Palliative Care Specialists Focus on Quality of Life
Sarah Beth Harrington, M.D., is director of the Palliative Care program at UAMS.
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Looking Beyond Cancer’s Limits SUMMER 2011 Editor Susan Van Dusen Art Director Mikel Holloway Photographer Johnpaul Jones
Seek is published quarterly for the Winthrop P. Rockefeller Cancer Institute by the Office of Communications & Marketing at the University of Arkansas for Medical Sciences, 4301 W. Markham St. #890, Little Rock, AR 72205-7199; phone (501) 686-5686; Fax (501) 686-6020.
Chancellor, University of Arkansas for Medical Sciences Dan Rahn, M.D. Director, Winthrop P. Rockefeller Cancer Institute Peter D. Emanuel, M.D. Associate Director of Administration, Winthrop P. Rockefeller Cancer Institute Shirley Gray
WINTHROP P. ROCKEFELLER CANCER INSTITUTE
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Welcome to this issue of Seek! We continue to live in a time of rapid changes! We continue to improve the UAMS campus publications — including Seek — so that they all identify with our main UAMS campus mission, yet each have their own identity. Changes continue to occur on the cancer landscape as well. The first floor of our original Walker Tower has reopened after a nearly yearlong renovation. Everyone welcomes The Gathering Place Café, as well as the Ford Patient Support Pavilion and its many amenities for patients and their family members. And thankfully, the landscape of cancer care is also rapidly changing. This spring saw the FDA approving a new drug, Yervoy, which is the first ever to change the survival pattern for melanoma skin cancer patients. Amazing results also were just announced for another melanoma drug still in development. We participated in many of the clinical trials leading to Yervoy’s approval. Many of the new cancer drugs now coming on the scene are based on targeting genetic mutations within cancer cells. The research work leading to these discoveries would not be possible if it were not for patients donating tumor tissue to tissue repositories such as at the Winthrop P. Rockefeller Cancer Institute. Read more about important facility in this issue of Seek. At the Cancer Institute, one of our most sincere privileges is sharing the stories of our courageous survivors. In this issue, we introduce you to Rhonda Ellis, a mother of three and an avid runner. When diagnosed with clear-cell chondrosarcoma in her hip bone, Rhonda faced some hard decisions that she knew would change her life forever. We’re happy to report that Rhonda is cancer free today, but we are all too aware of the challenging choices that come with any cancer diagnosis. We hope her story will inspire you, as it does us. Finally, the best thing doctors can do is provide hope, whether in the form of comfort or physical healing. Read about Sarah Beth Harrington, M.D.’s efforts to lead the up-and-coming palliative care effort within the Cancer Institute, as it addresses the whole-person approach to treatment.
Peter D. Emanuel, M.D. Director, Winthrop P. Rockefeller Cancer Institute
Looking Beyond Cancer’s Limits
contents SUMMER 2011
features Banking on the Future
Store of tissue samples aids cancer research.
Behind the Scenes
Teaching and research are catalysts for the Cancer Institute’s success.
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Finishing Touches
Renovated first floor offers a host of amenities for patients and guests.
WALKING THE PATH TOGETHER
On the rise, palliative care takes a whole-person approach to treatment.
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in every issue Profile ................................................................... 4 Cancer forces an avid runner to make a tough decision.
Medicine Bag....................................................... 14
Stephen R. D’Addario, M.D. Michael Fry Research Award winner Oncology On Canvas Upcoming symposia Early Detection Partners Card Surgical Advancements
Spotlight.............................................................. 25
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caBIG Face-to-Face Meeting First floor grand reopening Arkansas Repertory Theatre benefit
Cover photo by Johnpaul Jones
are PalliativeLCISTS OF LIFE SPECIA QUALITY FOCUS ON
M.D., is Harrington, Sarah Beththe Palliative Care of director . at UAMS program
Winthrop P. Rockefeller Cancer Institute
“It was luck of the draw that I was fortunate enough to be born a Rockefeller. But with that comes the additional obligation, or I should say opportunity, to do some good.” Winthrop P. Rockefeller 1948-2006
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Whatever it
Takes
For a year, Rhonda Ellis’ left hip popped and ached when she ran. The elementary school teacher and mother of two boys was too busy to have it looked at. Still, it nagged at her on her daily run as she logged up to 35 miles a week. The running was almost an addiction. She had started running to get healthy after years of struggling with post-baby weight, and now she was hooked. Her running buddy finally told her, “Something’s not right.” Ellis, who at that time
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Cancer forces an avid runner to make a tough decision. BY Liz Caldwell
lived in Searcy, went to her family doctor, but X-rays showed nothing. The doctor sent her to an orthopaedic specialist for further testing, and there it was — a marble-sized cyst, possibly a tumor. “The specialist said ‘I’m sending you to the only orthopaedic oncologist in Arkansas,’” Ellis said. By the time she arrived at UAMS to see Richard Nicholas, M.D., she was worried. After more tests, Nicholas told her and her husband, John, it could be a low-grade cancer —possibly
Looking Beyond Cancer’s Limits
