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Avera Cancer Institute FAITH AND HUMOR:




Fall 2018

DEAR READERS, We at Avera are highly involved in cancer research and clinical trials. Not only does this important work further the advancement of medical science, it offers our patients access to more treatment options. We always recommend the evidence-based standard of care. Yet clinical trials can give patients that additional chance for a cure, long-term remission or improved quality of life offered by a novel treatment. One of these projects we began seven years ago — an international collaboration using electron-based intraoperative radiation therapy (IORT) for breast cancer at the time of lumpectomy — has been proven to be effective and is now considered standard care. Our patients were the first in the nation to get this treatment because of Avera’s dedication to bring clinical trials here. We are thrilled that we had the opportunity to be on the ground floor. At the Avera Center for Precision Oncology, our genomics team is constantly bringing the latest cancer research to the bedside as they match the genomic profile of individual tumors to targeted therapies. In this issue of Avera Cancer Institute magazine, you’ll read about some of our latest research trials, including the NSABP B-59 trial that involves immunotherapy for breast cancer and the SPRING trial in which patients take a three-drug protocol including immunotherapy and targeted therapies for lung cancer. Other topics in this issue cover the newest diagnostic tools for breast cancer, what to focus on during cancer treatment and what to avoid, lung cancer screenings, advanced surgical techniques, and more. When the diagnosis is cancer, we at Avera strive to offer a seamless experience through the entire journey. Read to discover how Avera does cancer care differently — through the latest science, advanced technology, interconnectedness of the Avera system and compassionate care for the whole person, body, mind and spirit. Please visit Avera.org/cancer to learn more.

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

© Copyright 2018 Contents of Avera Cancer Institute are protected by U.S. copyright laws. All rights reserved. Reproduction or transmittal by any means, including photocopying, is prohibited without written permission of Avera.

Thanks for reading! In good health,

Tad Jacobs, DO Chief Medical Officer, Avera Medical Group



Avera Cancer Institute FALL 2018 WHAT’S NEW

Across the System.................................................................... 2

JUST ONE MILE AWAY Breast Cancer Patient Values Care Close to Home................... 4

FINDING YOUR FOCUS..................................................... 6 THE HELMSLEY CENTER

Celebrates Grand Opening........................................................ 8

PATIENT Q & A..................................................................... 9 MORE TOOLS FOR EARLY DETECTION

Avera Sites Add CESM.............................................................. 10

FAITH AND HUMOR: Patty Considine’s Breast Cancer Journey.................................. 12

CLINICAL TRIALS: Benefiting Patients Today and in the Future............................... 14


From Survivors.......................................................................... 15



A 15-Second Test Can Deliver Peace of Mind............................ 16

LEADING-EDGE APPROACHES IN BREAST SURGERY ....................................................... 18 MISSION IN CANCER CARE

Walking Forward........................................................................ 20

AN EASY CRAFT, A FUN ESCAPE.................................. 21 This magazine is published by Avera, sponsored by the Benedictine Sisters of Yankton, S.D., and the Presentation Sisters of Aberdeen, S.D. Thanks to the leadership and heritage of faith of the Sisters, Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 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.

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.




EXPERT RADIATION ONCOLOGY CARE James Simon, MD, now serves as the primary radiation oncologist at Avera Cancer Institute in Marshall. Having previously practiced at Avera Cancer Institute in Sioux Falls, he brings a wealth of clinical experience and knowledge. Simon holds a medical degree from the University of Iowa’s College of Medicine at Iowa City. He completed residency in radiation oncology at the University of Iowa Hospitals and Clinics, and is certified by the American Board of Radiation Oncology. He joins Mark Huber, MD, outreach medical oncologist, and Jessica Moriarty, CNP, in providing comprehensive treatment and support services – from diagnosis to survivorship.

Aberdeen Y-90 PROCEDURE Avera Cancer Institute in Aberdeen has begun to perform the Y-90 procedure, a minimally invasive combination of embolization and radiation therapy. This procedure can help treat liver cancer as small resin beads filled with a radioactive isotope are placed in the blood vessels that feed a tumor. This procedure can help extend the lives of patients with inoperable tumors and improve their quality of life. Les Lenter, MD, Avera Medical Group Radiology Aberdeen, serves as the interventional radiologist who provides this new service.


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Jason Jones, MD, Avera Medical Group medical oncologist, and Michael McHale, MD, FACP, Avera Medical Group medical oncologist and hematologist, are now providing outreach services in Mitchell. Jodie Miller, CNP, helps the outreach specialists manage each patient’s diagnosis and treatment plan. This care is complemented by radiation oncology provided by Stephen Dick, MD, MPH. This cancer care team is experienced in providing care for all types of solid tumors and blood cancers. Mitchell also has set out to reduce possible rectal side effects during prostate cancer treatment by conducting trials of the SpaceOAR (Spacing Organs at Risk) Hydrogel. SpaceOAR hydrogel acts as a spacer providing space between the rectum and the prostate, making it much less likely that the rectum is exposed to radiation. The hydrogel is not painful, remains stable during radiation therapy and then is gradually absorbed by the body after radiation therapy has been completed.

