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Avera Cancer Institute FINDING RELIEF

FROM SIDE EFFECTS

Look and Feel

Beautiful Inside and Out

Care for the Caregiver

Exploring all Options

After a Breast Cancer Diagnosis

FALL 2016

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DEAR READERS, At Avera, we “think pink” throughout the entire year when it comes to prevention and early detection of breast cancer, as well as innovative treatment and survivorship care. Yet as October is National Breast Cancer Awareness Month, it’s the perfect time for us to publish an Avera Cancer Institute magazine that focuses solely on the breast cancer journey. Aside from minor skin cancers, breast cancer is the type of cancer that women are most likely to experience. In fact, this disease affects one in eight women during their lifetime. Avera’s breast care program really begins at the level of your primary care provider – your family doctor. This is where important discussions take place, for example, are you scheduling regular mammograms as recommended? Are you feeling anything unusual or different? Avera Breast Center offers the latest diagnostic equipment to find breast cancer in its earliest stages, for example, digital mammography, 3-D mammography and contrast enhanced spectral mammography (CESM). Most suspicious breast lesions turn out to be benign. Yet if you are among those diagnosed with breast cancer, take heart. Avera offers the latest, most innovative treatment options and surgical techniques, which you’ll read about in this issue. You’ll also read how women can benefit from Avera’s second opinion consults, high-risk program and genomic medicine. These are just a few examples of what makes Avera’s cancer care remarkable. There’s also Avera’s interconnectedness that ensures seamless care between locations, and our commitment to care for you as a whole person – body, mind and spirit. Please visit Avera.org/breast to learn more.

ONE AVERA BREAST CENTER. SIX REGIONAL CENTERS. Avera Cancer Institute Avera Breast Center 305 S. State St. Aberdeen, SD 57401 605-622-5000 Avera Cancer Institute Avera Breast Center 300 S. Bruce St. Marshall, MN 56258 507-537-9000 Avera Cancer Institute Avera Breast Center 525 N. Foster Mitchell, SD 57301 605-995-5756 Avera Cancer Institute Avera Breast Center 1000 E. 23rd St. Sioux Falls, SD 57105 605-322-3000 Avera Cancer Institute Avera Breast Center 1115 W. Ninth St. Yankton, SD 57078 605-668-8000 Avera St. Mary’s Hospital Avera Breast Center 801 E. Sioux Pierre, SD 57501 605-224-3100

Thanks for reading! In good health,

Tad Jacobs, DO Chief Medical Officer, Avera Medical Group Several of the cancer programs and services you’re reading about are supported by generous donors from across the Avera system. To learn how you can help support local cancer patients through the Avera Cancer Institute, visit Avera.org and click on Donate to Avera.


CONTENTS Avera Cancer Institute

FALL 2016

WHAT’S NEW

6

Across The System.................................................................... 2

SPECIAL ATTENTION FOR HIGH-RISK PATIENTS............................................... 4 THE PROMISE OF GENOMICS

Helping Patients Stay Cancer Free............................................ 6

TECHNOLOGY AND TECHNIQUES

A Look at Innovative Approaches to Cancer Care ..................... 8

THOUGHTS ABOUT SURVIVORSHIP From Survivors.......................................................................... 11

EXPLORING ALL OPTIONS

12

Avera Breast Center Helps Women Make Treatment Decisions........................................................ 12

RELIEF FROM SIDE EFFECTS

Acupuncture Eases Chemo-Related Symptoms........................ 16

CAREGIVING

Tough Jobs Are Worth It............................................................ 18

LOOKING AND FEELING BEAUTIFUL........................... 20

Patient stories in this magazine describe the actual medical results of individual patients. These results may not be typical or expected for the disease type that is described, and all patients should not expect to experience similar results.

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WHAT’S NEW ACROSS THE SYSTEM: Avera St. Mary’s Hospital in Pierre

Avera Cancer Institute in Sioux Falls A BLOOD TEST THAT DETECTS BREAST CANCER

NEW HELMSLEY CENTER TO HOUSE CANCER CARE Avera recently announced plans to build a new cancer center in Pierre, thanks to up to $10 million in grant funding from The Leona M. and Harry B. Helmsley Charitable Trust. The new home for Avera Cancer Institute in Pierre will be named the Helmsley Center, and it will house state-ofthe-art cancer care as well as clinic space for primary and specialty care. The Helmsley Charitable Trust donated a grant of $7.5 million that will go toward construction of the new building, plus purchase and installation of a new linear accelerator for radiation treatment, specialized infusion chairs, and a TUG robot that delivers medications including chemotherapy to care units in the hospital and cancer center. The Helmsley Charitable Trust has also announced a $2.5 million dollar-for-dollar challenge matching grant. The Avera St. Mary’s Foundation will launch a fundraising campaign in 15 counties in central South Dakota to meet the $2.5 million challenge through donations of area individuals, families and businesses. This is the first time the Helmsley Charitable Trust has offered a challenge match in South Dakota and the Avera system. The new Helmsley Center will be constructed between Avera St. Mary’s Hospital and Avera Medical Group buildings. Construction is planned to begin next summer, with an estimated opening date of late fall 2018.

