Champion Against Big Tobacco Faces a Different Fight for His Life

When Doug Matheny accepted a new position at the state health department to fight Big Tobacco and work with a coalition to improve key tobacco control laws in Oklahoma, he never thought it would help save his own life 30 years later. As Chief of the Tobacco Use Prevention Service at the Oklahoma State Department of Health, Doug’s work was focused on raising awareness of the need to enact effective laws for reducing tobacco use, Oklahoma’s top cause of preventable death. In addition to fatalities from heart disease, cerebrovascular disease, and emphysema, smoking causes about one-third of all cancer deaths in Oklahoma.

One major success of the coalition was convincing the Oklahoma State Legislature to allow a statewide vote in 2004 that would significantly increase state excise taxes on cigarettes and other tobacco products. Raising the price of tobacco is one of the most effective ways to reduce tobacco use, especially among youth. The ballot question specified that the revenue generated by the tax would be used for critical health-related needs, including initial funding for a comprehensive cancer center at the University of Oklahoma. After voters approved State Question 713 in November 2004, a groundbreaking ceremony was held in October 2006 for what would soon become known as OU Health Stephenson Cancer Center.

The 2004 state tobacco tax increase was not the first or last time Doug has been involved in tobacco policy successes. He also helped the coalition raise awareness on the need to use Oklahoma’s annual share of payments from a 1998 legal settlement with tobacco companies to fund effective tobacco prevention programs and other public health initiatives. Oklahoma voters overwhelmingly supported passage of State Question 692 in November 2000 to create the Tobacco Settlement Endowment Trust (TSET), making Oklahoma the only state with a constitutionally protected fund to receive and allocate the settlement dollars to improve health. Life-saving research at the Stephenson Cancer Center are among the many major programs now funded by TSET.

Other key state tobacco laws in which Doug has had supportive roles include the 2003 Oklahoma Smoking in Public Places and Indoor Workplaces Act, which eliminated exposure to secondhand smoke in most workplaces, and a $1 per pack state excise tax increase on cigarettes and little cigars in 2018. He continues to help with several important unmet tobacco policy needs, most notably to finally return the rights of Oklahoma communities to fight Big Tobacco. Due to antiquated laws written by tobacco lobbyists over 30 years ago, Oklahoma is the only state in the nation that prohibits local governments from adopting any tobacco control ordinances stronger than state law.

After spending his career working to reduce tobacco-caused deaths, Doug developed sciatica in his left leg. He thought it would subside but after a couple of months of continuing pain, he went to see a physical therapist. A decade earlier Doug had benefited from physical therapy for similar symptoms, but this time, the pain grew worse and was affecting both legs. He reached out to his doctor who ordered an MRI.

On Feb. 1, 2024, Doug had the MRI. Early the next morning, he received a call from his doctor with the results. Doug had a destructive soft tissue mass on the fourth lumbar vertebra (L4) of his spine, which showed signs of cancer.

Finding a Diagnosis

Spinal tumors can develop in various locations along the spinal column, which encompasses the vertebrae (the bones forming the spine), the spinal cord (the bundle of nerves running through the vertebrae), and the surrounding tissues, such as the meninges (the protective membranes covering the spinal cord).

The majority of spinal tumors are metastatic, meaning they originate from cancer in another part of the body and spread to the spine.

Doug was referred to OU Health neurosurgeon Dr. Hakeem Shakir, M.D., assistant professor in the Department of Neurosurgery at the University of Oklahoma College of Medicine. Because of the likelihood that the tumor was metastatic, Doug underwent tests to find the primary source of cancer. Prostate cancer was the most likely suspect; however, all test results came back clear. Instead, a biopsy of the tumor revealed a large chordoma — a rare primary bone cancer on Doug’s L4 vertebrae.

What is a Chordoma?

A spinal chordoma is a rare, slow-growing malignant tumor that can develop in the spine or at the base of the skull. Also known as notochordal sarcomas, these tumors have some unique characteristics.

Causes

Chordomas develop from leftover notochord cells, which are crucial in forming the spine during fetal development. Normally, the notochord disappears by the eighth week of pregnancy, but sometimes, remnants stay in the spine or skull base. Changes in the TBXT gene or genetic conditions like tuberous sclerosis can cause these cells to grow into tumors.

Location

Chordomas can occur anywhere along the spine, but they are most commonly found in the sacrum (near the tailbone) or the skull base.

Symptoms

Chordomas can cause pain and nerve issues, including tingling, numbness, weakness, and vision problems. Sacral chordomas can also affect the nerves that control bladder and bowel function.

Treatment

Treatment typically involves a combination of surgery to remove the chordoma followed by radiation therapy.

Complex Surgery

Dr. Shakir, along with OU Health neurosurgeon Dr. John Burke, M.D., Ph.D., assistant professor in the Department of Neurosurgery at the OU College of Medicine, a spine deformity specialist, and OU Health vascular and endovascular surgeon, Dr. Benjamin Chou, D.O., assistant professor in the Section of Cardiac, Thoracic & Vascular Surgery at OU College of Medicine collaborated on the case. They decided on a staged procedure to stabilize the spine and remove the tumor.

