VOLUME XIII ISSUE 2
HOUSECALL HOUSECALL COMPLETE
CANCER CARE
Integrated. Personalized. World-Class.
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SINCE 1954, St. Clair has been dedicated to quality, innovation, responsiveness to community needs, and the humanity of the physicians, nurses, and caregiving staff.
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INTEGRATED CANCER CARE St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center delivers integrated, personalized, world-class cancer care.
RESHAPING THE FUTURE 20 Karen Conroy’s family history put her on high alert. Her integrated breast care team customized a surgical and reconstructive plan to the highest extent.
SCREENING THE SIGNS The guidelines for preventative screenings are moving to younger ages. For Shannon Gregg, getting a colonoscopy at 45 saved her life.
PLAN OF ATTACK 10 No two patients are exactly alike. Bob O’Neill experienced firsthand how St. Clair’s team-based approach fights cancer with pinpoint accuracy. COMMITTED TO 12 COLLABORATION
CLINICAL TRIALS 24 The next big thing is already
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Getting Dean Santo Colombo on the road to recovery included the diagnostic expertise of St. Clair’s clinical collaboration with Mayo Clinic.
here. Clinical trials exist for the betterment of future cancer care for all—and patients can access them right in the South Hills.
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16 HOUSECALL HOUSECALL A publication of St. Clair Health
Articles in this publication are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
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ROBOT-ASSISTED SURGERY An inside look at how the da Vinci® Surgical System gives surgeons minimally invasive techniques to enhance major urologic surgery.
WALGREENS SPECIALTY 26 PHARMACY Exclusively at St. Clair, the new MedsInHand™ program helps save patients a trip to the pharmacy and is also available for any member of the community.
Raye J. Budway, M.D., F.A.C.S. Director of St. Clair Hospital Breast Care Center Co-Chair, St. Clair Hospital Cancer Committee
COMPLETE CANCER CARE AT ST. CLAIR HEALTH
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en years ago I was recruited to develop the structure for a breast care team here at St. Clair Health. Breast cancer is one of the most common diagnoses of cancer, and St. Clair recognized the importance of leading the way in breast cancer care.
When I arrived, a strong foundation was already in place— including excellent breast imaging, dedicated pathologists, and access to radiation oncology and medical oncology services. My mission was to help develop the most effective and efficient structure for the breast cancer team. Enhancing the framework began with standardizing procedures in the operating room. Next, we integrated our infrastructure by bringing the breast surgery and breast imaging programs together, in one place, at St. Clair Health Village Square Outpatient Center, creating our main hub. We’ve since expanded our breast imaging capabilities, both at Village Square and also at St. Clair Health Peters Township Outpatient Center. Today, this practice with its highly-trained surgeons, medical oncologists, radiation oncologists, and breast imagers working together has grown to be the second largest program in the region, with plans to continue to expand. What we learned as we built out the St. Clair Hospital Breast Care Center has been taken to the next level with the groundbreaking growth of the state-of-the-art Dunlap Family Outpatient Center. Inside, the St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center brings our complete cancer
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care services together under one roof. Having surgeons, medical oncologists, and radiation oncologists working seamlessly to support your cancer journey is a huge advantage for patient care moving forward. Being diagnosed with cancer is one of the most stressful moments in a patient’s life. With the opening of Dunlap Family Outpatient Center, now patients have one place to go for all of their cancer treatment, right on the main campus of St. Clair. You don’t need to organize your care or your life around your cancer treatment; it’s the other way around. There’s no need to make an appointment with a surgeon in one location, with a medical oncologist at a different location, and a radiation oncologist in yet another location. The establishment of our Multidisciplinary Breast Clinic, in which our patients see both the breast surgeon and medical oncologist in one visit, was only made possible by consolidating services into a single location. We plan to expand this multidisciplinary clinic model to other specialties as well. I remain as humbled today by the opportunity to help our patients as I am proud of the growth of our cancer care programs. St. Clair Health is driven by visionary, forward-thinking leadership, focused on answering the question, “How can we best deliver cancer care to the communities we serve?” At St. Clair, you’re getting the very best of everything— and you’re getting it right at home. This is the top of the line, no matter what you need. For patients and their families, our team-based approach to delivering integrated cancer care is truly built around you. n
RAYE J. BUDWAY, M.D., F.A.C.S.
Dr. Budway specializes in breast surgery and general surgery, and serves as the Director, St. Clair Hospital Breast Care Center. Dr. Budway earned her medical degree at Hahnemann University Medical School, Philadelphia, and completed a residency in general surgery at The Western Pennsylvania Hospital. She then completed a fellowship in surgical critical care at UPMC. She previously served as the Site Program Director for the Allegheny General Hospital General Surgery Residency Program, and Director of the Surgical Breast Disease Program and Surgical Intensive Care at West Penn Hospital. Dr. Budway was named a Top Doctor in Surgery by Pittsburgh Magazine in 2021. She is board-certified in surgical critical care and general surgery. She is a Fellow of the American College of Surgeons and serves on the Fellowship’s Commission on Cancer. Dr. Budway practices with St. Clair Medical Group. To contact Dr. Budway, please call 412.942.7850. ST. CLAIR HEALTH
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EXPERT CANCER CARE IN THE SOUTH HILLS
DIAGNOSIS: CANCER. DESTINATION: ST. CLAIR HOSPITAL CANCER CENTER. Affiliated with UPMC Hillman Cancer Center, the opening of Dunlap Family Outpatient Center consolidated medical oncology into a single campus with surgical and radiation oncology.
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ANCER IS CAUSED BY an uncontrolled division of abnormal cells in a part of the body, resulting in a malignant growth or tumor—and the diagnosis can be overwhelming. Vincent E. Reyes, Jr., M.D., an Assistant Medical Director at UPMC Hillman Cancer Center who also serves as Chief of Hematology and Medical Oncology at St. Clair Health, understands that— and it’s why he’s so proud of what the uniting of two great institutions can offer to patients in his own backyard. “With St. Clair and Hillman together right here in the South Hills, you have a Cancer Center that gives patients the best of both worlds. St. Clair’s reputation in quality, safety, and patient experience—in addition to advanced diagnostic services and surgical care—blend seamlessly with UPMC’s expertise in radiation and medical oncology services,” he says. “Being fully-integrated across multiple specialties on one campus means the best protocols, the most treatment options, and innovative clinical trials plus access to the best doctors and staff for expert-level, compassionate care.” For Dr. Reyes, the proof is in the relentless progress of the relationship built between St. Clair Health and UPMC Hillman Cancer Center.
“We’ve always worked really well together, and now all of the patient care is right here. The Multidisciplinary Breast Clinic is only the beginning of what can happen when you achieve peak partnership, because proximity fosters great patient care,” he says, adding, “The decision processes and nuances of treating cancer are very complex—and now, we can give patients even more peace of mind because the communication between everyone is completely streamlined. Our entire staff is in this together, doing what’s best for each patient.” Standard process. Expert treatments. Clinical trials. All in the palm of a patient’s hand at St. Clair. “We look at patient outcomes and metrics to evaluate and consistently elevate workflows that make everything more efficient for patients— really, to make getting the treatment they need easier across the board,” says Dr. Reyes. “It’s part research, part science, part innovation—and no one else in the region bridges the gap between the research side and the clinical side like we can.” That line of thinking extends directly into the services offered at the Cancer Center and is exemplified by an acute level of care made possible by having medical, radiation, and surgical oncology all in one place. At the
ST. CLAIR HOSPITAL CANCER CENTER IS AFFILIATED WITH UPMC HILLMAN CANCER CENTER. THANKS TO THIS UNIQUE AFFILIATION, CANCER SPECIALISTS FROM ST. CLAIR PARTNER WITH ONCOLOGY EXPERTS FROM UPMC HILLMAN CANCER CENTER. UPMC Hillman Cancer Center is Western Pennsylvania’s only National Cancer Institute (NCI)-designated comprehensive cancer center (CCC). The NCI is the nation’s authority on cancer and extends CCC status to a group of just 51 cancer centers in the country that demonstrate scientific leadership in both clinical and laboratory settings. Hillman has been an NCI-designated CCC since 1990 and undergoes a rigorous and intensive evaluation of our research programs and related activities every five years. For patients, NCI designation can mean better outcomes; a 2015 study of individuals with newly diagnosed, adult-onset cancer showed that patients who received treatment from a CCC had better outcomes than those treated at cancer centers without this designation. 4
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St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center, passion becomes perspective. “The first level is the patients. Treatments can become complicated—they make you sick, they can be confusing—and when you have to drive all over town to get different treatments in different places, it can wear on you. With our patients, let’s say you start your day at radiation oncology—that’s literally in the same place as everything else, so now you can come right over to my office and receive chemotherapy before meeting with your urologist or another surgeon based on your needs,” Dr. Reyes says. “Our goal is to eliminate your other worries, because with cancer you already have enough on your plate. Our facility serves as your home base for cancer care.” Physicians comprise the second perspective. In between seeing patients, Dr. Reyes can meet with radiation or surgical oncologists to discuss finite details and maintain alignment on a case-by-case basis. From formal reviews of imaging studies to quick discussions about new details that emerge, the team is able to turn what might be seen as “extra steps” somewhere else into enhanced collaboration at every step of a patient’s journey.