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After taking part in two clinical trials, Avera Cancer Institute in Sioux Falls is among the first five sites in the nation and the only site in the region to fully implement use of a new blood test used to detect breast cancer after an abnormal mammogram. Videssa® Breast by Provista Diagnostics checks for tumor-associated antibodies and serum protein biomarkers. With an accuracy of 98.6 percent, a low protein result confirms the absence of breast cancer. A high protein result may indicate the presence of breast cancer and will prompt further clinical follow-up, such as contrast enhanced spectral mammography (CESM) or MRI and/or biopsy. In studies, when diagnostic mammography and Videssa Breast were combined, it detected 100 percent of cancers at an early stage. Currently, an abnormal mammogram finding leads to additional diagnostic tests and in certain cases, biopsy. Yet nationwide, up to 80 percent of breast biopsy results are benign. At the same time, using traditional screening methods, up to 30 percent of breast cancers can go undetected in women with very dense breasts. “This blood test offers the benefit of reducing the number of women who need to undergo biopsy. In many cases, they can just have the Videssa® Breast blood test, and we can confirm it’s benign with confidence,” said Tricia Merrigan, MD, Avera Medical Group breast surgeon. “Likewise, it gives us greater potential to detect breast cancers that we don’t find through imaging alone.”


Avera Cancer Institute in Marshall 3-D MAMMOGRAPHY Avera Cancer Institute in Marshall is now among Avera locations to offer 3-D mammography – new technology that provides better images of the breast. In addition to increased detection of breast cancer, one key benefit is reduced callbacks for further testing if a questionable mass is found. In fact, women who receive a 3-D mammogram are 15 percent less likely to be called back for more testing. Given a majority of callbacks turn out to be non-cancerous, this has the potential to save some women the stress and worry of additional tests. Also known as digital breast tomosynthesis, 3-D mammography is the newest version of digital mammography technology. The mammography experience for patients is very similar. The 3-D mammography unit sweeps around part of the positioned breast. 3-D mammography takes images using nine slightly different angles, and numerous views that show different depths of breast tissue. Certain women will especially benefit from 3-D mammograms – women with dense breast tissue, those who have experienced callbacks for diagnostic imaging, and women at high risk: family history of breast cancer, lobular carcinoma in situ (LCIS), atypical hyperplasia, and/or difficult breast exams.

Avera Cancer Institute in Aberdeen WELLNESS AND WEIGHT Cancer patients at Avera Cancer Institute in Aberdeen are now seeing Maria Lao, MD, with Avera Medical Group Internal Medicine, if they are interested in weight loss or healthy weight management. These are patients who are currently in treatment or who have completed treatment. “Research indicates that

Avera Cancer Institute in Mitchell and Yankton ELECTRONIC RECORDS ALLOW FOR SEAMLESS CARE

Avera Cancer Institute centers in Mitchell and Yankton recently merged into the One Avera Oncology electronic medical record (EMR). This project added Mitchell and Yankton to the same MOSAIQ® cancer EMR also used at Avera Cancer Institute centers in Sioux Falls, Aberdeen and Pierre, S.D., and Marshall, Minn., and is the final step in the creation of a One Avera Oncology EMR. The One Avera Oncology EMR holds all patient charts and information in one, centrally accessible database across the entire Avera system. For patients and staff alike, this helps ensure timely, efficient, and effective information sharing and communications, and a smoother continuum of care for patients between all Avera sites. This is the culmination of several years of work on the part of many dedicated staff members in various departments across Avera to achieve a truly monumental task: the centralization and standardization of the cancer EMR across all Avera Cancer Institute locations.

reaching a healthy weight can help reduce the risk of a recurrence of cancer or a diagnosis of a secondary cancer,” Lao said. The approach depends on the patient’s needs, but most often includes a well-balanced diet emphasizing fruits and vegetables, lean meats, whole grains and portion control, while reducing simple carb and sugar intake. Appropriate exercise is also important, and addressing symptoms that might limit mobility, such as back pain. “The key is helping people make a permanent lifestyle change,” Lao said. “It’s common to develop habits such as eating while you’re under stress or bored.” Lao’s patients often work with a behavioral health counselor and dietitian. “Wellness through healthy weight management is a natural progression in recovery and healing from cancer,” Lao added. Fall 2016

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SPECIAL ATTENTION for High-Risk Patients

Have you ever. . . Wondered if you’re at risk for developing breast cancer? Been confused or overwhelmed by all of the breast screening options? Felt uneasy about your mammogram results, but not sure what to do next?

