Cancer Annual Report 2016

UMASS MEMORIAL MEDICAL CENTER

2016 ANNUAL REPORT

OF THE CANCER COMMITTEE

An Inspiring Team Dedicated to Cancer Care

By William Walsh, MD, Interim Chair, Cancer Committee Dear Colleagues: Without question, a cancer diagnosis is one of the most difficult challenges in life.

Suddenly a person is coping with a new normal, filled with scans, appointments and tests. A new language almost seems to take hold, as a patient speaks a vocabulary peppered with medical terms and names of complex medications. Even with the most supportive network of family and friends, a cancer diagnosis is both frightening and isolating.

However, the cancer patients at UMass Memorial are not alone. From that very first concern, when something suspect requires further testing, through diagnosis, treatment and follow-up, our patients are immediately supported by an incredible team of medical professionals. I am proud to be part of this inspiring team, and to share some of their stories in this year’s Annual Report of the Cancer Committee.

Lung cancer has emerged in past years as one of the most common – and most deadly – cancers. Our Annual Report illustrates how the UMass Memorial is on the front lines with diagnosing and treating this aggressive cancer.

On these pages you will learn about the work of our Lung Cancer Team, which is on the leading edge of a new era in lung cancer treatments. Until recently, effective treatment options for patients with advanced lung cancer were extremely limited, but the advance of new, immune-based therapies are offering hope. Our patients have access to the latest FDA-approved immunotherapies as well as to promising novel treatments through participation in clinical trials, including one offering hope for patients with metastatic squamous non-small cell lung cancer.

You will also read about advances in oral chemotherapy, an emerging treatment that gives patients better prognosis and an improved quality of life and has revolutionized the treatment of lung cancer. Oral therapies are more targeted compared to IV chemotherapy, and our team of dedicated hematologists-oncologists lead the way in working with these advance treatments.

This past year saw several hallmark accomplishments by our Radiation Oncology Team, which treats patients throughout our system. This adept team works with four TrueBeam radiation therapy systems, giving our physicians the ability to image before and even during treatment, providing sophisticated, accurate, stateof-the-art care, precisely designed for each patient. They were also accredited by the American College of Radiology for their excellence throughout our system.

Just as critical as those on the front lines fighting cancer are those on our team who work to help detect, and wherever possible, prevent cancer.

Read about the interdisciplinary collaboration by medical professionals from radiology, pulmonology and thoracic surgery, and their efforts in establishing the region’s most comprehensive lung cancer screening program. A key component is the low-dose CT scan, one of the single most effective screening tools available in detecting lung cancer in its very early stages, when the most treatment options are available. I also encourage you to read about the Provencare Lung Cancer pilot program. We are only one of only eight locations in the United States chosen to take part in this groundbreaking program.

I am proud too of the work done by our team in championing cancer prevention. This past year a very dedicated group from gynecology-oncology and pediatric infectious disease came together for an extensive and focused effort to educate physicians, parents and patients about the importance of the HPV vaccine. Once seen as a vaccine only for girls against the human papilloma virus, this effective two-dose series is now recommended for all boys and girls as part of the Age 11 and 12 vaccination platform, and is one of the single most important steps in preventing cancers associated with the HPV virus.

As we all well know, in addition to emotional and physical stress, cancer causes financial difficulties for patients and families. Our dedicated financial services team combines knowledge, tact and financial acumen, identifying resources and insurance coverage to ease financial difficulties, so that patients can focus on getting better.

This year saw changes in our leadership team, as physician Robert Quinlan, MD, retired from our Comprehensive Breast Center. Read how his colleagues honor his work and look to the future.

Finally, a short while ago we proudly announced our affiliation with the Dana-Farber Cancer Institute, proudly making us the first academic medical center to join the Dana-Farber Cancer Care Collaborative. The agreement, for adult medical oncology services, formalizes the relationship between oncologists from the two hospitals; provides patients with especially complex cancers expedited access to Dana-Farber specialists; and enhances specialized educational, training and consultation opportunities for UMass Memorial Medical Center providers.

We are proud to have the support of Dana-Farber, joining our team and working with us in providing our patients with the most optimal outcome.

