Issue No. 23 / Spring 2011
In this issue
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Director’s Corner Radiation Oncology pioneers leading-edge technology Inpatient Oncology Unit offers 24-hour expectional care and support Specialized rehabilitation now available
cancer update Care Management team backs high school coach in his battle with cancer Tom Hogan is a tough, athletic type, who loves his high school coaching and teaching career. When colorectal cancer sidelined him temporarily last year, the Cancer Care Management team at the Helen F. Graham Cancer Center supported him all the way as he fought to get back in the game. “At first I was hardheaded and wanted to do everything myself,” Hogan recalls. “But I didn’t realize how a cancer diagnosis and treatment can weigh heavily on you.” At the Helen F. Graham Cancer Center, a multidisciplinary team of doctors, nurses, case workers and other professionals guide patients through treatment. “Meeting my nurse navigator was one of the best things that could have happened,” Hogan says. After years of suffering from irritable bowel symptoms, Hogan developed a rectal tumor diagnosed as stage III rectal cancer. Immediate surgery was required to remove the tumor. Seven weeks of radiation and months of chemotherapy followed to knock out any remaining cancer cells.
Tom Hogan relies on multidisciplinary care from the Helen F. Graham Cancer Center
His nurse navigator, Marlene Brown, RN, BSN, OCN, facilitated Hogan’s care through the Multidisciplinary Colorectal Cancer Clinic, helping to explain his treatment, answering questions, coordinating appointments and referrals – and, most importantly, calming his anxiety. In addition to the latest medical treatment and sphincter-sparing surgery, Hogan says he received the emotional support he needed to meet the challenges ahead. “Having my nurse navigator was critical to keeping my brain focused on healing and not on all the little worries that kept popping up,” he says. “Whenever I had a question or concern, I’d call Marlene first, and she would always get me an answer.” (continued on back page)
DIRECTOR’S CORNER Nicholas J. Petrelli, M.D., Bank of America Endowed Medical Director of the Christiana Care Helen F. Graham Cancer Center, sets new milestones.
It’s time for a change and moving forward Since opening in 2002, teamwork has established the Helen F. Graham Cancer Center as a National Cancer Institute Selected Community Cancer Center. As a team, we have met many milestones along the way. • Launching 16 multidisciplinary disease site centers featuring a team approach to cancer care with nurse navigators throughout the care continuum. • Recruiting full-time adult genetic counselors for gene counseling and testing through the Ruth Ann Minner High Risk Family Cancer Registry of more than 100,000 individuals. • Building the infrastructure for translational cancer research and a leading National Cancer Institute Clinical Trials program and Pharmaceutical Trials Program. • Initiating formalized oncologic pain and palliative care and survivorship programs. • Offering CyberKnife and other state-ofthe-art technology in radiation oncology. • Opening a Tissue Procurement Center with more than 3,000 specimens in conjunction with caTissue as part of the National Cancer Institute Cancer Bioinformatics Grid (caBig). • Expanding the Cancer Outreach Program with more peer-reviewed grants.
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In June 2009, the Graham Center added 124,000 square feet, bringing all outpatient services under one roof. The West Pavilion houses the Center for Translational Cancer Research (CTCR), a collaborative effort between the Graham Center, the University of Delaware/Delaware Biotechnology Institute and the Nemours Research Institute at the A.I. duPont Hospital for Children. Recruiting Bruce Boman, M.D., Ph.D., from Thomas Jefferson University and Csilla Szabo, Ph.D., from the Mayo Clinic solidifies CTCR as a leader in the region. Collaborating with the Delaware Cancer Consortium and other hospitals in the state, the Graham Center is reducing cancer mortality in Delaware. In fact, since ranking number 1 for cancer mortality in the nation 13 years ago, Delaware now has the most rapid decline in cancer mortality of any state. In 2010, the American Cancer Society ranked Delaware 13th in cancer mortality. In 2009, Delaware ranked number 11. Delaware is also a leader in providing screenings. In 2008, the state ranked number 5 for breast cancer screening in the United States. In 2009, the state was number 1 in colorectal screening.
Strategic goals for the next five years include: • Develop a Graham Center North with all services, including multidisciplinary disease centers, and establish a similar presence on the Wilmington Campus.