If you answer “yes” to any of these questions, the breast cancer experts at Avera High-Risk Breast Cancer Prevention Clinic can help you understand your personal risk and determine the best screening and preventive options for you.

T

en years ago, Amie Krie, MD, a breast oncologist at Avera Medical Group Oncology & Hematology, recognized the need to help women who were at high risk for breast cancer. “Breast cancer can be very treatable when it’s detected early,” says Krie. “With the cutting-edge imaging available at Avera, we have the ability to detect cancers at their earliest stages. We also look at diet and lifestyle modifications, medications and

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research focused on the prevention of cancers as well.” “Every woman takes a different journey though the clinic,” says Julie Reiland, MD, FACS, a breast surgeon at Avera Medical Group Comprehensive Breast Care.

a consultation. “We look at the big picture by talking through health history, family, lifestyle and any other risk factors,” says Krista Seurer, PA-C. “Our hope is that each woman feels comfortable coming to us with all of her breast health questions and concerns.”

To start the journey, women can ask their provider for a referral or simply call the High-Risk Breast Cancer Prevention Clinic to schedule

During the consult, women meet with multiple breast cancer experts. “It’s a great opportunity for women to meet with a team who specializes


High-Risk Breast Cancer Prevention Clinic women

High-Risk Factors • Family history of breast and/or ovarian cancer • Gene mutation in your family • Abnormal biopsy such as lobular carcinoma or atypical hyperplasia

Maintain your breast health and identify the best screening and preventive options for your specific risks at Avera High-Risk Breast Cancer Prevention Clinic in Sioux Falls, S.D.

Dense Breast Tissue or Difficult Breast Exams

Curious & Concerned

Genetic Counseling If you have a family history of cancer, you may benefit from genetic counseling with Kayla York, MS, CGC. York specializes in cancer genetics and can provide unique insight about your risk and the best preventive and screening options based on your genetics. “Clarifying risks and helping women be proactive can really reduce and minimize their chance of developing breast cancer,” says York. “It’s all about helping women be comfortable with what they choose to do.”

Family & Personal Health History Risk Assessment

Consultation with Breast Surgeon Consultation with Genetic Counselor, & Physician Assistant Breast Surgeon & Physician Assistant

No matter where you live throughout the Avera region, you can take advantage of genetic counseling services via Avera eCARE™ telemedicine technology.

Personalized Screening & Prevention Plan Options • Diet & exercise • 3-D mammogram • Digital mammogram • Genetic testing • Ultrasound • MRI

• Contrast enhanced spectral mammography (CESM) • Videssa® Breast blood test • Risk-reducing surgery • Referrals to integrative medicine and/or medical oncology

in breast health,” says Reiland. “We can explain why they’re considered high risk, make recommendations, answer questions and simply help them navigate through all of the screening and diagnostic options with confidence.” Each woman is encouraged to choose a plan that she is most comfortable with, which may include advanced screening and diagnostic procedures or tests.

Call the Avera Cancer Institute Navigation Center at

1-888-422-1410 16-ACAI-2490

“As we develop a relationship with each woman, we can really help by anticipating what’s next and providing proactive care to prevent and detect breast cancer,” adds Reiland. “So far, we haven’t seen a lot of high-risk women become cancer patients, which is fantastic.” True to Avera’s mission, the HighRisk Breast Cancer Prevention Clinic considers each woman’s needs as a whole. “When it comes to making

to schedule your consultation. recommendations, we take everything into consideration in order to determine what’s best for her not only physically, but also emotionally and financially,” says Seurer. “After meeting with us, women often share that they’re not as worried about breast cancer because they know that we’re looking out for them,” she adds. “It’s an ongoing relationship and they know we’re always here for them.” Fall 2016

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The Promise of

Genomics H E L P I N G PAT I E N T S S TAY C A N C E R F R E E

Women want to not only survive breast cancer, but thrive. That means years of cancer-free living, rather than years spent in treatment for future bouts of disease.

That’s what the genomic medicine team at the Avera Cancer Institute Center for Precision Oncology hopes to deliver, as they treat more breast cancer patients earlier in the course of their disease.


“One woman might have surgery for early stage breast cancer and remain cancer free. A second woman with a similar diagnosis might have a mastectomy, but then end up with another bout of cancer years later,” explained Casey Williams, PharmD, Director of the Avera Cancer Institute Center for Precision Oncology.

The 10-year survival rate of breast cancer is higher than it’s ever been, at 83 percent. When caught in early stages, five-year survival is as high as 99 percent, according to the American Cancer Society.