These are just a few of the remarkable stories happening here every day. We are proud that patients trust us with their cancer care and to be part of their team.

Sincerely, William Walsh, MD Interim Clinical Chief, Division of Hematology/Oncology Interim Medical Director, Clinical Research Office Interim Director, Cancer Center Interim Chair, Cancer Committee UMass Memorial Medical Center Clinical Associate Professor of Medicine University of Massachusetts Medical School

Table of Contents An Inspiring Team Dedicated to Cancer Care

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Immunotherapy: A New Era in Lung Cancer Treatment . . .............................................................................................. 4 Clinical Trial Tests Immunotherapy as First-Line Treatment Versus Metastatic Lung Cancer . . ................................. 5 Oral Chemotherapy Gives Cancer Patients Better Prognoses, Improved Quality of Life ......................................... 7 Financial Counseling: A Vital Part of Cancer Care at UMass Memorial ..................................................................... 7 Dana-Farber Cancer Care Collaborative ........................................................................................................................... 7 System-Wide, Multidisciplinary Collaboration: The Key to Lung Cancer Screening Success .. ................................ 8 The Interdisciplinary Collaborative for the Enhancement of Patient Care in Lung Cancer (ICEPaC) . . ................... 9 UMass Memorial Promotes HPV Vaccine Use to Prevent Cancer in Women and Men ........................................ 10 A Changing of the Guard at the Comprehensive Breast Center .............................................................................. 11 Radiation Oncology: A System-Wide Commitment to Advanced Technology and Collaborative Care ............ 12 National Accreditations .. ................................................................................................................................................... 14 A Far-reaching Network of Community Cancer Care ................................................................................................. 15

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Immunotherapy: A New Era in Lung Cancer Treatment Until recently, effective treatments for patients with advanced lung cancer were extremely limited. Today, however, new immune-based therapies—substances that treat disease by stimulating the body’s own immune response to attack the cancer—are offering new hope.

“This makes pembrolizumab available to an expanded subset of patients,” Dr. Walsh says. “If 50 percent or more of their tumor cells make PD-L1, evidence shows that immunotherapy is better than chemotherapy as a first-line treatment.

“And 90 percent of all patients who take the antiPD1 drugs tolerate them well, without the side-effects of nausea, vomiting and low blood counts associated with chemotherapy,” he adds.

The Cancer Center at UMass Memorial Medical Center remains on the leading edge of this exciting new era in lung cancer treatment, giving patients access to the latest FDA-approved immunotherapies as well as to promising novel treatments through participation in clinical trials.

Notably, UMass Memorial had several patients enrolled in the trial that led to pembrolizumab’s initial and expanded approvals.

“And 90 percent of all patients who take the anti-PD1 drugs tolerate them well, without the side-effects of nausea, vomiting and low blood counts associated with chemotherapy.”

Last year, in what many cancer experts hail as landmark events, two new immunotherapy drugs—nivolumab (Opdivo®) and pembrolizumab (Keytruda®)—came to market for treating lung cancer. These drugs are referred to as anti-PD1 checkpoint inhibitors, and they work by “taking the brakes off” the immune system, triggering it to mount a stronger and more effective attack against cancer.

William Walsh, MD, interim clinical chief of the Division of Hematology/Oncology, is leading the efforts to give patients access to the latest FDA-approved immunotherapies.

How do doctors determine who is a candidate for immunotherapy?

Nivolumab and pembrolizumab are used to treat nonsmall cell lung cancer (NSCLC) in patients whose cancer has progressed after first-line treatment with traditional platinum-based chemotherapy, notes board-certified hematologist-oncologist William Walsh, MD.

“Pathology plays an important role since we analyze the tumor sample obtained from a biopsy,” says Benjamin Chen, MD, PhD, a surgical pathologist and director of the Flow Cytometry Lab at UMass Memorial, noting that the hospital has invested in new equipment to perform the specialized PD-L1 testing.

“We can determine the expression level of PD-L1 in the tumor, and this will help determine whether the patient is a candidate for immunotherapy,” he adds.

Then, just this past October, the FDA approved a third anti-PD1 checkpoint inhibitor, atezolizumab (Tecentriq®), also for treatment of NSCLC that has progressed during or after first-line chemotherapy.

