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A PUBLICATION FOR COMMUNITY PHYSICIANS

OCTOBER 2012

Undiagnosed Breast Clinic pioneers new level of care

Provides rapid results — and relief — to women when they need it most By Michelle Talsma Everson

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hen a patient suspects that they might have breast cancer, the wait for further testing and an official diagnosis can be agonizing. With this in mind, Banner MD Anderson Cancer Center on the Banner Gateway Campus, opened the Undiagnosed Breast Clinic — a place where women who suspect breast cancer can get quick answers to some of their most daunting questions. Stephanie Byrum, M.D., F.A.C.S., a general surgeon at Banner MD Anderson with special training in the treatment of breast diseases, says that the Undiagnosed Breast Clinic was modeled after the benign breast clinic at MD Anderson Cancer Center in Houston.

Providing results Byrum says the clinic is operated in such a way that patients who might have breast cancer get the answers they need in as short a time as possible. “A patient can get imaging done, have a biopsy performed, get results, and meet with physicians within a 24-hour turnaround,” Byrum says. “Whatever the results, there is a sense of relief knowing that either that they are okay or that they have a treatment plan in place.” At the clinic, results and all consultations needed for a treatment plan are available to the patient by their second appointment. Byrum adds that if the

Banner MD Anderson Cancer Center patient Leaann Benzer, with her surgeon, Dr. Stephanie Byrum.

inside 2 Center of Excellence

5 Building a culture

3 Saving time, saving lives

6 Defining ‘cutting edge’

4 Palliative Program

8 Meet Banner MD Anderson physicians


A Center of Excellence Once patients meet with a physician in the Undiagnosed Breast Clinic, they are sent to the Women’s Imaging Center for appropriate testing. From diagnostic mammography and MRI to ultrasound and image-guided biopsies, this imaging center is second to none. The center is designated as a Breast Imaging Center of Excellence by the American College of Radiology (ACR). This designation is awarded to breast imaging centers that achieve excellence in all of the ACR’s voluntary breastimaging accreditation programs.

Leaann Benzer’s breast cancer was caught in the early stages thanks to Banner MD Anderson Cancer Center’s Undiagnosed Breast Clinic.

The accreditation certifies that Banner MD Anderson Cancer Center has achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs.

early stage breast cancer and had to undergo treatment. But, she believes her expedited treatment helped to relieve some of the tension and stress of her condition. “Nobody would choose to have cancer, but as far as dealing with Banner MD Anderson, they were wonderful,” Benzer recalls. “They were always friendly and up-to-date… I know that I’ve done everything I can do to fight this disease.”

Banner MD Anderson Cancer Center’s Breast Center is now fully accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy. Banner MD Anderson Cancer Center is proud to be the first Banner Health facility in Arizona to acquire the Breast Imaging Center of Excellence accreditation and is proud to be among an elite group of breast imaging centers that have achieved this designation. The Breast Imaging Center of Excellence designation reflects the importance we place on providing the highest quality of care to our patients.

Relieving anxiety

Refer a patient to the Women’s Imaging Center by calling 480-543-6900.

patient is diagnosed with cancer, they are referred to the center’s Comprehensive Breast Program.

Team approach “We [the physicians and staff members] take a team approach; the Comprehensive Breast Program has a strong team, which is great for patients,” she says. The Undiagnosed Breast Clinic, which officially launched this past April, is currently open one day a week. Byrum says the clinic is off to a strong start and she has ambitious hopes for its future. “Our goals with the Undiagnosed Breast Clinic are to eventually have daily operation, continue to have result turnaround in 24 hours or less, and ultimately serve more patients,” Byrum says. “The quick service helps to relieve that anxiety and provide relief. Everything we do is about supporting the patient.” Leaann Benzer, the clinic’s first patient, says that she received same-day results when she was tested for cancer. Unfortunately, she was diagnosed with

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Benzer’s case exemplifies one of the main missions of the clinic: to catch any potential cancer in the earliest possible stage, Byrum explains. She adds that relieving some of that anxiety patients may have about waiting to find out their results is one of the strong points of the program, too. “To get their results quickly and, if needed, have a treatment plan established, lifts a weight off their shoulders,” Byrum says. To refer a patient to the Undiagnosed Breast Clinic, call 480-256-3433.


Dr. Nikunj Doshi

New clinical trials spur new treatment, growth By Stephanie Conner

Saving time saves lives Suspicion of Cancer Clinic brings faster, more accurate results By Brian Sodoma

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patient walks into the Suspicion of Cancer Clinic at Banner MD Anderson Cancer Center in Gilbert with back pain and a doctor’s referral. Within a few hours a malignant tumor on his lumbar spine is diagnosed and an appointment is made with an oncologist to begin treatment. If only it could always be this easy. Dr. Nikunj Doshi, division chief of internal medicine at Banner MD Anderson, knows all too well that often times an accurate cancer diagnosis can mean jumping from one specialist to another, eating up precious time and bringing added frustration to patients. “When you’re sick the last thing you want to do is travel to different places and then wait for those places to communicate with each other,” Doshi says. The Suspicion of Cancer Clinic works to alleviate this by offering a multidisciplinary, research-driven approach that houses numerous needed specialties under one roof to help deliver an accurate and timely cancer malignancy diagnosis.