profile weekend getaway to celebrate the anniversary of their engagement. They continued with the trip, but all they talked about was what to do. “At first I said, ‘I’m not doing it, I’m not giving up what I worked so hard to accomplish,’” Ellis said of her passion for running. But when her husband looked at her and said, “The boys and I need you,” she determined to do whatever it took to get rid of the cancer. “God kind of broke my stubborn spirit and said ‘I’m going to take care of you — you need to trust Me.’” The next day they went to see their pastor. Her church family rallied around her, as did her fellow teachers. Along with family, they pitched in to help after surgery, bringing food and ferrying the kids to their activities. “We were blessed throughout the entire process,” Ellis said. “I learned a lot about myself. I will be the very first one in line to help someone out, but I will tell others, ‘I don’t need your help.’ Friends said do not rob someone else of the blessing to help you.” Her hip replacement took place in April 2006. “I totally trusted Dr. Nicholas and knew he was the best in the business.” She required three weeks of physical therapy, but no further treatment. She thanks her Rhonda Ellis’ faith and family helped husband, whom she called “my very best friend. her through the challenges of cancer. She is seen here with her husband, He was the biggest factor in my recovery because John, and sons, Ethan and Austin. he is so supportive.” She and John moved to Conway three years ago and she is now a stay-at-home mom to Ethan, 17, and Austin, 15, attending their activities and volunteering at church. She has found other types of exercise to replace her daily runs. Last spring she celebrated her five-year a clear-cell chondrosarcoma growing inside the anniversary of being cancer free by tossing a token femur, or hip bone. into the Seed of Hope sculpture “We are going to do a total on the first floor of the Cancer hip replacement,” she recalled Institute. We were blessed Nicholas saying. “You won’t “My initial reaction was what an throughout the entire amazing be able to run any more, but program for those who process.” we’re going to get it out of have beat it,” Ellis said. “I thought there.” of a friend battling cancer, and “We were very much in shock,” Ellis said, “but as I threw my seed in I sure was praying that he we are people of faith and we very much believe would have the same experience of the hope and in God’s providence.” They were on their way to a joy of being healed.”
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Winthrop P. Rockefeller Cancer Institute
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Mindy Gibbons, R.N., and Marwan Yared, M.D., are leaders in UAMS’ Tissue Procurement Facility. Looking Beyond Cancer’s Limits
Banking ON THE Store of tissue samples aids cancer research.
By Jon Parham
Normally tissue from surgery is discarded Mindy Gibbons, R.N., of the UAMS after pathology workup is completed. Through Tissue Procurement Facility, said patients she donation, the patient’s tissue is used in research. talks to are usually happy to give a piece of “Otherwise, these valuable tissues would themselves to science. be disposed of following pathology analysis,” Gibbons and other procurement facility said Gibbons, clinical nurse manager for the personnel speak with patients about donating procurement facility. tissue for use in research. The tissue in question is For Gibbons, a twoa small section of tumor time cancer survivor, collected from surgery. the cause of continued The procurement Our patients understand research is personal. facility collects and stores that the hope for a cure Twenty-six years ago, small slices of tissue starts with research.” while in nursing school, (about 0.5 centimeters she was diagnosed with across) that are then to Hodgkin’s lymphoma, and more recently breast be used by researchers — mainly to get genetic information that are the fingerprints of cancer and cancer. She also lost both parents to cancer. Her nursing career has taken her from could offer keys to future prevention, treatment or working a floor in the hospital to the infusion cure of disease. “Research today is mostly focused on sub-cellular room where she cared for cancer patients. She said she felt drawn to research and the disease mechanisms,” said Marwan Yared, M.D., tissue bank because of its mission. medical director for the Tissue Procurement Facility. "I definitely believe in what we do. Our staff is “Now they are looking for genetic markers of disease an amazing group of people who enjoy their work and need to study the DNA or RNA of tumors. This and take utmost interest in our patients and their requires the availability of tissue specimens from all futures," Gibbons said. u organ types and cancer disease categories.”
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Consenting A surgeon or clinic staff will ask the patient if they are interested in participating in tissue donation, Gibbons said. If so, the research staff will visit with the patient, obtaining an informed consent from the patient to collect tissue. The patient should feel comfortable that their rights and privacy will be protected throughout the process, she said. Consenting to tissue donation will in no way affect the patient’s clinical or diagnostic care. Gibbons said most patients are happy to participate. “Many patients have thanked us for asking.” There are some frequently asked questions from patients, family members and caregivers about tissue donation. Will my insurance company or I be charged for donating? No. There is no charge to the patient or insurance for tissue donation, and donation is voluntary. What will be done with the tissue specimen?