“On paper, the second woman has a very good chance of doing well without future cancer. But it still happens.”

CASEY WILLIAMS, PHARMD, DIRECTOR OF THE AVERA CANCER INSTITUTE CENTER FOR PRECISION ONCOLOGY

Providing genomic sequencing that guides chemotherapy or other treatments before surgery is called neoadjuvant therapy.

When women are sequenced before surgery, the genomic team knows exactly what they’re dealing with, and whether or not a woman needs to have aggressive treatment up front to fight her particular type of cancer and prevent future recurrences. Michele Reiman of Sioux Falls was such a case. In May 2015 she was diagnosed with stage I breast cancer, yet it was triple negative, a particularly aggressive type of breast cancer with a higher recurrence rate. Growth of triple negative cancer is not supported by hormones, so hormonal therapies are not effective against it. Her Avera Medical Group medical oncologist, Amy Krie, MD, recommended that she have genomic sequencing.

BRIAN LEYLAND-JONES MB BS, PHD, VICE PRESIDENT OF THE AVERA CANCER INSTITUTE CENTER FOR PRECISION ONCOLOGY

“The vast majority of women live for many years after a breast cancer diagnosis, but those years may include treatment for relapses,” said Brian Leyland-Jones, MB BS, PhD, Vice President of the Avera Center for Precision Oncology.

Relapse rates within 10 years vary from 20 to 40 percent, depending on the type of cancer and the stage at which it was diagnosed. “We want to do a better job of predicting the possibility of recurrence up front. Because if cancer comes back, it often comes back with a vengeance,” Leyland-Jones said. Patients treated through the Avera Center for Precision Oncology receive standard of care protocols, plus care guided by sequencing. “We maintain the best conventional care, but at the same time we’re pushing the leading edge to improve outcomes,” Williams said.

“We wanted to make sure we were fighting it from every direction,” Michele said.

“Our patient outcomes speak for themselves,” Williams said. Of 26 advanced-stage breast cancer patients evaluated at Avera’s Center for Precision Oncology, 46 percent whose treatment was guided by genomic sequencing experienced a complete response to treatment – or no evidence of cancer. That compares to 18 percent of patients with standard of care chemotherapy.

Michele had standard of care chemotherapy plus an oral medication as recommended by the genomic medicine team. At the time of surgery (a double mastectomy) Michele was found to have had a pathologic complete response to the treatment with no detectable disease remaining. “After my surgery, I was 100 percent cancer free. I will never really know what killed the cancer; all I know is that it worked.”

Avera is seeing patients from Canada, California, Florida, New York, and as far away as the United Kingdom and Australia. “Patients are starting to understand what genomics has to offer, not just locally, but regionally and even internationally,” Leyland-Jones said. 

If you are interested in genomic medicine, ask your oncologist about a referral to the Avera Cancer Institute Center for Precision Oncology or self-refer by calling 605-322-HOPE (605-322-4673). Fall 2016

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Technology Techniques

&

Contrast-enhanced spectral mammography (CESM):

Savi Scout:

The SenoBright CESM technology in use at Avera Breast Center allows multidisciplinary teams to confirm findings – especially in dense breast tissue – and locate lesions or tumors when initial screenings are inconclusive. Avera Medical Group radiologist Patrick Nelson, MD, said the enhancement that CESM provides makes accurate scans easier, regardless of the patient and her unique physiology.

Locating a breast tumor, in the past, could include the use of guide wires to assist the surgeon, or in some cases, the use of a radioactive marker. Savi Scout® is a non-radioactive alternative that helps improve efficiency and accuracy. Julie Reiland, MD, Avera Medical Group breast surgeon, said the device is a distinct improvement from past methods.

“We were among the first facilities in the nation to install CESM, and in just a couple of years it has become an integral problem-solving tool for us,” Nelson said. “It really helps in difficult cases, in situations where we have a positive lymph node test but where standard mammography images are inconclusive. It’s an irreplaceable part of our practice now – especially in complicated cases.” Nelson added that CESM is less expensive and faster than MRI.

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“We were among the early adopters of this technology and it allows us to put a reflective electro-magnetic marker in place prior to surgery. In doing so, we avoid any issues that go with a radioactive marker and the discomfort and difficulties that went with guide wires,” she said. “It makes our work easier and more accurate.”


A LOOK AT INNOVATIVE APPROACHES TO CANCER CARE Avera Breast Center never stops looking for advanced technology to help its patients. Here’s a brief look at some approaches and medical equipment that continue the top-quality approach patients have come to expect from Avera.