“The challenge with chordoma tumors is their tendency to affect the spine or skull base, and the primary goal is to keep these tumors contained to prevent spreading or leaking,” explains Dr. Shakir. “In this case, the tumor was well-contained within the vertebrae, specifically the posterior portion of the L4 vertebra. Our multidisciplinary team convened to thoroughly assess the case and determine the optimal approach for resection. We decided that it would be a staged procedure.”

With the removal of the chordoma and Doug’s L4 vertebrae, a huge void would be left. The team determined that they would place a radiolucent cage in the space in Doug’s spine. The cage allows for better visualization in and around the vertebrae so the radiation oncology team could target the area with much more accuracy and precision than if conventional materials like titanium, or cobalt chromium were used.

On April 16, 2024, Dr. Burke, with assistance from Dr. Shakir, performed the first stage of the surgery. Dr. Burke performed posterior screw fixation which involved placing the structure in Doug’s spine to support it. The surgery also loosened the L4 vertebrae so it could be removed easily with the chordoma in a second surgery.

Dr. Burke used carbon fiber pedicle screws instead of the usual titanium or cobalt chromium screws as Doug required radiation after chordoma removal. Carbon fiber is a resilient material for screws and implants used in radiation therapy as they are highly resistant to radiation damage and do not interfere with radiation therapy, allowing for more precise targeting of tumors.

Two days later, on April 18, Dr. Shakir, Dr. Burke, and Dr. Chou performed the second stage of the surgery. Dr. Chou provided access to the ventral spine through Doug’s abdomen so that Dr. Shakir and Dr. Burke could perform a corpectomy to remove the entire affected L4 vertebra. The tumor was successfully removed without any residual or suspicious tissue left behind, ensuring clear margins around the ventral thecal sac, where the spinal nerves are located.

“A lot of thought, consideration, and deliberation went into giving Doug the best tumor resection surgery and simultaneously the best spinal construct,” said Dr Shakir.

After the surgery Doug was up and mobile almost immediately.

“I was a little uncomfortable, but not in much pain considering the new structure in my back and the two long surgeries,” Doug recalls.

The Best in Cancer Care

After retiring from the state health department in 2011 and serving for several years as a volunteer tobacco control advocate at the state Capitol, Doug accepted a part-time position in tobacco policy research at the Stephenson Cancer Center in 2015. He was still working there when he received his cancer diagnosis in early 2024.

For Doug, the choice was clear for his cancer treatment — it had to be Stephenson Cancer Center.

“Not only do tobacco tax increases reduce smoking rates, they can also provide essential funding for critical health needs. Stephenson Cancer Center has saved many lives through cancer treatment as well as ongoing prevention policy work in our state and community,” said Doug.

“It’s such a privilege to have been a small part of the huge process which led to the creation of Stephenson Cancer Center, then to have been able to work with their dedicated policy research team, and finally to receive excellent treatment for the chordoma there.”

As a career public health professional receiving a live-saving procedure at Stephenson Cancer Center, Doug’s story exemplifies how effective efforts to reduce cancer deaths must involve a comprehensive combination of prevention policy and medical care.

Proton and Photon Therapy

After the chordoma was removed, Doug had a combination of seven photon and 30 proton radiation therapy treatments at Stephenson Cancer Center to remove any cancerous cells that may be present in the area around the site of the tumor.

Photon radiation, also known as traditional radiation or X-ray radiation, delivers beams of photons to general areas of concern.

Proton therapy, also known as proton beam therapy, is a newer type of radiation treatment that uses protons to more precisely target and destroy cancer cells. Unlike traditional radiation, protons have unique properties that allow for more accurate targeting, minimizing any potential damage to surrounding healthy tissue.

In proton beam therapy, protons are taken from hydrogen atoms and sped up in a machine called a particle accelerator. A special device, which can rotate all around the patient, uses a strong magnet to focus the protons into a thin beam. This beam can then be directed at tumors or potential cancer cells from different angles. The energy of the beam can also be adjusted to reach different depths of the tumor, allowing for precise treatment.

The radiation from the protons damages the cancer cells DNA, stopping tumors from growing and causing them to shrink.

Cancer Free

Doug finished his treatment in September 2024 and is recovering well from the surgery.

“I feel extremely fortunate and thankful for the outstanding expertise and amazing technologies that have restored my health,” said Doug.

“This whole case was a tour de force,” said Dr. Shakir. “No other place in Oklahoma City could have done this kind of case because of the expertise and technology required to do it. We have a collaborative team of top physicians. It all comes down to collaboration and a multidisciplinary approach, putting our heads together to determine the best course of action for the patient.”

Get an Appointment or Second Opinion

OU Health Stephenson Cancer Center provides expert multidisciplinary care for the most complex cases. Learn more about OU Health neurosurgery services and treatment, request an appointment or get a second opinion at OU Health Stephenson Cancer Center by calling (855) 750-2273.