With cardiologists, pulmonologists, endocrinologists, nephrologists, neurologists, gastroenterologists, oncologists, hematologists, radiologists and surgeons all working in one place, many minds can weigh in on each case, helping to eliminate obvious non-factors and zero in on the real problem. “Our goal is to minimize unnecessary intervention and expedite the clinical diagnosis,” Doshi says. “We want to know ‘Is this a malignancy or just noise?’” More complicated cases are referred to a tumor board that meets every Tuesday and Thursday. The group of specialists then comes to a consensus for either further testing or treatment, Doshi says. Open for one year, Doshi hopes the Suspicion of Cancer Clinic can be a resource for local physicians helping their patients find an accurate cancer diagnosis in an efficient and timely manner. The site takes both physician and self-referrals. To make a referral to the Suspicion of Cancer Clinic, call 480-256-3433 or go to www.bannermdanderson. com/physicians.

At Banner MD Anderson Cancer Center, a growing clinical trials program is helping patients today and in the future. “Research is an integral component of our organization. In addition to seeing patients, we are a knowledge development organization,” says Lee Seabrooke, M.A., MBA, the Center’s director of research. “It’s important to align the knowledge we develop with the problems we’re trying to solve.” The clinical trials program currently offers phase II and III drug trials. Four trials — including those for pancreatic cancer, colorectal cancer, breast cancer and chronic lymphocytic leukemia — are actively enrolling patients. And that’s just the beginning, which is an impressive start in just one year. “In addition, we have a growing pipeline of about 18 trials that will be offered in the near future,” Seabrooke says. Those trials will explore therapies for metastatic melanoma, ovarian cancer, bladder cancer and more. “Although the research organization is small at this point, it’s in a continuous growth mode,” Seabrooke adds. “Over time, we expect to have a very robust enterprise.” Banner MD Anderson Cancer Center has been officially accepted into the National Cancer Institute’s (NCI) Southwest Oncology Group (SWOG) and Gynecology Oncology Group (GOG) as an affiliate of The University of Texas MD Anderson Cancer Center in Houston, TX. The SWOG and GOG memberships represent major steps for the research program at Banner MD Anderson that will provide additional access for our patients to new and innovative therapies within NCI sponsored clinical trials.  BannerMDAnderson.com

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Palliative Program alleviates symptoms, provides comfort Banner MD Anderson Cancer Center model is not ‘end of life’ care By Debra Gelbart

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he Palliative Care program at Banner MD Anderson Cancer Center is much more than keeping patients comfortable. This specialty has only been boardrecognized as a separate discipline since 2008. After 2012, physicians in other disciplines who sit for the board exam in palliative medicine will be required to complete a fellowship in palliative medicine specifically. “This is not end-of-life care and it’s not hospice,” said Kerry Tobias, D.O., who completed her residency and is board certified in palliative medicine and pain management as well as directs the Palliative Care program at Banner MD Anderson. “I don’t manage a cancer patient’s diagnosis; I manage the patient’s symptoms as much as possible regardless of the reasons for those symptoms.” Patients suffering from significant nausea, constipation, pain, shortness of breath or weakness — among other symptoms — can benefit from a palliative medicine physician’s care, said Tobias, who completed her residency in physical medicine and rehabilitation.

Patients benefit Palliative care is not just for current cancer patients or terminal patients, she emphasized. “A cancer survivor can suffer from residual neuropathy, for example, or fatigue,” she said. “My job is to alleviate those symptoms or make it easier for that patient to cope with them.” Typically in the past, cancer patients in treatment and suffering side

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Kerry Tobias, D.O. effects looked to their oncologist to address treatment of those side effects. But palliative medicine makes it possible for the oncologist to focus solely or primarily on treatment of the diagnosis and on additional medical issues that arise. The palliative medicine physician develops a regimen of treatment modalities to reduce the severity of the patient’s symptoms. Treatment may include medications, pain management applications and recommendations for low-grade aerobic exercise, Tobias said.

Qualify for care Palliative Care program patients are not required to be under the care of a Banner MD Anderson oncologist or any

other specialist at the cancer center. But they must have a current or past cancer diagnosis; carry participating health insurance; and permit forwarding of their medical records from their current or previous treating physician. “Our goal is to ensure the highest quality of life for cancer patients undergoing treatment or those who have completed treatment and for cancer survivors who have residual symptoms, by optimizing pain management and by alleviating or reducing the severity of other symptoms,” Tobias said. A patient’s physician (including a primary care provider) can refer a patient to the Palliative Care program by calling 480-256-3433.