WHAT THIS MEANS FOR ST. CLAIR PATIENTS • Accessing the most cutting-edge treatments • Participating in advancements of science • Furthering the understanding of cancer • Interacting with the highest-level researchers, physicians, and clinicians • Being part of an environment that fosters academic breakthroughs • Bringing forth new ways of treating cancer
“The little things make a huge difference, and that idea is paramount when considering the third level that’s just as important: the caregiver’s perspective. We know that the people in our patients’ lives who help get them to and from treatments have a lot going on in their own lives—and we’re able to provide that home base with all the resources their loved ones need to keep them moving forward,” adds Dr. Reyes. The desire to take care of those who help take care of his patients stems from a deep sense of community that Dr. Reyes feels throughout the South Hills. “On a personal level, it’s very satisfying—I love being a part of this community. My parents still live here and my kids go to school and play sports with patients who we’ve treated at the Cancer Center. We really do see each other quite often, whether it’s at church or the grocery store, and that makes it easy to feel like we’re all in this together,” he says. With such strong ties that bind the St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center throughout the region, the integrated care is woven into the fabric of each patient’s personalized fight against cancer today—with a hopeful eye on the future of cancer care for all. “I have a tremendous sense of pride in being part of a bigger mission: life without cancer,” Dr. Reyes says. “We’re driven to explore what we can do today to advance the science of oncology and help the next person down the road. The question becomes, ‘What more can we do for future generations?’ so that the idea of life without cancer becomes a reality.” Because of this unique partnership with UPMC Hillman Cancer Center, cancer care—like all services at St. Clair Hospital—is in-network for all major insurance providers, including most Highmark insurance products. n
“I have a tremendous sense of pride in being part of a bigger mission: life without cancer.” VINCENT E. REYES, JR., M.D. Chief of Hematology and Medical Oncology Co-Chair, St. Clair Hospital Cancer Committee
VINCENT E. REYES, JR., M.D.
Dr. Reyes is Chief of Hematology and Medical Oncology at St. Clair Hospital. He earned his medical degree at the University of Cincinnati College of Medicine, and completed a residency in internal medicine at Temple University Hospital, Philadelphia. He then completed a fellowship in hematology and oncology at Fox Chase Cancer Center, also in Philadelphia. Dr. Reyes is board-certified by the American Board of Internal Medicine. Dr. Reyes was named a Top Doctor in Medical Oncology and Hematology in Pittsburgh Magazine’s 2021 Top Doctors report. Dr. Reyes is the Assistant Medical Director of Medical Oncology at UPMC Hillman Cancer Center and practices with Integrated Cancer Services, which is in-network for all major insurers. To contact Dr. Reyes, please call 412.942.8701.
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COLORECTAL/GI CANCER CARE
SMALL SIGNS,
BIG IMPACT ON LIFE Why any symptoms are worthy of your preventative screening time. President. Working Mom. Doctor of Philosophy. Jazz Dance Team Member. All of these superlatives describe Shannon Gregg. Up next: Cancer Survivor.
The American Cancer Society’s newest guidelines recommend colorectal screenings beginning at age 45. Most insurance carriers have accepted and will cover colonoscopies at age 45 starting in January 2022.
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uring the summer of 2021, in the first few weeks after Dunlap Family Outpatient Center opened on the main campus of St. Clair Health, a 45-year-old woman was referred to Mark A. Cedar, D.O., Chief of Gastroenterology and Director of the GI Lab at St. Clair Hospital. “At first I was happy to see someone who met the new screening age criteria (down from 50) for colorectal cancer exams coming in to see me. But there was a reason: a small change in bowel habits. Shannon presented with no weight loss and no abdominal pain and her labs showed iron deficiency anemia—which is not uncommon for a woman her age,” Dr. Cedar says. An otherwise healthy, young woman, Shannon had no significant medical history, no family history of colon or rectal cancer, and no smoking history—which increases the risk. “I have a great life—a full life—and really just thought there was a little something going on in my stomach. I went through a number of tests with my primary care physician (PCP). We knew something wasn’t right, and that was the most frustrating part, the not knowing,” she says. “I began Shannon’s colonoscopy and immediately found a large, obstructing mass in the upper rectum, about 5cm in length—which is very large. It was not resectable with the scope, but fortunately I was able to get around it and complete a full colonoscopy,” Dr. Cedar says. “I found many other polyps in her colon, including two large ones that were precancerous, and was able to resect them and remove three additional polyps. So then we had to deal with this rectal mass, and I could tell right away: this is cancer.” “When I woke up,” Shannon says, “I heard ‘cancer of the rectum’ and actually felt relief— because now I knew what the problem was to solve. My first feeling was, ‘So where do we start?’ I’m a project manager—this is what I do. Dr. Cedar told me right away what he thought would happen and who all would be involved, so I knew right then and there that my story would have a lot of characters. I decided to kind of be the Creative Director of my cancer story.”
CHEMOTHERAPY. RADIATION. RESECTION. During a long talk with Shannon and her family, Dr. Cedar added one key detail. “With a large tumor like hers, I was suspicious it was metastatic. Depending on the location of the tumor and whether or not it’s metastatic will determine whether the patient receives chemotherapy and radiation prior to Dr. Holekamp performing surgery,” he says. Shannon quickly experienced one of the greatest benefits of the truly integrated design at Dunlap Family Outpatient Center. “I met with Dr. Holekamp the very next day and he said the very same thing as Dr. Cedar. He also looked me square in the eye and said, ‘You’re used to being successful and I am, too. We’re going to get the best team together and we’re going to push you. Here’s exactly what we’re going to do—and we’re going to crush this cancer together,’ ” she says. For Scott A. Holekamp, M.D., treating every patient comes down to three things. “We take the tumor out so it doesn’t come back, we minimize the chances that it’s spread, and we put everything back together so your body works correctly again after treatment,” he says.
“And our goal is to communicate quickly and effectively so we can get patients on to the next stage right away. The process may include advanced imaging studies like MRI, PET, or CT, plus consultation with all of the oncologists who become part of your cancer care team here— and they get to work on shrinking your tumor so I can perform surgery. Everyone works together to increase your chances of having a complete response to treatment.” For Shannon, the next stage following her diagnosis and surgical consult led directly to Christopher R. Marsh, M.D., a medical oncologist and hematologist at the St. Clair Hospital Cancer Center. “We take a team-based approach to everything we do. As doctors, we feel more comfortable that way—and it helps patients feel more confident, too. That level of collaboration brings all of our expertise together for every patient. That way we all know the patients and we’re able to keep their priorities in mind as we evaluate the most effective way to treat their respective cancer,” says Dr. Marsh.
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MARK A. CEDAR, D.O.
Dr. Cedar serves as Chief of Gastroenterology at St. Clair Hospital. He earned his medical degree at Lake Erie College of Osteopathic Medicine and completed his internal medicine residency at UPMC Mercy Hospital of Pittsburgh. Dr. Cedar then completed his fellowship in gastroenterology and hepatology at AHN West Penn Hospital. He is board-certified in gastroenterology and was named a Top Doctor by Pittsburgh Magazine in 2021. Dr. Cedar is affiliated with Pittsburgh Gastroenterology Associates. To schedule an appointment with Dr. Cedar, please call 412.232.8104.
SCOTT A. HOLEKAMP, M.D.
