Banner MD Anderson Creating Hope

creating hope JANUARY 2013

Reduce your risk

February is Cancer Prevention Month.

Here’s what you can do to lower your own risk

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BY STEPHANIE CONNER

here’s a good chance you know someone who’s been diagnosed with cancer. It’s natural to start wondering about your own risk.

Diljeet Singh, M.D., program director for Gynecologic Oncology and program director of Integrative Medicine and Cancer Prevention at Banner MD Anderson Cancer Center in Gilbert, offers the following tips for reducing your cancer risk.

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Eat more veggies. “We’re learning more and more that what we eat and how we live has an impact on not just cancer but diabetes and heart disease,” Singh says. She recommends starting any dietary change with an increase in fruits and vegetables, which help provide antioxidants and isoflavones that help fight cancer.

“We should be getting at least seven servings of fruits and vegetables a day,” she says. “If you’re cutting back on calories, then I say five servings and focus on vegetables.”

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Get moving. Singh and other experts recommend 150 minutes of moderate activity a week.

“That’s half an hour five times a week,” she says. “It doesn’t have to be a class or the gym. Just put on comfortable shoes and get out walking.” Then, as you become more fit, there are plenty of other workout options.

INSIDE 2 Expansion plans

6 Thanks for your help

3 New breast reconstruction procedure

7 Cancer survivor stays active, positive

4 Meet Drs. Craft and Tan

8 Events and activities

5 Ask the expert

Exercising and eating well are key ingredients in achieving a healthy body weight. For more information on the connection between cancer history and lifestyle, attend Dr. Singh’s Cancer Prevention Series on Feb. 13. See more details on Page 8.

“Obesity plays a role in a lot of cancers,” Singh says “And if someone is diagnosed, there’s evidence that a healthy body weight plays a role in getting through surgery or chemotherapy or radiation.”

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Manage your stress. “More and more evidence is adding up that the neurotransmitters and hormones related to stress can be related to cancer and to cancer progressing and spreading,” Singh says.

The bad news is that stress is unavoidable. But the good news, Singh says, is there are steps you can take to alleviate your stress.

“Laughter, meditation, prayer and deep breathing are all ways to turn on the parasympathetic (or healing) nervous system and turn off the hormones of the stress-based nervous system,” she says. “Exercise is also a great form of stress management — it’s a twofer.”

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A few other healthy choices.

Avoiding tobacco, drinking alcohol in moderation and sleeping seven to nine hours a night also help lower your risk of cancer. Plus, Singh advises, maintain a strong social network for optimal health.

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Banner MD Anderson Cancer Center expanding in 2013

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he need for cancer care in our community coupled with the trust our patients have put in our team have resulted in the rapid growth of cancer treatment at Banner MD Anderson Cancer Center in Gilbert. This has led the Banner Health Board of Directors to approve a $62.6 million dollar expansion project for the Banner Gateway Campus. In January, Banner MD Anderson will break ground to expand its outpatient cancer facility.

“This is an exciting development for our campus and for the members of our community that entrust us with their care,” said Todd Werner, chief executive officer for Banner MD Anderson and Banner Gateway Medical Center.

Since opening our doors in 2011, the cancer center has experienced rapid growth in outpatient volume and has attracted more than 5,000 patients and resulted in 50,000 patient visits. In addition, more than 50 subspecialty physicians are now providing cancer care to patients at the cancer center.

The 111,000-square-foot expansion will take place to the south of the existing 130,000-square-foot building and will add: • Three linear accelerators (two at opening and one vault for future use) for a future total of six • 30 additional clinic exam rooms for a total of 60 rooms • 13 additional infusion bays for a total of 53 (and shelled space to bring the future total to 76) • Expansion of Laboratory Intake Center and Welcome Center • The Cox Center for Integrative Oncology and Cancer Prevention funded in large part by a grant from the James M. Cox Family Foundation • Additional shell space for future expansion needs.

Advances in

breast reconstruction

New surgery at Banner MD Anderson Cancer Center offers many benefits

BY DEBRA GELBART

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usan Brown of Chandler never imagined that the results of her breast reconstruction would be so natural or that she’d get a kind of tummy tuck as a bonus. But as the first patient at Banner MD Anderson Cancer Center in Gilbert to undergo a relatively new reconstruction procedure, she is thrilled with the outcome of her surgery.