Sioux Falls


NEW BREAST ONCOLOGIST Avera Medical Group Oncology & Hematology has welcomed Jason Jones, MD, a new breast medical oncologist. He joins Amy Krie, MD, and together they serve as South Dakota and the surrounding region’s only dedicated breast medical oncologists. Jones holds a medical degree from the University of Toledo Medical School in Ohio. He completed residency and fellowship at the Mayo School of Graduate Medical Education. He is a Diplomate of Hematology, Medical Oncology and Internal Medicine with the American Board of Internal Medicine. WIN CONSORTIUM Benjamin Solomon, MD, Avera Medical Group Oncology & Hematology, continues to serve as a principal investigator on the board of the Worldwide Innovative Networking (WIN) in Personalized Cancer Medicine consortium at Avera. Avera was the first WIN cancer research entity to open in the upper Midwest. NEW ONCOLOGY OUTPATIENT THERAPIST Avera Medical Group Integrative Medicine has welcomed Brenda Ling, MSW, CSW-PIP, OSW-C, a new outpatient therapist. She has nearly 30 years of clinical oncology social work experience, and provides individual, family and group therapy for people responding to unexpected changes caused by a cancer diagnosis.

Michael Peterson, MD, Avera Medical Group radiation oncologist

NEW LINEAR ACCELERATOR Patients now are benefiting from the new Elekta Infinity™ linear accelerator at Avera Cancer Institute in Yankton, after the new machine was put into service in December 2017. The leading-edge radiation oncology equipment allows “beam matching” so that cancer patients who begin treatment at one site can continue it at other Avera Cancer Institute locations. Yankton also added a nurse navigator to its cancer team. The navigator can answer questions, expedite appointments and ensure that patients are getting the appropriate care at the opportune times during the course of their disease. This addition is being brought to the community by Avera Cancer Institute in Yankton and Yankton Medical Clinic.

Pierre HELMSLEY CENTER CAMPAIGN SUCCESSFUL The community-based Helmsley Center Dollar for Dollar Match Challenge has been successful in raising $2.5 million. This means that $2.5 million was matched by The Leona M. and Harry B. Helmsley Charitable Trust, in addition to the $7.5 million granted to the project by Helmsley. Together, generous donors and the Helmsley Charitable Trust are contributing $12.5 million toward the $30 million project. Going forward, additional funds raised will be placed in an endowment fund for future cancer care needs in Pierre. The Helmsley Center opening was celebrated Sept. 29-30, and the center is now open. To learn more, see page 8.

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Avera Cancer Institute





Breast Cancer Patient Values Care Close to Home As she was taking her usual shower, Karen Gerhardson’s hand grazed something unusual — a lump in her breast bigger than the size of a golf ball. Without hesitation, her mind said, “Oh no, this time I know it’s cancer.” Knowing she was due for her annual mammogram, she scheduled her appointment right away. Finding a huge lump would terrify most people, but this wasn’t the first time Gerhardson heard the words “breast cancer.” During a normal physical exam in her early 20s, the doctor came across a large, abnormal lump in her breast. Though a follow-up mammogram reported a negative finding, the experience was jarring.


Then, about four years ago, Gerhardson had a biopsy which returned with another negative finding for breast cancer. Both of these experiences had her on the lookout for any new breast concerns. “If anything was discovered this time around, I knew exactly what the plan would be — double mastectomy,” said Gerhardson. Gerhardson’s treatment began at Avera Cancer Institute in Sioux Falls with multiple sessions of chemotherapy before surgery. After the first round in Sioux Falls, she returned home to Marshall, where she needed follow-up care to address some of the chemotherapy side effects. An attending physician explained that all of the care she required could be handled just one mile away from her home.


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“I didn’t even realize cancer care in Marshall could be an option for me,” said Gerhardson. Her care in Sioux Falls was very good, but the ability to receive treatment close to home was the game-changer. “It was fabulous, just unbelievable,” said Gerhardson, “and it’s right here in town — the great staff, organization and cancer care.” Acupuncture with Josh Bruning, DC, chiropractor with Avera Medical Group Marshall, relieved some of her side effects. Gerhardson appreciated the amazing outpouring of support shown by the community. Coworkers donated hundreds of hours of sick time, and some even chipped in to pay for medications. Friends and family stopped by with delicious meals and to clean her home. A best friend from St. Paul even drove and stayed with Gerhardson every three weeks when she had chemo. Gerhardson’s mastectomy took place in May 2018 at Avera Marshall Regional Medical Center. While some women may fear losing an intimate part of their body, that’s not how Gerhardson saw it. “They’re just flesh and have only posed a danger to me,” she said. “I did what is safest for me.”

“A comprehensive breast cancer program is available here in Marshall. Not only do we perform breast surgeries, we offer access to advanced imaging technology, local biopsy and testing, radiation oncology, chemotherapy, support care, home medical equipment for prosthetics, and social services.” - TRACI KRUSE, MD, GENERAL SURGEON

Her outlook on life has shifted 100 percent. “As someone who has struggled with depression in the past, I finally feel like I’ve found the cure,” reflected Gerhardson. “For the third time, I’ve been given a new lease on life; I now enjoy the life I am given.” 