Plans for the next five years encompass a competitive strategy for expanding valueadded services to an even broader patient population, including the following:
• Implement an integrated cancer electronic health record and continue development of the NCI Cancer Bioinformatics Grid with NIH funding.
• Offering a program of minimally invasive surgery for pancreatic and liver cancers.
• Expand the medical genetics program. • Follow up our pilot program and establish a medical/hematology oncology fellowship with Thomas Jefferson University, and potentially, a future surgical oncology fellowship. • Develop the Delaware Center for Cancer Biology as an expansion of the Center for Translational Cancer Research, part of the Delaware Health Sciences Alliance, and secure grant funding.
• Expanding genetic counseling and gene testing to include molecular biomarkers of interest. • Enhancing program development (clinical/translational) in lung, colorectal, breast and melanoma cancers. • Developing a formal phase I clinical trials capability for pharmacokinetics/genomics. • Expanding the gene research clinical trials program. (A phase I-B trial involving dendritic cells in advanced melanoma began in August 2010.) • Studying the adoption of a Supportive Oncology Home Project as part of multidisciplinary care of the cancer patient. Are these goals and strategies more than we can handle? I don’t think so. Our cancer program has a talented group of individuals who continue to work hard to bring the best cancer care possible to our patients in Delaware and the surrounding region. With their effort and the support of the community, we will strengthen our growing regional and national reputation. z
Cancer Update 3
Radiation Oncology pioneers leading-edge technologies IN MEDICINE TODAy, technology changes quickly.
Radiation Oncology professionals at the Helen F. Graham Cancer Center are leaders in adapting the latest imaging and radiation treatment advances into clinical practice. Our physics staff, radiation oncologists, nurses and clinic personnel are partners in the Graham Center’s multidisciplinary approach to treating a wide range of cancers, including breast, brain, gastrointestinal, gynecological, head and neck, lung, spine and prostate cancer. “The major goal of radiation therapy is to maximize our ability to destroy cancer cells while preserving optimal organ function and quality of life,” says
Radiation Oncology Department Chair Chris Koprowski, M.D. “We embrace technology wherever it will help improve patient outcomes and treatment capabilities.’’ The Helen F. Graham Cancer Center offers radiation therapy using external beam radiation delivered by our newest-generation linear accelerators with realtime treatment planning, image-guided, intensity modulated radiation therapy (IGT/IMRT), stereotactic radiosurgery and radiotherapy, and total body irradiation. We also offer CyberKnife robotic radiosurgery and low- and high-dose-rate brachytherapy. An advanced form of radiation therapy, brachytherapy delivers radiation from inside the body. The Radiation (continued on next page)
Radiation Oncology Team First row (from left): Dave Cook, Mark Liberti, Karen Karchner, Sharon Bowen, Lisa Anderson, Kelly Smith, Jon Strasser, M.D., Viroon Donavanik, M.D., Mary Hemphill, Carla Schurga Second row (from left): William Holden, Leslie Verucci, Melissa Hable, Modesty Hofmann, Kywanna Bost, Carole Robinson, Erin Hendrickson, Barb Vasudevan, Lisa Smith, Ji Fang, Becky Dalton Third row (from left): Lisa Ressler, Linda Gott, Chris Koprowski, M.D., Kathleen Wooster, David Huang, Sharon Massello
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Oncology team is pioneering these new brachytherapy applications for cervical, breast and prostate cancer. New packing device for cervical cancer – the Alatus™ vaginal balloon packing system is designed to displace and protect non-targeted areas – particularly the bladder and rectum – when delivering highdose-rate brachytherapy for cervical cancer. According to Radiation Oncologist Michael Sorensen, M.D., “The air-filled balloon is more comfortable than traditional packing methods and forms itself to the contours of the treatment area, allowing for maximum effective doses to be delivered safely.”