PEAK PlasmaBlade: Radiofrequency energy allows a surgeon using this device to cut and control bleeding, all at one time. Reiland said the precision it provides gives breast surgeons an advantage. “It controls bleeding with less heat, thus avoiding the char that may come with older electro-surgical methods,” Reiland said. “It reduces tissue damage as well as time in the operating room.” The electrode the PEAK PlasmaBlade® employs is thinner than a human hair; it also allows incisions to heal more rapidly.

Tricia Merrigan, MD, Avera Medical Group breast surgeon, talks with a patient about options.


Avera Medical Group breast surgeons Julie Reiland, MD, and Wade Dosch, MD, utilize IORT during surgery.

Electron-based intraoperative radiation therapy (IORT): This technology offers a concentrated dose of radiation to the tumor bed, in the operating room, at the time of lumpectomy – surgery to remove the breast cancer but preserve the rest of the breast. Radiation is typically given one month after lumpectomy to reduce the risk of cancer recurrence in the breast. It usually involves daily treatment for six weeks. IORT is part of an international clinical trial at Avera. Equipment was purchased thanks to a grant from The Leona M. and Harry B. Helmsley Charitable Trust.

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Reiland explained that IORT offers simplicity in terms of radiation treatment. “We know we are getting the radiation to the right area and in a timely fashion.” For women age 60 and older with less-aggressive cancers, it can be a one-time treatment and eliminate the need for any other radiation treatment. For younger women, a dose of radiation is given in the operating room, reducing follow-up radiation treatments down from six weeks to three weeks. Radiation after lumpectomy serves to reduce the risk of recurrence at the same site. Avera Cancer Institute was the first facility in the nation to put this treatment to use for breast cancer patients through the international trial. Reiland said this approach can reduce radiation damage to healthy tissue and in many cases help patients avoid return trips to have additional follow-up radiation therapy.

Breast reconstruction: Avera Medical Group plastic surgeons Barry Martin, MD, and Mark Shashikant, MD, recently began their practice in Sioux Falls, and the experienced duo offers their skills to augment the surgical services of the Avera Cancer Institute. Surgeons from both groups collaborate to help all women consider their approaches. Martin said there are advantages to completing reconstruction during the initial surgery for lumpectomy or mastectomy, but that each case is unique. “Each time, we match the operation to the patient, especially in terms of their health,” he said. “In many cases they may need additional treatment post-surgery, and then reconstruction can be considered and planned.” Avera Medical Group Plastic & Reconstructive Surgery now features Vectra XT 3-D Imaging technology. The system can help women who are considering reconstruction have clear, understandable information about the possibilities of reconstruction. The clinic is the only one in the region to offer the leading-edge imaging technology. 


Thoughts about

Survivorship

– FROM SURVIVORS

It’s good to let others in…

Make the most of every day…

Take cancer one step at a time Don’t be afraid to talk about your cancer diagnosis. When I allowed myself to talk about it, and let people ask questions, the better I was able to cope and face breast cancer, and it was helpful for others, too.” EMILY SASS BREAST CANCER SURVIVOR BROOKINGS, S.D.

Lean on family, friends and God...

Sometimes we get so busy with work and our daily routine, the things we enjoy or have always wanted to try fall to the wayside. Having cancer encouraged me to go and do new things and revisit interests that are important to me.” JULIE KUSLER BREAST CANCER SURVIVOR ABERDEEN, S.D.

My best support group was those closest to me. Family and friends were there to help me think positive with encouraging words. I turned to God for guidance as he is the only one who has the answers. Together, they helped me move forward.”

As a high school athletic trainer, I looked at cancer treatment as a basketball game plan. I counted down the chemotherapy sessions like the first quarter. Surgery — a double mastectomy — was halftime. The possibility of facing radiation — I told myself to think about that in the last quarter.” SIERRA MOELLER BREAST CANCER SURVIVOR FORT PIERRE, S.D.

SHARON CUKA BREAST, STOMACH CANCER SURVIVOR WAGNER, S.D.

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Exploring all Options W

hen Lisa Dieren was diagnosed with breast cancer she knew she wanted to explore all her options.

She considered it a sign when things fell into place so easily for it to happen — a friend recommended Avera the day after her diagnosis. She had an MRI and other appointments set up on Monday of the following week. “So I thought of that as a sign from God that this may be the direction I’m supposed to go,” Lisa said. That evening her nerves were further soothed when Nancy Terveen, FNP, a Breast Patient Navigator, called to talk her through the process and give her the answers she needed for herself and her family.