The Tissue Procurement Facility’s staff includes (left to right) Remelle Eggerson; Sue Johnson; Marwan Yared, M.D.; Brandy Johnson; and Mindy Gibbons, R.N.
It will be stored in the tissue procurement facility until it is requested by a researcher for an approved study. Will the sample be used in cloning? No. (She said that most aren't serious when they ask that question.) Will my privacy be protected? Absolutely. All participants are given donor identification numbers that are used instead of their names to maintain their privacy.
That's Cold The UAMS Tissue Procurement Facility — previously known as the Tissue Bank — was established in 2005 as a shared, campuswide collection and storage facility for specimens including solid tissue, blood and bone marrow. Today about 10,000 samples are available for research through the facility. With the tissue procurement facility, researchers have access to a variety of samples. The scientists can be assured that the samples
are being handled and stored following the latest national and international quality assurance guidelines. In addition, all activities are conducted under strict safety measures set by the federal Occupational Health and Safety Administration. The samples are stored in liquid nitrogen, which keeps them frozen at temperatures from minus 80 degrees to minus 180 degrees. At that temperature, the samples can be stored indefinitely while maintaining usefulness, Yared said. If a researcher needs a tissue sample for a project, they submit a request that is reviewed by a Disease Oriented Committee that includes specialists in the particular disease to be studied. “The committee will review the validity of the research proposal, asking questions such as 'Does it make sense?', 'How sound is the proposal?' and 'Is the request reasonable?'," Yared said. The committee also weighs the value of the specimen request to ensure available specimens are dispensed in a way that maximizes the benefit to the UAMS research community while protecting
available resources. That means that if 100 samples have been stored for a certain tumor type and the scientist is requesting just two samples, it will be considered differently than if only five samples exist and the researcher wants all five. Upon committee approval, the facility will issue the requested specimen to the researcher. Many types of research studies require tissue samples. Some researchers use tissue to develop new tests to diagnose cancer or other diseases. Some are testing potential treatments. Gibbons said 95 percent of UAMS patients approached with tissue banking are agreeable to tissue donation. “We're received really well by our patients,” she said. “Cancer patients are a unique and generous group. Our patients understand that the hope for a cure starts with research.” Gibbons and Yared emphasized the facility was a team effort that also included project manager Remelle Eggerson, along with research associates Brandy Johnson and Sue Johnston.
Sue Johnson and Brandy Johnson are part of the UAMS Tissue Procurement Facility team. Winthrop P. Rockefeller Cancer Institute
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BEHIND the SCENES Teaching and research are catalysts for the Cancer Institute’s success. By David Robinson
UAMS’ Brian Badgwell, M.D., talked quietly to a medical student and resident as the group exited a clinic room and pushed through a swinging door a few steps down the hall. Once inside the sparsely furnished work room on the Cancer Institute’s seventh floor, the resident and student peeled off and Badgwell went directly to a desk in a back corner. Speaking into the desk phone at warp speed, he dictated the particulars of his most recent patient consult. When he hung up and swiveled in his chair a few minutes later, Mario Rueda, M.D., a surgery resident, was at his side, ready to discuss the next patient. Rueda quietly briefed Badgwell on the patient’s melanoma on the bottom of her foot, which had spread to lymph nodes in her pelvis. “All right, what do you want to do?” asked Badgwell, a fellowship-trained surgical oncologist. Rueda outlined the treatment approach, and Badgwell suggested some additional measures, concluding, “Let’s make sure she doesn’t have any neuro complaints, and that’s about it.” Seconds later, Badgwell and Rueda were examining the patient together. u
caption Brian Badgwell, M.D., discusses a patient with surgery resident Mario Rueda, M.D.
Hand in Hand
treatment in an attempt to shrink the cancer so that it could be removed. Such scenes are played out every day in the “When you’re in an academic medical center, UAMS Winthrop P. Rockefeller Cancer Institute, where teaching goes hand in hand with healing. In you tend to see the most complex cases,” Badgwell fact, without the significant academic and research said, explaining that although hectic, it was a typical clinic day. components, especially within the College of Given the time spent teaching and the Medicine, the Cancer Institute wouldn’t exist, said seriousness of his patients’ conditions, it’s a Kent Westbrook, M.D., a surgical oncologist and struggle to stay on schedule. “These patients need co-founder of the Cancer Institute. more of my time, but that’s what I like,” he said. “The Cancer Institute’s affiliation with UAMS gives us access to scientists and clinicians who are interested in research and access to all the Academics Plus different radiological innovations, and you just Like many other cancer surgeons with years can’t bring all that into a free-standing center,” of advanced training, Badgwell is drawn to the Westbrook said. academic and research side of cancer treatment. Back in the work room, Rueda was joined The combination of those elements helped make by a second surgical resident and two College of the UAMS Cancer Institute Badgwell’s choice when Medicine students on rotation with Badgwell. he finished a surgical oncology fellowship in 2008. They were responsible for gathering and Without being an institute of UAMS, the organizing each patient’s Cancer Institute couldn’t information and visiting each attract many of its elite patient ahead of Badgwell. cancer specialists, Westbrook The Cancer Institute, They also accepted tasks that said, adding that it is the came up, like contacting the presence of a range of cancer when you boil it down, team pharmacist to find out specialists who make the is about knowledge how long it would take a new Cancer Institute what it about cancer.” type of blood thinner to clear is today. a patient’s body. “The Cancer Institute, On another case, Badgwell was briefed by when you boil it down, is about knowledge student Ethan Helm on a patient back for a follow- about cancer,” Westbrook said. “It’s applying up CT scan to see if her cancer had grown. the knowledge to patients; it’s generating new Badgwell squinted at the scan on the knowledge through research, and it’s transmitting computer screen over Helm’s shoulder. “See how new knowledge to the next generation of health it’s kind of blurry? Let me show you a trick,” he care professionals. And it is that environment that said as he reached for the mouse and sharpened attracts many of our best doctors.” the focus with a couple of clicks.
