Dr. Higano is a medical oncologist who specializes in treating prostate cancer.
Communication is a key element in the physician-patient relationship. I enjoy the challenge of educating patients about their disease and treatment options. Maintaining or improving quality of life should be the goal of any treatment modality.
Genitourinary oncology including prostate, bladder and testicular cancer.
- Professor, Medical Oncology Division, University of Washington School of Medicine
- Member, Clinical Research Division, Fred Hutchinson Cancer Research Center
- University of Massachusetts Medical School, 1979
- Residency: Mayo Clinic Internal Medicine, 1979-1982
- Fellowship: University of Washington Hospitals Hematology/Oncology, 1982-1984
Visit PubMed for a full listing of Dr. Higano's journal articles.
Dr. Celestia Higano: Striving for Better Treatments
Dr. Celestia Higano is a medical oncologist at Seattle Cancer Care Alliance, a powerhouse in the world of prostate cancer treatment and research.
At SCCA, about 20 percent of men with prostate cancer participate in clinical trials, says Higano, compared to about 2 percent to 4 percent of all people with cancer nationwide.
Higano is no doubt part of the reason. She has been working with men who have prostate cancer for about 20 years—since the time when hormone therapy was the only treatment option for metastatic disease.
The limited options drove her and others in prostate care to spend the next two decades searching for more effective treatments. “It’s been very gratifying because over those years there have been a lot of really significant changes in the field,” she says.
Now chemotherapy, immunotherapy, and other targeted anti-cancer agents are part of the mix, especially for patients who take part in studies. Research to hone these treatment options and to discover others continues in earnest. Higano and the rest of the SCCA prostate cancer research team help lead the charge, offering studies whenever appropriate to men who come to SCCA for care.
No one recipe for everyone
Nationally there are probably fewer than 20 medical oncologists considered experts in prostate cancer, Higano estimates, a small group compared with experts in other common cancers, such as breast cancer. Her years of experience and dedication to research put Higano in this elite group.
Creative thinking is the key, she says, to devising the best treatment plan for an individual patient and to unearthing new treatments with the potential to benefit many people who have the disease. This demand for creativity is both the most challenging and most enjoyable aspect of her work, she says.
“There’s not a recipe that you can follow for every situation,” says Higano. If the standard first-line treatment fails to halt the disease in a particular patient, oncologists have to be willing to think creatively about that individual’s situation and all available treatments, including those that are experimental.
“You have to look at the whole patient,” she says.
Research makes headway
Around 1995, SCCA began building a prostate cancer research team, says Higano, and since then the group has matured. Most members have been with the team four years or more.
“With the kind of research that we do, I have to emphasize the importance of our team,” Higano says. “It’s not about me.” There are research nurses, coordinators, managers, and others who help run the studies, she explains. “We couldn’t do this research if we didn’t have these people,” Higano says.
The team is studying protocols for men at all stages of prostate cancer, from those who are newly diagnosed to those with advanced disease. Immunotherapy is one of the most exciting areas of research right now, Higano says.
Immunotherapy works with the body’s built-in immune system, directing it to identify and destroy cancerous cells. This type of therapy includes cancer vaccines, which have prompted good responses in some patients, including some with solid tumors, like prostate cancer. Currently cancer vaccines are mainly being studied as treatment for cancer rather than as prevention.
“[At SCCA] we are currently studying the Provenge vaccine, which is a product in development by Dendreon, a Seattle biotech company. Patients who are eligible to enter the trial must have metastatic prostate cancer that has failed hormonal therapy and must not have any symptoms of pain,” says Higano.
“We’re not at the point where we can say that vaccines are going to be part of the everyday treatment of prostate cancer, but our data suggest we just may be on the brink of that,” says Higano. “That’s fabulous!”
In another interesting research project, the SCCA team is collaborating with Monique Cherrier, PhD, a clinical psychologist at the Veterans Administration Medical Center in Seattle to examine how hormone therapy for prostate cancer affects brain function.
Anecdotally, doctors hear from patients—or their spouses—that certain cognitive functions seem to deteriorate during treatment in some men. Extremely rarely some men experience profound changes, including dementia. Many men have no such effects at all.
The current study uses positron emission tomography (PET) scans and functional magnetic resonance imaging (MRI) to see how men’s brains function when they are asked to navigate a maze or identify geographic landmarks in a computer program. Each participant is studied before he starts hormone therapy to establish his baseline function. Then he is studied again after several months of hormone therapy to see whether his function has changed. Researchers will also study a control group of men of similar age who have prostate cancer and who are not receiving hormone therapy.
At least one drug, called finasteride (Proscar), shows promise in helping to prevent prostate cancer. “That’s where we want to get,” says Higano, to the point of preventing the disease in men at risk—“including some of our own patients’ family members,” she adds.
Getting to know her patients
Building strong relationships with patients and their families is one of the best parts of working at SCCA, says Higano. She enjoys getting to know each patient and their family too.
“Because men with prostate cancer often live for many years, we get to know a lot of people on a very personal level,” says Higano. “It’s what makes us love what we do.”
When a doctor knows a patient well, this supports successful treatment. For instance, it helps the doctor anticipate how the patient may respond to health changes and helps the doctor interpret the patient’s answers to questions about how treatment is going, says Higano.
Strong doctor-patient relationships can start early in treatment, she says. Getting to work with patients for several years only strengthens the connections.
“I have a lot of patients I’ve seen for over 10 years,” she says.
Life away from work
Outside of work, Higano balances the joys and demands of family. Her husband, who helped found a Seattle biopharmaceutical company, is also a medical oncologist. They have two daughters.