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Lisa with her husband, Terry

Avera Breast Center Helps Women Make Treatment Decisions Comprehensive breast care is nothing new for the Avera Breast Center, which offers patients who are already diagnosed a second opinion by scheduling a meeting with a medical oncologist, radiation oncologist and breast surgeon in one visit. This provides a rare opportunity to get a full breadth of treatment options mapped out in one sitting. Patients also learn about research opportunities and other support services: • Support groups • Integrative medicine • Lymphedema specialist assessments • Dietitian • Genetics counseling

Before a patient’s consultation, her case is presented at Avera’s weekly Breast Cancer Conference during which a multidisciplinary team reviews the case and discusses optimal care options. “Every patient is different based on size, location and tumor biology, which determines what treatments will work best,” said Tricia Merrigan, MD, breast surgeon with Avera Medical Group. “Having all the providers working together and meeting with the patient on the same day makes it more informative and convenient.” There are not only many types of breast cancer but also many types of treatment. Although women may initially desire a mastectomy, lumpectomy with radiation therapy is now encouraged for the majority of women presenting with early stage cancers. Recent technology known as electron-based intraoperative radiation therapy (IORT) is another option in some cases. IORT provides a radiation boost at the time of surgery and shortens the course of standard breast radiation after surgery. For certain women age 60 and older, a single radiation treatment at the time of surgery might be all the radiation they need to prevent a recurrence. Fall 2016

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Lisa, center, and Terry, left, enjoy family game time with their children, Ashley, Matthew and Ellie.

During her consultation, Lisa, a mother of three from Rock Rapids, Iowa, talked with a clinical trial specialist and decided to take part in genomic research to have her tumor tested to help doctors determine the best potential medication matches for future treatment.

“Avera Breast Center helps women make an informed decision and really fosters a team approach to treatment through close collaboration with the entire cancer team ranging from oncology to radiation and research.” - AMY KRIE, MD, MEDICAL ONCOLOGIST AVERA MEDICAL GROUP

She also learned about integrative medicine and how services such as acupuncture and massage could be helpful with symptoms. “I never knew you could have acupuncture and I couldn’t believe how much that helped me with side effects during chemotherapy.” Lisa’s tumor was triple negative, meaning that it tested negative for estrogen, progesterone and HER2 receptors. While it was caught early, it is known as a more aggressive cancer. During her consultation, Amy Krie, MD, Avera Medical Group medical oncologist, recommended that she have chemotherapy prior to surgery. This allowed her doctors to make sure that the cancer was being completely eliminated by the treatments, a sign that a patient will have a good outcome. Lisa also opted to pursue research as part of her treatment in hopes of achieving the best chance of cure. Lisa said it was an easy choice to choose Avera after her second opinion consultation. “After the very first meeting with Dr. Krie I looked at my husband and said ‘this is where I want to go,’ and he agreed completely,” Lisa said. “When we were meeting with these doctors I was also thinking about how my children and husband would like being here. To me, Avera was where we needed to be, and that’s where I’ll continue to doctor.”

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Second Opinions for Breast Cancer Patients. Avera’s mission is one of caring for the whole person, body, mind and spirit. The end goal is to help people through the cancer treatment process both physically and mentally. - KYLE ARNESON, MD, PHD RADIATION ONCOLOGIST AVERA MEDICAL GROUP

Though all patient cases are presented and discussed during the Breast Cancer Conference, Avera Medical Group radiation oncologist Kyle Arneson, MD, PhD, said he may not meet with the patients until radiation is necessary, sometimes after surgery. Talking earlier in the process can put people at ease about what’s coming down the road. “When someone is diagnosed with cancer it’s a roller coaster of emotions,” Arneson said. “To be reassured and receive the full scope of treatment options during one appointment can really help relieve some of the anxiety.” 

It’s happening now at Avera Breast Center. We’ll connect you to an entire team to provide a full outlook of your treatment and service options from beginning to end, including survivorship.

You receive a breast cancer diagnosis and desire a second opinion. Talk with breast health experts regarding questions about consultation. Set up appointment for second opinion with Avera Breast Center.

Your case may be presented to the Breast Cancer Conference where a multidisciplinary team discusses the best options for you.

Your second opinion consultation gives you opportunity to meet one-on-one with: • Medical oncologist • Radiation oncologist • Surgeon

For more information call the Avera Cancer Institute Navigation Center at

1-888-422-1410

• Licensed social worker • Lymphedema specialist • Genetics counselor • Clinical trial experts • Breast health navigator • Dietitian

Learn about related services beyond treatment. • Financial counseling • Support services • Integrative medicine • Chaplaincy

Develop a treatment plan with your expert team to make the best plan for you. Call for a consultation at 888-422-1410. Avera.org/breast

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Burning pins and needles – that was the feeling Georgia Albrecht noticed in her feet and hands as she began chemotherapy for breast cancer in March.