What’s Going to Happen to My Breasts?


Traci Kruse, MD, Avera Medical Group general surgeon in Marshall, explains the surgical options often recommended to women facing breast cancer.

Lumpectomy – Only the tumor and surrounding tissue is extracted from the affected breast. Mastectomy – One or both breasts are completely removed because cancer has spread or the woman is at higher risk for ongoing breast cancer concerns. Axillary dissection – Removal of lymph nodes; this only occurs if the initial tested lymph nodes, 2018nodes, Avera Cancer Institute the sentinel Fall lymph prove to have cancer.

Receiving a cancer diagnosis and undergoing treatment can be overwhelming, to say the least. However, knowing what to focus on can help you prioritize your time, simplify your life and reduce stress — leaving more energy for what matters most to you. Richard Conklin, MD, Avera Medical Group oncologist and hematologist in Aberdeen, S.D., shares his advice about what to focus on and what to avoid during treatment. With over 30 years of experience in cancer care, he’s found several common themes, yet emphasizes that each cancer journey is unique.

Finding Your Focus


Hold Your Treatment Plan Loosely “The treatment plan is important. I discuss it with my patients, but I also tell them not to worry or stress about it,” says Conklin. “Throughout the course of treatment, we adapt the plan based on each patient’s tolerance to the treatment, so we’re flexible.” Conklin adds that when patients are too focused on completing the treatment plan on a strict schedule, it can cause them unnecessary stress when the plan is changed.

“Know your plan, but don’t fixate on it. You can trust your care team to make any adjustments needed to ensure that you receive the best care possible.” - RICHARD CONKLIN, MD

Reduce Stress with Favorite Hobbies and Activities “After a cancer diagnosis, many people find themselves reevaluating their priorities and that can be a good thing. Ask yourself what activities and responsibilities cause you stress and whether or not they’re important to you — or worth the stress.” Conklin also suggests adding more activities and hobbies that you enjoy. “When you’re doing

something that brings you joy, it decreases stress, which decreases cortisol from the adrenal glands. This is important because excess cortisol is counterproductive to the body’s ability to heal.” In addition to hobbies, Conklin recommends stress-reducing activities such as meditation, massage therapy, music therapy and aromatherapy using essential oils. When you have the strength and energy, exercise — such as walking or yoga — is also a great option. Movement can actually help reduce fatigue and lower anxiety and depression.

Nourish Your Body Eating well can be especially challenging during treatment, which may have a number of side effects that impact appetite, such as dry mouth, nausea, mouth sores, a change in palate, painful swallowing and more. “If what you’re eating works well for you, it’s usually OK to continue that during treatment. After treatment is when we start looking at how to optimize nutrition,” Conklin said. If you’re having trouble maintaining your weight or finding foods that are appetizing, a health coach or dietitian can offer ideas and alternatives for you to try. As part of your cancer care team, these professionals can also recommend food choices that will help you feel your best.

When you take time to focus on what matters most — including caring for your body, mind and spirit — it can have a positive effect on how your body responds to treatment. 

k c i Qu s Tip What to Avoid During Treatment During cancer treatment, some patients experience changes in the immune system — caused by the cancer itself or therapy — which put them at a higher risk of infection. That’s why Conklin advises avoiding the following while undergoing treatment: • People with contagious illness • Cleaning up after pets, such as emptying a litter box • Excessive sun exposure and tanning booths. Always use sunscreen when outdoors. • Things that irritate the mouth like mouthwash with alcohol and hard toothbrushes.

Fall 2018

Avera Cancer Institute



“Patients used to travel hundreds of miles back and forth, paying for hotel rooms, to receive this kind of cancer care.” - STEVEN LEE, DIRECTOR OF CLINICAL SERVICES FOR AVERA MEDICAL GROUP PIERRE.


Home to the sixth Avera Cancer Institute location, the Helmsley Center in Pierre opened its doors mid-fall of 2018 to serve central South Dakota with comprehensive cancer care. Housed on the campus of Avera St. Mary’s Hospital in Pierre, the Helmsley Center was made possible by $10 million in funding from The Leona M. and Harry B. Helmsley Charitable Trust and generous donors to the $2.5 million community-based Helmsley Center Dollar for Dollar Match Challenge. “Radiation oncology is offered right here in Pierre for the first time. That’s a victory for patients and their families who in the past have had to drive hundreds of miles or be away from home for days at a time,” said Avera St. Mary’s President and Chief Medical Officer Mikel Holland, MD. While medical oncology services have already been offered in Pierre for some time, these services are now enhanced. This includes infusion suites that are connected to the oncology clinic so patients can receive care in one convenient location. Specially designed chairs recline and offer heat for comfort. Large windows offer a view of a garden, creating a serene environment. 


HELMSLEY CENTER 1. At 57,000-square-feet in size,

and its beautiful natural design, the Helmsley Center reflects Avera’s goal to achieve the best possible care for patients in a patient-centered environment.