“We embrace technology
wherever it will help improve patient outcomes and treatment capabilities.” Chris Koprowski, M.D. Radiation Oncology Department Chair
New applicator for early-stage breast cancer – The SAVI® applicator delivers radiation through multiple catheters surrounding the tumor inside the breast. Radiation Oncologist Jon Strasser, M.D., explains, “In experienced hands, this multi-lumen applicator allows for high-quality dose shaping to limit radiation close to the skin or chest wall and thus minimize long-term complications.” New seed implants for prostate cancer – Polymer-coated, biodegradable AnchorSeeds™ used to deliver lowdose-rate brachytherapy for prostate cancer hold their position in tissue better than non-coated loose seeds, allowing placement in strategic target areas for maximum benefit.
F E AT U R E D E M P L O Y E E
According to Radiation Oncologist Adam Raben, M.D., director of Clinical Studies, “The radiation dose we deliver to the prostate is critical, and under-dosing is always a big concern. Having this type of seed that offers higher concordance with the treatment plan gives us a more accurate and reliable implant.” Dr. Raben is currently evaluating use of the new seeds for presentation at the American Brachytherapy Society. Gold standard for radiation dose calculation – Monte Carlo simulation is now being used for precise dose calculation in treatment planning for CyberKnife. A noninvasive alternative to surgery, the CyberKnife Robotic Radiosurgery System treats tumors anywhere in the body. “Extreme accuracy is required when delivering high doses of radiation around critical areas, particularly in the head and neck or the lung,” says Chief Medical Physicist Hank Chen, MS, DABR. “Complex dose calculations that used to take weeks or even a month to accomplish are now achieved in minutes using Monte Carlo.” In addition to industry-sponsored and investigatorinitiated studies, Radiation Oncology is a top enroller of patients in National Cancer Institute clinical trials through the Community Clinical Oncology Program (CCOP). Their Radiation Therapy Oncology Group (RTOG) trials lead to important new cancer therapies by linking basic research with clinical care. Currently, 18 RTOG trials that integrate radiation therapy with a variety of new drugs, systemic therapies and surgery are open to Christiana Care patients to treat many different cancers. Two new trials pairing Monte Carlo with CyberKnife are underway. z Radiation Oncology offices are located in the East Pavilion of the Helen F. Graham Cancer Center and two other locations in Wilmington, DE and Elkton, MD. For information or referrals, call 302-623-4800.
Nancy Lambert, MSN, RN, OCN, Breast Cancer Nurse Navigator
“My role is to touch as many patients as possible. I am my patient’s resource, support center and educator. I meet patients one on one who are referred to the Helen F. Graham Cancer Center or in the Breast Multidisciplinary Clinic. I assess their need for referrals to the social workers, financial assistants, registered dieticians, genetic counselors or the health psychologist. Many times patients can’t absorb all that is said in meeting with their doctor or treatment team. My patients know they can call me as often as they need for clarification or just to talk. I can offer them education, reinforcement and most of all compassion. This is my job and I love it.” Cancer Update 5
Tending to a patient on 6B are (from left) Jennifer Rowe, RN, OCN, patient care coordinator, Courtney Crannell, RN, MSN, OCN, staff development specialist, Dr. Biggs, unit medical director and Elizabeth Stone RN, MS, OCN, nurse manager
Christiana Hospital’s Inpatient Oncology Unit 24-hour exceptional care and support for cancer patients THE 40-BED INPATIENT HEMATOLOGy/ONCOLOGy UNIT (6B) at Christiana Hospital
is dedicated to caring for patients across the spectrum of cancerrelated illness. A multidisciplinary team of professionals provides care for cancer patients who require hospitalization for complex chemotherapy regimens, treatment for cancer-related complications, pain and symptom management, rehabilitation and supportive care for progressive disease. An adjacent, six-bed “positive pressure” unit provides specialized inpatient care for our Bone Marrow/Stem Cell Transplant program. The Federation of Accreditation of Cellular Therapies accredits this one-of-a-kind program in Delaware.
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“Our clinical leadership team is working together to institute the highest standards of care for our patients,” says David Biggs, M.D., 6B medical director. “Important to the process is our patient and family centered approach, which begins on day one, to establish an appropriate plan of care for each patient that clearly addresses everyone’s expectations and treatment goals.”