Dr. Holekamp specializes in colon and rectal surgery. He earned his medical degree at University of Cincinnati College of Medicine, and completed a residency in general surgery at Beth Israel Medical Center in New York City. He then completed a fellowship in colon and rectal surgery at the University of Miami/Jackson Memorial Hospital. In 2021, Dr. Holekamp was named a Top Doctor by Pittsburgh Magazine. He is board-certified by the American Board of Colon and Rectal Surgery and the American Board of Surgery. Dr. Holekamp practices with St. Clair Medical Group. To contact Dr. Holekamp, please call 412.572.6192. ST. CLAIR HEALTH
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COLORECTAL/GI CANCER CARE CONT. Continued from Page 7
Talking daily. Interacting on a number of mutual patients. And complete accessibility connecting them all the time. With each patient’s goals in the front of their mind, Dr. Marsh leaned right in to the cues he received from Shannon. “She’s a very intelligent and driven woman. She understood what was on the road ahead with her cancer and wanted to take the treatment head-on,” he says. “There was no trepidation, because there’s been so much transparency in my treatment and that’s awesome,“ says Shannon. “Personalized medicine is why I chose St. Clair—it’s a one-stop shop and that’s what I preach all day long with my company: Why go to multiple places if you can get everything you need from one? It was glaringly apparent that I made the right decision because I had a vacation planned. Dr. Marsh said, ‘You’re going on this vacation—go do your thing, and then we’ll get you right back on your course.’ I really felt like I was being treated like a human being, not just a number—from the beginning, my treatment has been about living my life and curing me of cancer,” Shannon says. “One thing that’s extremely important for every cancer patient is maintaining quality of life,” Dr. Marsh says. “Work, family, exercise, church— patients tend to do better and be more driven to
Dr. Cedar follows up with Shannon Gregg at Dunlap Family Outpatient Center.
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do better when they’re able to keep doing what they love. And that’s why we strive to integrate our care plans with their activity levels throughout their cancer journey.” With state-of-the-art imaging adding to Dr. Cedar’s expert diagnostic work, Shannon’s rectal cancer was defined as stage 3. Treated initially with chemotherapy, she is now set for a combination of chemotherapy and radiation before surgery. “We know patients have a better response to that—a more complete response— including some cases where the tumor is completely shrunken away,” says Dr. Marsh. “In Shannon’s next phase, the chemotherapy will work as a sensitizing agent—a low dose of chemotherapy that makes her cells more susceptible to radiation, allowing it to be more effective. The two treatment types work together to create synergistic, personalized medicine.” For Shannon, that level of curated care leads to Felicia E. Snead, M.D., a board-certified radiation oncologist and Chief of Radiation Oncology. “We create her radiation plan via a simulation process. In this simulation, we use imaging of her pelvis to allow us to perform accurate calculations of exactly where the tumor is and also areas of risk like the pelvic lymph nodes. This allows me to spare organs like the
bladder, small bowel, and bones that do not require treatment,” Dr. Snead says. “This will also give her reference marks so we can find these areas accurately and safely on a routine basis.” During the radiation planning process, Dr. Snead uses techniques like Intensity Modulated Radiation Therapy (IMRT) that allow the team to dose-paint the areas where radiation is desired to ensure that the area of disease receives the therapeutic amount while the areas they want to spare get significantly lower doses with respect to their radiation tolerance. “We coordinate everything— Dr. Marsh and I are in lockstep, starting the chemotherapy and radiation together and meeting with her weekly to make sure the treatment is accurate and safe,” Dr. Snead says. “After she completes her radiation,” says Dr. Cedar, “then Shannon will have surgery with Dr. Holekamp. Then I will repeat her colonoscopy again in one year to make sure she doesn’t develop additional polyps. I stay connected to the patient’s PCP forever—and hopefully, Shannon and others like her never have to see Dr. Holekamp and the rest of the team down the road.”
THE IMPORTANCE OF RECOGNIZING THE SIGNS “Most importantly, blood in your stool may not just be a hemorrhoid,” says Dr. Holekamp. “If you’re seeing blood, let us take a look and find the cancer that might otherwise be missed. The reason the American Cancer Society’s guidelines are moving to a younger age is because we’re seeing younger patients with cancer. And those guidelines for screening are meant for anyone, even if they don’t have any symptoms—we want to find the polyps before they become cancerous. And I’ll put it more bluntly: you want Dr. Cedar to find them before you need me,” says Dr. Holekamp. When it comes to definitive testing, data associated with the colonoscopy is overwhelming: 60 percent lower incidence and risk of death compared to some other methods. “For colon and rectal cancer, getting a colonoscopy is the most sensitive and specific way to detect precancerous polyps and colorectal cancer—and yes, I can take out that precancerous polyp before it even becomes cancer. It’s the gold standard colorectal screening test—head and shoulders above the other options,” Dr. Cedar says. And from an oncology perspective, Dr. Snead emphasizes that, “Most cancers are not related to genetics, so everyone should get screening regardless of family history.” Adds Dr. Marsh: “When we screen early, we can catch it early— not only in colorectal, but with breast, prostate, urologic, and more. The earlier we can detect cancer, the better the outcomes are across the board. If we catch it early enough, I may not even have to give a patient chemotherapy at all.” Shannon Gregg seconds the respective insights of her care team, personifying how St. Clair delivers advanced cancer care close to home. “Timing really is everything. I didn’t even want to go to the dentist during COVID, but with my belly not feeling right…I knew I had to listen to my body. It’s going to tell you the truth every time. You have to be your own advocate, understanding the risk factors, the symptoms, and not putting off early screening. One of the main reasons I’m documenting my cancer journey is to help others who may be on the fence. Cancer doesn’t define me—I have a nine-year-old and it feels like every doctor at St. Clair just gets it: I’m not living for myself—I live for this kid. And getting screened— even when I didn’t necessarily want to and I didn’t have any major symptoms—getting a colonoscopy saved my life.” n
Dr. Cedar answers patient Shannon Gregg’s questions about the procedure.
CHRISTOPHER R. MARSH, M.D.
Dr. Marsh specializes in hematology and medical oncology. He received his medical degree from the University of Cincinnati College of Medicine and completed his internal medicine residency and a hematology/medical oncology fellowship at UPMC. Dr. Marsh is board-certified in internal medicine, hematology, and medical oncology. He is a member of the American Society of Clinical Oncology and the American Society for Hematology. Dr. Marsh practices with Integrated Cancer Services, which is affiliated with UPMC Hillman Cancer Center, and is in-network for all major insurers. To contact Dr. Marsh, please call 412.942.8701.
FELICIA E. SNEAD, M.D., F.A.S.T.R.O.
Dr. Snead is the Chief of Radiation Oncology and practices with Integrated Cancer Services, which is affiliated with UPMC Hillman Cancer Center, and is in-network for all major insurers. She began her career as a radiation therapy technologist at Memorial Sloan Kettering Cancer Center in New York City and has a bachelor’s of science degree in Radiologic Health Physics from Manhattan College in Riverdale, N.Y. Dr. Snead completed medical school at Albert Einstein College of Medicine in New York City and residency training at New York Presbyterian-Columbia University. Dr. Snead can be reached at 412.942.7001.
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THORACIC CANCER CARE
ATTACKING THORACIC CANCER FROM EVERY ANGLE
State-of-the-art surgical, radiation, and chemotherapy options are integrated through a team-based approach to help deliver remarkable results for patients.