2. The Helmsley Center is home

to more than just cancer care. Other specialties include orthopedics and podiatry; physical medicine and rehabilitation; interventional pain medicine; dermatology; ear, nose and throat; urology; and specialty outreach clinics.

3. The Helmsley Center is

equipped with telemedicine equipment for access to specialty visits through Avera eCARE®.

4. Amenities for patients,

families and visitors include the Riverstone Bistro, meditation room, multicultural room and two outdoor healing gardens.

5. The main floor features

120 green Amazonite stones within the floor, representing Avera St. Mary’s Hospital’s 120 years of service. Amazonite is known as the hope stone and said to have healing properties.

“Because the Helmsley Center is close to home, patients can sleep in their own beds, continue working as much as possible, attend their children’s events, and receive support from those that matter most — their friends and family.” - STEVEN LEE



Every cancer patient’s journey is unique, and so are the questions people have when the diagnosis comes to light.

What is a common question you hear when someone receives a cancer diagnosis? Peterson: Many people wonder if they will feel the radiation, and my answer would be that it depends on the area we are treating. Patients will not feel the beam itself when it is activated, but in some cases, they may notice effects in tissue near the site. When someone has therapy in the abdomen, they may feel cramping. Some patients report temporary swallowing discomfort when we conduct therapy on the chest. There’s no jolt, though. Not everyone feels the inflammation or swelling that sometimes comes with the treatment.


What are some common worries people facing cancer may have? MICHAEL PETERSON, MD, AVERA MEDICAL GROUP RADIATION ONCOLOGIST IN YANKTON


After my therapy, is it OK for me to hold a baby or hug people? Am I radioactive or a danger to anyone? Peterson: At Avera Cancer Institute, patients receive radiation therapy using our linear accelerator, and after treatment they are not radioactive. It’s like when a light turns on. When it goes out, you do not glow. After your treatment, you can feel free to do anything you wish as you won’t be dangerous to anyone.

Danner: It can be hard to verbalize the rush of questions and emotions that come with cancer. People want to know what it is, and what they are going to feel. They want to know about the side effects, both physical and mental. Many patients also consider how their lives will change. They wonder how they will pay for the treatment, as well as how they will keep on being there for their family. We do our best to reassure them and help them find resources. We offer the compassion they need in order to press forward on the cancer journey. 

Fall 2018

Avera Cancer Institute


More Tools For Early Detection AVERA SITES ADD CESM

Diagnostic imaging tools are valuable in the fight against cancer because they help physicians find potential cancers earlier. Contrast-enhanced spectral mammography (CESM) is being offered at Avera Cancer Institute in Sioux Falls, and was recently added in Pierre and Aberdeen, S.D., and Marshall and Pipestone, Minn. “It’s a great additional tool and it’s used in many cases where mammography or ultrasound show questionable findings,” said Josie Alpers, MD, Avera Medical Group diagnostic radiologist in Sioux Falls.

“This tool helps to decrease the number of potential biopsies. It can also make a clinic visit more convenient for patients, because with CESM, we know we have the best possible imaging, all in one day.” - JOSIE ALPERS, MD, DIAGNOSTIC RADIOLOGIST


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Patients have an injection of contrast immediately prior to a mammogram. Through a combination of low- and high-energy X-rays, an image is produced that removes all the dense tissue; only areas of concern are enhanced. It can show where there is increased blood flow — a sign that may be associated with cancer. Cysts, breast density or other benign conditions can lead to inconclusive results from mammography or ultrasound. Yet CESM can deliver more definitive information that physicians can use.

James Simon, MD, Avera Medical Group radiation oncologist in Marshall, says CESM is also a great tool for evaluating how treatment is affecting a tumor. “It can provide us with a much clearer determination.” For Jan Perrion of rural Ipswich, S.D., CESM made a tremendous difference. Her physician determined she carried a genetic trait that could make her susceptible to breast cancer, which she faced 11 years ago. JAN PERRION She was on a routine of mammograms every six months, and a breast MRI each year. In January 2018, she and her doctor, Roger Werth, MD, Avera Medical Group general surgeon in Aberdeen, agreed she should substitute her MRI appointment with one for CESM. “I’m glad they had this new approach because six months before,

MULTIPLE BREAST CANCER EXPERTS, ONE VISIT For women newly diagnosed with breast cancer, a second opinion may confirm what their physician has already recommended. Or, it may open their eyes to new possibilities. In any case, a second opinion can offer peace of mind during a turbulent time. For more information about the Breast Cancer Consult Clinic or to make an appointment, call


James Simon, MD, radiation oncologist (left), consults with senior physicist Xiang Kong.

