DISCOVERIES Dr. Anthony Dragun and the Breast Care Multidisciplinary Team Embrace Todayâ€™s Advances and Look Ahead to Tomorrow
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letter from the director Dear Friends, Nearly every day headlines across the country use words like “downturn,” “freeze,” “slowdown,” and “reduction” to describe industries from manufacturing to banking to health care. While we are not immune from the effects of the financial times, none of those words describe the vibrant growth in research, clinical care, and capital improvement we are enjoying at the James Graham Brown Cancer Center. Even in the midst of these trying economic times, we continue to renew our commitment to our mission each day – a commitment that drives our continued success. Allow me to share with you just a few examples of these recent successes: The University of Louisville recently opened the Clinical and Translational Research Building (CTRB), a $143 million, 285,000+ square foot facility located just behind the Brown Cancer Center housing laboratory space for research that has potential for clinical and translational applications, particularly cancer research. The CTRB offers our research teams flexible and adaptable state-of-the-art biomedical research facilities, designed to promote interdisciplinary collaboration between scientists. Its core laboratories include flow cytometry, micro-array, advanced diagnostic imaging services and tumor bank.
INSIDE THIS ISSUE... COVER STORY page
New Options & Team Approach to Breast Cancer Treatment
A study supporting the use of transgenic plants in HIV prevention was published by Kenneth Palmer, PhD, associate professor of pharmacology and toxicology and senior scientist in the James Graham Brown Cancer Center working at the Owensboro Cancer Research Program (OCRP). The study indicates that growing large quantities of the protein griffithsin in Nicotiana benthamiana—a close relative of tobacco—offers an affordable, preventative measure for HIV. This work highlights our work at the OCRP, strengthens our partnerships with Kentucky BioProcessing and Intrucept Biomedicine, LLC, and offers hope to communities ravaged by HIV all over the world.
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New HIV Drug
Discoveries is published for the friends, faculty and staff of the James Graham Brown Cancer Center. Discoveries Brown Cancer Center, 2nd Floor 529 S. Jackson Street Louisville, KY 40202 www.browncancercenter.org Editor Craig Fairfield Contributors Tom Fougerousse Kathy Keadle Diane Konzen Albert Leggett Marion Whelan
The University of Louisville established two endowed chairs, the Auerbach Family Endowed Chair and the Dr. Renato LaRocca Endowed Chair in Oncology Social Work, to address the needs of cancer patients beyond treatment of the physical disease. These chairs, the first residing in the Brown Cancer Center and the second in the Raymond A. Kent School of Social Work, will both support the cancer center’s commitment to advance research and treatment for the whole patient. The Brain Tumor Clinic, our latest multidisciplinary clinic, saw its first patients in the summer of 2009 under the leadership of UofL School of Medicine Dean Edward C. Halperin, MD. The Brain Tumor Clinic is the latest example of our commitment to clinical excellence through cross-disciplinary teamwork. The Brown was the first in the region to introduce Contura, a new clinical innovation in Accelerated Partial Breast Irradiation. This new tool gives more patients in our Breast Care Multidisciplinary Clinic yet another option to more aggressively target the treatment of cancer with fewer side effects and vastly reduced damage to surrounding healthy tissue. As always, I am amazed at what we continue to accomplish through teamwork, vision, and commitment to excellence. Please read on to learn more about how the Brown Cancer Center continues to change the cancer landscape in Kentucky and beyond.
Donald M. Miller, MD, PhD Director of the James Graham Brown Cancer Center
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welcome... NEW FACULTY Swapna Kartha Chandran, MD, has joined the Brown Cancer Center’s Head and Neck Multidisciplinary Clinic. Board-certified in otolaryngology, Dr. Chandran received her undergraduate degree at the University of Chicago and her MD at the University of Louisville. She completed two fellowships, the first in laryngology/professional voice care and professional voice disorders at Drexel University, and the second in pediatric otolaryngology at the Alfred I. DuPont Hospital for Children in Wilmington. Among her numerous awards are the Banas and Rose Cohen Compassionate Service Award from the University of Louisville School of Medicine, and the Seymour R. Cohen Award for Pediatric and Neurolaryngology from the American Laryngological Association.
Guilherme Rabinowits, MD recently joined the Head and Neck Multidisciplinary team at the Brown Cancer Center. Dr. Rabinowits received his MD from the Fundacao TecnicoEducacional Souza Marques in Rio de Janeiro. After completing his residency in radiation oncology at the Instituto Nacional de Cancer, Dr. Rabinowits completed an internship in internal medicine at the Metro West Medical Center in Framingham, Mass., and a residency in internal medicine at the Lahey Clinic in Burlington, Mass. He then came to Louisville, where he served as chief fellow in the Brown Cancer Center’s hematology/oncology program.
