Cancer Update May 2012

Issue No. 25 / May 2012

In this issue Cancer Survivorship Program Helps Transition Patients to Life After Cancer

Genetic Testing Empowers Cancer Survivors

cancer update Helen F. Graham Cancer Center hires pioneering scientific couple

Collaboration with Wistar Institute to Develop Early Screening Tool for Lung Cancer

New Tool Helps Patients Evaluate Their Symptoms

Stephen Grubbs, M.D., Elected to Board of Directors of the American Society of Clinical Oncology

W I T H T H E H I RI NG OF TWO PROMINENT SCIENTISTS from the MD Anderson

Cancer Center, the Helen F. Graham Cancer Center enriches both the translational cancer research and medical physics programs.

Jennifer Sims-Mourtada, Ph.D., former director of Molecular Research and Development, at RadioMedix, Inc., in Houston and previously from the University of Texas MD Anderson Cancer Center (UTMDACC), is the Helen F. Graham Cancer Center senior clinical scientist for the Center for Translational Cancer Research (CTCR).

Her husband, Firas Mourtada, M.S.E., Ph.D., D. ABR, is the new chief of Clinical Physics in Radiation Oncology. Previously, Dr. Mourtada was a tenured associate professor in the Departments of Radiation Physics and Experimental Diagnostic Imaging at UTMDACC. He retains an adjunct professorship with The University of Texas Graduate School of Biomedical Sciences. (continued on next page)

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S C I E N T I S T S J O I N T H E H E L E N F. G R A H A M C A N C E R C E N T E R

Translational science

All in the family

At the CTCR, Dr. Sims-Mourtada continues her pioneering work, investigating why some cancers are resistant to treatment and developing the imaging tools to target them for destruction.

The Mourtadas’ passion for science brought them together 13 years ago. Their partnership has inspired creative approaches to solve some of the thorniest scientific questions about invading cancers and how to beat them.

“My goal is to find out which tumors would be resistant to treatment and which tumors are not likely to progress at all,” she says. The ability to characterize a patient’s tumor in this way would provide important information for doctors to prescribe the most effective course of treatment for individual patients.

Dr. Sims-Mourtada holds a Ph.D., in Biomedical Sciences from the Department of Immunology at The University of Texas Graduate School of Biomedical Sciences (2004). Her research on immune system genetics earned her a spot in the prestigious journal, Nature.

Expert in radiation oncology physics Dr. Firas Mourtada is an expert in radiotherapy physics, brachytherapy and dosimetry. He was on the faculty at UTMDACC since 2002. He holds several patents and has published and consulted extensively in the field of radiation oncology physics, contributing to best practice standards. As chief of Clinical Physics, he brings the unique perspective of a trained scientist as well as an experienced clinician to the Graham Center multidisciplinary cancer care team. He and his staff of dosimetrists and medical physicists, working with the entire radiation oncology team, play an important role in assuring accurate delivery of all aspects of the radiation treatment prescription.

Their passion for science brought them together 13 years ago and they have worked together on ways to solve some of the thorniest scientific questions about invading cancers and how to beat them.

One of Dr. Mourtada’s goals is to develop a medical physics residency training program and master’s degree program in medical physics at the Graham Center in the next few years. “Our efforts to establish a medical physics education program coupled with our leadership in patient care and research, I believe will solidify us as one of few, nationally recognized community hospital cancer centers,” he says.

At RadioMedix, Inc., (2006-2011), she built the company lab from the ground up and developed imaging agents for use with PET or CT scans. Under contract to the U.S. Defense Department, her group was the first to show that a radiolabeled protein called sonic hedgehog (named for a video game character) could differentiate stem cell-like breast cancer cells from other tumor cells, and potentially identify aggressive tumors. Her previous fellowship research in experimental radiation oncology at UTMDACC (2004-2006) was among the first to link hedgehog expression with resistance to radiation and chemotherapy.