they found nothing. This time, they found a tumor,” she said. After a double mastectomy, Perrion is doing well. “I was happy they found it and got rid of it. If we had waited another six months, it could have spread … thankfully we got it out soon enough.” The Breast Cancer Consult Clinic at Avera Cancer Institute in Sioux Falls offers the opinions of an entire team of breast cancer experts – at one setting. The Breast Cancer Consult Clinic gives patients the rare opportunity to meet with and receive personalized treatment recommendations from a medical oncologist, radiation oncologist and breast surgeon during one visit. The day of the consultation starts at 8 a.m. and typically lasts until noon. Patients can meet with each physician separately for up to an hour – offering plenty of time to learn about their recommendations, ask questions and get to know them. Patients also learn about a variety of cancer support services, including: • Counseling and support groups • Genetic testing and counseling • Integrative medicine services such as acupuncture, aromatherapy and massage • Lymphedema specialist assessments • Nutrition • Research and clinical trials “Every day, our providers work together as a cohesive, multidisciplinary team, doing what’s best for each individual patient,” says Nancy Terveen, BC, FNP, Avera Cancer Institute breast health navigator. “We’ve designed this clinic so patients can benefit from an entire group of experts – not justFall one person’s opinion. ” Institute 2018 Avera Cancer



Bob Polly and his wife, Betty, enjoy time at home.

Fitness enthusiast Patty Considine remembers getting her picture taken in front of the new Prairie Center when she was in Sioux Falls to celebrate its opening in 2010.

“I remember feeling so happy that this place was here for people who need it,” she said of the Prairie Center, home to Avera Cancer Institute. Seven years later, when she herself was in need of breast cancer care, that picture came to her mind. Considine, who works as a physical therapist assistant in Sioux City, Iowa, is an extremely active wife and mother who enjoys running, biking and taking part in triathlons. After her first husband died of cancer, she remarried, and she and her husband, Bob McClintock, have a 5-year-old son, Tyler. She also has grown children — Mike and Kelly. “I was very conscious of my health and very adamant of getting my mammograms done each year, because I had a grandmother who was diagnosed in her 50s,” she said. Her January 2017 routine mammogram resulted in an unwelcome surprise: she had developed stage III breast cancer that had spread to her lymph nodes.


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Patty is pictured with her supportive family.

The first thing Considine wanted to do was to get out into nature. “I dropped my son at preschool, got out my fat tire bike, and took off riding in the snow. I rode and rode and found myself at the church, where I lit the prayer candle and prayed for a medical team to take care of me, and for my family, and to find the grace to make it through.” Later that day she put on her winter running gear and went to a nearby state park to run, listening to spiritual music through her headphones. “There were just moments of sun shining through and feeling the power and strength that was already within me.”

“I knew that with taking on cancer, I needed to find my own strength. I already had a strong faith and it grew even more.” Fitness enthusiast Patty Considine enjoys biking and other outdoor activities.

“The Avera Race is very personal to me because of the Avera team and people I’ve met who are so amazing.” - PATTY CONSIDINE

When asked where she wanted to go to treatment, Considine opted for the Avera Cancer Institute in Sioux Falls. “Knowing I had a team behind me was huge. It started with the nurse navigator, Nancy. I called her a lot and she was always so great to calm me down and find whatever answers to my questions.” Her Avera specialists were Amy Krie, MD, medical oncologist, and Julie Reiland, MD, breast surgeon. “I made such a great connection with all of them.” Patty Considine took part in the Avera Race in both 2017 and 2018.

She had her surgery and first round of chemo in Sioux Falls. Then, because Krie provides outreach visits in Spencer, Iowa, Considine was able to have her second round of chemo there, and then go to her family’s cabin at Lake Okoboji for the weekend. To help cope with the side effects of her treatment, she took advantage of Integrative Medicine services, including acupuncture, massage and a mindfulness class. “I’m also a big believer in aromatherapy — it helped me with nausea and sleep,” Considine said. In addition to her cancer care team, Considine credits her husband, her family and friends for their amazing support. Considine took part in the Avera Race Against Breast Cancer in 2017 and 2018.

“Being among so many women and survivors and in the group photo of survivors was beyond words — it was so powerful. It’s a great cause and Avera is able to do great things with the money raised,” she said, mentioning the wig program. Considine faced her cancer with humor, faith and a positive outlook. The Avera Cancer Institute infusion units have “bells of hope” that patients can ring to celebrate milestones in their journey. “I rang the bell every chance I had. I met some amazing people I can call friends at Avera. No matter what challenges you face, with faith, family and friends, you can do it.” Most people hope they will never get cancer, but for Considine, she doesn’t regret that she had to go through it. “I am forever changed and forever blessed.”  Fall 2018

Avera Cancer Institute


Doc talk Jason Jones, MD, Breast Oncologist with Avera Cancer Institute What is immunotherapy? Some cancers have developed mechanisms that allow cancer to bypass the immune system. New drugs interfere with this bypass and allow the cancer cells to be attacked by the immune system. How do you use different treatment options to work together? Cancer is like a dandelion. If you leave part of the plant or root, it will grow back. Surgery is like pulling the weed. Radiation is like spraying weed killer for local control. Immunotherapy or chemotherapy is like the weed preventer to help protect the whole yard, in case the seeds have spread. We are preventing cancer from spreading by administering chemotherapy or immunotherapy. How is Avera’s research program different? Our research program is robust and includes diverse clinical trials from Phase 1, to test safety and dosages, to Phase 3, to determine if it should be standard of care. Patients here have access to opportunities that otherwise would not be available. We have a dedicated team helping us to bring the most cutting-edge treatments to South Dakota.