Jarod A. Little, MD, has joined the Brown Cancer Center’s Head and Neck Multidisciplinary Clinic. Dr. Little received his undergraduate degree at Baylor University before earning his MD at the University of Texas, Houston. He completed his residency in otolaryngology and his fellowship in plastic and reconstructive surgery at the University of Louisville.
Elizabeth C. Riley, MD, joins the Lung Cancer Multidisciplinary team from Beth Israel Deaconess Medical Center in Boston, where she recently completed her fellowship in hematology/oncology. Dr. Riley received her undergraduate degree from Duke University and MD from the University of Louisville. She then completed her internship and residency in internal medicine at Beth Israel Deaconess, where she was named chief resident. Dr. Riley served as clinical fellow in medicine and instructor in medicine at Harvard Medical School.
Michael Milam, MD, MPH, joined the Gynecologic Multidisciplinary team August 1. Dr. Milam received his MD from the University of Kentucky College of Medicine and an MPH from the University of Texas School of Public Health in Houston. He completed an internship in obstetrics and gynecology at Barnes-Jewish Medical Center, Washington University in St. Louis; a residency in obstetrics and gynecology at Vanderbilt University in Nashville; and a fellowship in gynecologic oncology at The University of Texas MD Anderson Cancer Center in Houston.
Kevin L. Potts, MD, also joins the Head and Neck Multidisciplinary Clinic team from a private practice in Louisville. Dr. Potts, board certified in otolaryngology, completed his undergraduate, medical and residency training at the University of Louisville, where he served as chief otolaryngology resident. Dr. Potts received the Michael B. Nolph Award for Academic Excellence, the Serge A. Martinez Award for Outstanding Performance in Otoloaryngology, and the Resident Research Award.
Kara Joyce Collins Sedoris, PhD, joined the Molecular Targets research program team after completing her postdoctoral fellowship in cancer research at the Brown Cancer Center. Dr. Sedoris received her BA from Ohio Wesleyan University, as well as a master’s degree and PhD in Physiology and Biophysics from the University of Louisville. She has presented at numerous national and international meetings and has been published in several peer reviewed journals including Biochemistry and the Journal of Applied Physiology.
Huang-Ge Zhang, MD, PhD, has joined the Brown Cancer Center’s Tumor Immunology research program team from the University of Alabama at Birmingham. Dr. Zhang received his MD from the Medical School of Inner Mongolia and his DVM from the Veterinary Medical School of Inner Mongoloia before completing his PhD in viral immunology at Mississippi State University. He completed his postdoctoral fellowship at UAB before joining the faculty there, where he received several awards including the Basic Clinical and Translational Research Award from the Susan G. Komen Foundation and the Career Scientist Award from the VA Administration. His NIH-supported research is chronicled in many publications, including the International Journal of Cancer, the Journal of Immunology, and the American Journal of Pathology. FALL 2009
preventative drug for HIV MANUFACTURED IN PLANTS READY TO BEGIN CLINICAL DEVELOPMENT A University of Louisville faculty member at the Owensboro Cancer Research Program (OCRP) published research on March 30 supporting the use of transgenic plants in HIV prevention. The study indicates that growing large quantities of the protein griffithsin in Nicotiana benthamiana – a close relative of tobacco – offers an affordable, preventative measure for HIV.
extracting enough griffithsin to produce about 100,000 HIV microbicide doses from the leaves. The chemical performed identically to griffithsin produced by other methods. In a petri dish model incorporating cervical tissue, it strongly inhibited HIV and did not induce markers of inflammation; a standard animal test confirmed it was not a chemical irritant.
Kenneth Palmer, PhD, Associate Professor of pharmacology and toxicology and senior scientist in the James Graham Brown Cancer Center is senior author of the article, “Scaleable Manufacture of HIV-1 Entry Inhibitor Griffithsin and Validation of its Safety and Efficacy as a Topical Microbicide Component,” in the Proceedings of the National Academy of Sciences of the United States of America. The published study was the result of a close collaboration between Dr. Palmer and the scientists who discovered the drug, led by Dr. Barry O’Keefe at the National Cancer Institute. Two Kentucky biotechnology companies, Intrucept Biomedicine, LLC and Kentucky Bioprocessing, and scientists at Duke University and the University of London in the United Kingdom also participated in the study.
Many HIV entry inhibitors are biological molecules, making them virtually impossible to produce by a purely chemical process and requiring synthesis by living organisms. In comparison with cell-culture based manufacturing processes, plant-based manufacturing of biologicals offer significant cost savings by reducing the need for expensive infrastructure for growing organisms to produce the protein, and also provide the economies of scale offered by agricultural production.
Kentucky BioProcessing, which specializes in the expression, extraction and purification of proteins and other high value products from plants, will manufacture proteins for the drug for future clinical trials. ■
Dr. Kenneth Palmer led the study indicating that growing large quantities of the protein griffithsin in Nicotiana benthamiana – a close relative of tobacco – offers an affordable, preventative measure for HIV.