In addition, the agency expanded the approval of pembrolizumab for the first-line treatment of patients with metastatic NSCLC whose tumors overexpress the protein PD-L1, a key molecular partner to PD1 forming an immunologic interaction that is the target of anti-PD1 therapy.

Immunotherapy first gained traction in the treatment of advanced melanoma—former President Jimmy Carter’s favorable response to treatment with pembrolizumab was highly publicized. Today, however, immunotherapy is being tested against a growing array of cancers including bladder, kidney, 4

Clinical Trial Tests Immunotherapy as First-Line Treatment Versus Metastatic Lung Cancer “Immunotherapy is now finding its way to being used in conjunction with chemotherapy as a firstline treatment against metastatic lung cancer,” says Barbara Butler, clinical research coordinator at UMass Memorial Medical Center.

Case in point: A clinical trial now underway in which chemotherapy is being used with and without pembrolizumab (Keytruda®) in patients with metastatic squamous non-small cell lung cancer.

Benjamin Chen, MD, PhD, is a surgical pathologist and director of the Flow Cytometry Lab, which performs specialized PD-L1 testing.

This clinical trial—which is currently enrolling eligible patients—is sponsored by Merck, makers of pembrolizumab. This immunotherapy drug is an antiPD1 checkpoint inhibitor; it works by triggering the body’s immune system to attack cancer. It received FDA approval in 2015 for use in patients whose cancer has progressed after first-line treatment with traditional platinum-based chemotherapy.

head and neck, and lymphoma, in addition to lung cancer. And there are literally hundreds of clinical trials underway—a good number of them here at UMass Memorial.

In this trial, however, pembrolizumab is being tested as a first-line treatment. Participants are randomized to one of two study arms, receiving either pembrolizumab or a saline solution by intravenous infusion together with the standard chemotherapy for this type of lung cancer on Day 1 of each 21-day cycle.

“These clinical trials are testing new drugs as well as combining older and newer treatments to see if we can safely get better response and survival rates.”

The main hypotheses of the study are that treatment with pembrolizumab prolongs progression-free survival and overall survival for patients with metastatic squamous non-small cell lung cancer.

“Immunotherapy drugs are revolutionizing how these patients respond, especially at later stages of lung cancer, and without the toxicity profiles we see with chemo and radiation,” Butler says. “We not only offer access to these new drugs but also to trials that are testing them in novel ways.”

“We have extensive clinical trials going on here, including at least seven for lung cancer alone,” Dr. Walsh says (see related article on this page for more information). “These trials are testing new drugs as well as combining older and newer treatments to see if we can safely get better response and survival rates.”

For more information about this and other lung cancer clinical trials, please contact the UMass Cancer Research office at 508-856-3216, or email cancer. research@umassmed.edu

“We really are on the cusp of a whole new era in cancer treatment that cuts across a range of malignancies and, at the same time, focuses on improving personalized medicine,” Dr. Chen adds.

Additional information about the clinical trials available at UMass Memorial is available at www.umassmed. edu/ccoe/Cancer-Center-Clinical-Trials

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Oral Chemotherapy Gives Cancer Patients Better Prognoses, Improved Quality of Life Thanks to advances in cancer therapies, a growing number of patients now can take chemotherapy drugs in pill or liquid form instead of via traditional intravenous (IV) infusion.

“Over the last decade, new oral therapies for treating several different cancers, including lung, colon, kidney, and thyroid among other malignancies, have become available,” explains Nahida Islam, MD, a board-certified hematologist-oncologist with UMass Memorial Medical Center. Dr. Islam, like many of those on the cancer team, practices at the Cancer Center in Worcester as well as at the UMass Memorial Cancer Center at Marlborough Hospital. “The advantages of this approach are significant.”

Hematologist-oncologist Madhavi Toke, MD

“The side-effect profile and efficacy of this oral chemotherapy is far superior to that of traditional IV chemotherapy,” says Madhavi Toke, MD, a boardcertified hematologist-oncologist who practices at UMass Memorial Medical Center and UMass Memorial – HealthAlliance Hospital, another member of the UMass Memorial Health Care system.