“The breast cancer diagnosis was just numbing,” said Brown, 50. “But I am so pleased by the amazing job that my surgeons did and by how much better I feel than I ever thought I would after my diagnosis.”

Her plastic surgeons at Banner MD Anderson recently began performing microvascular breast reconstruction surgery for cancer patients.

The procedure uses the patient’s own abdominal tissue as a means of reconstruction and eliminates the need for an artificial implant and future reconstruction surgeries.

EXPANDING PATIENTS’ OPTIONS “Although a silicone or other type of implant may be the best approach for many patients,” said surgeon Randall Craft, M.D., “it’s important to understand that because these implants cannot adjust to a changing body, more reconstructive surgery is often necessary within the first 10 years.

But with this new procedure, the

Plastic surgeons Benny Tan and Randall Craft are at the forefront of a new breast reconstruction surgery at Banner MD Anderson Cancer Center. patient’s own tissue will change with her as she ages.” He and reconstructive surgeon Benny Tan, M.D. typically perform the procedure together. They practice in Banner MD Anderson’s Division of Surgical Oncology.

“This procedure has not been widely available in Arizona before now,” Dr. Tan said. “We want to give more patients an opportunity to choose this approach to breast reconstruction.”

The procedure is called a Deep Inferior Epigastric Perforator, or DIEP (“Deep”) for short. It involves removing skin and fat from a patient’s abdomen while preserving the major abdominal muscle called the rectus, commonly referred to as the “abs” or “six-pack.”

The skin and fat from the abdomen are disconnected from their

blood supply in the pelvis and then— using a microscope and very fine sutures—attached to a new blood supply from the internal mammary artery in the chest.

Autologous breast reconstruction surgery—where the patient’s own tissue is used—is not new. But typically, this type of surgery has required that the abs “go along for the ride,” Dr. Craft explained, to provide a blood supply for the relocated tissue.

“What often happens to the patient after that is a bulging of the abdomen, hernias or weakness,” he said.

“But by taking the extra time to detach and reconnect the blood supply of abdominal skin and fat and leaving the rectus intact, we can often give patients a better quality of life.”

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PROCEDURE NOT FOR EVERYONE Not all patients are candidates for the DIEP, Dr. Tan said, explaining that sometimes a patient’s blood vessels are too small to accommodate the reattached tissue. “Although there is no age cutoff,” said Dr. Tan, “a patient must be physiologically fit enough to endure a six-to-12-hour surgery, depending on whether the reconstruction is unilateral (one breast) or bilateral (both sides).” A patient can’t be morbidly obese or especially thin.

Her ideal Body Mass Index (BMI) is between 25 and 35, he said, so that she has enough abdominal tissue to be used for the reconstruction. And, ideally, she has not had previous abdominal surgery, although a C-section, for example, would not preclude a DIEP. The post-surgical hospital stay is typically four to seven days.

We want to give more patients an opportunity to choose this approach to breast reconstruction.

— Benny Tan, M.D. “This procedure is well-suited for a patient who has undergone radiation therapy,” Dr. Craft said, “because skin exposed to therapeutic radiation often cannot be stretched to accommodate an artificial implant.”

“I would tell other breast cancer patients to strongly consider this procedure,” said Susan Brown. “It’s tough, because of the length of the surgery, but it’s well worth it. I am so grateful to have a natural-looking and natural-feeling breast again and I really like knowing I won’t need another surgery in 10 years like I would with an implant.”

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Training is critical to perform new procedure Randall Craft, M.D. became interested in the Deep Inferior Epigastric Perforator (DIEP) procedure while he was a surgical resident in the Harvard Plastic Surgery Combined Residency Program in Boston, Mass. “They did a high volume of these in the Harvard system,” he said, “and I was able to learn a lot about the procedure. Since then, I’ve published a lot about it in the medical literature.”

Dr. Craft, who is board-certified in surgery, said he’s always “been drawn to the creativity of plastics. “There’s nothing routine about it, and I like the reconstructive aspects of this type of surgery.” Most of his patients undergo breast reconstruction, but he also performs reconstructive surgery on any part of the body affected by cancer.