FROM SIDE EFFECTS

Albrecht, a retired registered nurse from Sioux Falls, was diagnosed with breast cancer in January 2016. “The worst part was in my feet – the pain was truly unpleasant. It affected my sleep, and I felt more fatigue,” said Albrecht. “I later felt the same sensation in my fingertips.” The condition Albrecht faced is called peripheral neuropathy, and it’s a common chemotherapy side-effect. Albrecht did not want to take more medication on top of the chemo, so she decided to try something that while new to her, has been helping people with pain for more than 4,000 years. Dawn Flickema, MD, is one of two physicians with the Avera Medical Group Integrative Medicine. She consulted with Albrecht, and Flickema encouraged her to try acupuncture as a possible source of relief for the “pins and needles” feeling that typifies peripheral neuropathy. “Acupuncture can provide relief from the burning sensation often associated in the fingers and toes that makes up some of the worst symptoms of the disorder,” Flickema said. “It can help many chemotherapy patients, because acupuncture activates nerves elsewhere in the body and they help reduce that discomfort.”

Acupuncture eases chemo-related symptoms “As a hospice nurse, I was familiar with families and individuals who tried things that were out of the ordinary. I was familiar with the idea of acupuncture, but I would say I was skeptical,” Albrecht said.

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Georgia Albrecht experienced relief from side effects thanks to acupuncture, recommended by Dawn Flickema, MD.

She remembers her first session of acupuncture. “The room was toasty warm, quiet and comfortable. Dr. Flickema explained the process, and then she put the acupuncture needles in spots on my lower legs and my wrist.” Many people who are reluctant to try acupuncture fear what they expect to be pain – after all, needles are involved.

The acupuncture treatments not only helped the pain in her feet and hands, but it also helped her manage the nausea and fatigue that come with chemotherapy.

Results of acupuncture vary from patient to patient, but when faced with chemotherapy and its effects, all options are worth consideration, Flickema said.

Albrecht said outside of a few brief “zingers” as the application took place, most of the acupuncture was hardly noticeable. Once placed, the needles remained in place for about 20 minutes.

“Georgia is a good example of the benefits, and her weekly sessions have proven to help,” Flickema said. “There was a short period where she wasn’t able to have acupuncture, and she reported the symptoms – especially those burning pins and needles in her feet – had returned.”

The relief didn’t happen overnight, yet Albrecht started to notice improvements. “It wasn’t all at once. But about four to five weeks into the treatments, it really helped, and now, I only have some mild numbness.”

“It’s helping me, and that’s good news,” Albrecht said. “It’s something I would recommend that anyone try, especially cancer patients, who, like me, don’t want to add another medication to their treatment.” Fall 2016

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Caregiving: When a loved one is diagnosed with cancer, you don’t think twice about stepping alongside to join the fight. Even though you can’t rid your mother, father or sister of the disease, you strive to make the journey easier. Cooking, cleaning and attending appointments become the norm.

“When it happens to you, you don’t think, ‘I’m a caregiver,’” said Pat Sudbeck, support group facilitator at Avera Cancer Institute in Mitchell, S.D. “You’re just caring for your loved one. It becomes part of your day.” “And there’s a lot of emotion tied to it,” said Sheila Letcher, nurse and support group facilitator at Avera Cancer Institute in Mitchell. Both Sudbeck and Letcher have cared for their own family members through various illnesses, and are a testament to the caregiving experience.


TOUGH JOBS ARE WORTH IT “It can be a rewarding and precious experience, too. Your attitude and your approach are everything.” - PAT SUDBECK SUPPORT GROUP FACILITATOR

You’re on call 24/7. There are sleepless nights worrying about your to-do list, even when your body is physically drained. After a few months, you realize you haven’t seen a movie, gotten a haircut or had lunch with a friend. You find yourself in new, complex situations such as handling bills. Great caregiving starts with you. Letcher compared it to airplane masks: put on yours before assisting your neighbor. In other words, you must care for yourself before you care for another. “Sleep is so important so that you have the strength to fulfill your duties throughout the day,” said Letcher. Proper nutrition is also necessary to sustain your energy; watch your intake of sweet or salty treats, which are easy to turn to when feeling stressed. A simple way to alleviate stress is laughter, even while facing cancer. You and your loved one can find humor from an online video, a favorite TV show or a past story.