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horacic cancer can present in the lungs, esophagus, chest wall, or glands—and sometimes, all of them at once. Meeting the challenge of treating thoracic cancer demands a collaborative, one-to-one approach—and that’s exactly the type of care patients receive at St. Clair Health. “It all starts with the plan—and that comes down to understanding that no two patients are exactly alike,” says Jordan A. Torok, M.D., a radiation oncologist at the St. Clair Hospital Cancer Center. “By working together, we’re able to provide complete cancer care to each patient based on their unique circumstances—and we do that in a very personalized way, right here in the South Hills.” At first, 63-year-old Bob O’Neill thought that he had a scratch or a small cut somewhere inside his throat. “There was a little bit of blood when I coughed, but I didn’t think it was anything to worry about,” he recalls. “Then it kept
Bob O’Neill, Patient
getting worse and worse.” After an ear, nose and throat specialist’s examination revealed nothing to explain the bleeding, a CT scan was ordered and Bob went home to await the results. The next morning, he received a call to meet with his primary care physician (PCP). “Even then I didn’t think a lot of it,” Bob says. “I’m in good shape, I’m a workout guy—nothing serious even entered my mind.” But when he met with his PCP, the reality of the situation struck with full force: the scan showed a ping pong ball-sized tumor in his lower left lung. “The things that go through your mind are what only people who have cancer know,” Bob says. “Am I going to see my next birthday? That’s the first thought that hit me.” Early the next week, Bob met with Richard H. Maley, Jr., M.D., a thoracic surgeon with St. Clair Medical Group who serves as Chief of Thoracic Surgery at St. Clair Hospital. Dr. Maley confirmed the diagnosis and referred Bob to Vincent E. Reyes, Jr., M.D., an Assistant Medical Director at UPMC Hillman Cancer Center who serves as the Chief of Hematology and Medical Oncology at St. Clair Health. Bob quickly learned that in addition to a tumor in his lung, imaging had also detected cancer in one of the nearby lymph nodes. “Dr. Reyes was a real straight shooter about it,” Bob says. “He talked to me in a way that gave me hope but didn’t sugarcoat what the plan of attack would be.” Based on Bob’s overall health, that plan began with an aggressive course of chemotherapy that was administered every three weeks. After five rounds, a second scan was ordered to determine whether the treatment was effective in shrinking the tumor ahead of surgery. “I went into Dr. Reyes’ office and he was holding his phone. He said, ‘I want to show you something.’ He showed me the first scan with that big tumor. Then he showed me the new scan: gone. I said, ‘Should I be happy?’ and Dr. Reyes said, ‘You should be ecstatic!’ ” The scan also showed that the spot on Bob’s lymph node was significantly smaller as well, and surgery was scheduled for August of 2021. “The plan was to remove a third of my lung and that one lymph node,” Bob says. “Dr. Maley wanted to make sure I was on that table for as short of a time as possible. He worked his schedule around a second surgeon’s so that I would have two doctors in the room. What Dr. Maley did surgically…I’m amazed anyone can do that.” “When I went back in and met with Dr. Reyes, he said to me, ‘Bob, you’ve been asking me for a while now if you’re going to be cancer-free. We’re really confident that we got everything out of you that was cancerous. As we’re speaking today, you’re cancer-free. Now we need to keep it that way.’ ” FIGHTING CANCER WITH PINPOINT ACCURACY What Bob didn’t know until after his surgery was that very small tumors— too small to be revealed by imaging—also had developed on three other lymph nodes. What had originally been diagnosed as stage1 cancer was actually stage 3, which required further treatment, such as radiation.
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Dr. Maley reviews the positive results of treatment with patient Bob O’Neill.
Therefore, he meets with Felicia E. Snead, M.D., a board-certified radiation oncologist and Chief of the Radiation Oncology Department. “With cases like Bob’s, we have data that shows radiation helps prevent the cancer from coming back in that area of the lymph nodes. Using Intensity Modulated Radiation Therapy (IMRT), we’re able to tailor the beam to dose-paint our target area and preserve healthy tissue around it, like the esophagus and the heart,” she says. “The treatment occurs five days a week for five weeks, and then I’ll follow up with subsequent imaging every six months to make sure nothing has grown back.” Due to advanced technology, St. Clair is able to offer multiple radiotherapy techniques to patients. In addition to IMRT, Stereotactic Body Radiotherapy (SBRT) delivers a higher dose of radiation over a shorter number of sessions. “SBRT works for stage 1 patients with more localized forms of cancer who might not be ideal candidates for surgery because of underlying health problems or advanced age,” says Dr. Torok. “It’s a very precise dose of radiation mapped with extensive imaging right onto their tumor to limit side effects.” The availability of these new techniques presents key benefits for patients at St. Clair. “IMRT and SBRT are both image-guided radiation therapy treatments. This allows for a treatment plan that is better customized for the patient and can be delivered with pinpoint accuracy,” says Dr. Torok.
This acute level of care can even take into account how a patient breathes. “With our advanced imaging studies, we’re able to track the motion of the lung cancer itself to be more precise with each treatment in concert with the movement of the tumor inside the patient’s body,” adds Dr. Torok.
THE FULL IMPACT OF COMPLETE CANCER CARE Bob O’Neill’s story encapsulates how St. Clair’s commitment to providing the most advanced cancer care is making a difference in the life of the South Hills community. “I feel unbelievably lucky,” Bob says. “There are so many wonderful people there. As bad as it is to have cancer, they made the experience better—even though I was a pain in the butt sometimes. The nurses were very calming when I was panicked over something. They understand that it’s a very vulnerable time. You’re scared, and this is cancer-scared. This is life or death. They treated me and helped me beyond the physical care my body needed.” “There’s nothing here that we don’t offer as far as state-of-the-art thoracic surgery, whether it’s robotic, minimally invasive, or major surgery,” Dr. Maley says. “But what’s different about St. Clair as a full-service cancer center is that face-to-face, personalized care. There’s no intermediary between the patient and the doctor. I do the diagnosis, I do the surgery and I do the follow-up care. What we have here is a full range of cancer care that you don’t have to leave the South Hills to receive.” Bob O’Neill’s perspective is a little more succinct, “This place is a godsend.” n
RICHARD H. MALEY, JR., M.D.
Dr. Maley is Chair of Surgery and Chief of Thoracic Surgery at St. Clair Hospital. He earned his medical degree at Hahnemann University Medical School, and then completed residencies in general surgery at the University of Kentucky and in cardiothoracic surgery at UPMC. Dr. Maley then completed fellowships in trauma/critical care at the University of Kentucky and in thoracic surgery at Memorial Sloan Kettering Cancer Center, New York City. He is board-certified by the American Board of Surgery and the American Board of Thoracic Surgery. Dr. Maley was named a Top Doctor in 2021 by Pittsburgh Magazine. Dr. Maley practices with St. Clair Medical Group. To contact Dr. Maley, please call 412.942.5710.
JORDAN A. TOROK, M.D.
Dr. Torok specializes in radiation oncology. He earned his medical degree from Pennsylvania State College of Medicine in Hershey. Dr. Torok completed his radiation oncology residency at Duke University Medical Center in Durham, NC. He is a member of the American Society for Therapeutic Radiology and Oncology (ASTRO), Alpha Omega Alpha Honor Medical Society, the American College of Radiation (ACR), and the Radiological Society of North America (RSNA). Dr. Torok is board-certified in radiation oncology and practices with Integrated Cancer Services, which is affiliated with UPMC Hillman Cancer Center, and is in-network for all major insurers. To contact Dr. Torok, please call 412.942.7001. ST. CLAIR HEALTH
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UROLOGIC CANCER CARE
ON THE ROAD AGAIN A complex urologic cancer case meets its match.
Sometimes experts need experts. As a member of the Mayo Clinic Care Network, St. Clair Health can provide patients with second opinions from Mayo Clinic specialists—without the need to travel for them. Patients are able to continue their ongoing care right in the South Hills at no additional cost.
W
hile each cancer diagnosis usually has an existing framework for a course of treatment, no individual case can ever be considered routine. Other factors always come into play, and doctors must draw on their own expertise and their patients’ preferences to choose the best possible plan of attack. For Shailen S. Sehgal, M.D., a urologic surgeon with St. Clair Medical Group, one patient’s recent diagnosis doubled the complicating factors in choosing a course of action. “Sometimes, the more challenging part is coming up with a plan,” Dr. Sehgal says. “With the advanced technology we have and the expertise we have using it, we’re extremely confident in that aspect, but the key is planning out exactly how, when, and where we utilize it.” That was the case with Dean Santo Colombo, a patient in his mid-50s. “I thought I had a kidney stone,” he says. “It turned out to be a whole lot more major than that. That was tough to take at first.”
Dean met with Dr. Sehgal, who after an exam in his office decided that more testing was needed. Shortly thereafter, Dean was diagnosed with a large tumor in his ureter, one of the tubes leading from the kidneys to the bladder. Additional diagnostic tests also revealed a tumor inside the bladder itself. “Now we had two areas we were concerned with that require very different approaches,” Dr. Sehgal says. “Not only did we have to decide the best strategy for each one, we had to decide which one to prioritize while being cognizant of how we would treat the other.”