After graduating from medical school at The Ohio State University College of Medicine in Columbus, he completed his general surgery residency at Mayo Clinic Arizona before beginning his plastic surgery residency at Harvard. He also completed a combined research and clinical fellowship at the Bernard O’Brien Institute of Microsurgery in Melbourne, Australia.

Dr. Craft said the most rewarding aspect of performing the DIEP is “providing an opportunity for women to have their sense of self restored,” he said, “without having a foreign body inside them. “The DIEP preserves the symmetry of the chest and patients are typically quite happy with the outcome.”

Benny Tan, M.D. was born and raised in Singapore. At 21, he went to Ireland to attend medical school. After graduation and a general surgery and orthopedic surgery residency, he came to the United States and completed a three-year general surgery residency at Johns Hopkins Hospital in Baltimore, followed by two years of a general surgery residency at Massachusetts General Hospital in Boston.

He then completed an orthopedic hand and microsurgery fellowship at Jackson Memorial Hospital in Miami, Fla., followed by a plastic surgery residency at the Cleveland Clinic Florida in Weston, Fla. He is board certified in plastic surgery and general surgery.

“I performed many types of reconstructive surgery,” Dr. Tan said, “but I gravitated toward breast reconstruction because the patients are so appreciative when we’re able to give them back their normal life.” He said he began performing the DIEP procedure at Banner MD Anderson because of patient demand. Like Dr. Craft, Dr. Tan also performs implant- and autologous-based breast reconstruction.

Dr. Tan noted that DIEP patients also appreciate the extra benefit of the tummy tuck that comes with the procedure. He said both the chest and abdominal scars are well-tolerated by patients. “They also like that their abdominal contour is improved,” he said. “It’s a change most patients are very happy with.”

askthe expert Javier Munoz, M.D., staff physician for Hermatology/Oncology Gorgun Akpek, M.D., director of Stem Cell Transplantation and Cellular Therapy Gorgun Akpek and Javier Munoz

BY KRISTINE BURNETT

What are the similarities and differences between lymphoma and leukemia?

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Lymphoma and leukemia are two distinct types of hematologic (blood) cancer, each of which has multiple subtypes. In the most simplistic terms, they boil down to two basic definitions: • Lymphoma is cancer that develops when white blood cells grow out of control and accumulate in the lymph nodes.

• Leukemia is cancer that originates in the spongy tissue in the middle of the bones called the bone marrow, which is where blood cells are made.

Despite having multiple subtypes, lymphoma and leukemia can present with similar overlapping symptoms.

In addition to a noticeable swelling of the lymph nodes caused by the accumulation of excess white blood cells, signs of lymphoma may include fever, weight loss and night sweats.

For those with leukemia, these symptoms may also be accompanied by fatigue, bleeding that occurs easier than usual and an increase in infections.

Diagnosing lymphoma generally entails a lymph node biopsy to examine the structure of the nodes. When cancer is confirmed, a bone marrow

biopsy to collect blood cells from within the marrow helps determine the stage and extent of the lymphoma.

Leukemia is diagnosed through blood tests and a bone marrow biopsy.

As with most diseases, lymphoma and leukemia can affect everyone differently. Therefore, treatment protocols, including decisions about pursuing aggressive therapies like stem cell transplantation, vary based on such factors as cancer subtype and the speed with which it grows as well as a person’s age and overall health status.

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Who is a candidate for stem cell transplantation?

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Stem cell transplantation, commonly referred to as bone marrow transplantation, is a potentially curative cancer treatment approach used for patients with acute and chronic leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, multiple myeloma, myelodysplastic syndrome, and other bone marrow failure disorders such as aplastic anemia. While it is used to cure a multitude of hematologic (blood) cancers originating in the bone marrow and lymph nodes, not everyone is a candidate for the procedure.

There are two primary types of stem cell transplantation: autologous and allogeneic. Autologous transplants

Worldwide, approximately 35,000 autologous and 25,000 allogeneic stem cell transplants are done each year. About one-third of those are performed in the United States.

use a patient’s own stem cells and the administration of very high-dose chemotherapy and/or radiotherapy to fight certain types of cancer, whereas allogeneic transplants use matching stem cells derived from a family member, most commonly a matched sibling, or an unrelated donor. Allogeneic stem cell transplants may also be performed using umbilical cord blood as well as haploidentical donor stem cells, which come from a family member who is not a complete match.