“This drug works by binding to sugar molecules on the surface of HIV, preventing the virus from infecting cells of the immune system,” Dr. O’Keefe said. “Using plants to produce griffithsin will offer underdeveloped countries with an affordable solution for prevention of HIV transmission.” According to Dr. Palmer, when manufactured in the form of a microbicide gel or film for topical application, the product’s selling price could compare to that of male condoms. HIV research is a focus of OCRP as contracting HIV increases risk for cancer. The study modified the tobacco mosaic virus to incorporate the griffithsin gene and infected more than 9,300 plants,
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UofL establishes two endowed chairs TO ADDRESS THE PSYCHO-SOCIAL SIDE OF CANCER A diagnosis of cancer often will send a patient into a spiral of depression, pain and hopelessness. The University of Louisville will be addressing this issue through the establishment of the Auerbach Family Endowed Chair at the Brown Cancer Center and the Dr. Renato LaRocca Endowed Chair in Oncology Social Work at the UofL Raymond A. Kent School of Social Work.
nary approach to care,” says Donald M. Miller, MD, PhD, Director of the Brown Cancer Center. Sy Pearson Auerbach, MD, an emeritus assistant clinical professor of orthopedic surgery at UofL says he decided to make this donation following many of his family members’ long struggles with cancer, including that of his late wife, Minx.
The holder of the Auerbach Family Chair will be a psychologist or psychiatrist who will research the impact of psychosocial cancer care and will develop a teaching program for medical students and others that focuses on the psychosocial needs of patients. The chair will be expected to strengthen partnerships with other support service organizations that provide cancer support for the whole family.
Oncology social workers serve as patient advocates, providing answers, guidance and support. They connect cancer patients and their families to community resources, including physicians, financial aid, local and government agencies and support groups. The Dr. Renato LaRocca Endowed Chair in Oncology Social Work will train social workers on the unique aspects of cancer care related issues.
“This endowment will allow us to recruit a world-class clinician who specializes in psychosocial aspects of cancer and who embraces our collaborative, multidiscipli-
“We don’t know of another (social work) program in the nation that focuses on cancer patients; we want to fill that void,” said Terry Singer, dean of the Kent
School of Social Work at UofL. “Through this chair, we will create a state-of-the-art training and research program targeted at this very vulnerable population.” Local cancer medicine specialist Renato LaRocca, MD, recognized the need for helping his patients navigating their way through the maze of emotions and health care systems associated with a cancer diagnosis. The result was his leading the effort to establish the nation’s first known endowed chair in oncology social work. “A cancer diagnosis immediately impacts patients and generates a tremendous amount of emotional and technical needs,” Dr. LaRocca said. “I don’t know of any formal program in the United States, let alone the world, that researches the topic or that specifically educates and trains social workers in this arena. There is a tremendous need in our community and beyond and I can’t think of a better place than UofL to lead the way in this new specialty area.” ■
CLINICAL & TRANSLATIONAL RESEARCH BUILDING GOES LIVE The new UofL Clinical and Translational Research Building (CTRB) on Hancock Street is humming with activity. More than 40 members of the Brown Cancer Center faculty, plus their students, assistants, technicians and other staff members are in the process of moving into the 285,000 square foot building. The CTRB is a flexible and adaptable state-of-the-art biomedical research facility and is designed to promote collaboration between scientists working in the building. At full occupancy, the $143 million facility will house as many as 650 principal investigators, junior investigators, research assistants, fellows and support staff. Initial programs will include: Structural Biology Program, Biostatistics and Core Facilities (Drs. Chaires, Cunningham, Ghim, Jenson, Lane, Rai, Rodu, Trent, Ye and Zacharias)
The CTRB is designed to meet LEED certification from the U.S. Green Building Council.
Prevention & Control Program including Pharmacology & Toxicology members, and Tumor Immunobiology Program (Drs. Bodduluri, Gercel-Taylor, Hein, Jala, Kakar, Kidd, Lillard, McGregor, Milam, Singh, States, Taylor, Yan and Zhang) Molecular Targets Program and UofL labs of the Owensboro faculty (Drs. Bates, Chesney, Clark, Clem, Donninger, Eaton, H. Hao, C. Li, Miller, Mitchell, Sedoris, Telang, Wattenberg and Zhou; and the researchers from Owensboro - Drs. Davis, Matoba, Palmer, and Sankar) FALL 2009
Breast cancer survivor Pam Reas visits the Brown Cancer Center's Mobile Mammography Unit, where her cancer was first detected.
mobile mammography EXPANDS CANCER CENTER’S REACH Every year since the Brown Cancer Center’s Mobile Mammography Unit began coming to her work, Pam Reas had had her annual mammogram performed during a quick break from her duties at Brown Forman. It had become routine; almost an afterthought, although her own mother’s breast cancer more than a decade before made her appreciate the convenience. In 2008, however, Ms. Reas received a call for follow-up to a suspicious reading of her annual screening. She reported to the cancer center for an ultrasound with biopsy, and learned that she did, indeed, have breast cancer. “The radiologist was very understanding,” Ms. Reas said. “I was so appreciative of the time she spent with me.”