Chief among them is that the oral therapies are more targeted compared to IV chemotherapy. Targeted therapies are drugs that identify and attack specific types of cancer cells with less harm to normal cells.

“In fact, oral chemotherapy really has revolutionized the treatment of lung cancer,” Dr. Islam notes. “We now know that a certain percentage of patients, whether or not they smoked, have specific mutations that we can target with an oral form of chemotherapy.”

“As result, patients are able to tolerate the medication more easily, with fewer, more easily treatable sideeffects,” she continues. “And, most importantly, they have a better prognosis and better survival rates.”

To determine if targeted oral chemotherapy is the appropriate treatment for an individual patient’s cancer, experts at UMass Memorial perform what’s called molecular profiling. This is an advanced method of testing the genetic characteristics as well as any unique biomarkers of each person’s tumor. The information this reveals is used to identify and create targeted therapies designed to work best against a specific cancer tumor profile.

“Molecular profiling is arguably the biggest change we’ve seen in oncology in the last five years,” Dr. Toke notes. “And our molecular profiling capability is one of the best in New England.”

Hematologist-oncologist Nahida Islam, MD

Notably, UMass Memorial is involved in ongoing clinical trials of new oral chemotherapy agents, giving cancer patients in Central Massachusetts convenient access to novel treatments as well as the most advanced FDA-approved medications available at any major cancer center.

Another major advantage of oral chemotherapy is that it allows patients to have a relatively normal quality of life while undergoing cancer treatments.

“With infusion chemotherapy, patients must sit in that infusion chair for hours, and spend a lot of time in clinic having blood work,” says Dr. Islam. “Oral chemotherapy allows them to spend most of their time outside the hospital setting, leading a normal life, since they can take the pills at home.”

“We also have a specialty pharmacy that dispenses oral agents,” Dr. Toke notes. “And a financial services expert who works with patients’ insurance plans to ensure that these medications are covered (see related story on page 7), which is a huge relief for patients.”

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Financial Counseling: A Vital Part of Cancer Care at UMass Memorial Dealing with a cancer diagnosis and treatment is difficult enough. Pile on the stress of figuring out how to pay for care—with or without insurance coverage— and it can be downright overwhelming.

For patients at UMass Memorial Medical Center in this situation, Katherine “Kathy” Orawsky has their back.

She blends extensive knowledge and compassion in her role as a financial coordinator, helping to ease the burden during what is arguably one of life’s most difficult times.

“I just want to reassure them that we’ll help in whatever way we can.”

Kathy Orawsky provides cancer patients with important financial guidance.

The issues Orawsky addresses range from how to deal with high out-of-pocket or deductible costs or being in the Medicare “donut hole” for prescription coverage, to setting up payment plans, to getting qualified patients without insurance enrolled in the state’s MassHealth plan or other programs that provide financial assistance. She also follows up on referrals—for chemotherapy, for example—to ensure they are authorized.

“I check to make sure each patient coming into our clinic has insurance coverage and that we’re a contracted provider,” Orawsky explains. “If prior authorization is needed, I’ll help obtain it.”

From there, Orawsky provides an exceptional level of personalized guidance to help cancer patients navigate the complexities of their coverage or, if they don’t have insurance, to connect them with appropriate resources. To access her help, patients simply need to let a Cancer Center nurse or social worker know they’re having a financial issue.

“It’s such a stressful time for people,” Orawsky says. “I just want to reassure them that we’ll help in whatever way we can.”

Proud member of Dana-Farber Cancer Care Collaborative 855-UMASS-MD On March 10, 2017, the Massachusetts Health Policy Commission approved the affiliation between the DanaFarber Cancer Institute and UMass Memorial Medical Center. The agreement, for adult medical oncology, formalizes the relationship between our two hospitals and makes us the first academic medical center to join the Dana-Farber Cancer Care Collaborative. The collaboration will provide our patients with especially complex cancers expedited access to Dana-Farber specialists and also enhance specialized educational, training and consultation opportunities for Medical Center caregivers.