Since stem cell transplantation is not and should not be used as a last resort approach to rescue very sick patients, those being considered for the procedure must meet certain physical and disease-related criteria to ensure the potential benefits outweigh the risks. Generally speaking, those selected for transplant are in at least partial disease remission and/or have it under control with other treatment methods, are physically fit and have adequate overall organ function.

Age can be another qualifying factor.

Presently, the age limit for Banner MD Anderson Cancer Center in Gilbert is 75 for autologous transplants and 70 for allogeneic transplants.

At Banner MD Anderson, all patients with hematologic malignancies are referred to the stem cell transplant program for consultation to determine whether transplantation is a viable treatment option that would provide curative benefits to prolong and improve a patient’s quality of life.

Ref: Pasquini MC, Wang Z. Current use and outcome of HCT: CIBMTR Summary Slides, 2010. http://www.cibmtr.org

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Arizona Cardinal Larry Fitzgerald, who lost his own mother to cancer, has helped create needed awareness for the Cancer Has Met Its Match campaign.

Thanks for your help

Generous donors help Banner MD Anderson make a difference

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he Banner MD Anderson Cancer Center in Gilbert opened its doors on September 26, 2011, marking a genuine evolution in Arizona’s capacity to diagnose and treat cancer patients. The lantern of hope—a four-story illuminated metal

structure symbolizing hope and healing—is lit each night and has already greeted thousands of patients and visitors.

Cancer care, treatment and prevention require much more than a new facility. They require the latest

for more info: BANNER MD ANDERSON CANCER CENTER On the campus of Banner Gateway Medical Center U.S. 60 and Higley Road in Gilbert Schedule an appointment: 480-256-6444

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Follow us on Facebook: Facebook.com/bannermdanderson Check out our website bannermdanderson.com

medical technologies; expansive treatment and support programs; and staffing capable of delivering the excellence in patient care for which Banner is so well known. Banner MD Anderson’s promise is to deliver customized, comprehensive and compassionate care for every patient.

While Banner Health funded the cost of bricks and mortar for the state-of-the-art facility at US-60 and Higley Road, many essential elements of the project must be funded by the generosity of those who support Banner’s mission to make a difference in people’s lives through excellent patient care. The Cancer Has Met Its Match campaign was launched in 2010 with a goal of raising $40 million to fund screening and prevention services, patient and family support programs, research and much more, all of which are funded through charitable gifts.

Just in time to celebrate the one-year anniversary of Banner MD Anderson, The Cox Family Foundation announced a $5 million gift to fund the creation of The Cox Center for Integrative Oncology at Banner MD Anderson Cancer Center. The Cox Center for Integrative Oncology will serve people who have cancer, cancer survivors and the general public, whether they are at risk of cancer or seeking to decrease their risk.

The Center is an integral part of the MD Anderson treatment model, which addresses the global impact of cancer on people and their families.

The Center will include: integrative oncology, individualized prevention, screening and diagnosis programs, palliative care and rehabilitation and community outreach programs.

With this incredibly generous gift, the Cancer Has Met Its Match campaign is nearly halfway to its $40 million goal. For more information, visit www.BannerMDAnderson.com.

Breast cancer survivor

doesn’t slow down Banner MD Anderson Cancer Center doctors work together to treat aggressive breast cancer

BY BRIAN SODOMA

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rystal Reidy is no stranger to overcoming adversity. In youth, her family was poor and battled homelessness. Reidy worked her way out of poverty, earning a bachelor’s degree in human service and a master’s in counseling. She is even working on a doctoral dissertation focusing on the topic of teaching resilience.

Today, the community outreach officer for the Maricopa County Attorney’s office and Army National Guard sergeant is grateful for many things, but perhaps even more so after recently winning a battle against a very aggressive form of breast cancer.