Don’t be afraid to accept help or ask for help. “We midwesterners aren’t good at asking for help,” commented Letcher. Start by making a list, and when a family member or friend offers their help, request one of the listed chores. This could be cooking a meal, mowing the lawn, or running to the grocery store or post office. Friends and family may be just waiting to be asked. Allowing yourself to step back from your duties is easier said than done. It’s inevitable to worry when you let another person take over. Will they remember to give mom her medicine? Will dad get to his appointment on time? “You tend to feel personally responsible for your loved one’s well-being,” said Letcher. “Give yourself permission to detach. You’ll come back energized, and better able to care for him or her.” “These moments are therapeutic,” added Sudbeck, “when you aren’t a ‘caregiver’ but rather resuming your role as a daughter, brother, sister or spouse.” While caregiving requires time and energy, it offers priceless gifts. Barriers are broken down and topics you and your loved one have never discussed come to the forefront. You have a reason to share time and conversation with the person you are caring for without distractions. “You find satisfaction in caring for them, and in return, they are grateful you were always there for them,” said Sudbeck. A sincere expression of gratitude from a loved one through a word, smile or hug makes caregiving a calling and one of the most blessed acts of mercy and compassion one can share with another person. “That expression of gratitude is so worth it,” Sudbeck said. “It will last forever in our hearts and will make each day for a caregiver a little brighter.”

Fall 2016

Avera Cancer Institute

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Looking andFeeling Beautiful Cancer treatment is a time to “Yes,” answers Avera Cancer Institute wig and beauty consultant Del Lomheim, concentrate on your health and who is also a cancer survivor, because looking your best is closely tied to feeling healing – is it really a time to be your best. concerned about how you look? “Looking in the mirror and seeing

Avera Cancer Institute

Fall 2016

a bald head or no eyebrows can be defeating,” Lomheim said. “It’s about having the self-confidence to carry on with life and continue on with normal life. It’s about not being singled out as the woman who has cancer. It gives women back their identity.”


Cosmetologist Jenessa Blomme leads the American Cancer Society’s Look Good Feel Better workshops at Avera Cancer Institute in Marshall, Minn. This program, also offered through Avera Cancer Institute in Sioux Falls and Aberdeen, S.D., provides makeup and style tips ranging from how to wear scarves and head turbans, to what colors and clothing styles are most flattering for different individuals. “Drier skin, weight loss or weight gain, skin coloring changes, and of course hair loss are all issues women deal with when they have cancer treatment,” Blomme said. “We teach a lot of techniques to help overcome these changes so women feel more confident about their looks.” Examples of these techniques include using concealer to hide dark circles or blotchiness, an eyebrow pencil to draw in eyebrows, and cheek and lip shades to add color. JoAnn Williams Ruppert, RN, directs the cancer program at Avera Cancer Institute in Marshall, and also experienced breast cancer herself nine years ago. As a patient, she took part in Look Good Feel Better, and encourages patients to give it a try. “It builds your self-esteem and confidence. Anything that can help you feel better about yourself during cancer care is helpful,” she said. It’s common for cancer patients to want to stay home, but a pretty scarf, bright clothes and makeup can help you feel more comfortable when you’re out in public, whether that’s going to work or an event.

The camaraderie among cancer patients is empowering as well, Williams Ruppert added. “You can talk to others who are going through a similar experience. I find that patients are very supportive of each other and form lasting bonds of friendship.” Appearance remains important to women, even when they’re undergoing cancer care, said Linda Johannsen, cosmetologist who leads Look Good Feel Better in Aberdeen. “Nowadays people are more aware of cancer. Years past, you didn’t talk about it. This program not only helps women with makeup and style. It helps them know that they’re not alone.”

Thanks to wigs, hats, scarves and makeup, it’s possible that you pass by women every day who are undergoing cancer treatment and you don’t even realize it.

Thanks to the Avera Race Against Breast Cancer held each May, female cancer patients receiving care anywhere in Sioux Falls and across the Avera system who will lose their hair due to cancer treatment are offered a free wig. Today’s wigs look more natural than decades past – so natural that it’s often difficult to tell it’s a wig. “Finding out you have cancer is the most devastating thing, but then finding out you’re going to lose your hair is the next most devastating thing. Your hair is part of you,” Lomheim said. She suggests that women go with a similar look and color to their own for their first wig. But then, women often want to branch out with a different style or color for a second wig. “You’re not sick, you’re undergoing cancer treatment. So you don’t want to look sick,” Lomheim said. 


More than 40 physicians across 5 states connecting you to the breast cancer services you need. It’s happening now at Avera Breast Center.

Wherever you are in the Avera Breast Center five-state region, you’ll have access to our team of specialists for screenings, diagnosis, treatment and beyond. We work with high-risk patients to create personalized screening plans, provide comprehensive second opinions for women already diagnosed, and answer questions 24/7 through our cancer navigation center. Your treatment options include innovative strategies that best fit you, including new radiation therapy with reduced treatment times, genomic testing and breast-conserving surgery. That’s just some of the remarkable services happening at Avera Breast Center.

Schedule a consultation near you by calling 888-422-1410.

Learn more at Avera.org/breast Share your story on social media. #remarkable 16-ACAI-2666


Avera Cancer Institute Magazine - fall 2016