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System-Wide, Multidisciplinary Collaboration: The Key to Lung Cancer Screening Success

Max Rosen, MD

Karl Fabian Uy, MD

UMass Memorial Health Care launched a systemwide lung cancer screening program for current and former smokers on October 1, 2016. While UMass Memorial has offered lung cancer screenings for several years at the Medical Center and member hospitals, this comprehensive new program provides more convenience and integrated expertise from a multidisciplinary team of specialists.

Paulo Oliveira, MD

The specialists involved in the screening program include diagnostic radiologists like Dr. Dill as well as interventional pulmonologists and thoracic surgeons.

“I can’t say enough about how important this multidisciplinary team approach is,” concurs Paulo Oliveira, MD, director of Interventional Pulmonary Procedures and medical director, Respiratory Care.

“We provide one location for patients to get input from multiple specialists, all in one day. It’s one-stop shopping so the patient doesn’t have to see multiple specialists over time.”

“We’ve designed the most patient-centric lung cancer screening program that involves multidisciplinary input from start to finish.”

“This provides two major advantages to the patient,” says Karl Fabian L. Uy, MD, chief of the Division of Thoracic Surgery. “First, they get different points of view to answer the question of what’s the best next step. Second, it makes the process go faster, speeding the time to treatment.”

“This is really important because there might be different options for the best way to work up a patient and even what treatment options there are,” explains Max Rosen, MD, MPH, FACR, chair of the Department of Radiology. “With a multidisciplinary team approach, you have a group looking at the problem and coming to consensus at the outset.”

The program evolved from the U.S. Preventive Services Task Force recommendation that individuals at high risk for lung cancer undergo annual screening using low-dose CT scans. This recommendation was based on findings from the National Cancer Institute’s National Lung Screening Trial, published in 2012, showing that CT screening reduced lung cancer deaths among current and former heavy smokers by 20 percent compared to standard chest x-rays.

“Plus, patients can go to any of our community sites for their scan, but it’s read and, if abnormal, discussed centrally,” he adds. “This combines convenience with the centralized resources of a major academic medical center.”

“It’s essential to have a team approach for this patient population,” says Karin Dill, MD, chief of the Division of Cardiovascular and Thoracic Imaging, who has played a key role in organizing the system-wide program at UMass Memorial. “There are multiple specialists involved in diagnosing and treating lung cancer, and we need to work together to provide the full circle of care.”

“Bottom line, we’ve designed the most patientcentric lung cancer screening program that involves multidisciplinary input from start to finish,” Dr. Uy adds.

Dr. Dill points out that helping current smokers kick the habit is also an integral part of the program.

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The Interdisciplinary Collaborative for the Enhancement of Patient Care in Lung Cancer (ICEPaC)

“The screening program isn’t to reassure smokers they can continue smoking if they have a clean scan,” she stresses. “We have resources to support them in quitting, which is the number-one way to prevent lung cancer.

“It’s also important that, once they enroll in the screening program, patients continue to have followup scans at recommended intervals,” she continues.

“Lung cancer can also occur after someone stops smoking, but the sooner we can catch it, the better survival rates we see.”

For more information: UMass Memorial provides low-dose CT scans at four locations. Each facility is certified by the American College of Radiology (ACR) as a “Designated Lung Screening Center” as well as being linked to the National Lung Screening Data Registry.

Karl Fabian Uy, MD

CLINTON HOSPITAL 201 Highland Street, Clinton Hours: 24/7

UMass Memorial Medical Center is one of eight institutions across the country chosen to pilot a program of the Commission on Cancer called Provencare Lung Cancer. This project seeks to study the standardization of care for lung cancer patients across their entire experience, employing the principles of evidence-based medicine, reliability science, and patient-centered care. This project is being undertaken by our Interdisciplinary Collaborative for the Enhancement of Patient Care in Lung Cancer (ICEPaC), a joint effort of Hematology-Oncology, Interventional Pulmonology, Palliative Care, Radiation Oncology and Thoracic Surgery, all working together and leading the effort on behalf of our Cancer Center.