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Medically Challenging That Tuesday the team saw 18 patients, including many who came to the Cancer Institute due to their complex and challenging medical conditions. Examples of patients seen that day were: a 76-year-old man with obstructive jaundice and pancreatic cancer; a 33-year-old woman with a liver mass who was seeking a second opinion; a 72-year-old man with colon cancer that had spread to his liver and right abdominal wall; and a 50-year-old man with inoperable pancreatic cancer who was receiving chemotherapy and radiation 12
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RX for Learning
The Cancer Institute is staffed by UAMS College of Medicine faculty doctors who teach medical students, residents and fellows. Other UAMS colleges also have roles within the Cancer Institute. For example, the College of Nursing is conducting myeloma research, and the College of Pharmacy offers student rotations at the Cancer Institute. Lindsey Dayer, Pharm.D., a College of Pharmacy faculty member, oversees two students for a half day each day at the Cancer Institute. The students pick out patients who are taking at least Looking Beyond Cancer’s Limits
eight drugs in addition to their oral chemotherapy medicine. The students look for side effects or negative drug interactions and screen patients to ensure that they are adhering to their medication schedule. Their research has led to recommended changes in patients’ medications. In one recent case, a student was able to help relieve a patient’s chronic pain by recommending a dosage adjustment. Pharmacy oncology is taught in the classroom, but the real-world experience is invaluable for learning how to communicate with other health care professionals and patients, Dayer said. “Even if they’re not going to be practicing in a hospital or clinic setting, they may be in retail and will definitely come in contact with patients who have cancer,” she said. “Those patients may experience side effects or may have negative interactions with other drugs they’re already on.”
A Subtle Edge In addition to the cutting-edge treatment offered at an academic institution, Westbrook said the teaching environment benefits patients by keeping faculty on their toes. “You can give excellent care where you’re simply taking care of patients, but having the residents and students around makes more questions be raised, and you question, ‘Is this the best way to do it, or is there a newer way or a better way?’” Westbrook said. “The atmosphere is more one of trying to improve what you’re doing rather than simply delivering really good care. I think it makes everyone perform at a higher level.”
Lindsey Dayer, Pharm.D., instructs UAMS College of Pharmacy student Jason Parsons (left) and Bill Hill.
Winthrop P. Rockefeller Cancer Institute
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Calling ALL
Shoppers
Dozens of shops and boutiques in central and northwest Arkansas will offer discounts on their merchandise Oct. 28 – Nov. 6 as part of Partners Card, a fundraising project of the volunteer auxiliary of the Winthrop P. Rockefeller Cancer Institute. For information or to purchase the auxiliary’s Partners Card starting Aug. 31, call (501) 6868286 or visit www.cancer. uams.edu/partnerscard. For 10 days, shoppers who purchase the $50 cards will receive a 20 percent discount at about 160 area stores. All proceeds from the sale of the Partners Cards will go to the Cancer Institute’s volunteer auxiliary to fund projects that directly benefit cancer patients in Arkansas.
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Looking Beyond Cancer’s Limits
Physician Joins Dermatology Cancer Clinic
Surgical Advancements
Matthew Katz, M.D., a urologiconcologist at UAMS recently performed what is believed to be the first minimally invasive surgery in Arkansas to remove lymph nodes in a patient with testicular cancer. The procedure spares patients the traditional foot-long, open-incision surgery. Instead, Katz was able to remove the lymph nodes through three incisions, each about one inch long. Laparoscopic surgery requires special tools that can fit through the small incisions, including a laparoscope, which is a tiny camera that allows the surgeon to see inside the body. Katz noted that testicular cancer is the most common cancer for men ages 18 to 35, with that age group receiving 53.7 percent of all testicular cancer diagnoses, according to the National Cancer Institute.