“Through the whole thing, Dr. Sehgal has been my contact and advisor– as well as my surgeon. He kept me informed the whole way, and I feel like I’ve been personally involved in the care I’ve received.” DEAN SANTO COLUMBO, Patient
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In conjunction with the medical oncology team, Dr. Sehgal put together a plan to cauterize and excise the bladder tumor first, administer systemic chemotherapy to treat the ureteral tumor, and then remove the ureter, kidney, and a larger portion of the bladder. But before discussing this course of action with the patient, Dr. Sehgal sought one more consultation—with the urology team at Mayo Clinic. “I consulted with a Mayo Clinic urologist, explained the approach that we wanted to take, and he felt that our plan was completely viable,” Dr. Sehgal says. “This level of clinical collaboration is rare and critical to patient success.” “That wasn’t me asking for a second opinion, that was something Dr. Sehgal did on his own,” Dean recalls. “He felt like he wanted every resource that he could have at his disposal and he used them. If that doesn’t give you confidence in your doctor, I don’t know what does.” “That type of clinical collaboration helps to build a high level of trust,” adds Dr. Sehgal. “When the patient knows they have an expert team of surgeons and oncologists working together—and on top of that, a second opinion from a highly-regarded institution like Mayo Clinic—that reinforces their confidence in us and in the outcomes we’re hoping to achieve.”
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In 2021, St. Clair celebrated its fiveyear anniversary as a member of the Mayo Clinic Care Network. This relationship entails everything from providing second opinions from a Mayo Clinic specialist or subspecialist— like the case explored in this section’s article—to leveraging best practices, advancing programs, such as the Pharmacogenomics Program, and working together to combat a global pandemic. The Mayo Clinic Care Network launched in 2011 with the idea to extend Mayo Clinic’s world-renowned expertise and create meaningful relationships between Mayo Clinic and high-quality organizations that could make a positive impact on the lives of patients. St. Clair Health is privileged to be the only healthcare system in the region that holds this designation. As part of St. Clair’s mission to provide highquality, low-cost health care, patients benefit from not having to travel in order to get a second opinion, continuing their ongoing care right on the St. Clair campus—at no additional cost.
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UROLOGIC CANCER CARE CONT. Continued from Page 13
Dean Santo Columbo is grateful for every mile.
After first cauterizing and removing tissue from the bladder tumor for biopsy, the St. Clair team’s solution included two surgical techniques. The first was a laparoscopic procedure using the robotic-assisted da Vinci® Surgical System to remove the kidney and ureter. “Urology is a unique field in that a number of surgeries are done with a robotic technique. Visualization is better, we can magnify more definitively, and we felt that was the best option for this stage of the plan,” Dr. Sehgal says. Dr. Sehgal then employed a more traditional incision technique as the most thorough approach for removing a part of the bladder to determine if the ureter tumor had spread further. After those tests came back with negative margins, the next phase of the patient’s treatment began. On November 1, Dean began the process
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of receiving six treatments with BCG (Bacillus Calmette-Guérin) to combat his bladder cancer. Originally developed as a vaccine to help prevent tuberculosis, BCG has proven effective as immunotherapy in battling bladder tumors. BCG causes an immune system reaction that directs germ-fighting cells to the bladder, attacking the tumor. At St. Clair Health’s Dunlap Family Outpatient Center, the treatment is given via catheter and takes only 30 to 60 seconds. Patients are usually able to go home in just 10 minutes. “Overall, the prognosis is very good,” Dr. Sehgal says. “Obviously, we’re going to keep an eye on it, but right now, it looks like we’re going to be successful.” “I’m feeling good,” says Dean, a truck driver for 37 years. “That was a major operation and I’m back at work. I owe that to Dr. Sehgal.”
Dr. Sehgal takes great pride in the small details that can make a big difference.
“St. Clair invested in the newest robot last year. It’s the most advanced technology offered anywhere. The fact is: at St. Clair Health, our patients receive tertiary level surgical care from physicians that are easily accessible to them. It’s truly advanced care close to home, and that’s a unique combination.” SHAILEN S. SEHGAL, M.D. Urologic Surgeon
SHAILEN S. SEHGAL, M.D.
Dr. Sehgal earned his medical degree at Cornell University and completed his urology residency training at the University of Pennsylvania. He completed a research fellowship at the National Institute of Health and a robotic surgery fellowship at the University of Pennsylvania. Dr. Sehgal is board-certified by the American Board of Urology. He practices with St. Clair Medical Group. To contact Dr. Sehgal, please call 412.942.4100.
COLLABORATION, COMMITMENT & PATIENT-CENTERED CARE Throughout Dean’s experience, developing a close doctor-patient relationship has been the key. “Through the whole thing, Dr. Sehgal has been my contact and advisor—as well as my surgeon,” he says. “I’m pretty amazed at the amount of contact I’ve had with him. He kept me informed the whole way, and I feel like I’ve been personally involved in the care I’ve received.” Dr. Sehgal joined the St. Clair team in 2013 following six years at University of Pennsylvania Health System. Going from a large urban health system to a communitybased system was a welcomed transition. “One of the key benefits of a hospital that is truly embedded in the communities it serves
is that patients have much better access to their physicians—they’re more involved in the process. If they have a question, it’s easy to get in touch with a doctor or member of the staff to get an answer,” he says. “I can’t say enough about the people,” Dean adds. “The doctors all discuss the case together and come up with the best plan for me. It’s not just one mind at work—it’s the whole group working together. The same-day surgery folks were awesome and the nurses were great. I really got great care.” Dr. Sehgal is particularly proud of St. Clair’s relentless effort to provide his urology team with everything it needs to consistently deliver the highest level of care. “One of the unique things at St. Clair is that we have five urologists who all do cancer surgery—and we all work
very well together. The organization has a very strong commitment to ensure that we have the best tools to work with in order to provide high-quality treatment options to our patients.” In Dean’s case, that included the most up-to-date iteration of the da Vinci® System. “St. Clair invested in the newest robot last year. It’s the most advanced technology offered anywhere. The fact is: at St. Clair Health, our patients receive tertiary level surgical care from physicians that are easily accessible to them. It’s truly advanced care close to home, and that’s a unique combination,” Dr. Sehgal says. n
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DA VINCI® ROBOT-ASSISTED SURGERY
MINIMALLY INVASIVE TOOLS & TECHNIQUES ENHANCE MAJOR UROLOGIC SURGERY The most advanced technology enables surgeons to perform delicate and complex operations through a few tiny incisions with increased vision, precision, and control.
U
rologic cancer comes in many forms, from bladder and kidney cancer in both men and women to prostate and testicular cancer in men alone. Treatment options can vary just as much and depend on several factors, such as the stage of the disease and patient preferences. Chemotherapy, radiation, immunotherapy, or surgery can work as a standalone approach or together in a variety of combinations. Continued on Page 18
Kevin P. Bordeau, M.D., performs surgery using the da Vinci® robot at St Clair.
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GREATER PRECISION SMALLER INCISION ST. CLAIR HEALTH
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DA VINCI® ROBOT-ASSISTED SURGERY CONT. Continued from Page 16
The da Vinci® System translates Dr. Bordeau’s hand movements at the console in real time, bending and rotating the tiny instruments while performing the procedure.
For surgical treatment, urologic surgeons are increasingly turning to robotics, says Kevin P. Bordeau, M.D., of St. Clair Medical Group. “The goal is to take a major radical operation and make it less invasive. In urology, robotic surgery has become the norm in many cases.” PROSTATE CANCER That’s especially true for prostate cancer. In the United States, 75 percent of prostate surgeries today are performed using the da Vinci® Surgical System for robotic-assisted surgery. At St. Clair, Dr. Bordeau says, it’s 99 percent. “Prior to da Vinci, a prostatectomy was open surgery. That moved first to less radical laparoscopic surgery and then ultimately to robotic surgery, primarily da Vinci. That shift was slow to evolve in the city, and St. Clair was one of the first to utilize this technology in the region on a regular basis.” The state-of-the-art da Vinci System consists of four interactive robotic arms controlled by the surgeon. Three of the arms are for tools—including a scalpel
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and scissors—while the fourth holds an endoscopic camera with two lenses that gives the surgeon a 3D image of the patient during the procedure. “It’s a seamless operation, with the da Vinci translating the surgeon’s movement in real time. Every maneuver is under the direct control of the surgeon,” Dr. Bordeau says. St. Clair urologic surgeons will often take a multi-modal approach to prostate cancer. After a biopsy confirms cancer and radiology determines that the cancer hasn’t spread, in some cases of locally advanced disease, hormonal therapy can be used. This is followed by robotic surgery to remove it, then radiation treatment to the area once it has completely healed. Dr. Bordeau says, “That’s a little outside the box. Others may look at the patient’s age and decide to do radiation and keep the patient on hormones. Our outcomes are good. I look at each patient like, ‘That could be my dad. Now, how are we going to approach this to get this person cancer-free?’ That’s an approach to prostate cancer we’ve used to great success.”