Ms. Reas was one of more than 4,600 women screened by the state-of-the-art technology offered by the Mobile Mammography Unit in 2008. “In all, the Brown Cancer Center’s mammography program screens around 9,000 women a year,” explained Laura Fry, program director. “Our mammography outreach program accounts for well over half that number. We feel great about reaching women who may find it easy to postpone important screenings by making screenings more convenient. We feel even better about reaching women who may not otherwise have access or opportunity to have a regular mammogram.” The Mobile Mammography Unit is busy nearly every day of the year at locations throughout Louisville, surrounding counties, and beyond.
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BUSINESSES PROMOTE HEALTH In addition to the partnership with Brown Forman which facilitated Pam’s regular screening, the mobile mammography program has other corporate partner clients across the area who feel the program is a great way to promote employee health (see sidebar). "The Mobile Mammography Unit provided by the James Graham Brown Cancer Center has been a valuable tool in Papa John's ‘Campaign for Better Health,’ at our corporate campus,” said Annette Calhoun, senior director for benefits at Papa John's International, Inc. “We've been extremely satisfied with the mobile mammography unit and so have our team members. We book to capacity each time we schedule the unit to come on campus."
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In addition to the long list of Louisvillebased corporations that benefit from mobile mammography, the van makes regular trips to more rural-based businesses as well. American Greetings in Bardstown and Nationwide Uniforms in LaRue County have both enjoyed a long-standing partnership with the Brown Cancer Center.
COMMUNITY OUTREACH IS KEY TO REACHING UNDERSERVED POPULATIONS While annual trips to area businesses are a large part of the outreach program, it is the visits to area churches, rural health departments, extension offices and the state fair that make the most impact. “For many patients we see at community events, there is a significant distrust of the health care system and a fear of a hospital setting,” Laura Fry said. “Meeting patients on their ‘home turf’ provides a level of comfort that makes the screening process less intimidating.” As an additional comfort, the center brings interpreters to promote communication when visiting areas with a significant Hispanic population. “We try to do whatever we can to make sure that the women we see can ask questions and have them thoroughly answered,” Ms. Fry continued. The mammography outreach program works closely with the Louisville Metro Department of Health, Kentucky Cancer Program, and the Louisville/Jefferson County Partnership in Cancer Control to identify and connect with populations that may most benefit from mobile mammography. A new community outreach program that began last year under the leadership of Kentucky First Lady Jane Beshear is “Horses and Hope”. Along with a highly successful awareness campaign run through each of Kentucky’s race tracks during active meets, the Brown Cancer Center Mobile Mammography Unit provides mammograms on the “backside” of each track for horse industry workers and their families, many of whom are uninsured or underinsured.
BEST TECHNOLOGY AVAILABLE – ON WHEELS OR OFF The Brown’s Mobile Mammography Unit features the same advanced digital mammography services offered at the James Graham Brown Cancer Center’s Breast Care Center. In fact, the Brown Cancer Center’s unit was among the first in the country to offer digital imaging. This advanced technology provides dramatically improved image contrast in all tissue, even denser breasts. Patients benefit from reduced exposure times, improved imaging, and a more comfortable exam. In addition, the digital images are provided instantly to the technician and, when wireless is available, to the physicians of University Radiology Associates, eliminating time that may be wasted when available physicians must wait for films to be delivered.