Specialized cancer care More than 30 percent of 6B’s nursing staff have made the extra effort to meet the rigorous standards of training and expertise in cancer care by earning national certification from the Oncology Nursing Certification Corporation. These nurses have an in-depth understanding of the clinical aspects of oncology care as well as a wide knowledge of social and community resources, support
groups, insurance and many other issues relating to the care of cancer patients. Oncology Nurse Manager Elizabeth Stone, RN, MSN, OCN, and her nursing staff are supported by an expert team that includes a unitbased pharmacist who collaborates to ensure safe and accurate administration of the most advanced chemotherapy and the latest approved clinical trial regimens. Cancer nurse navigators and social workers collaborate to ensure coordinated care for patients on the unit and after discharge. Oncology rehabilitation and pain specialists work with patients to address side effects related to cancer or cancer treatment. Dietitians, a health psychologist, pastoral counseling and hospice caregivers complement a full range of services to meet the needs of each individual patient. z
Specialized rehabilitation now available at the Helen F. Graham Cancer Center NOT LONG AGO, a walk around the block was
impossible for 55-year-old Tony Giuffre. Multiple rounds of chemotherapy and radiation for lung and brain cancer had derailed this retired Amtrak foreman from Middletown. Now, Giuffre is back on track. “At least I can stand up and not have my legs come out from under me,” he says. Giuffre receives therapy through Specialty Rehabilitation (SR) at the Helen F. Graham Cancer Center. He rarely misses his twice-weekly workouts in SR’s comprehensive Cancer-Related Fatigue Syndrome program. First in Delaware to offer specialized physical and occupational therapy for patients living with cancer, SR provides services for rehabilitation from all types of cancers, including breast, prostate, head and neck, gynecological, lymphoma, multiple myeloma, lung and brain. Therapy is also available to address generalized weakness and fatigue, balance and range of motion, lymphedema, scarring and chemotherapy-induced
neuropathy. The facility features private treatment rooms as well as an open exercise area that follows guidelines to protect immune sensitivity. “Cancer rehab helps clients regain control in their lives at a time when cancer treatment takes that control away,” explains SR Director Lisa Marshall, OTR-L. She and her team of oncology rehabilitation specialists work closely with Theresa Gillis, M.D., director of Oncology Pain and Symptom Management Services, to coordinate individualized rehab programs that help patients regain strength and daily living skills, relieve pain and restore well-being. “I would highly recommend rehab during cancer treatment,” Giuffre adds. “After a workout you really feel the results.” Working out with others has lifted his spirits, too. z For more information or to make a referral, call 302-709-3411 or visit christianacare.org/cancerrehabilitation.
Tony Giuffre works out with SR therapists Brenda Grassett, PT, MEd (left) and Sharon Carey, PTA, CLT. SR is located in the West Pavilion at the Helen F. Graham Cancer Center.
Cancer Update 7
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One of the 14 original cancer centers in the nation selected for the National Cancer Center Institute Community Cancer Center Program.
C OV E R S TO RY continued
Care Management team backs high school coach in his battle with cancer
She encouraged him to use his personal treatment journal to keep track of appointments and information and to record his own thoughts and experiences. The Graham Center’s Cancer Resource Library also helped. When concerns about the future kept him from sleeping, Brown suggested he meet with health psychologist Scott Siegel, Ph.D. “After only a couple of sessions, Dr. Siegel helped me get my feet back on the ground,” Hogan says.
Now in recovery and back to teaching at A.I. DuPont High School, Hogan knows his Cancer Care Management team is only a phone call away. He plans to check out nutrition support and cancer rehabilitation programs offered at the Graham Center and has volunteered to help others through the Cancer Companion phone mentoring program. “I think supporting others has helped me heal faster,” he says. “That, plus the good doctors and good care I received at the Helen F. Graham Cancer Center. It was like walking into a place where my family was waiting for me every day.” z
The nationally recognized Cancer Care Management team at the Helen F. Graham Cancer Center helps navigate patients throughout their experience with cancer. Patients, their families and caregivers find support and benefit from a long list of services:
• Nurse navigator • Cancer nutrition • Cancer rehabilitation • Pain and symptom management
• Ostomy support • Life and wellness coaching • Cancer survivorship • Health psychology • Pastoral services
• Genetic counseling • Social work • Financial assistant • Cancer support groups • Community resources • Hospice care
For information or referrals, call 302-623-4700.
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. Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2011. All rights reserved.