KIDNEY CANCER In addition to prostate cancer, urologists also use the da Vinci System for treating cancers of the kidneys. “Nephrectomy (kidney removal) is usually done either purely through a laparoscopic technique or robotically,” Dr. Bordeau says. “But one of the major advancements that da Vinci has allowed is a partial nephrectomy. We can remove the tumor and leave most of the kidney intact, then perform a reconstruction of the kidney.” For certain kidney cancers, tumors can also be destroyed through a minimally invasive freezing process called cryoablation. Using imaging as a guide, an interventional radiologist applies a super-cold needle (-112°F) to the mass, freezing and thawing the tumor in a one- to two-hour procedure. “If a patient, usually an older patient, doesn’t have adequate kidney function, you can’t necessarily do the best chemotherapy,” Dr. Bordeau explains. “There are also cases of small tumors that are difficult to diagnose as cancerous through imaging. In both instances, cryoablation is an excellent option.”
BLADDER CANCER Laparoscopic and incision surgery remain the norm for bladder cancer, which tends to be more complicated, causing obstruction of one or both kidneys or spreading outside of the bladder to the pelvis. If caught early, however, bladder tumors can be treated with BCG (Bacillus Calmette-Guérin) immunotherapy. But in many cases, the bladder must be removed. “One of the main things that people facing bladder removal are concerned with is, ‘What happens next?’ Our goal is to give them options,” Dr. Bordeau says. The most common approach after bladder removal is to use part of the small intestine to create a stoma which passes urine into an ostomy pouch. At St. Clair, another option is an advanced reconstructive technique to fashion a “neobladder” from part of the small intestine. This internal solution connects to the urethra and in time functions as a normal bladder.
TESTICULAR CANCER Surgical treatment of this condition, typically afflicting young men in their 20s and 30s, is performed through a small incision in the groin to avoid lymphatic damage. Advancements in surgical techniques now generally allow this surgery to be performed on an outpatient basis, with a goal of delivering minimal disruption to a patient’s life. The cancerous testicle is removed, and often replaced with a prosthetic. A COMMITMENT TO ADVANCED CANCER CARE Dr. Bordeau has had a front-row seat to the evolution of urologic cancer care since joining the St. Clair team in 2005. In addition to roboticassisted surgery, St. Clair’s adoption of the most modern technology also includes imaging and radiology, both of which are vital in the fight
against cancer. “We had a patient recently with locally advanced bladder cancer,” Dr. Bordeau says. “When he arrived, he also had obstructed kidneys. It was our imaging that pinpointed what and where the problem was. We inserted tubes that normalized the patient’s kidney function and allowed for preoperative chemotherapy to shrink the tumor, followed by surgical removal.” At St. Clair Health, advanced cancer care close to home means taking each patient’s care personally. “We focus on building our approach around each patient,” Dr. Bordeau says. “We collaborate to come up with their specific plan. It’s like a script. Sometimes we have to go off-script due to circumstances, but we stick to the plan and usually, 10 years later, most of our urology cancer patients are still cancer-free. Those positive outcomes are a true joy.” n
“I look at each patient like, ‘That could be my dad. Now, how are we going to approach this to get this person cancer-free?‘” KEVIN P. BORDEAU, M.D. Urologic Surgeon
KEVIN P. BORDEAU, M.D.
Dr. Bordeau specializes in urology. He earned his medical degree at Tufts University, Medford, Mass., and completed a residency at Eastern Virginia Medical School, Norfolk. Dr. Bordeau is board-certified in urology, and was named a Top Doctor in 2021 by Pittsburgh Magazine. He practices with St. Clair Medical Group. To contact Dr. Bordeau, please call 412.942.4100.
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BREAST CANCER CARE
A FAMILY HISTORY OF CANCER
A FUTURE RESHAPED BY COMPASSIONATE CARE How a closer look at genetic markers, preventative screening, and an integrated care team helped one woman look to the future with hope—for herself and others like her.
Karen Conroy, Patient
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K
aren Conroy is no stranger to cancer. “The word ‘cancer’ doesn’t really scare me, because I’ve been around it all my life,” she says. “From my mom to grandmother to my greatgrandmother to all my aunts and my sister, they’ve all either been diagnosed or passed away due to breast cancer or ovarian cancer.” “I was thirteen when my mom was first diagnosed with throat cancer. I thought it was just normal to go down to the Cancer Center to get treatment,” she adds. In 2020, that family history led her to pursue preventative screenings, which revealed that the hardworking mother of three carried the cancer gene. With the knowledge that her chances of contracting both breast and ovarian cancer were very high, a follow-up exam revealed a cancerous breast tumor and findings in her ovaries in January of 2021. Karen’s ever-vigilant mindset made her next stop the St. Clair Hospital Breast Care Center. “It wasn’t like walking into a doctor’s office and they’re just going to tell you what kind of cancer you have,” recalls Karen. “It was meeting a group of women that were so compassionate and friendly and warm.” “When I met with Karen,” says Tara L. Grahovac, M.D., a breast surgeon with St. Clair Medical Group, “there was the surgical decision-making process, but her case also involved genetic counseling. And that was in large part why, even though this was a very small, early-detected breast cancer—one that might normally have called for a lumpectomy— we customized her plan to her specific genetics that put her at a high risk for getting a second, unrelated breast cancer in the future.” In March, Karen had a hysterectomy, followed seven days later by a double mastectomy performed by Dr. Grahovac— with reconstruction immediately thereafter performed by Edward J. Ruane, Jr., M.D., plastic and reconstructive surgeon with St. Clair Medical Group.
“Both breasts were removed,” says Dr. Grahovac, “in what’s called a skin-sparing mastectomy—saving all the skin so Dr. Ruane could use it for the reconstruction.” The team’s integrated, innovative approach meant that Dr. Ruane could begin Karen’s reconstruction right after Dr. Grahovac set them all up for success. Dr. Ruane used a two-stage approach to the reconstruction. “First, we placed a balloon-type device called a tissue expander, which gives the patient more control over the exact size and shape they want. Then, about three months later, Karen had a minor outpatient procedure to place her permanent silicone implants,” Dr. Ruane says. As with every breast cancer case, Karen’s two surgeons had distinct and equally critical roles. “My job is to give them the best possible outcome from their cancer diagnosis,” says Dr. Grahovac. “Dr. Ruane is all about, ‘We’re going to take care of your cancer—that’s a given—so now how would you like to look at the end of this? What’s your goal?’ Then he further customizes the reconstruction to achieve each patient’s wishes regarding their preferred look and feel.”
“Just know you’re in such great hands... I’ve had amazing support with the doctors, the nurses, and everybody that’s touched my life through this… I’m blessed.” KAREN CONROY, Patient
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Dr. Ruane meets with Karen Conroy to discuss how far she’s come. ST. CLAIR HEALTH
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Customization, in fact, is a theme at St. Clair Health, which offers a full range of surgical and reconstructive options, including tissue-based and implant-based reconstruction; breast conservation when appropriate, with or without plastic surgery; and, if necessary or preferred by the patient, mastectomies completed without reconstruction or with different versions of reconstruction. “Dr. Ruane initially took scans and pictures of me, then graphed on my body what I’d look like,” recalls Karen. “I didn’t want to look like I’d had an implant. I wanted to look very natural. So I tell people that he paints you like a canvas...as he’s drawing and showing you what you’re going to look like, he has that paintbrush in his hand and he can tweak you and make you look the way you want to look. It’s pretty incredible how they can give you the shape you want.” “We provide all of the most modern techniques,” adds Dr. Ruane, “with the breast oncologic surgeon and plastic surgeon working closely together for patients undergoing mastectomy or lumpectomy. We offer patients the cancer care they deserve, along with the best possible cosmetic outcome.” Karen’s successful outcome is a great example of St. Clair’s relentless effort to look at the whole patient across their cancer journey—uniting skilled surgeons and modern techniques with the patient’s resiliency. “My husband Brian is my rock,” says Karen. “I call him Superman, because he does everything. He’s helped me throughout the journey. When they told me I had cancer, I didn’t crawl in a hole. I didn’t get depressed. It was, ‘Let’s go do what we have to do. Do whatever you have to do to get the cancer out of me.’ I knew with Brian’s support, with my positive attitude, and these amazing doctors, it would be okay. They walked me through every step of what I was going to experience, how I was going to deal with it afterwards, and how they would manage my pain. They were very detailed about how they were going to get me from Point A to Point B. Every time I had a question, when I would email or call them, they would call me right back within minutes. They were never too busy to talk to me. I’ll be a lifelong patient going to see the fantastic team at St. Clair.” Karen’s positive outcome is a testament to Dr. Ruane’s patient-centric approach.