EARLY DETECTION MEANS IMPROVED RESULTS Today, former cancer patient Pam Reas is enjoying a cancer-free life, although her follow-up treatment still requires two mammography screenings a year. “From the day we got my diagnosis – on our 20th wedding anniversary – I’ve felt that all the education and support I needed was provided at the Brown Cancer Center,” she said. “My husband, Greg, always felt welcomed, and we knew that any of my physicians would give us all the time we needed during clinic. “I am blessed to have a supportive husband, a wonderful daughter, Hailey, and fantastic extended family, friends and co-workers,” she continued. “I was also blessed by the support and care I received at the Brown; care that began in a van just outside my office.” ■
MOBILE MAMMOGRAPHY Corporate Partners American Greetings Anthem BA Merchant Services Brown Forman Horseshoe Casino CitiGroup Courier Journal General Electric Humana KCIW Kelloggs Larue County Extension Office Louisville Water Company Louisville Gas & Electric Metropolitan Sewer District National City Bank Nationwide Uniforms Papa Johns International Passport Insurance Company Publishers Printing SHPS Sud-Chemie Tyson Foods UofL Hospital UPS YUM! Brands Metro Council Sponsored Community Screenings Councilwoman Welch, Blessed Teresa Councilwoman Butler, Salvation Army Councilmen Benson, Kramer, and Engel, Glen Ridge Health Campus Councilwoman Green, Highland Park Councilwoman Flood, St. Luke Councilmen Fleming, Stuckel, and Downard, Lyndon City Hall Councilwoman Ward-Pugh, Clifton Center Councilman Blackwell, Beechland Baptist 2009 Community Screenings Hillebrand House Antioch Church Urban League Appointment w/ Life Church Junior League Crum's Lane Elementary Jewish Community Center Greencastle Baptist Forest Tabernacle Presbyterian Community Center Faith Presbyterian Church Presbyterian Seminary Mother's Day Screening Most Blessed Sacrament St. Bernadette St. Rita Caanan Christian Church Greater Friendship Baptist Boat People SOS Fern Creek Christian Church Berrytown Community Center Iroquois Shopping Center Sun Valley Community Center Race for the Cure St. Catherine Women of Vision (Central HS) SW YMCA J-town Baptist Church VFW Middletown First Gesthsemane Britthaven Shivley City Council Health Departments Green River Health Dept Louisville Metro Health Dept Portland FHC East Broadway FHC Fairdale FHC Southwest FHC Iroquois FHC Park DuValle Health Clinic Newburg Health Clinic Bullitt County Health Dept Lexington-Fayette Co. Health Dept. (Keeneland) Green River Health Dept. (Ellis Park)
new options AND TEAM APPROACH TO BREAST CANCER TREATMENT “She didn’t want her elderly mother to
James Graham Brown Cancer Center are
he was reunited with Dr. Brady,
know she had cancer; didn’t want her
combining groundbreaking research
completing the circle.
to worry,” Anthony Dragun, MD, said
with the latest technology to provide the
of one recent patient who decided to
best treatment options for each patient.
undergo a lumpectomy with partial
After an internship at Crozer-Chester Medical Center at Temple University,
breast irradiation using the new
It is also a perfect illustration of what
Dr. Dragun began a residency at the
multi-channel Contura balloon
inspired Dr. Dragun to pursue medicine,
Medical University of South Carolina
catheter. This method, which is available
and his specialty of radiation oncology in
(MUSC) where he met the visionary
regionally only at the James Graham
particular – the opportunity to be both
Joseph “Buddy” Jenrette, MD, chairman
Brown Cancer Center, reduced her
scientist and physician, and a passion
of radiation oncology. MUSC was one of
treatment time from six weeks to just
for finding minimally invasive ways to
five beta test sites for a new device – a
five days, and allowed her to get back
effectively treat cancer.
catheter used to administer radiation
to her normal routine quickly, sparing
directly to breast cancer tumor sites
her mother from worry.
following a lumpectomy.
This story is just one example of how
When he was 12 or 13, as he recalls,
Dr. Dragun, Anees Chagpar, MD, and
Dr. Dragun was afforded a unique
Research Drives Advances in Care
the other talented members of the
opportunity. His mother, who was a
Breast Care Multidisciplinary team at the
licensed dietician at the time, decided
Dr. Jenrette believed that this new
to go back to school and pursue her
approach, called Accelerated Partial
medical degree. One of her professors at
Breast Irradiation (APBI), would be
the Hahnemann University School of
a dramatic step toward shortening
Medicine in Philadelphia (now the
treatment times and minimizing risk
Drexel School of Medicine), Luther
to healthy tissue. He assigned
Brady, MD, was a pioneer in the
Dr. Dragun to collect the data, and,
emerging field of radiation oncology.
with participation from other MUSC colleagues, they began publishing
Dr. Brady’s passion for combining
science and clinical care inspired both mother and son. His influence,
APBI quickly proved effective, and
combined with that of Barbara Hoopes,
popular with patients. It provided
PhD, who mentored Dragun while he
results comparable to mastectomy and
completed his undergraduate work in
shortened treatment time from six weeks
molecular biology at Colgate University
to just five days – which was especially important for patients who had to travel long distances for treatment.
“The give-and-take is what makes the difference.” Anees Chagpar, MD Surgical Oncologist
The most recent innovation in APBI, called Contura, improves on previous technology by incorporating multiple channels into the catheter. This allows more precise control of dosage and
in New York, convinced Dragun that
direction, making the procedure
cancer would be his field. Not
available to women with smaller
surprisingly, he chose Hahnemann
breasts, tumors closer to the surface
University for his medical studies where
and other complications.