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Clinical Trials: Benefiting Patients Today and in the Future New trials available with Avera Cancer Institute’s robust research program focus on two key areas of cancer treatment: genomic profiling to target therapy to a patient’s specific cancer mutations and immunotherapy to boost the patient’s immune system to fight the cancer cells. The NSABP B-59 study is trialing an immunotherapy drug that research has shown to work well with cancers that have a high number of mutations, which typically occurs in triple-negative breast cancer, said Jason Jones, MD, one of two dedicated breast oncologists at Avera Cancer Institute. The B-59 clinical trial combines immunotherapy and chemotherapy infusions in an effort to improve response to treatment and eliminate the tumor before surgery, which decreases the chance of recurrence, Jones said. “Clinical trials, including the B-59, are a great opportunity to improve outcomes,” Jones said. “The hope for immunotherapy is it will work better long term with few side effects.”

Other projects: • SPRING Clinical Trial through the Worldwide Innovative Networking (WIN) Consortium, meant to provide better treatments for metastatic non-small cell lung cancer by using a three-drug protocol, involving immunotherapy and targeted therapies. • Phase 1 Trials at Avera Cancer Institute Center for Precision Oncology to pinpoint the optimal multiple-drug protocols for various solid tumors, including breast and ovarian. 

Thoughts about

“One of the most important things to remember is that

SURVIVORSHIP – F RO M S U RV I VO RS “I went in to treatment with a pretty good attitude because of my faith. You can have faith, too, that the good Lord is going to help you along the journey. I was encouraged when family and friends sent me Bible verses, which I read over and over again, that say,

‘Do not be afraid or discouraged for the Lord your God is with you wherever you go’ (JOSHUA 1:9)


‘I can do all things through Christ who strengthens me’ (PHILIPPIANS 4:13).”


“Stay strong and stay positive.

cancer is what you have; it’s not who you are. You’re still you. Even if you have less energy, less hair or more scars, cancer is not how you should define yourself. I was determined not to let cancer dictate how I lived my life. I wanted to stay true to myself regardless of how my treatment made me feel or look.”

I found courage and strength throughout my treatments and surgery from my wife, my children and grandchildren and my sisters. They were there every step of the way with visits, calls, positive encouragement and helping me enjoy life. I remind myself every day that I am a lucky man to have such a supportive family which allowed me to be away from home for several weeks, to continue being an active rancher, and have the livestock to be well cared for on the ranch. I am so grateful to be able to return to ranching and get my life back."


“I know it’s tough, but try not to jump to the ‘worst case scenario.’ The people at Avera are knowledgeable and know what they’re doing. Have faith, lean on prayer, family, friends and your care team.”



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Avera Cancer Institute





Avera Cancer Institute

Fall 2018

Because lung cancer is a serious diagnosis that can be life-threatening, catching it early could make all the difference.

That’s why Avera offers low-dose CT lung cancer screenings at various locations — to find small growths of cancer, commonly called nodules, in the lung before they can grow and spread. The annual screening is also one that gives peace of mind to people who may worry about lung cancer — the top cause of cancer deaths among both men and women in the U.S.

Kay Long of Mitchell, S.D., was successful in her efforts to quit smoking. Yet she knows that her 30 years of smoking still place her at increased risk for lung cancer. “There’s always that question in your mind, so this screening offered that reassurance,” Long said. She also knows of people for whom the screening detected suspicious spots in the lungs. “Maybe if it will help someone catch cancer earlier and get it treated, it can make a difference.” Similarly, as a long-time smoker, Brenda Bohn of Mitchell is pleased to have the annual screenings available to her. “It’s a wonderful relief to know that I’m doing OK — lung cancer is not something to fool around with.” The screening is easy and convenient, too. “I was done in about eight minutes — there’s nothing to it.” Having known others who were diagnosed with lung cancer, Bohn knows this screening can save lives. “Everyone has a Pap and a mammo every year, I do all that and have a lung screening too,” she said. “Catching lung cancer early increases the possibility of successful treatment,” said Carole Chell, CNP, who was instrumental in developing the lung screening program at Avera Cancer Institute in Sioux Falls. “Research is constantly advancing toward finding better ways to effectively treat this cancer, including the SPRING trial at Avera that involves immunotherapy and targeted therapies,” she said. Unfortunately, more than 60 percent of non-small cell lung cancer cases are detected in an advanced stage, and for these advanced stage cancers, five-year survival is less than 5 percent.

Results of the National Lung Screening Trial showed that screening current and former smokers with low-dose CT scans reduced their risk of dying from lung cancer by 20 percent. During a low-dose CT scan, the patient lies on a table that passes through the center of the CT scanner. The procedure is painless and can be performed with a single short breath hold and takes less than 15 seconds. Radiation from a low-dose CT scan can be up to 90 percent less than the dose from a standard chest CT. The benefit of finding and treating early lung cancer far outweighs the risk. The amount of radiation exposure from a low-dose CT scan is about the same as a person would receive from background radiation (such as sun exposure) over a year. Getting a lung screening starts with a conversation with your primary care provider. If your provider agrees that you fit within screening guidelines, he or she can schedule the test for you at an Avera location near you. This service is offered at Avera Cancer Institute centers in Sioux Falls, Mitchell, Aberdeen and Pierre, and other Avera locations. Your primary care provider can also offer resources to help you quit smoking. 