The program was launched in July 2016 and will run for approximately three years. The results of this study will inform the Commission on Cancer of the feasibility of standardization of lung cancer care in all Commission on Cancer-accredited institutions in the United States. The Commission on Cancer is a Quality Program of the American College of Surgeons. In December 2015, our Cancer Center once again earned the prestigious distinction of a full three-year accreditation with five commendations from the Commission on Cancer. For more information about the Provencare Lung Cancer pilot program, contact Karl Fabian Uy, MD, chief of the Division of Thoracic Surgery, at Karl.uy@umassmemorial.org

HEALTHALLIANCE HOSPITAL Leominster Campus 60 Hospital Road, Leominster Hours: 24/7 MARLBOROUGH HOSPITAL 157 Union Street, Marlborough Hours: Monday-Friday 7am - 7pm

Saturday 7am - 4pm MEMORIAL CAMPUS CT & Diagnostic Imaging 119 Belmont Street, Worcester Hours: 24/7

To schedule an appointment: Patients: For more information about our low-dose lung CT scan, call 855-UMASS-MD. Medical Professionals: Low-dose lung CT exams can be ordered through Allscripts with the exam code CTLUNGSCR or using the Radiology Lung Screening Request Form.

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UMass Memorial Promotes HPV Vaccine Use to Prevent Cancer in Women and Men “It’s the only vaccine we have to prevent cancer,” says board-certified gynecologic oncologist Sarah Hughes, MD, “so it’s a unique opportunity to prevent both precancerous changes and cancers in women and men that can have horrible effects on lifestyle, reproduction and life itself.”

the Massachusetts chapter of the American Academy of Pediatrics on its immunization initiative, visiting physicians around the state to provide continuing medical education about the safety and effectiveness of this vaccine.

“The most important message is that we are vaccinating against cancer.”

Dr. Hughes is referring to the human papilloma virus (HPV) vaccine, which studies show could help prevent tens of thousands of cases of HPV-related cancers.

These include cervical, vaginal, vulvar, head and neck, anal, and penile cancers. These cancers kill more than 30,000 Americans every year. Head and neck cancers caused by HPV are one of only several types of cancer that are increasing in frequency in the US. The HPV vaccine is a valuable tool that can prevent up to 90% of all these cancers.

Massachusetts is doing better than the rest of the United States, due in part to a state law that mandates coverage of all recommended childhood vaccines— the HPV vaccine among them—removing a significant financial barrier since the vaccine costs $150 per shot.

Through this legislation, Massachusetts has a fund that provides all CDC-recommended vaccines at no charge for children through age 18 years of age. Most commercial insurance companies cover the cost of the HPV vaccines series, but this fund ensures that every child is covered.

The first HPV vaccine was introduced in 2006, and at the time was only recommended for girls between the ages 11 and 12, administered in three separate doses spread over 6 months. In 2009, Gardasil was recommended for boys that age as well.

Why so young? Because research has shown if a child is vaccinated at 11 or 12, there is a stronger immune response than if vaccination occurs at 17 or 18.

Because HPV is transmitted through sexual contact, however, many parents have resisted vaccinating children that young. But it is very important to receive the vaccine well before sexual contact starts so the immune response will be the strongest.

“As of last fall, across the country only 42% of girls and 28% of boys had received all three doses of the vaccine,” Dr. Moriarty notes. “But here in Massachusetts, 52% of girls and 35% of boys had received it.”

In October 2016, the CDC announced that studies showed for children age 15 years or younger, two doses of the vaccine given six to 12 months apart can be just as effective as three doses, which Dr. Moriarty believes will make it much easier to fully immunize children with HPV vaccine.

“Sex may sell in the movies, but not in getting preteens vaccinated,” Dr. Hughes says. “And when the vaccine first came out, a lot of physicians didn’t have the training to convince parents to vaccinate their children, especially amid fears the vaccine would encourage promiscuity—although studies have shown it does not.”

He also acknowledges that some parents have concerns about vaccine safety, so he is sharing with pediatricians factual information about vaccine safety based on large-scale studies.

Last year, the poor immunization rates prompted all 69 National Cancer Institute cancer centers to issue a first-of-its-kind consensus statement calling the HPV vaccine “tragically underused,” and urging doctors to strongly recommend it.

“More than 200 million doses have been given around the world, along with 100 million in the United States, and there has been no link to any chronic or serious problem with this vaccine,” he notes. The most common side effects reported are arm soreness and feeling faint.”

