common type of head and neck cancer.

ASCO estimates that an estimated 66,920 people (49,190 men and 17,730 women) will be diagnosed with head and neck cancer this year. In the United States, these cancers account for about 4 percent of all cancers.

The two main risk factors for this group of diseases include the following:

• Tobacco use. This is the single largest risk factor for head and neck cancer with researchers estimating that 70 to 80 percent of head and neck cancers being linked to tobacco use. Also worthy of note is that secondhand smoke may increase a person's risk of developing head and neck cancer.
• Alcohol use. Using alcohol and tobacco together increases your risk even more.

"Head and neck cancer patients, we know that tobacco smoking is a risk but also heavy alcohol use," Dr. Jessica Geiger, a medical oncologist specializing in head and neck cancer at Cleveland Clinic Cancer Center, previously told SurvivorNet. "So, drinking more than two or three drinks if you're a man per day, in addition to smoking. Smoking and alcohol are sort of additive carcinogens. Especially in cancer of the larynx or the voice box, we know that drinking heavily, heavy alcohol use, is just as important of a risk factor as tobacco smoking is."

Other factors that can increase your risk of developing a head and neck cancer include the following:

• Prolonged sun exposure. This is especially linked to cancer in the lip area, as well as skin cancer of the head and neck.
• Human papillomavirus (HPV). Research shows that infection with HPV is a risk factor for head and neck cancer. Nearly every sexually-active person will get HPV at some point in their lives, but most people with the infection do not know they have it and never develop symptoms or health problems from it. The virus is spread via sexual activity and can manifest as warts on your genitals or mouth. Thankfully, we have three types of HPV vaccines that can reduce the rates of certain cancers.

Why the HPV Vaccine is so Important in Preventing Cancer

• Epstein-Barr virus (EBV). Exposure to EBV, which is more commonly known as the virus that causes mononucleosis or "mono," plays a role in the development of nasopharyngeal cancer.
• Gender. Men are two to three times more likely than women to develop head and neck cancer. However, the rate of head and neck cancer in women has been rising for several decades.
• Age. People over the age of 40 are at higher risk for head and neck cancer.
• Poor oral and dental hygiene. Poor care of the mouth and teeth may increase the risk of head and neck cancer.
• Environmental or occupational inhalants. Inhaling asbestos, wood dust, paint fumes and certain chemicals may increase a person's risk of head and neck cancer.
• Marijuana. Research suggests that people who have used marijuana may be at higher risk for head and neck cancer.
• Poor nutrition. A diet low in vitamins A and B can raise a person's risk of head and neck cancer.
• Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). Reflux of stomach acid into the upper airway and throat may be associated with the development of head and neck cancer.
• Weakened immune system. A weakened immune system can raise a person's risk of head and neck cancer.
• Exposure to radiation. Exposure to radiation is associated with salivary gland cancer.
• Previous history of head and neck cancer. People who have had one head and neck cancer have a higher chance of developing another head and neck cancer in the future.

Treatment for head and neck cancers vary, but it generally involves a many-sided approach.

"The treatment of head and neck cancer and to cure head and neck cancer, it involves multiple specialties, radiation oncology, medical oncology, nutrition, speech and language pathology to make sure that patients are swallowing appropriately and getting their nutrition in," Dr. Geiger said. "All of us need to work together as a cohesive team in order to make that happen."

Dr. Geiger also says it can be difficult for some patients to get through treatment, but there are people out there to help.

"It can be a challenge to get them through treatment," Dr. Geiger said. "However, by the time I see them, they've already been diagnosed with cancer and so, I, in addition to being a medical oncologist and giving chemotherapy and following patients through their treatment, I also tell them that I serve as their cheerleader. I'm there to coach them through treatment."

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Another thing to consider when thinking about head and neck cancer patients or any cancer patient for that matter is their mental health. Dr. Geiger says it's not uncommon for head and neck patients to "feel depressed or down," and a good support system will be key for their cancer journey.