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“We offer patients the cancer care they deserve, along with the best possible cosmetic outcome.” EDWARD J. RUANE, JR., M.D. Plastic and Reconstructive Surgeon
Dr. Ruane and Dr. Grahovac working seemlessly together during a procedure.
A POSITIVE OUTLOOK WITH AN EXCELLENT PROGNOSIS While no surgery can entirely guarantee that cancer won’t come back, because Karen’s was caught early with advanced imaging, expert care, and treated to the maximum extent, her prognosis is excellent. And with her diagnosis, surgery, and reconstruction adding to her lifetime of experience dealing with cancer, Karen finds herself in the proud position of being able to help others. During a follow-up appointment at St. Clair, Karen says: “A woman had just gotten out of the initial meeting where she was diagnosed with cancer. She was with her husband, overwhelmed with both information and emotion. I went over and told her, ‘Just know you’re in such great hands,’ to reassure her. I’ve had amazing support with the doctors, the nurses, and everybody that’s touched my life through this…I’m blessed. At my next appointment at the Breast Care Center, I’m going to ask if I can be an advocate—a lifeline to somebody before, during, or after they go through what I’m overcoming.” n
EDWARD J. RUANE, JR., M.D.
Dr. Ruane specializes in all aspects of plastic surgery, ranging from reconstructive to cosmetic. He earned his medical degree at Duke University School of Medicine and completed a residency in Plastic Surgery at the University of Pittsburgh Medical Center, where he served as Administrative Chief Resident in the Department of Plastic Surgery. Dr. Ruane was named to the 2021 list of America’s Best Plastic Surgeons by Newsweek. Along with Dr. Robert W. Bragdon, Dr. Ruane practices with St. Clair Medical Group. To contact Dr. Ruane, please call 412.572.6164.
TARA L. GRAHOVAC, M.D., F.A.C.S.
Dr. Grahovac specializes in breast surgery. She earned her medical degree at the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Grahovac completed her residency in general surgery at Allegheny General Hospital, and a fellowship in breast surgery at UPMC Magee-Womens Hospital. She is board-certified by the American Board of Surgery and is certified as a trained clinical fellow in breast surgical oncology by a Society of Surgical Oncologyaccredited program. Along with her partner Raye J. Budway, M.D., F.A.C.S., Dr. Grahovac practices with St. Clair Medical Group. To contact Dr. Grahovac, please call 412.942.7850.
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CLINICAL TRIALS
ACCESS TO MORE THAN
500 CLINICAL TRIALS
T
he most innovative, up-to-date potential treatment. Something that you can participate in that could be the next big thing. “That’s what clinical trials are,” says Vincent E. Reyes, Jr., M.D., an Assistant Medical Director at UPMC Hillman Cancer Center who also serves as Chief of Hematology and Medical Oncology at St. Clair Health. “All drugs, therapies, and interventions need to be studied— we learn how efficacious and safe they are through a very formalized verification process. Every drug and every therapy we offer has gone through it.” Models and goals for clinical trials have only one thing in mind: the patient. “We have access to more than 500 clinical trials, but it’s not about the number. It’s the full breadth of clinical trials that allows us to personalize and tailor clinical trials to each patient. And that takes collaboration in concert with each patient and their family—that level of cohesion is what makes us different,” says Dr. Reyes.
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Experimental treatments exist to provide patients the options that wouldn’t otherwise be available. The excitement for what’s new can also include hesitancy regarding what’s as-yet unproven. “What often drives a patient to choose to participate in a clinical trial is two-fold: it can help you right now, and it can also help someone else down the road to the point where maybe they don’t need harsher therapies at all. There’s a real sense of altruism involved because it’s a selfless act—clinical trials exist for the betterment of future cancer care for all,” says Dr. Reyes. At St. Clair Health, surgical, medical, and radiation oncology work together to deliver complete cancer care. “Having all three in one place is an integral part of our patient-first approach,” says Katerina A. Hunter, M.D., a medical oncologist and hematologist at the St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center. “Different specialists are able to meet directly with the patient at the same time, which expedites their care because we’re able to coordinate based on more specific—and more immediate—doctor-patient interactions.” Equally important from Dr. Reyes’ perspective, each discipline is driven by the same goal. “How do we get to the point where we don’t need to conduct clinical trials at all—because there is no cancer? Striving for a life without cancer is where trials, research, and science come together in pursuit of that lofty ideal,” he says. As long as cancer exists, oncologists at St. Clair Hospital Cancer Center will use clinical trials to help answer the wide-ranging questions that cancer treatment presents. “For example: ‘What is the best, most efficient way to use radiation so that
St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center brings many of them right to patients in the South Hills.
it’s not harmful to a patient?’ We want to help with symptoms while we work to eviscerate your cancer, so our focus is on exploring new techniques and treatments that can help get you back to living your life—with less symptoms along your journey—as quickly as possible,” Dr. Reyes says. That line of thinking is equally integrated with medical oncology. “Immunotherapy utilizes new classes of drugs so we might not have to use chemotherapy,” Dr. Reyes adds. “And from kidney cancer to cancers of the lung, breast, and prostate, it’s only through clinical trials that we’re able to see it work.” “That’s obviously very important,” adds Dr. Hunter. “Clinical trials are an essential part of our mission to help patients and deliver treatment options that are in line with their priorities. Trials help us provide great care to patients while advancing the field of oncology, and that’s how we figure out what new and emerging therapies are helping patients live longer and which ones aren’t—and that’s the point: figuring out what works and what doesn’t.” Variables that may make someone a good candidate for a clinical trial include their disease type, previous treatment history, and the rapidity of their current cancer’s progression. “Another big element is timing. Not all cancer types have trials available upon diagnosis, a patient may have an unknown primary source of cancer where we don’t know exactly when their cancer started, or their present organ function may be threatened by the current stage their cancer is in, so we may need to use another treatment with greater immediacy,” Dr. Hunter says. Clinical research nurses help identify eligible patients by assisting the Cancer Center team with screening to define both current patient regiment progression and identify new patients parallel to a respective cancer type’s clinical trial availability. In addition to a patient’s standard level of care, clinical trials demand additional monitoring,
tests, and scans. “At St. Clair Health, our standard of care is the best care possible, period. And in many cases we are now able to offer something in addition to that—something that helps us discover better treatment options for both today’s patients and future generations,” Dr. Reyes says. St. Clair Health’s team-based approach to cancer care is built on a highly-collaborative foundation. “The ability to get different perspectives is at the heart of everything we do. It’s a roll-up-your-sleeves mentality where everyone is doing their utmost to help patients beat cancer. In many ways it comes back to the question, ‘What made you want to become a doctor?’ And the answer is our motivation to provide the best care we can with a tremendous amount of compassion for every patient involved,” says Dr. Hunter. “Clinical trials are all about the bond between the patient and their care team. It’s comfort, confidence, and trust. We all come together to support the advancement of cancer care,” adds Dr. Reyes. In addition to that expert level of care, this unique relationship also affords patients a seamlessly integrated experience all the way through their clinical trials. “It doesn’t matter who your primary care doctor is, what surgeon you may have seen before, or what health insurance you have. We’re here to help—and we want to take care of you,” says Dr. Reyes. “It’s an incredible privilege to be surrounded by a team that’s the best of the best across the board—and an even greater privilege to be able to combine that expertise into the clinical trial process for patients,” says Dr. Hunter. “What we’re able to do is important— and it’s only achievable because of the collective team, working together to give every patient every opportunity to succeed in their fight against cancer.” n
“Clinical trials are all about the bond between the patient and their care team. It’s comfort, confidence, and trust. We all come together to support the advancement of cancer care.” VINCENT E. REYES, JR., M.D. Chief of Hematology and Medical Oncology Co-Chair, St. Clair Hospital Cancer Committee
Dr. Reyes strives to deliver the most innovative potential treatment options.