Building a culture of excellence at Banner MD Anderson Cancer Center By Dr. Edgardo Rivera, Medical Director

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he past year has been an exciting one — one filled with great pride. I always tell people that when you build something from the ground up, it’s not for the faint of heart. It took a lot of hard work and a bit of faith to open a brand new cancer center. And in just our first year, we’ve had a lot of opportunities to celebrate. Together, we’ve opened a beautiful facility. We’ve built a culture of excellence and professionalism. We’ve hired the very best physicians and staff. We’ve established a comprehensive breast cancer program and

are developing other comprehensive programs. We’ve recently opened four clinical trials with 18 more in the pipeline. We’ve established ourselves in the community as experts in our field, and we’ve seen more than 3,500 patients. And that’s just in our first year. I’m also proud of our efforts to integrate with The University of Texas MD Anderson Cancer Center in Houston. We have seamlessly integrated our computer systems, we communicate with their staff regularly, and we communicate regularly with our colleagues to continue our evolution and growth. What we have built in the past year is a cancer center that brings together oncology

experts in medication therapy, radiation, surgery, imaging, pharmacy, psychology, physical therapy, nutrition and more to provide superior multidisciplinary care. When I came here a year and a half ago, our building was under construction. And after just one year, we’re exploring expansion opportunities. In fact, we have already begun the installation of a third linear accelerator to meet the increasing need for radiation treatments. This is a tremendous accomplishment for a center as young as ours, and I believe the best is yet to come. Thank you for your continued support. As always, please contact me if you have any questions about Banner MD Anderson Cancer Center or referring a patient. I can be reached at 480-256-3335.

BannerMDAnderson.com

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Dr. Andrew Price

Defining ‘cutting edge’ By Brian Sodoma

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or a long time, a radiologist’s work seemed to only be associated with imaging. But in the past decade, advances in imaging technology combined with other tools have helped to create actual treatments that are extending lives and minimizing side effects for cancer patients. Dr. Andrew Price, an interventional radiologist with Banner MD Anderson Cancer Center, sees radioembolization — or “Y-90” — treat-

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ment for metastatic and primary liver cancers as the biggest game changer in his field of late.

Radioembolization Radioembolization uses a small catheter inserted through the groin to deliver tiny beads loaded with the radioactive isotope, yttrium-90, or Y-90, directly into the feeding arteries of a tumor. This selective approach delivers a high dose of radiation directly into the arteries of tumor cells, while minimizing the impact

on surrounding normal liver tissue. The outpatient procedure is generally well tolerated and associated with minimal side effects. It can often lead to a dramatic improvement in tumor burden, Price explained. “It has been shown to improve quality of life and prolong survival, giving hope to those patients with advanced liver cancer,” Price says. Finding Y-90’s place in a treatment plan is still being investigated. In many cases, a patient has failed several rounds of chemotherapy


before trying Y-90. But more evidence is surfacing that indicates using the treatment earlier in a program may produce better results.

TrueBeam linear accelerator Radiation oncology has also seen significant advances through the years, and there may be no greater example of these strides than some of the stateof-the-art technology found at Banner MD Anderson Cancer Center. Dr. Emily Grade, a radiation oncologist at the center, said the site’s state-of-the-art Varian TrueBeam linear accelerators are one of her best options for better pinpointing treatments and minimizing side effects when treating cancer. The image-guided radiation therapy (IGRT) system uses 3D and 4D technology to give Grade the ability to effectively locate tumors on the move. “Tumors in the body don’t just stay still. They can move daily by a few millimeters or more in one direction or another,” Grade says. Once the tumor is effectively tracked, the machine’s state-of-theart collimators allow Grade to shape the treatment field almost perfectly to within a millimeter of the tumor. Past technologies, she explained, didn’t have the contouring ability that the newer machines have that now allow her to be more exact with where in the body she can deliver the treatments. “The whole goal is to treat only the tumor and avoid the normal tissues,” Grade added. “As we get better technology we can go higher with our doses. Often, the higher the dose, the better the cure rate.”

Stereotactic Body Radiation Therapy Specialists at Banner MD Anderson also use Stereotactic Body Radiation Therapy (SBRT), which uses a specific coordinate system to more

Dr. Andrew Price exactly localize a tumor in cases like lung, spine, brain and other cancers. Image-guided HDR (High-Dose Rate) Brachytherapy is also used in a dedicated Brachytherapy suite. This method of treatment uses a radioactive source placed in the target, such as a breast or for a gynecologic tumor and delivers a high dose in a shortened time precisely. This approach allows some patients to receive treatment for breast cancer in one week rather than six weeks.