Hedgehogs and tumor cells “Given the successful tissue banking and procurement capability here at the Helen F. Graham Cancer Center,” she says, “I want to use the imaging techniques I’ve developed to go back and look at multiple aggressive tumor types for the sonic hedgehog signature.”

Unlike his wife, who is a Texas native, Dr. Firas Mourtada came from Syria. A new English speaker at 17, he studied biomedical engineering at Mercer University in Georgia.

Upon graduation in 1992, he was one of 14 master’s degree candidates funded by the Whitaker Foundation Graduate Fellowship at The Johns Hopkins University in Baltimore, where he stayed to complete a Ph.D., in Radiation Health (1997). After a one-year fellowship at the National Institute of Standards and Technology in Maryland, in 1998, he joined Guidant Vascular Interventions Corp., a Fortune 100 biotech company in Houston, as senior medical physicist. Over the next two years, Dr. Mourtada and colleagues developed a number of novel intravascular brachytherapy devices to treat cardiovascular disease.

At about this time, he met his future wife, Jennifer Sims.

“I thought she was a brilliant scientist,” he recalls. The coupled married, and, in 2002, Dr. Mourtada joined UTMDACC as an assistant professor in the Department of Radiation Physics. His biomedical engineering

2 Christiana Care Health System

“My goal is to find out which tumors would be resistant to treatment and which tumors are not likely to progress at all.”

—Jennifer Sims-Mourtada, Ph.D.

“Our efforts to establish a medical physics education program coupled with our leadership in patient care and research, I believe will solidify us as one of few, nationally recognized community hospital cancer centers.”

—Firas Mourtada, M.S.E., Ph.D., D. ABR

background and experience designing cardiovascular brachytherapy devices led to new collaborations that would benefit his cancer patients.

One example of his innovative work is a novel applicator for cervical cancer brachytherapy, which is expected to reach market in 2013. An unlikely partnership with scientists from Los Alamos National Lab produced an advanced dose calculation algorithm now used for planning external beam radiation and brachytherapy treatments. Dr. Mourtada contends, “If we are to eradicate cancer, we need to find ways to work together across all scientific disciplines.”

While at UTMDACC, Dr. Mourtada also served as an advisor to RadioMedix, Inc., which afforded opportunities for the couple to work together. In 2011, the company earned support from the Texas Emerging Technology Fund to launch a novel device developed and tested in Dr. Mourtada’s lab at UTMDACC to radiolabel pharmaceuticals for PET imaging. The device potentially enables users to generate and label PET radiotracers on-site at much lower cost than those produced by current Cyclotron technology.

Cancer Update 3

Darcy Burbage, RN, MSN, AOCN, CBCN, Cindy Waddington, RN, MSN, AOCN with patient Marilynn Renz.

array of wellness programs, support groups and social work services. After about six weeks, Burbage meets with patients again to assess progress and to provide a written treatment summary to share with their physicians.

“Part of my job is to help transition patients from active treatment to life after cancer,” says Burbage, who was recognized in 2010 by the national Oncology Nursing Society for her creative leadership in patient care. “I’m here to connect patients with the services they need, to answer their questions and sometimes, just listen.”

Cancer Survivorship Program helps Newark woman embrace life after breast cancer MARI LY NN RENZ COULD NOT SH AKE THE FEAR that her cancer might return some day.

“After my surgery and radiation treatments, I tried to convince myself that I would be fine, but I wasn’t,” she says. “I was drifting in a lifeboat without an oar.”

Renz found her lifeline at the Helen F. Graham Cancer Center through its nationally recognized, multidisciplinary Cancer Survivorship Program.

Led by Scott Siegel, Ph.D., the Cancer Survivorship Program and Survivorship Multidisciplinary Center help survivors by focusing on the physical, psychological, social and spiritual changes they can experience after cancer.