KATERINA A. HUNTER, M.D.
Dr. Hunter specializes in hematology and medical oncology. She earned her medical degree from the University of Virginia, School of Medicine in Charlottesville. Dr. Hunter completed her internal medicine residency at University of Wisconsin Hospital and Clinics in Madison, and hematology/ oncology fellowship at UPMC. She is board-certified in hematology and oncology, and practices with Integrated Cancer Services, which is affiliated with UPMC Hillman Cancer Center, and is in-network for all major insurers. To contact Dr. Hunter, please call 412.942.8701.
Bringing clinical trials to patients in the South Hills is a privilege for Dr. Hunter.
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WALGREENS SPECIALTY PHARMACY
EVERYTHING YOU NEED. EVERY TIME YOU’RE IN NEED.
MedsInHand™ is saving patients a trip to the pharmacy— and reducing return visits to the Hospital.
Ashley M. Blazewick, PharmD, Registered Pharmacy Manager of the Walgreens onsite pharmacy inside St. Clair’s Dunlap Family Outptient Center.
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t. Clair Health and Walgreens Specialty Pharmacy have partnered on the MedsInHand™ program, inaugurated in the Fall of 2021 with the mission to get patients the right medication as efficiently as possible so they can concentrate on their recovery—not tracking down prescriptions. The MedsInHand program, a service offered directly through the Walgreens Specialty Pharmacy located within Dunlap Family Outpatient Center, saves patients a stop at the drugstore on their way home and eases the transition from Hospital care to their home life—all while reducing the likelihood that they’ll have to come back. Working together, St. Clair and Walgreens ensure that patients have everything they need when they leave the Hospital, following up to make sure they’re using their medications properly. Ashley M. Blazewick, PharmD, Registered Pharmacy Manager of the Walgreens Onsite Pharmacy, says, “We have highly-trained
technicians, along with access to limiteddistribution medications. We work directly with St. Clair’s provider offices to overcome any barriers patients might experience in processing their prescriptions quickly. We also help connect eligible patients to financial assistance.” For Robert B. Reynolds, PharmD, Director of Pharmacy at St. Clair Health, Walgreens is “a big part of Dunlap Family Outpatient Center’s emphasis on an enhanced, integrated experience for inpatients being discharged to home, same-day surgery patients, and emergency department patients. And with Walgreens, we can better serve all of them.” “Once we have the prescriptions at Walgreens,” says Dr. Blazewick, “the streamlined communication between us and the St. Clair staff is something I’ve never seen before. I have a direct line to every prescriber at St. Clair. That’s one of the best parts of this relationship and our program.” The benefits of the MedsInHand program
In addition to the patient services offered on the St. Clair Health main campus, the MedsInHand™ program is available for any member of the communities we serve to fulfill their prescription service needs. To learn more about how the MedsInHand program can help you, please call 412.502.2863 or visit stclair.org.
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include fewer readmissions, greater patient satisfaction, and the convenience of shorter wait times to have a prescription filled. According to Dr. Reynolds, “We know that in general, 30 percent of patients don’t get their prescriptions filled due to a variety of barriers and challenges—and many of those medications are intended to keep them from having to come back to the Hospital. At St. Clair, Dr. Blazewick and her team work diligently to identify any problem, interact directly with prescribers, and fix it before the patient even knows it exists. That’s a huge advantage. Altogether, the MedsInHand program works cohesively to help patients get well more quickly.” Expert care from people who care. The partnership with Walgreens is a direct connection to St. Clair’s commitment to excellence, providing the kind of patient-first attention to detail that patients can count on—and that begins with the passionate people driving the program. “We’re all extremely excited to be here and be able to provide this extraordinary care to all of the patients at St. Clair. We take great pride in having the opportunity to coordinate such a positive experience...from identifying problems to answering patients’ questions in real time, directly, at their bedside. I’m thrilled about the impact we’re having on the community,” says Dr. Blazewick. Adds Dr. Reynolds, “St. Clair and Walgreens share a like-minded commitment to deliver whatever the patient needs, right here and now. There’s no sending them somewhere else and fewer complications as a result. It’s all about providing everything you need, every time you’re in need.” n Robert B. Reynolds, PharmD, Director of Pharmacy
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NURSING MANAGER PRACTICES WHAT SHE PREACHES
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ach day begins with a report from the nightshift. Collaborative in spirit, coordinated across the team working the floor, curated for each patient. Upon admission: a question that tells you everything you need to know about Megan Rhoades, R.N., BSN, Oncology Unit Nursing Manager. “What do they need in order to get back home? That’s the driving force for everyone. Cancer care is many different things—from screening to help prevent cancer to follow-up with our oncologists to confirm a diagnosis; respective treatments including radiation, chemotherapy, and surgery; and also survivorship. So from that very first interaction, we laser focus on what they need to get where they want to be,” she says. With tremendous respect for the continuum of care, Rhoades finds each part of the process rewarding. “We see the full spectrum of patients—cancer doesn’t care about how old you are or anything else. So we work at all different levels of support, from helping you find out what’s wrong to seeing you through to cancer-free,” she adds. The stronghold that support maintains throughout is exemplified by the role Rhoades serves as community coordinator for the Hospital’s outreach
and support programs—from free screenings to helping loved ones pick up the pieces. “Survivorship is part rehabilitation—retraining your body from a physical and occupational standpoint. But it’s also about humanity—would a wig make you feel more comfortable or would you like help learning how to do your hair and makeup as you go through treatment? And more than anything it’s about being there for the patients and their families who are going through one of the most difficult and challenging times of their lives. It’s a privilege to help them,” she says. Rhoades came to St. Clair in 2008 as a nursing intern on the telemetry unit and quickly impressed. She jumped at the opportunity to serve as a nursing aide through graduation from Waynesburg University. Rhoades then joined St. Clair full-time as a nurse in the medical surgical unit, progressed to the float pool with an eye on gaining perspective from many different disciplines, and
Expert care from people who care. It’s more than our tagline— it’s the relentless drive we bring to carry out our mission every single day. Interested in joining the team? Follow St. Clair Health Careers on Facebook and LinkedIn or visit stclair.org.
became a patient placement manager before finding her current home in oncology. “I took a journey at St. Clair—and I’m still on that journey. I love learning and the field of nursing is so unique with many different paths you can take. That’s one of the best parts of being here...I’ve been fortunate to be able to grow into different roles and still have that feeling of, ‘I don’t know what I want to be when I grow up!’ ” she says. Rhoades, a lifelong resident of Washington, plays the bassoon in the Washington symphony and teaches 4th grade Sunday school classes at St. James Parish. The 2017 Cameos of Caring® recipient was also a Pittsburgh Magazine Excellence in Nursing honoree in 2019. “We have very seasoned nurses who have been here forever and brand-new nurses just starting out. Every day is an education—and then I also get to teach my staff. What’s really great is that continues to be a two-way street: we’re all learning from and teaching each other,” she says. n Megan Rhoades, R.N., BSN Oncology Unit Nursing Manager
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1000 BOWER HILL ROAD PITTSBURGH, PA 15243 STCLAIR.ORG
@StClairHealth
To find a doctor, along with a full list of services and locations, visit stclair.org.
Complete Cancer Care Close To Home
Driven by cutting-edge science, and combining the strengths of its partners, St. Clair Health has assembled a full-service clinical oncology program for residents of the South Hills, close to home.
Surgical Oncology
Radiation Oncology
Some of the region’s leading cancer surgeons, using advanced and minimally invasive techniques, are part of St. Clair Medical Group. St. Clair’s breast, colorectal, thoracic, and urology surgical programs are among the largest in the region.
One of only a few programs in the region to offer stereotactic radiation therapy, a technological advancement that delivers more precise doses of radiation to kill cancer cells.
Second Opinions
Medical Oncology
Second opinions from Mayo Clinic experts are available to patients of St. Clair Health at no additional cost.
One of the largest cancer centers in the region, offering the latest immunotherapy advances, like CAR-T cell therapy.
Network Access St. Clair Hospital Cancer Center is in-network for all major insurance plans, including most Highmark insurance products.
Screening & Diagnostics Clinical Trials Access to more than 500 clinical trials through UPMC Hillman Cancer Center.
St. Clair Health uses the most sophisticated imaging and diagnostic equipment to ensure patients receive fast and accurate readings to diagnose and devise a course of treatment.