"It's important for caregivers and support that patients have either a spouse or a close family member, or friend or relative to help get them through treatment as well," Dr. Geiger said. "No one can get through treatment for head and neck cancer on their own. It really does take a community. Not just with the medical professional staff but also caregivers and support at home."

Currently, there are no screening methods for head and neck cancer that have been proven to improve patient outcomes. Even still, it's important to be on the lookout for signs and symptoms of the disease and report them to your doctor should any appear.

Advancements in Therapy for Head and Neck Cancers

In recent years since Roger Ebert was diagnosed with his cancers, proton therapy has been used as an alternative to standard radiation, particularly in more sensitive areas like head and neck cancers and lung cancer. (Protons are positively charged particles found in the nucleus of atoms.)

Different from X-rays, protons are very heavy, and they lose speed quickly. Physicians can better control where the proton releases most of its energy so that the radiation stops at the target, resulting in fewer side effects compared to radiation. Basically, it spares surrounding tissue.

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The American Society of Clinical Oncology (ASCO), says that proton therapy, which is often more expensive than standard radiation, delivers “60 percent less radiation to healthy tissue around the target site, while delivering a higher dose to the tumor itself.”

"Traditional X-ray therapy and the newer proton therapy are both types of radiation," Dr. Keith Cengel from the University of Pennsylvania told SurvivorNet in an earlier interview. They destroy cancer cells by damaging their DNA, or genetic makeup.

Radiation Therapy What's the Difference Between X-Rays and Protons?

Dr. Cengel explained further, "X-rays are kind of like a bullet. As they pass through a person, they cause the most damage right under the skin. They keep on passing through your tissues and eventually exit the body. That's why they can often damage healthy cells along with the cancer cells.”

Proton therapy, which has actually been around for decades but became FDA-approved for use in the U.S. in the late 80s, is ideal for patients whose cancer has not yet spread to other parts of the body. Meanwhile, there is some debate about whether proton therapy is necessary given its cost and its limited availability.

"The second-generation proton therapy that's becoming more common in the United States is called pencil beam scanning proton therapy," Dr. Charles Simone, the Chief Medical Officer of the New York Proton Center, previously told SurvivorNet. "That allows us to really decrease the amount of radiation that's being delivered before the tumor, still has the advantage of stopping at the tumor, but then we can really sculpt our radiation dose to exactly the shape of the tumor."

Dr. Simone doesn't think that protons are more effective at killing the tumor, but they may be able to give higher doses by reducing side effects to other areas. For example,  people who have difficulty swallowing following radiation is related to "how much radiation is going to the esophagus."

The Benefits of Proton Therapy

FDA Approves Immunotherapy Drug Keytruda For Some People With Head and Neck Cancer

Following a late-stage trial that showed the beneficial effects of an immunotherapy drug called Keytruda on some head and neck cancer patients, the Food and Drug Administration (FDA) has approved the drug for those patients.

The FDA said recently that Keytruda can be used either alone or in combination with a common chemotherapy regimen for patients with relapsed head and neck cancer. Keytruda itself is an immunotherapy drug, meaning it uses the body's own immune system to attack the cancer.

Keytruda is already approved for some types of cancer including lung and skin cancer, and is provided by the pharmaceutical giant Merck & Co Inc. It was first approved for melanoma in 2014, and has been a driver of growth for the company.

Merck & Co. known as MSD outside the US and Canada, also sponsored the trial, which involved 206 research centers worldwide.

"The study is important because it's the first study where patients with metastatic head and neck are being randomized to receive immunotherapy or immunotherapy and chemotherapy together. It's the first time immunotherapy has been tested in this setting," Dr. Charu Aggarwal, an assistant professor of Hematology-Oncology in Penn's Abramson Cancer Center told SurvivorNet after the trial was revealed.

Usually, patients with relapsed head and neck cancer are treated with a combination of two chemotherapy drugs and a targeted antibody. A targeted antibody is a drug that blocks cancer cell growth my interfering with specific targeted molecules, and the chemotherapy component is aggressive to the point of being characterized "extreme."

Contributing: SurvivorNet Staff

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