“For many patients, the post-treatment phase of cancer can be even more challenging than their treatment,” Dr. Siegel says. “Our studies and others nationally show that fear of recurrence is a top concern for almost every cancer survivor.” The Graham Center’s Survivorship Program is at the forefront of behavioral research particularly in this area, which Dr. Siegel says resembles post-traumatic stress disorder.

“I don’t know of any other program in the country that emphases this strong psychosocial focus to survivorship care. Patients tell us they want and need help to manage fear and anxiety just as much as medicine to relieve treatment side effects or physical symptoms.”

Essential patient follow up Integral to the Survivorship Program is the patient’s posttreatment meeting with Clinical Nurse Specialist Darcy Burbage, RN, MSN, AOCN, CBCN. Her thorough patient assessment guides recommendations for psychological counseling, symptom management, and a comprehensive 4 Christiana Care Health System

Multidisciplinary approach In the aftermath of her breast cancer, Renz had multiple concerns, so Burbage recommended the Graham Center’s Survivorship Multidisciplinary Center. At the Survivorship MDC, providers from multiple specialties, including Dr. Siegel and Clinical Nurse Specialist and wellness coach Cindy Waddington, RN, MSN, AOCN, sat down together with Renz to devise a customized care plan.

Cancer Care Connections Director Janet Teixeira, LCSW, was a helpful link to resources in the community, and Ellyn Hutton, RN, a licensed massage therapist and certified yoga instructor, provided mind-body techniques and integrative medicine approaches.

“I left that first meeting feeling that there might be hope for me,” Renz recalls. “Since then, Dr. Siegel has helped me work through my fears and build up confidence that I could beat this thing. He also suggested a community support group, which I look forward to every week.”

Social worker Michelle Bailiff, LCSW, addressed concerns about insurance and with dietician, Elena Schumacher, RD, CSO, devised a nutrition and wellness plan that helped Renz drop some unwanted weight and control hot flashes caused by her medication. She continues to benefit from meditation and the exercise programs offered at the Graham Center through the Mind, Body, Spirit Wellness Program and is a frequent visitor to the Cancer Resource Library.

“The Cancer Survivorship Program put my life back together again,” says Renz. “Everyone should know there is help out there. You don’t have to face life after cancer alone.”

Established in 2006, the Cancer Survivorship Program has touched the lives of thousands of survivors and has been recognized as one-of-a-kind in multiple professional publications.

Patient Kathryn Bender-Jones with Genetic Counselor Marcie Parker.

Genetic Counselor Becky Milewski with patient Donna Harris.

Cancer survivors say genetic testing can empower us DOCTORS D I AG NOSED KAT H RY N BENDERJONES W I T H BREAST CANCER AT 4 9 . The Familial

Cancer Genetic Risk Assessment Program at the Helen F. Graham Cancer Center gave her the information she needed to make an informed and confident decision about her medical care.

“There is so much cancer in my extended family,” Bender-Jones says. “When I found out I had breast cancer, I felt there had to be a connection.”

EBUS procedure Genetic testing at the Graham Center confirmed for Bender-Jones that she carries a BRCA2 gene mutation linked to hereditary breast and ovarian cancer. For women who carry such a mutation, the odds of developing breast cancer are five times greater than for someone who doesn’t have the mutation. BRCA2 mutations can also increase the risk of developing other cancers.

“Having that information empowered me to be more proactive about my own care,” she says.

“Genetic testing won’t tell us when a person might get cancer, but it can tell us who is at greater risk due to hereditary factors.”

—Zohra Ali Khan-Catts, MS, CGC Director of Cancer Genetic Counseling

According to Zohra Ali Khan-Catts, MS, CGC, director of Cancer Genetic Counseling, “Genetic testing won’t tell us when a person might get cancer, but it can tell us who is at greater risk due to hereditary factors.”

An important first step is taking a comprehensive personal and family medical history. “From the family cancer risk assessment we can identify whether genetic testing is available and if there is a clinical or research study of potential benefit,” Ali Khan-Catts says. “Armed with this information, we can offer patients the best possible information about screening and options for cancer risk reduction and early detection.”