Stephen F. D’Addario, M.D.,
recently joined the UAMS faculty and sees patients in the Dermatology Cancer Clinic at the UAMS Winthrop P. Rockefeller Cancer Institute. His specialties include skin cancer and Mohs micrographic surgery, an advanced surgical technique that minimizes the chance for recurrence and lessens the potential for scarring. He also performs cosmetic procedures including laser treatments, Botox and cosmetic peels.
Addressing Lung Cancer in Arkansas The 2nd Annual Lung Cancer Symposium scheduled for Oct. 7 at the Cancer Institute will bring together health care professionals from a variety of specialties to discuss innovations and controversies in all stages of lung cancer treatment. Dr. Thaddeus Bartter, professor of pulmonary and critical care medicine in the UAMS College of Medicine, is course director.
Winthrop P. Rockefeller Cancer Institute
Among the topics to be covered are: u Mechanisms of Oncogenesis u Revised Pathology of Lung Cancer u Principles of Chemotherapy u Lung Cancer Screening: Pro and Con u Small Cell Lung Cancer For information or to register, visit www.cancer.uams.edu/LungCancerSymposium.
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Radiation Research Award
UAMS researcher Marjan Boerma,
Ph.D., was recently selected to receive the Michael Fry Research Award from the Radiation Research Society. The award recognizes junior scientists who have made extraordinary contributions to the field of radiation research.
Boerma’s research focuses on
the mechanisms of radiation-induced heart disease, a side effect of radiation therapy of the chest that can be a major determinant of quality of life among long-
Artistic Expression
term cancer survivors. She is an assistant professor in the UAMS Department of Pharmaceutical Sciences, Division of Radiation Health.
Oncology On Canvas, an art exhibition honoring the journeys people face when confronted by a cancer diagnosis, was featured at the Cancer Institute July 11-22. This free public exhibit, which tours communities nationwide, showcased 75 pieces of art from the 2010 Oncology On Canvas competition sponsored by Lilly Oncology, in partnership with the National Coalition for Cancer Survivorship. This biennial art competition invites people from the United States and Puerto Rico diagnosed with any type of cancer — as well as their families, friends, caregivers and health care providers — to express, through art and narrative, the life-affirming changes that give their cancer journeys meaning.
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Oncology Nursing Education Florence Zook, R.N., used her passion for nursing as inspiration to help nursing students achieve their professional goals. While being treated at the UAMS Winthrop P. Rockefeller Cancer Institute, Zook experienced firsthand the importance of nursing from a patient’s perspective. In honor of her commitment to nursing, the Cancer Institute hosted the 10th Annual Florence Zook Memorial Oncology Nursing Symposium on Aug. 26. The day-long event included topics such as palliative care and the latest development in breast cancer and melanoma treatment. The Florence C. Zook R.N. Nursing Scholarship also is named in Zook’s honor and is awarded annually to a student in the UAMS College of Nursing.
Early
DETECTION
The Cancer Institute earlier this year offered two free cancer screenings. The oral, head and neck cancer screening, held May 13 by the UAMS Department of Otolaryngology – Head and Neck Surgery, saw a total of 147 patients. Several patients were referred to the clinic for ear, nose and throat conditions; possible cancers; and other symptoms, while about 40 others were recommended to visit their primary care physician for a variety of concerns. The skin cancer screening, sponsored by the UAMS Department of Dermatology on May 21, saw 115 patients and resulted in 35 referrals for follow-up of possible skin cancer.
Symposium Highlights Blood Cancers Health care professionals gathered Sept. 9 at the Cancer Institute for the annual Maddox Blood Cancers Symposium. Course director for this year’s event was Peter Emanuel, M.D., Cancer Institute director and professor of medicine in the UAMS College of Medicine. The Maddox Blood Cancers Symposium is designed to provide practitioners with the most up-to-date information in the field of hematologic malignancies.
Winthrop P. Rockefeller Cancer Institute
Among the topics covered were: u Management of AML in the Elderly
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Genomics as a Prognostic and Predictive Tool in Acute Leukemia Understanding Myeloproliferative Diseases
The symposium was sponsored by UAMS College of Medicine, Division of Hematology/ Oncology.
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Finishing Touches
The Gathering Place Café serves breakfast and lunch daily.