UMass Memorial has taken this to heart, working to educate pediatricians and family practitioners to help parents make the right choice to protect their children from later-in-life cancers.

“The most important message is that we are vaccinating against cancer,” he adds. “Pediatricians don’t normally see these types of cancers, and we need to vaccinate against them so no one else will in the future, either.”

“We know that a recommendation from a physician is the most important factor in whether children get the vaccine,” explains Richard Moriarty, MD, a pediatric infectious disease specialist who works with 10

A Changing of the Guard at the Comprehensive Breast Center “He helped us create such a strong, collegial team here, bringing multiple disciplines together in the care of patients.”

As Robert Quinlan, MD, retires from his longheld post as director of the Comprehensive Breast Center at UMass Memorial Medical Center, the two physicians who succeed him reflect on his legacy— and look ahead to what they aim to achieve in their new co-director roles: “Bob’s longevity contributed to tremendous continuity with referring physicians, and he has a way of relating to patients that’s unparalleled,” says breast surgeon Anne Larkin, MD. “He also helped us create such a strong, collegial team here, bringing multiple disciplines together in the care of patients.”

“We also want to strengthen our participation in clinical trials,” Dr. Larkin says, noting that the Comprehensive Breast Center currently is adding a study using MRI and 3-D printing technology to help decrease positive margin rates in breast surgery.

Another study using CT in lobular cancers (UMass Memorial is one of only five sites in the U.S. with this advanced CT technology) is underway.

Robert Quinlan, MD (left) has a way of relating to patients that is unparalleled.

Breast surgeon Anne Larkin, MD (left) and medical oncologist Kathryn Edmiston, MD (right)

“He has been a remarkable role model to everyone, from students and residents to clinical providers,” says medical oncologist Kathryn Edmiston, MD. “He always asked the right questions, working with researchers to accomplish our mission of state-ofthe-art, bench-to-bedside research.

Dr. Edmiston anticipates continued advances in breast cancer treatment, with new FDA-approved drugs and ongoing treatment research protocols using novel approaches.

“Above all, under Bob’s leadership, the Comprehensive Breast Center established a track record for compassionate, expert care,” she adds. “That will not change.”

“We intend to maintain the same high standards that Dr. Quinlan set for us,” she adds, “and continue to recruit the best people to give expert care across the spectrum of breast disease.”

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Radiation Oncology: A System-Wide Commitment to Advanced Technology and Collaborative Care UMass Memorial Health Care is making lifesaving cancer treatment more precise, safe, effective and accessible with the recent acquisition of two new TrueBeam™ radiation therapy systems. There are now four of these sophisticated systems available to patients throughout our health care system, with two located at the University Campus in Worcester as well as one each at HealthAlliance Hospital on the Burbank Campus in Fitchburg and at the UMass Memorial Cancer Center at Marlborough Hospital.

These state-of-the-art linear accelerators and radiosurgery treatment systems enable a radically different approach to treating cancer with imageguided radiotherapy. Sophisticated imaging and computing technology focuses treatment, targeting the tumor even when it is moving due to patient breathing.

Yuan-Chyuan Lo, PhD (left) Thomas (TJ) FitzGerald, MD (center), and Christopher Riberdy, MHA, BS, RTT (right)

The TrueBeam™ system also performs stereotactic radiosurgery, a technique that can often replace brain or lung surgery for tumor destruction. Instead of surgically removing a tumor, radiosurgery replaces the surgeon’s scalpel with a high dose of radiation that destroys tumor cells—without damaging nearby healthy tissue. With radiosurgery, treatment can be completed in as little as one session.

“Because we are able to image the patient before and even during treatment, it makes treatment significantly more accurate,” says Yuan-Chyuan Lo, PhD, director of Medical Physics.

Equally important, the TrueBeam™ alters the shape and intensity of the radiation beam to match the shape of a tumor—what’s called intensity-modulated radiation therapy (IMRT). This precision ensures that the optimal dose of radiation targets the tumor while sparing healthy surrounding tissue, resulting in fewer side effects.