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â€œAs a medical professional, it is my responsibility to be on the front lines; to educate the people who rely on me; to make sure they know about the latest and most effective therapies.â€? Anthony E. Dragan, MD Radiation Oncologist
Team Provides Critical Eye and Human Touch
important considerations. What is the
difference,” Dr. Chagpar, a surgical
patient’s family situation? Do they have
oncologist, notes. “It is far more
the support they need to successfully
productive to gather a team around a
While the technology is impressive, the
complete a particular course of
table to discuss every situation than it is
team approach to treatment is the real
to pass charts around a building or try to talk to peers on the phone.”
key for patients. At a recent meeting of the Breast Care Multidisciplinary team,
By asking these less-conventional
more than a dozen people with a variety
questions and bringing a wide variety
As the primary surgeon on the team,
of specialties and expertise discussed
of expertise to the table, the team is able
Dr. Chagpar is often the first to meet
each case. They considered the obvious –
to make better determinations about
with a patient. She sees her role as that
medical histories, pathology and tumor
of counselor and facilitator.
“The give-and-take is what makes the
“When I see a patient, I discuss all of the
sites, for example; but they also talked about the less obvious but equally
THE BREAST CARE MULTIDISCIPLINARY TEAM INCLUDES:
Anees Chagpar, MD
Anthony Dragun, MD
Dharamvir Jain,MD Carolina Salvador, MD
Sunati Sahoo, MD
Lane Roland, MD Sara Mizuguchi, MD
Jessica Lehman, PhD
Rebecca Tamas, MD
Barb Kruse, RN, OCN, M.Ed
Breast Care Nurse:
Ellen Galbraith, RN
Barb Steele, RN
Amy Thorn, MSW
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surgical options with her. We discuss
“The accelerated treatment time seems
solutions. Soon, they expect to have even
the advantages and disadvantages of
to be the driver for many people,”
more advanced therapies available. And
different choices,” she said. “The
Dr. Dragun notes. “Patients who would
when they do, the process will continue.
management of breast cancer, however,
have chosen a radical mastectomy before
”As a medical professional, it is my
goes beyond surgery alone. Patients
because they couldn’t spend months
responsibility to be on the front lines,
benefit from the culmination of the
traveling back and forth for treatment
to educate the people who rely on me,
expertise of a wide array of specialists
now have another option. We are very
to make sure they know about the
that make up the multidisciplinary team
happy that we can make that possible.”
latest and most effective therapies,”
working together with her to achieve optimal results.”
Dr. Dragun says. “My goal, and the While Contura is a breakthrough,
goal of the team, is to help every patient
Dr. Dragun, Dr. Chagpar and the rest of
understand all of their options and to
For many breast cancer patients, Contura
the Breast Care Multidisciplinary team
guide them toward the one that best
seems to be the answer.
are constantly working toward better
suits their situation.” ■
the elite 8 SEVEN YEARS AFTER THE FIRST CLINIC OPENED, THE BROWN CANCER CENTER LAUNCHES ITS EIGHTH MULTIDISCIPLINARY CLINIC AND LOOKS EXPECTANTLY TO THE FUTURE “In our clinics, physicians and health professionals work together, shelve egos, and consult with one another to develop an individual plan that best suits each patient.”
“We launched on September 6, 2002,” multidisciplinary clinic coordinator Liz Wilson remembers. After several months of planning and still a bit of apprehension, the Brown Cancer Center Head and Neck Multidisciplinary Clinic welcomed its first patients on a Friday morning. Seven years later, the staff remembers that day as one that changed the course of the development of clinical care at the cancer center forever. “It was a groundbreaking approach for an ENT surgeon, a radiation oncologist, a medical oncologist, and a dental oncologist along with a speech pathologist, social workers and nurses to review cases and plan and monitor treatment strategies together,” Ms. Wilson said. “Seven years and 1,200 patients later, we are a finely oiled machine that can fully concentrate on the patient rather than the process.”
Barb Kruse Associate Director of Multidisciplinary Clinics
Today, the team approach is the gold standard of care at the Brown Cancer Center, which has developed dedicated multidisciplinary teams for the treatment of breast, gastrointestinal, genitourinary, gynecologic, head and neck, lung, melanoma, and, as of 2009, brain and spine cancers. (See “Brain Tumor Clinic Opens at Brown” on page 14.) While each clinic operates independently and with variations on the theme, all value a team approach to the diagnosis, treatment, and post-treatment recovery from cancer. “In a community medicine setting, a cancer patient’s treatment plan will likely be navigated by whichever physician the patient sees first,” explains Barb Kruse, associate director of multidisciplinary clinics. “In our clinics, physicians and health professionals work together, shelve egos, and consult with one another to develop an individual plan that best suits each patient. “The culture change has been really quite extraordinary.”