Patients also have the opportunity to participate in the High Risk Family Cancer Registry, which now documents 3,175 families and 143,773 individuals from Delaware and neighboring states who either have cancer or are at high risk for developing the disease. These data are incorporated into a comprehensive database of family histories that in many cases extend back generations.

The Registry is an important resource for genetic science and epidemiological (population-based) studies, such as those underway at the Center for Translational Cancer Research on breast, colon and endometrial cancer.

Donna Harris had no idea that her breast cancer and recurrent uterine tumors were related. “My experience with the genetic risk assessment team answered a lot of questions that for years made my doctors just throw up their hands.” She was relieved to find out she did not have heredity breast cancer and that she could join a research study on Cowden syndrome, a possible risk factor for benign and cancerous tumors.

“I would have driven anywhere to get the best medical care, but at the Cancer Center I didn’t have to go far. All of my care providers worked well as a team, all in one place, and to me that made all the difference.”

To speak with a genetic counselor, call the Family Cancer Genetic Risk Assessment Program at 302-623-4593.

Cancer Update 5

Helen F. Graham Cancer Center shares $1 million grant with Wistar and Temple to develop world’s first blood test for lung cancer CLI NI CI ANS AT T H E H ELEN F. G RAHAM CANCER CENT ER join scientists at The Wistar

Institute and Temple University to develop the world’s first practical blood test for lung cancer. A $1 million grant to fund the project for two years comes from Pennsylvania’s Commonwealth Universal Research Enhancement (CURE) Program.

Nicholas J. Petrelli, M.D.

“Collaborating with Wistar scientists to develop an early screening tool for lung cancer is a compelling example of our translational cancer research effort,” says Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center. “Our historic partnership with Wistar to speed discoveries from their labs to clinical trials will benefit patients at the Graham Center and elsewhere, and this project is an important first step.”

Lung cancer is the most common cause of cancerrelated deaths in Delaware and the nation. Right now, there are no clinically effective ways to screen for and detect lung cancer at an early stage when it might be curable. But that is about to change.

According to Thomas Bauer, II, M.D., chief of Thoracic Surgery, “Our ability at the Graham Center to recruit large numbers of patient volunteers to provide blood samples in the quantities needed for analysis is critical to take Dr. Showe’s concept to clinical trials.”

“With a simple blood draw,” says Dr. Showe, “we can detect lung cancer, show the effectiveness of cancer Thomas L. Bauer, II, M.D. surgery, by sampling the same patient’s blood for analysis after surgery, and hopefully even determine if the cancer may return.”

Dr. Showe and her colleagues at Wistar first discovered the link between NSCLC and white blood cell gene changes in 2009. Two years later, the researchers found that gene expression patterns change when a tumor is removed and could return to normal after successful lung cancer surgery. They showed further that certain genes distinguish between malignant tumors and nonmalignant lung nodules, suggesting that a blood test could guide treatment decisions and potentially prevent unnecessary surgeries.

Recently, Louise C. Showe, Ph.D., a professor in Wistar’s Molecular & Cellular Oncology program and director of Wistar’s genomics facility, showed it is possible to detect early stage non-small cell lung cancer (NSCLC) by examining changes in gene activity in white blood cells, important to the body’s immune system. By partnering with the Helen F. Graham Cancer Center and Temple University Health System, Dr. Showe aims to streamline blood collection and analysis to develop a commercially viable test for NSCLC.

“With a simple blood draw, we can detect lung cancer, show the effectiveness of cancer surgery, by sampling the same patient’s blood for analysis after surgery, and hopefully even determine if the cancer may return.”

—Louise C. Showe, Ph.D. Wistar Institute 6 Christiana Care Health System

Cancer patients pilot award-winning software honored by Computerworld CHRISTIANA CARE WON A 2012 LAUREATE AWARD from International Data Group’s Computerworld Honors Program for creating a unique self-assessment tool that helps patients evaluate their symptoms.