Medicare and insurance plans often cover this service for people who qualify. Check with your insurance provider to verify your coverage.

Lung Cancer Screening Lung cancer is the leading cause of cancer-related deaths in the United States, causing more deaths than breast, prostate and colorectal cancers combined.

Who should be screened for lung cancer? People with a history of cigarette smoking have a higher risk of lung cancer. Based on the National Lung Screening Trial findings, lung cancer screening is recommended for these groups of people:

Ages 55-77 years And Current smokers with a smoking history of at least 30-pack years (for example, 1 pack/day for 30 years, 2 packs/day for 15 years, etc.)

or Former smokers

with at least a 30-pack year smoking history who have quit within the last 15 years


BREAST SURGERY Avera Medical Group surgeon Julie Reiland, MD, performs a recent breast surgery.

When a woman is diagnosed with breast cancer, her treatment plan most often includes surgery. “When a woman finds out she has breast cancer, how her breasts will look after surgery is often the furthest thing from her mind. But a year down the road, after treatment is over, she will care,” said Julie Reiland, MD, FACS, Avera Medical Group breast surgeon in Sioux Falls. “Studies show a woman with a good cosmetic result after her cancer treatment has better long-term quality of life.”

Avera offers innovative surgical options to not only remove the cancer, but also offer the best possible cosmetic result. 18

Avera Cancer Institute

Fall 2018

Oncoplasty Oncoplasty is breast surgery to remove the breast cancer while incorporating techniques that improve the appearance of the breast. “When a woman has a lumpectomy, there are numerous techniques we use to remove extra skin and improve the cosmetic appearance. We do equalizing work on the other breast to make them look like they belong together,” Reiland said. As early adopters, Reiland, along with her partners in Sioux Falls, Wade Dosch, MD, and Tricia Merrigan, MD, are among only 11 percent of breast surgeons who use oncoplastic techniques. Reiland also trains other surgeons nationwide and internationally in oncoplasty. Breast surgeons and plastic surgeons also use surgical techniques to hide scars for less visible reminders. “We approach each treatment as an individual problem to solve and incorporate methods that allow us to provide that whole-patient care and consideration,” Merrigan said.

“Quality of life, post-surgery,

is an important consideration during the planning for treatment.” - BARRY MARTIN, MD, PLASTIC & RECONSTRUCTIVE SURGERY

Plastic and Reconstructive Surgery Avera Medical Group plastic and reconstructive surgeons in Sioux Falls, Mark Shashikant, MD, and Barry Martin, MD, offer surgical skills to help patients feel whole again after cancer. All patients have access to plastic surgery consultations, and plastic surgeons take part in weekly tumor conferences, where they can offer insight on every surgical case. “With our expert team, we can offer nipple-saving and scar-reducing approaches that will remove those visible signs of the cancer,” Shashikant said. Plastic surgeons may also provide breast reconstruction surgery after mastectomy, or combine breast reduction or enhancement techniques with reconstructive surgery after lumpectomy.

IORT Electron-based intraoperative radiation therapy (IORT) is a combination of surgery and radiation therapy in one procedure for patients who are 50 and older and who have small tumors. “Typically, after a lumpectomy, a woman will require daily radiation treatments for six weeks,” Reiland said. The daily treatment regimen can be a concern, especially for women who live in rural areas. “With IORT, a woman may be able to receive a single dose of radiation in the operating room and be done.” Avera’s IORT uses electron-based radiation to deliver radiation, and this differs from low-voltage (LV) X-ray-based IORT, offered at some cancer centers. The difference is a matter of physics and the depth at which low-voltage X-rays or electrons are able to penetrate tissue. LV X-rays only penetrate about a half centimeter, while electrons penetrate up to 3 centimeters within any direction of the tumor site. Reiland says electron-based IORT is endorsed by national radiation oncology experts, and she describes it as the best and safest IORT treatment possible. Many patients have breast surgery options within their own community, and sometimes, optimal care can be provided to patients utilizing a combination of local and Sioux Fallsbased services. 

“Surgery is an important decision. You should discuss your options with your primary care provider and local surgeon, so you are well educated and make the right choice for you and your specific case of cancer.” - Roger Werth, MD Clinical Vice President, Avera General Surgery Service Line Fall 2018

Avera Cancer Institute


WALKING FORWARD American Indians on the Northern Plains have one of the highest rates of cancer deaths in the United States. In 2002, that staggering statistic led Daniel Petereit, MD, FASTRO, to create Walking Forward — a grantfunded research program designed to address the high cancer mortality rates among American Indians in South Dakota. Today, Walking Forward is a department of Avera Cancer Institute Center for Precision Oncology and works closely with Regional Health in Rapid City, S.D., to provide tribal communities with cancer-related services such as community education and navigation, and access to cancer screenings and clinical trials.

