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Musician’s personalized cancer care strikes right chord

October 25, 2016 | UCI Health
Tonsil cancer patient Richard Faugno
Tonsil cancer patient Richard Faugno has played the piano since he was three years old.

Richard Faugno has played the piano since he was 3 years old. Music is his passion and his profession. The Costa Mesa man, 64, was the resident pianist at the Villa Nova restaurant in Newport Beach for 32 years and teaches piano lessons.

So when Faugno was diagnosed with tonsil cancer in June, 2014, he first worried for his life, and then he worried about his livelihood.

Tonsil cancer: A rare disease

Tonsil cancer is a rare disease that requires a rigorous course of chemotherapy and radiation. But Faugno soon learned that the treatment itself, while saving his life, could also make him unable to play the piano at a professional level. High, prolonged doses of chemotherapy can cause neuropathy, a condition in which the toxicity of the drugs damages the nerves in the hands and feet, leaving tingling and numbness.

"I had a lot of fear," he says of the days following the diagnosis. "I didn't even think I'd have a future. And if I did survive, I might have neuropathy. That really worried me because my whole livelihood relies on my playing."

A personalized treatment approach

His UCI Health cancer specialist took note of his concerns and designed a course of treatment personalized to Faugno’s needs.

"Tonsil cancer is a challenging cancer," says hematologist-oncologist Dr. Chaitali Nangia.

Faugno's tumor was too large to remove surgically. "Heavy-duty chemotherapy and radiation is almost as tough as having a bone marrow transplant. The tonsils sit at the back of the throat, and the treatment can cause canker sores, mouth pain and secretions. Some patients can't even swallow saliva."

Daily treatments can go on for months and because eating and swallowing become so painfully difficult, many patients require a feeding tube to maintain strength and withstand weight loss of 60 to 80 pounds. Trying to avoid neuropathy made Faugno's case even trickier, Nangia says.

Steps taken to avoid neuropathy

"When I learned he was a pianist, we took all precautions we could to minimize the impact on his nerves," she says. Nangia decided to schedule chemotherapy treatments weekly instead of daily. She ordered special hydration and medications that could curb the toxicity that causes neuropathy.

"I promised him I would try my best to cure this cancer," she says. "But we had to balance the best possible outcome with limiting the toxicity."

"She knew I was concerned about neuropathy in my hands," Faugno says. "I can't tell you how much I appreciate what she did to try to avoid it."

The treatment was as harsh as Faugno expected. He lost about 35 pounds and needed a feeding tube for almost two years. UCI Health head and neck cancer specialists provided a special dental oncologist who worked with Faugno to help prevent permanent damage to his teeth and oral tissues.

After the chemotherapy and radiation therapy were completed, another UCI Health specialist performed laser surgery to remove scar tissue — the result of radiation therapy — from Faugno's throat to improve his ability to swallow.

Enrolling in a clinical trial

Then, after the acute phase of his treatment ended, Nangia recommended that Faugno enter a UCI Health clinical trial that is examining the potential of a lung cancer drug called afatinib for prevention of recurrence of tonsil cancer.

"I considered the clinical trial a win-win," Faugno says. "I was seen more often and monitored more often. So I felt it was special, extra treatment. It was the best thing I did. I thought that I could possibly help other people. It was my way of contributing."

Faugno endured more side effects from the investigational medication but completed the trial with the support of his healthcare team and his wife, Alice, who, Nangia says, "was at every appointment, never left his side, and laughed and cried with him."

Benefits of an academic medical center

"Because we're an academic medical center, Richard got the benefit of everything we do here," Nangia says.

"Our focus is not just on surviving but also on making the journey as comfortable as possible, and there is a big emphasis on supportive care and survivorship. Then he was offered entry into a clinical trial to minimize his chances of recurrence. That wouldn't have happened at a community hospital."

Alice Faugno credits UCI Heath with providing the special services needed to treat her husband and protect his quality of life.

"So many people were involved in his care, and every single one of them was wonderful," she says. "I don't think he would have survived if he'd been treated anywhere else. UCI Health knew exactly what to do to save his life."

And his livelihood. Faugno is now in remission and has resumed playing and teaching piano.

"I'm getting back to it little by little," he says. "It would have been horrible if I could no longer play. I would have been very depressed. But I have no neuropathy. What a miracle. I tell the people at UCI Health: From the bottom of my heart, thank you for saving my life."

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Jack Rice
November 15, 2016

A great story. I am grateful to be a patient of Dr. Nangia and of Drs. Armstrong and Farol. I am very glad that our "second opinion" was at UCI.

UCI Health
November 15, 2016

Thank you for your comment, Jack. We're so glad you're happy with your care and are doing well!

Perry Faugno
November 19, 2016

I am also grateful for the great care you gave to my brother and only sibling Richard. No words can describe my thanks and the thanks of his entire family. He is so talented that I too was concerned that he would not be able to continue his music. Thank you that that's not the case here. He was a real trooper all along during his treatment. God bless you all!

UCI Health
November 21, 2016

Perry, thank you for your comment. We're glad we were able to help your brother, and we appreciate your thanks. Happy holidays!

Roxanne Mahoney
December 07, 2016

Dear Richie, I am so happy for you and Alice making it through these hard times with the cancer. You can't hold down a good man . My love and prayers are with you both. Much love.

Jade Faugno
December 07, 2016

I'm Richard's niece, and I echo my dad's comment above. The whole family is so grateful for the personalized treatment and ongoing care of my beloved uncle. If possible, please pass my thanks along to Dr. Nangia and her team.

UCI Health
December 07, 2016

Thank you for your comment, Jade. We will let Dr. Nangia and her team know of your gratitude!

Ted Jolly
December 07, 2016

I played drums with Richie at the Villa Nova restaurant. Hi is such an amazing pianist and vocalist, the like of which are hard to find these days. And it's not only that, Richie is a true entertainer who has such an amazing rapport with the audience and the singers and musicians who come to listen, sing or sit-in and play. We are so very happy that Richie is back to playing and singing and enjoying his passion in life again, together with his life long mate, Alice. Bless you both!

UCI Health
December 07, 2016

Thank you for your comment, Ted. It's so nice to hear how Richard has touched people's lives!

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