NO FAMILY HISTORY OF CANCER A lump found in March surprised both she and her doctors. Reidy has no family history of breast cancer and having her first baby before the age of 20 further reduced her chances of

Cancer survivor Crystal Reidy is thankful her Banner MD Anderson Cancer Center doctors encouraged her to keep active and stay positive while undergoing treatment. nothing unusual. Before telling her two teen-age sons about the diagnosis, Reidy established her treatment plan with doctors at Banner MD Anderson Cancer Center in Gilbert.

“At first you don’t have any answers. You just have cancer,” she says. “I think it’s answers and information that is the most calming thing you can get to combat cancer.”

Reidy was also fortunate to experience very few side effects from chemo-

I think it’s answers and information that is the most calming thing you can get to combat cancer.

— Crystal Reidy, cancer survivor ever getting it. Even more, Reidy was diagnosed with the very fast-spreading Triple Negative form of breast cancer.

She was at Stage 3 by the time she was diagnosed and prepping for chemotherapy treatment in April even though an October 2011 routine exam showed

therapy. Yes, she lost her hair and there was nausea and vomiting, but not to the extent she expected. The mom of three boys with ages ranging from 17 months to 17 years also chose not to slow down her daily life while undergoing treatment. She still worked

full time and even completed her annual Army basic training assignment, which includes firing an M-16 rifle.

MAKING THE RIGHT DECISIONS Reidy said her Banner MD Anderson doctors encouraged her to make the right decisions for herself when it came to everyday living while undergoing treatment.

“For some people, working would stress them out. My goal was not to give up everything,” she says. “They didn’t pressure me either way. I didn’t feel like they said ‘Here are the rules of cancer.’”

After finishing her last few rounds of radiation treatment, the now cancerfree Reidy has one thing on her mind.

“I was always a real road tripper with my boys. We would always go out and take a trip in the car and go to places in and around Arizona,” she says. “I’m ready to get the hair growing and go on vacation.”

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Events and Classes B

anner MD Anderson Cancer Center in Gilbert offers a variety of classes and support groups to assist cancer survivors and their support teams. These classes are free and open to the public. Classes are held at Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Drive, Gilbert, AZ, 85234.

Gentle Yoga Yoga aimed at releasing the tension in your muscles and mind.

This is a mat-based class focused on core work.

WHEN: 4 p.m. every Wednesday WHERE: Banner MD Anderson Cancer Center 2496 E. Banner Gateway Drive, Gilbert, 85234

Restorative Yoga A mat based yoga class that uses props to support the body and allow the mind to decompress. The class also will include breath work and meditation.

WHEN: 3 p.m. every Thursday WHERE: Banner MD Anderson Cancer Center 2496 E. Banner Gateway Drive, Gilbert, 85234

Wellness Classes Cooking for Wellness A cooking demonstration class that will focus on recipes with cancer fighting ingredients.

WHEN: 4 p.m., First Thursday of each month WHERE: Banner MD Anderson Cancer Center 2496 E. Banner Gateway Drive, Gilbert, 85234

Journey to Wellness Group A wellness education group for cancer survivors. A different topic is discussed every month related to cancer wellness after completing cancer treatment.

WHEN: 4:30 p.m., Second Thursday of each month WHERE: Banner MD Anderson Cancer Center 2496 E. Banner Gateway Drive, Gilbert, 85234

Chair Yoga A calming yoga that promotes balance. Yoga is practiced sitting or standing behind the chair for support.

WHEN: 10 a.m. every Monday WHERE: Banner MD Anderson Cancer Center 2496 E. Banner Gateway Drive, Gilbert, 85234

Special Event Cancer Prevention Series Lifestyle and Genetic Risk Assessments: Can they prevent cancer?

Dr. Diljeet Singh, Director of Integrative Oncology, will discuss the relationships between lifestyle and cancer prevention. April O’Connor, Genetic Counselor, will share the latest research relating to family history and genetic risk assessments as a tool for cancer preventions.

WHEN: February 13, 2013, 6 to 7:30 p.m.

WHERE: Grand Canyon Conference Rooms Banner Gateway Medical Center 1900 N Higley Rd, Gilbert, AZ 85234 RSVP: Call 602-230-CARE

To learn more about these events or to register, please visit www.BannerMDAnderson.com.

To schedule an appointment, call 480-256-6444