Each year, Computerworld honors visionary companies who apply information technology toward positive social, economic and educational change. Christiana Care’s collaboration of clinical and Information Technology staff won in the health category, one of 10 classifications that in total received more than 500 nominations.

Theresa Gillis, M.D., reviews the features of Insight with a patient.

“Insight makes it easier for the patient and the doctor to have a conversation about more sensitive issues or symptoms they might not otherwise volunteer.”

—Theresa Gillis, M.D. Medical Director of Oncology Pain and Symptom Management and Rehabilitation Services

Christiana Care’s winning software program, called Insight, enables patients to use a tablet-based, clinician-friendly wireless format to report the severity of their symptoms and affect on quality of life.

Cancer patients first used the tool in a pilot program in May 2010 followed by heart failure patients. Their feedback helped develop the program.

“Insight makes it easier for the patient and the doctor to have a conversation about more sensitive issues or symptoms they might not otherwise volunteer,” says Theresa Gillis, M.D., medical director of Oncology Pain and Symptom Management and Rehabilitation Services at the Helen F. Graham Cancer Center. “The patients’ ratings give ‘insight’ into their distress, their function and independence and their well-being. Patients seem more comfortable discussing feelings of anxiety and depression after using this tool.”

Seventy-six percent of patients report they like using Insight, with 67 percent claiming the tool better prepares them to speak with their doctor. Christiana Care’s Information Technology team is launching a new release this year for a wider patient audience for use with an Apple iPad.

F E ATURE D E M PL OYE E S

Working on the front line to welcome new patients Cancer Care Management Access Coordinators Michele Dailey and Lori Maugle work as a team to welcome patients to the Helen F. Graham Cancer Center. “We consider ourselves the ‘front line,’” Dailey says. “We are often the patient’s first point of contact when coming to meet with their multidisciplinary cancer team. What’s important is the patient I am going to make smile today.”

“Our patients expect and deserve great care,” Maugle adds.

“It takes all of us working as a team to achieve that. This is the place where their healing begins.”

Lori Maugle and Michele Dailey

Cancer Update 7

Non-Profit Org. US Postage

PAID Wilmington, DE Permit No. 357

P.O. Box 1668 Wilmington, Delaware 19899 www.christianacare.org

One of the original 14 cancer centers in the nation selected for the National Cancer Institute Community Cancer Centers Program.

Stephen Grubbs, M.D., elected to ASCO board Christiana Care Medical Oncologist Stephen S. Grubbs, M.D., begins a three-year term, starting June 1, 2012, on the board of directors of the American Society of Clinical Oncology (ASCO), the world’s leading professional organization representing physicians who care for people with cancer.

As managing partner of Medical Oncology Hematology Consultants located at Christiana Care’s Helen F. Graham Cancer Center, Dr. Grubbs brings a “community oncologist” perspective to ASCO deliberations. An accomplished researcher and author, Dr. Grubbs also serves as principal investigator for Christiana Care’s Community Clinical Oncology Program and on the board and executive committee of the Alliance of Clinical Trials in Oncology, which, through the National Cancer Institute, speeds the latest cancer control, prevention and treatment clinical trials to patients at community cancer centers.

M U LT I D I S C I P L I N A R Y C A N C E R C E N T E R S A T T H E H E L E N F. G R A H A M C A N C E R C E N T E R

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Lung / CyberKnife Neuro / CyberKnife Breast Cancer Genetic Risk Assessment Genitourinary Cancer Head & Neck Cancer Hepatobiliary / Pancreatic Cancers Hepatoma Screening

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Lymphoma Melanoma / Soft Tissue & Bone Sarcoma Mind, Body & Spirit Wellness Rectal / Anus Cancers Pain & Symptom Management Thoracic / Esophageal Cancers Young Adult Follow-up Survivorship

8 Christiana Care Health System Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit www.christianacare.org/donors.

Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2012. All rights reserved.

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