New Culture – New Identity According to Ms. Kruse, the multidisciplinary system has opened doors and created opportunities that no one anticipated in 2002. “We have grown from competing with community medicine providers to competing with other top-tier regional cancer centers such as Vanderbilt and Indiana University,” she said. “We are a A publication of the
leader in counseling patients seeking a second opinion. “The physicians and health professionals on each team feel ownership in the team and in the plan for each patient. I believe that feeling of commitment is evident to patients who come through our doors.” In fact, a recent review of second opinions offered for breast cancer patients showed that more than
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Dedicated clinical research nurses, such as Charita Weathers and Stacy Baum, work with multidisciplinary teams to match qualifying patient volunteers to the latest clinical trials. 80 percent of patients entering the system for a second opinion chose to receive care at the cancer center’s Breast Care Clinic. That kind of ownership is present in each of the center’s clinics. “Each of our multidisciplinary teams has a unique and dedicated group of physicians,” said Brown Cancer Center Director Donald Miller, MD, PhD. “Each team has a dedicated radiologist, pathologist, and oncologist. We’ve added three full-time social workers to ensure quality of service to each team. We’ve also recruited a psychiatrist who conferences each month with our nurse coordinators to discuss any patient psychiatric needs. “The clinical culture has shifted to become highly customer-service oriented, which is a more pleasant environment for our professionals to work in.” The cross-specialty cooperation has also been a benefit to health professionals throughout the community and beyond. The structure has supported the accreditation of continuing education
credit for various team meetings, and several teams have annual or biannual educational conferences that feature not only Brown Cancer Center faculty, but cancer leaders from around the world. These conferences give the Brown team the opportunity to learn from and with colleagues from across the region, strengthening ties and potential referral networks. Clinical research is active and vibrant throughout the clinics. “The multidisciplinary setting makes our clinical research better,” Dr. Miller said. “Our clinical researchers have vibrant and active clinical settings in which to work creatively.” Dedicated clinical trial research nurses serve in each clinic conference and match qualifying patients with available trials in consultation with the entire team. This immediate consideration of emerging treatment advances is an obvious benefit to Brown Cancer Center patients.
Clinical Evolution The research and education-rich environment also allows for clinics to
grow and evolve in their approach to best serve patients with the latest developments. For instance, the Head and Neck Clinic has grown to heavily consider, along with eradication of the cancer, the quality-of-life impact of each viable treatment option. “Head and neck cancers and their traditional treatments can be disfiguring and can drastically affect communication and self-care,” Liz Wilson explains. “Working with each patient, we discuss these issues and work toward organ preservation whenever possible, without losing focus on the extension of a quality life.” This slight shift in focus has resulted in promising results, with low rates of cancer recurrence and high marks for quality of life. “We continue to work with our patients after cancer treatment has ended, as many need a variety of therapies to achieve full recovery,” Ms. Wilson continues. “The continuity of care that FALL 2009
ELITE 8 continued...
Members of the Genitourinary Multidisciplinary Clinic, led by Dr. Damian Laber (center), discuss treatment options.
includes speech pathologists and others urges everyone on the team to look at each case through both a short and a long lens.”
Looking Ahead Never one to rest on past accomplishments, Dr. Miller continues to look forward to the next stages of multidisciplinary care. “We are working with members from across our clinic teams to work out how they can work together and learn from each other more effectively even as each team continues to hone its own work,” he said. “In addition, we will continue to look across the spectrum of cancers and the unique needs of our regional health landscape to identify new multidisciplinary opportunities. ■
BRAIN TUMOR CLINIC OPENS AT BROWN The latest addition to the Brown Cancer Center multidisciplinary clinical service is the Brain Tumor Clinic, which saw its first patients in the summer of 2009. According to Edward C. Halperin, MD, clinic radiation oncologist and dean of the UofL School of Medicine, Kentucky’s dire health statistics called for a specialized clinic for tumors of the brain and spine. “Nationally, roughly half of all brain tumors are metastasized cancers from the lung, breast or melanoma,” Dr. Halperin explains. “Kentucky has the highest adult smoking rate in the country, along with the lowest lung cancer survival and high rates of both breast cancer and melanomas.” Dr. Halperin explains that, in Kentucky, brain tumors metastasized from other cancers outnumber primary brain tumors ten to one, accounting for 30 percent of cancer-related deaths. “With the focused care of a multidisciplinary team, we can make a difference in the quality and longevity of life for many patients from across the region,” he said.