Renovated first floor offers a host of amenities for patients and guests. By Susan Van Dusen
It’s been a busy year at the UAMS Winthrop P. Rockefeller Cancer Institute. While more than 500 supporters gathered July 30, 2010, to dedicate the institute’s new 12-story tower, construction workers were already preparing the original Walker Tower for major renovation. Less than a year later, supporters gathered again for the unveiling of the tower’s renovated first floor. What at one time housed the Myeloma Infusion Center, Dixon Waiting Room, front desk, chapel and gift shop has been completely re-imagined as a hub for patient education and comfort. “We wanted to create an area where patients and their caregivers could relax and enjoy a meal together, as well as a centralized location for patient education and volunteer services,” said Cancer Institute administrator Shirley Gray. “I believe we accomplished both of these goals in a 18
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beautiful and comforting atmosphere.” The Ford Patient Support Pavilion, named in honor of longtime UAMS supporters Joe and Jo Ellen Ford, gives patient education and support services its most prominent place ever in the Cancer Institute. In 2007, the Fords announced a $1 million gift to the institute’s expansion, which was the first donation to the project. The pavilion’s wig shop provides a private area for patients to try on a variety of wigs and hats. A free wig for each patient is offered courtesy of the Cancer Institute Auxiliary. Patients, caregivers and visitors also can pick up educational materials; use the pavilion’s computers, copier and fax machine; or attend classes on topics relevant to cancer patient health and well-being. Across from the pavilion is The Gathering Place Café, the Cancer Institute’s first-ever eating establishment. “It was very important for us to provide Looking Beyond Cancer’s Limits
healthy food choices for the patients, visitors and employees in this building. While UAMS offers food service in other areas on campus, our building has been lacking in that regard. We are happy now to provide this option,” Gray said. The café, which is operated by Aramark, is open 7 a.m.-6 p.m. Monday-Friday and 8 a.m.–1 p.m. Saturday-Sunday. The space also provides a direct connection to
Infusion Clinic 1 in the UAMS Outpatient Center and is home to the Auxiliary-run gift shop; the Department of Volunteer Services; a chapel; and consultation areas for services including social work and nutrition. CDI Contractors Inc. is the general contractor for the expansion. Cromwell Architects Engineers of Little Rock and FKP Architects of Houston are the architecture/engineering firms.
The Ford Patient Support Pavilion offers educational materials, computer access and a place to relax between appointments.
Construction Continues Construction is now under way on two research laboratory floors at the Cancer Institute. The construction is funded by a $10.5 million grant from the National Institutes of Health (NIH) announced in 2010. Funding for the grant comes from the American Recovery and Reinvestment Act of Winthrop P. Rockefeller Cancer Institute
2009 stimulus monies allocated to the NIH for construction grants. The floors will house open lab space, improving researchers’ ability to collaborate and share resources. Ultimately, the construction project will result in an additional 33,660 net square feet of research space. seek
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Comprehensive
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palliative care takes a whole person approach to treatment. By Nate Hinkel
Looking Beyond Cancer’s Limits
A. Reed Thompson, M.D., (right) started UAMS’ palliative care program and helped recruit Sarah Beth Harrington, M.D., who now serves as its director.
and is dealing with the accompanying pain If Sarah Beth Harrington, M.D., related to radiation or chemotherapy. It often had one wish, we’d live in a world where the lingers, sometimes for years. That patient can go often-blurred distinction between hospice and straight to Harrington’s clinic and explore pain palliative care would be well-defined and management options. common knowledge. “On the other end of the continuum, take “I don’t think that’d be overstating it too a patient with advanced stage 4 cancer with a much,” joked Harrington, who is one of the state’s limited life expectancy. I burgeoning leaders in the might initially see him or emerging new subspecialty her for pain and symptom of palliative care. “There You can really make management,” Harrington is a very fine line between a huge difference in said. “But I can also start the two that tends to the conversation with the give people the wrong a person’s life.” patient and family about impression of what palliative goals of care and transition care is. In all seriousness, into hospice when the time is right. Once that misconstruing the two can be detrimental to the transition takes place, I would continue to serve as incredible benefits this field offers.” primary hospice physician once the patient goes Most people are familiar with the scope of home in order to provide good continuity of care.” hospice, which deals strictly with end-of-life care, Along with Thompson and Harrington, Bob planning and comfort for patients generally in Lehmberg, M.D., and Marie Sullivant, R.N., their last six months of life. Palliative care is the medical specialty focused on improving the quality are both integral parts of the UAMS palliative care team. of life of people facing serious illness. It can be offered at any stage of any illness no matter how long a patient is expected to live. Catching the Fever Patients can benefit most from palliative care Harrington got her first dose of palliative care when suffering from hard-to-treat symptoms like in a fourth-year elective course during medical pain, fatigue, depression, anxiety and nausea. A school at UAMS. palliative care specialist also is helpful to patients “Most of my peers at the time sort of frowned facing tough treatment options and coordinating upon the idea of hospice and palliative care, those efforts. Because of these benefits, palliative because when you’re in medical school you feel like care is a natural fit into the overall treatment plans you’re becoming a doctor to save lives and not be of cancer patients. a part of the latter stages,” Harrington said. “But I It was the vision of A. Reed Thompson, M.D., saw it as a very meaningful part of patient care.” that brought palliative care services to UAMS, a The most appealing aspect of palliative path that he began nearly a decade ago. Through care to Harrington was being able to treat the his efforts, Harrington was recruited to the Cancer “whole patient,” she says, meaning the ability Institute in 2008 and is now off and running with to offer physical, emotional and mental healing a swiftly expanding program. at the same time. That interest prompted her to seek a residency that she could follow with a palliative care fellowship program. At that time, All-Phase Fight in 2003, there were just six such programs in the The Palliative Care Clinic at the Cancer country. She decided on Virginia Commonwealth Institute works closely with patients’ oncologists University in Richmond, Va. and treatment teams in all phases of the disease. “The plan was always to come back to UAMS By aggressively treating symptoms, patients are and, with the help of Dr. Thompson, who is better able to function and tolerate their cancer a mentor of mine, get a fully integrated treatments. palliative care program off the ground here,” For example, Harrington said, take a breast Harrington said. cancer patient who has undergone a mastectomy
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On the Rise Since returning in 2008, the number of patient visits in the palliative care clinic at the Cancer Institute has more than doubled, skyrocketing from 313 in 2008 to 672 in 2010. That’s on par with a palliative care trend nationally that has seen the field grow to being recognized as a key player in health care delivery as a whole. The six palliative care fellowship programs available when Harrington was looking for one in 2003 has since grown to 55. The number of palliative care programs in hospitals has doubled in the last half-decade, with more than 1,300 hospitals participating. More than 50 percent of hospitals with more than 50 beds have a palliative care program. Harrington says even though the vastly growing statistics are validation in itself, it takes time to prove the field’s worth among experienced physicians. Providing excellent palliative care to cancer patients in all stages of illness is a high priority at the Cancer Institute.