Frontier Mentality “When the Benedictine and Presentation Sisters — the founders of what we now know as Avera — came to the Dakotas in the 1880s, it was all frontier territory,” says Sister Mary Thomas, Senior Vice President of Mission at Avera McKennan Hospital & University Health Center. “We always need to have somewhat of a frontier mentality — expanding and stretching our services into new areas in order to bring health care to those who need it, but don’t have easy access to it.”

This involves asking and acting on this question: How can we remove or mitigate the barriers so that people aren’t disadvantaged simply because of where they live?

“Through Walking Forward, we work with the American Indian community to discover what the barriers are to cancer care, increase early cancer screening and detection, and ensure that those who are diagnosed with cancer receive the best cancer care available,” describes Petereit. $1.6 Million Grant Funds Lung Cancer Screening Study Currently, Walking Forward is working on a study for lung cancer, which is the leading cause of cancer deaths in South Dakota. Low-dose computed axial tomography (LDCT) scans are an effective way to screen for and diagnose lung cancer sooner, resulting in earlier treatment and lower mortality rates. In early 2018, Walking Forward was awarded a grant for over $1.6 million from the Bristol-Myers Squibb Foundation to increase lung cancer screening rates for high-risk smokers living in western South Dakota. As part of the study, the Walking Forward team will offer primary care providers and clinic staff in western South Dakota — including those on the Pine Ridge and Rosebud Reservations — with educational opportunities designed to increase their awareness of and ability to identify and refer high-risk tobacco users to LDCT lung cancer screenings. They will also host community workshops to educate those who are considered high risk for developing lung cancer.


Avera Cancer Institute

Fall 2018

“We are very grateful and excited to be the recipient of this grant. We hope our study leads to higher cure rates for this deadly cancer through increased LDCT lung cancer screening, early detection and successful treatment,” said Petereit. 

This Craft Recycles Ribbon and Fabric –

Plus It’s Lots of Fun For patients and their loved ones alike, art projects offer a way to “escape” the realities of cancer treatment, while enjoying some camaraderie and the chance to do something expressive and creative. One popular project is the rag wreath, due to the simplicity of the work, inexpensive materials and the beauty of the craft when it’s completed. “They’re a great touch for decorating a room or to just use up surplus supplies. All you need is a little time and the hoop,” said Avera Cancer Institute artist-in-residence Denise Cameron Nelson. SUPPLIES • 1 9-inch floral wreath (Styrofoam works best; available at hobby supply stores) • 1 3-foot ribbon • A wide range of fabric scraps, ribbon, tulle, netting or old shirts.

Avera Cancer Institute artist-in-residence Denise Cameron Nelson shows off the finished project.




Gather all supplies together and consider your theme, color scheme or other ideas.

Tie a strip onto the wreath, making a firm but not-too-tight knot. Tie the strip a second time.



Cut strips that are 11 inches long and about 1½ inches wide.

Continue to add strips, alternating colors or material as you go. You can press the knots together to give the wreath a fuller look.

Cover the wreath as much or as little as you wish. 5 Tie a decorative bow or use any festive accent to attach at the 6 o’clock (bottom) position on the wreath. You can attach it with a straight pin or a dab of hot glue.  Fall 2018

Avera Cancer Institute


3900 W. Avera Drive Sioux Falls, SD 57108


Regular screenings can find cancer in the earliest stages before symptoms occur and when it’s easiest to treat. Talk with your provider about the need for screenings, which can vary by age and family history.

• Ages 21-30, Pap every 3 years • Ages 30-65, Pap plus an HPV testing every 5 years • Stop at age 65 if you had 10 years of normal Paps* • Yearly mammogram • Consult with your provider; he or she will help you determine a screening schedule that is best for you


PROSTATE CANCER Discuss need for screening with provider. For men who decide to proceed:


PSA screening with or without digital rectal exam

See your doctor every year for a professional skin cancer exam Speak with a physician if you notice new lesions or a progressive change.

LUNG CANCER Certain patients are candidates for low-dose CT screening of the chest, which can find lung cancer in its earliest stages.

Women Men Men and Women

20 years old



If you are age 55-77 years old and have at least a 30-pack-year smoking history, currently smoke, or have quit within the past 15 years

Colonoscopy recommended every 10 years. Beyond age 75, discuss the risks and benefits of testing with your provider




888-422-1410 | Avera.org/NavigationCenter

These guidelines are recommended by Avera Cancer Institute. *Certain medical conditions may require you to be screened on a different screening schedule. Consult with your provider to discuss. 17-ACAI-9413-REV-08302018


Profile for Avera

Avera Cancer Institute Magazine - fall 2018  

In this issue find topics like cancer care close to home, more tools for early detection, leading-edge approaches in breast surgery, and mor...

Avera Cancer Institute Magazine - fall 2018  

In this issue find topics like cancer care close to home, more tools for early detection, leading-edge approaches in breast surgery, and mor...