A publication of the
Like other Brown Cancer Center multidisciplinary teams, the Brain Tumor Clinic weaves together the expertise of health professionals from across the spectrum, including neurosurgery, neurology, radiation oncology, medical oncology, neuroradiology, pathology, nursing, social work, and psychology. In all, approximately 15 health care professionals are actively involved in reviewing and mapping a treatment plan for each case. Patients may attend conference meetings — increasing their own education about their diagnosis, and giving the team the opportunity to work with the patient in developing a strategy. “A patient may check in for an initial work-up at 9 a.m., meet with the conference at 11 a.m., and have the group decision by early afternoon,” Halperin explained. “By the time a patient leaves the clinic, he or she will have had the opportunity to meet and ask questions of physicians and health professionals on the team without having to make multiple trips or appointments.” The Brain Tumor Clinic, still in its early months, is seeing a handful of patients. However, Dr. Halperin’s experience as a member of the Duke University Brain Tumor Clinic leads him to expect the clinic to grow to roughly 150 new cases per year when it reaches maturity.
J A M E S G R A H A M BROWN CANCER CENTER
Cancer Survivor Rebecca Hinsberger
An Alaskan woman with a rare eye cancer; a baby bottle nipple with the tip filled with lead; and the personal touch of the UofL Department of Radiation Oncology. All these things combined to equal another James Graham Brown Cancer Center success story. After drug therapy at Duke University failed to help, Rebecca Hinsberger, who has lived for thirty years in Alaska, called the James Graham Brown Cancer Center. She had heard of the specialized work in radiation oncology performed there by UofL School of Medicine Dean Edward Halperin, MD. A bacterial infection in Ms. Hinsberger’s eyes had turned into conjunctival lymphoma. The tumors covered some of the white of her eyes, folding onto the inside of the eyelids. “Every case is different,” Dr. Halperin explains. “The tumor is never in exactly the same location. The stakes are very high. Shielding is very complicated. If the lenses are exposed to even a small amount of radiation it increases the chances of cataract formation.” “I went to two other radiation oncologists, but they didn’t have special equipment to protect my eyes,” Ms. Hinsberger notes. At the Brown Cancer Center, lead shields are made to the specifications of each patient. For the eye lens itself, Dr. Halperin has used a drinking straw filled with lead positioned above the eye. However, concerned about the rigid nature of the straw, Brown Cancer Center Chief of Physics Michael Mills, PhD, used his imagination to create a new approach. “Occasionally we have to be clever,” says Dr. Mills. “I stopped at Walgreens on the way home from work and looked over the selection of baby bottle nipples.” He learned that baby bottle nipples come in an assortment of sizes and, as it happened, the largest available was what was needed. He filled the tip of the nipple he had chosen with lead, and, after some rigorous testing, found that the nipple protected just the right amount of tissue.
Watch Rebecca’s story at w w w. b r o w n c a n c e r c e n t e r. o r g
Dean Halperin says using a nipple also has a safety benefit. “If the patient were to be startled, or jump, the nipple’s pliability allows it to give as needed.” After two visits to Louisville for treatment, Ms. Hinsberger’s eyesight is intact and the cancer appears to be gone.
attention paid to this case, which was the focus of a report on WAVE-3, the Louisville NBC affiliate, and was also picked up in more than a dozen other cities around the country. “We do creative little things like this all the time,” Dr. Mills said with a smile. ■
Although thrilled with the results, Dr. Mills was a little amused by the FALL 2009
JAMES GRAHAM BROWN CANCER CENTER
NON-PROFIT ORG US POSTAGE PAID LOUISVILLE, KY PERMIT NO 879
529 South Jackson Street Louisville, KY 40202
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mark your calendar... 10/20
Mobile Mammography screening - YMCA - Southwest Family Branch
Mobile Mammography screening - Baptist Church of Jeffersontown
Mobile Mammography screening - The Clifton Center
Horses and Hope special event - Keeneland
Minds Behind the Cure Brown Cancer Center Tour - Clinical
Horses and Hope special event - Churchill Downs
WHAT MAKES THE BROWN CANCER CENTER DIFFERENT? The James Graham Brown Cancer Center at the University of Louisville is an academic cancer center. Our physician-scientists are on the forefront of cancer treatment discoveries, and they bring this knowledge to patient treatment and care. Our mission is to generate new knowledge relating to the nature of cancer, and to create new and more effective approaches to prevention, diagnosis and therapy, while delivering medical advances with compassion and respect to cancer patients throughout our region. How can I donate?
Horses and Hope Mobile Mammography screening Churchill Downs
Horses and Hope Mobile Mammography screening - Turfway
Horses and Hope special event - Churchill Downs - Oaks
You may make a tax-deductible gift by visiting www.browncancercenter.org. To learn more about how you can support the work of the James Graham Brown Cancer Center, please contact Kelly Wesley, Director of Development, at 502-562-4642 or email@example.com.
For more information about any of these events, please call 502-562-8021. Or, visit www.browncancercenter.org for additional information regarding all upcoming events and classes at the Mint Jubilee Cancer Resource Center.
Published on Sep 1, 2009
Published on Sep 1, 2009
Nearly every day headlines across the country use words like “downturn,” “freeze,” “slowdown,” and “reduction” to describe industries from m...