“We work closely with oncologists and surgeons here to make sure the whole patient is treated and good communication and quality of life are maximized,” Harrington said. For oncologists, having resources and expertise in palliative care within the Cancer Institute means more time for them to focus strictly on fighting cancer and may result in overall better patient outcomes.
Palliative Proof Though it’s still a relatively new and emerging subspecialty and palliative care research is limited, the few studies that have been completed show positive results. Harrington points to one in particular dealing strictly with cancer patients that caught many oncologists by surprise. Released in 2010, a study of advanced lung cancer patients given less than one year to live was done by mixing in randomized palliative care treatments. The palliative care group had the usual oncologic care, plus pain u
Palliative Care Conference Draws a Crowd Yet another signal the emerging subspecialty of palliative care is hitting its stride was the recent success of the first-ever Hospice and Palliative Care Conference. Sponsored by the UAMS College of Medicine and the Winthrop P. Rockefeller Cancer Institute, the conference drew more than 200 physicians, nurses, chaplains, social workers and other medical professionals from around the country. “We felt like there was plenty of interest that led up to us making the decision to organize our first-ever palliative care conference,” said Sarah Harrington, M.D., director of the hospice and palliative care program at UAMS. “It
Winthrop P. Rockefeller Cancer Institute
shows that the need is there for sharing expertise and information in this field, and that we can continue to grow.” Held June 8-9 at the Wyndham Riverfront in downtown North Little Rock, the conference’s success already has her thinking about doing it again in 2012, possibly on the UAMS campus. Those in attendance heard lectures from experts about starting palliative care programs in hospitals, pediatric palliative care programs, wound care, ethical issues, spirituality and end-of-life management, among many others. “It was a very positive step forward for Arkansas and for the palliative care advancement as a whole,” Harrington said.
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and symptom management and advanced care planning with a palliative care specialist. “At the end of the study, one group lived almost three months longer and its quality of life was much stronger,” Harrington said. “It caught some by surprise to learn that it was the palliative care group that showed the positive results.” The theory, explained Harrington, is that if pain and symptoms are better controlled, patients will be more functional, may tolerate chemotherapy and other treatments better, and might live longer. And, those who discuss goals of care early may choose not to pursue particularly aggressive treatments in the last months of life in order to focus on quality of life and comfort. “Palliative care has consistently proven to be beneficial to patients facing serious and complex illness,” said Diane E. Meier, M.D., director of the Center to Advance Palliative Care. “This study should encourage patients to seek palliative care early in the course of their illness.” And that is precisely what drives Harrington to continue to grow the palliative care movement within the Cancer Institute.
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Fellowship Program the First in the State Sarah Beth Harrington, M.D., arrived back at UAMS in 2008 after completing a Hospice and Palliative Medicine fellowship program at Virginia Commonwealth University in Richmond, Va. At the time there were few such programs across the country. With the new subspecialty quickly expanding among hospitals and private clinics nationwide, Harrington was able in 2009 to start the state’s first fellowship program and one of a small handful available in the South. “We have the resources, the patient population and the teachers at UAMS, and everyone was very supportive of getting this started,” Harrington said. The first two fellows began the oneyear UAMS Hospice and Palliative Medicine Fellowship Program in 2009, while two more finished in 2010, and three more are on board to start the program in July 2011. With palliative care programs rapidly expanding in hospitals nationwide, those who participate in the programs are in high demand. “No doubt it’s a very coveted specialty to have right now,” Harrington said. “One of the benefits is that they can choose to pursue palliative care as a streamlined career or use it as sort of a feather in their cap to mix in with another specialty.” Like Whit Robertson, M.D., who finished the fellowship program last year and is now pursuing a hematology and oncology fellowship, is doing. “I know the benefits of palliative care and how that experience will lend itself to treating cancer patients,” Robertson said. “I will be a more well-rounded and efficient medical professional by having gained the expertise from the palliative care fellowship program.” Harrington said she hopes soon to start a walk-in palliative care clinic at the Cancer Institute that would largely involve fellows in consultation with patients.