The multi-disciplinary team environment also complements the state-of-the-art technology found at Banner MD Anderson, Grade added. Specialists housed under one roof meet regularly to discuss and make treatment decisions for cases. This collaboration also decreases travel time and frustration for patients. “We meet and talk about all the cases collaboratively and this provides the best care for patients. It’s one of the big reasons I chose to come here,” Grade says. BannerMDAnderson.com

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PRESORTED STD U.S. POSTAGE PAID LONG BEACH, CA PERMIT NO.1677

Introducing Banner MD Anderson Physicians

Vilert Loving, MD Breast imaging and intervention

anner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. Below is a listing of physicians currently on our full time staff. Physicians continue to join Banner MD Anderson, so this list will continue to evolve. To make a referral to a physician on our staff, please call 480-256-3433. To contact a member of medical staff, call 480-256-6444 and ask for the physician to be paged.

Rizvan Mirza, MD Abdominal and pelvic magnetic resonance imaging

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Hematology & Medical Oncology Section

Al Chen, MD General surgery

Oncology; Program Director, Cancer Prevention & Integrative Medicine

Tomislav Dragovich, MD, PhD, Section Chief Digestive tract cancers including colorectal, esophageal, stomach, pancreatic, hepatobiliary

Randall Craft, MD Full spectrum of both implantbased and autologous breast reconstruction, comprehensive plastic and reconstructive options for all areas of the body

Benny Tan, MD Plastic and reconstruction surgeon Breast cancer reconstruction and most forms of cancer reconstruction

Gorgun Akpek, MD, MHS Director of Stem Cell Transplantation and Cellular Therapy program Shakeela Bahadur, MD Lung, colorectal, breast cancers Mary Cianfrocca, DO Breast Cancer Program Director Jade Homsi, MD Melanoma, sarcoma, immunotherapy H. Uwe Klueppelberg, MD, PhD Multiple myeloma and other plasma cell disorders, lymphomas, myelodysplastic syndrome, brain cancers, head and neck cancers, thoracic cancers Edgardo Rivera, MD, Medical Director Breast cancer Kerry Tobias, DO Pain management, palliative medicine, physical medicine, rehabilitation

Mark Gimbel, MD Melanoma, sarcoma, cancer of the stomach, small bowel, colon and rectum, thyroid, pancreas, liver, breast, and other rare cancers Christine Landry, MD Pancreatic cancer, carcinoid tumors, thyroid cancer, adrenal tumors, parathyroid tumors, melanoma, sarcoma, gastrointestinal cancers, breast cancer, liver tumors Matthew Schlumbrecht, MD, MPH Gynecologic oncology; gestational trophoblastic disease; a variety of surgical techniques including radical abdominopelvic exploration and minimally invasive procedures. Rob Schuster, MD General surgery

Oncology Surgery Section

Thomas Shellenberger, MD Recurrent thyroid cancers, cancers of the oral cavity, oropharynx, and larynx, salivary gland cancers, advanced skin cancers and melanoma of the head and neck, complications from treatment of head and neck cancer.

Stephanie Byrum, MD Breast surgery

Diljeet Singh, MD Program Director, Gynecologic

Bryan Wong, MD Genitourinary cancers

Judith K. Wolf, MD, Section Chief Gynecologic oncology

Radiation Oncology Section Matthew Callister, MD, Section Chief Gastrointestinal, skin, sarcomas, and head and neck cancers Emily Grade, MD Breast treatment including partial breast brachytherapy, prostate brachytherapy, gynecological and thyroid cancers Terence Roberts, MD, JD Brain, lung and prostate tumors; stereotactic radiosurgery; partial breast brachytherapy

Diagnostic Imaging Section Donald Schomer, MD, Section Chief, CAQ Neuroradiology Oncologic diseases of the brain, spine, head and neck John Chang, MD, PhD Advanced magnetic resonance and computerized tomography imaging of gastrointestinal and genitourinary systems; imaging guided biopsies

Harvinder Maan, MD, CAQ

Neuroradiology Director of Neuroradiology Neuroradiology and interventional spine procedures

Susan Passalaqua, MD Director of Nuclear Medicine and Molecular Imaging Oncologic imaging, nuclear medicine, radiology, PET/CT Andrew Price, MD, CAQ Interventional Radiology Interventional radiology, including percutaneous tumor ablation, chemoembolization, and radioembolization David Russell, MD, FACP Breast imaging and intervention

Critical Care Section Shiva Birdi, MD, Section Chief Jijo John, MD Deven S. Kothari, MD Dean Prater, MD Ravindra Gudavalli, MD

Internal Medicine Section Nikunj Doshi, DO, Section Chief Internal medicine David Edwards, MD Internal medicine Ronald Servi, DO Pulmonary medicine

Pathology Section Kevin McCabe, DO Section Chief


Banner MD Anderson Rounds - October 2013