Looking Beyond Cancer’s Limits
spotlight
caBIG Face-to-Face Meeting
What: aBIG Clinical Trials Management Systems/ Population Sciences Joint Faceto-Face Meeting
Susan Van Dusen
Who: About 100 developers of the National Cancer Institute’s cancer Biomedical Informatics Grid (caBIG) came together in Little Rock to discuss advances in the network linking cancer researchers and physicians around the world.
UAMS’ Laura Hutchins, M.D., with conference participant Randall Alexander.
When: May 9, 2011
Participating in the conference were UAMS’ Umit Topaloglu, Ph.D.; John Speakman of the National Cancer Institute; Jose Galvez; and Anthony Kerlavage.
Susan Van Dusen
Why: Through caBIG’s opensource software, organizations engaged in cancer research may share information, enabling widespread access to tools, data and infrastructure for the cancer and biomedical research communities. The host of this year’s meeting, UAMS has been a nationally recognized leader in the initiative since implementing the program in 2007.
Susan Van Dusen
Where: Meeting sessions were held at The Peabody Little Rock, and the reception (pictured here) was held at the Winthrop P. Rockefeller Cancer Institute.
Cheryl Lane of UAMS Information Technology with Edward Helton, Ph.D., of the National Cancer Institute.
Winthrop P. Rockefeller Cancer Institute
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First Floor Grand Reopening Who: Cancer Institute donors, volunteers and employees
Chadley Uekman
What: The grand reopening of the renovated first floor of the Cancer Institute’s original Walker Tower.
Chadley Uekman
The Gathering Place Café is now open on the Cancer Institute’s first floor.
When: June 15, 2011 Where: Winthrop P. Rockefeller Cancer Institute Why: Following the opening of the Cancer Institute’s 12-story expansion tower in August 2010, renovation began on the original Pat and Willard Walker Tower. The renovated first floor space was revealed to include The Gathering Place Café, Ford Patient Support Pavilion, Department of Volunteer Services, gift shop, chapel and convenient access to the UAMS Outpatient Center.
Cancer Institute Director Peter Emanuel, M.D., addresses the crowd.
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Chadley Uekman
Chadley Uekman
Donors, supporters and staff members gathered for the grand reopening ceremony.
Kent Westbrook, M.D., with Joe and Jo Ellen Ford
Looking Beyond Cancer’s Limits
spotlight
Arkansas Repertory Theatre Benefit Who: Cancer Institute board member and Tony Awardwinning producer Remmel Dickinson, along with Arkansas theater lovers
Chadley Uekman
What: A benefit performance of Alfred Hitchcock’s “The 39 Steps” When: June 21, 2011 Where: Arkansas Repertory
Theatre
Cathy Matthews, Leslie Thiela and Beck Remmel
Chadley Uekman
Why: One of the original New York producers of “The 39 Steps,” Remmel Dickinson assisted in production of the play at the Arkansas Repertory Theatre, from which 100 percent of the proceeds benefited the Cancer Institute.
Cornelya Dorbin and Oluwakemi Talabi
Winthrop P. Rockefeller Cancer Institute
Chadley Uekman
Chadley Uekman
Remmel Dickinson, Kay Arnold, Lana Rahn and UAMS Chancellor Dan Rahn, M.D.
Robb Fiser, Shawn Cozeen, Derek and Heather Owens
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NONPROFIT ORGANIZATION U.S. POSTAGE
WINTHROP P. ROCKEFELLER CANCER INSTITUTE
PAID
LITTLE ROCK, AR PERMIT NO. 1973
4301 W. Markham St., #623 Little Rock, AR 72205
Four Corners
Board members bring expertise from across Arkansas and beyond. Mary Flowers
Pine Bluff Office Manager, Flowers Pediatric Clinic
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Serving on the Cancer Institute board has afforded me the opportunity to speak out loudly as an advocate Dick Trammel for cancer awareness – breast cancer in particular. Rogers Executive vice president and member, Arvest I speak out on behalf of my older sister, Norma Yeargin Jolley, who succumbed to this disease at the Bank Benton County board of directors young age of 46.” Member of UAMS Area Health Education Center Northwest Board Member of the UAMS Northwest Advisory Board
“
Having had both family and friends touched by cancer, the promise of a cure is very important to me. I am proud to serve in support of UAMS — which I think is truly a diamond for health care in Arkansas — and the Cancer Institute in the hope that one day no one will have to deal with this disease.”