Providing additional depth to the radiation oncology program is the brachytherapy program on the Memorial Campus. ‘High dose-rate’ brachytherapy is an invaluable technique for treating gynecological cancers, and ‘low dose-rate’ brachytherapy is a highly effective option for treating prostate cancer in a single session. UMass Memorial is the only medical facility in Central Massachusetts with a high-dose system.

“Because we are able to image the patient before and even during treatment, it makes treatment significantly more accurate.”

“The duration of treatment can decrease as a greater dose can be administered at a time,” Dr. Lo adds.

This accuracy and precision also enable doctors to target cancers in difficult or hard-to-reach areas, including the head and neck, breast, lung, paraspinal, gynecologic, pancreas, brain and prostate. The system can be used to treat primary tumors as well as metastatic disease, and for palliative pain management.

Radiation therapists Raymond Gietler, RT (left) and Kelly Fournier, RT (right) ready a patient for a CT scan.

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“The willingness to invest in these progressive treatment machines and our unique ability to have our doctors interact at all campuses allows all of the cancer patients throughout our system to receive progressive care, regardless of location and with the convenience of short travel distances.”

Radiation oncologist Bruce Bornstein, MD (left) and radiation oncology nurse Susan Sands, RN (right) speak with a patient.

The fact that all four of the UMass Memorial radiation oncology sites—University Campus, Memorial Campus, Burbank Campus and the Cancer Center at Marlborough Hospital—earned American College of Radiology (ACR) accreditation at once in 2016—signifying that they all have met rigorous national standards for quality—is a testament to this tight integration and consistency across the system.

As one of the largest and most respected radiation oncology programs in the eastern United States, UMass Memorial Health Care is responsible for more than 60,000 patient treatments per year, notes Thomas J. FitzGerald, MD, chair of the Department of Radiation Oncology—delivering radiotherapy to an estimated 150 cancer patients daily.

“Our upgrade of technology has been significant, and we’re now able to offer the latest technology at all our sites,” says Christopher Riberdy, MHA, BS, RTT, director of Radiation Oncology, for UMass Memorial Health Care. “In fact, we’re the only facilities in Central Massachusetts to have these TrueBeam™ systems.”

Close coordination and collaboration between UMass Memorial Medical Center and its member hospitals ensures that “the same treatment protocols available in Worcester are provided in the community,” says John Varlotto, MD, a board-certified radiation oncologist who practices at HealthAlliance Hospital and on the University Campus in Worcester. Dr. Varlotto is also a professor with the UMass Medical School.

“Our patients deserve nothing less,” he adds.

“Progressive clinical investigations and patient treatment strategies are devised by interacting directly by live and remote attendance at tumor boards whereby the physician’s input and guidance are not directed by physician location,” notes Varlotto.

“The willingness to invest in these progressive treatment machines and our unique ability to have our doctors interact at all campuses allows all of the cancer patients throughout our system to receive progressive care, regardless of location and with the convenience of short travel distances, which is hugely advantageous for patients,” he adds.

The TrueBeamTM, a state-of-the-art linear accelerator and radiosurgery treatment system.

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National Accreditations UMass Memorial Health Care is proud to be nationally recognized for providing exceptional medicine to our patients throughout our system.

American College of Radiology (ACR): Three-year Accreditation, Radiation Oncology: •

UMass Memorial Medical Center – Memorial Campus

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UMass Memorial Medical Center – University Campus

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HealthAlliance Hospital – Leominster Campus

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UMass Memorial Cancer Center at Marlborough Hospital

Designated Lung Cancer Screening Center: •

UMass Memorial Medical Center – Memorial Campus

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UMass Memorial Medical Center – University Campus

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HealthAlliance Hospital – Leominster Campus

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Marlborough Hospital

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Clinton Hospital

Mammography: •

UMass Memorial Medical Center – Memorial Campus

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UMass Memorial Medical Center – University Campus

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UMass Memorial Medical Center – Hahnemann Campus

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HealthAlliance Hospital – Leominster Campus

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HealthAlliance Hospital – Burbank Campus

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Clinton Hospital

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Barre Family Health Center

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Shrewsbury Mammography

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Women’s Imaging Center (Marlborough Hospital)

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Tri-River Family Health Center

American College of Surgeons Commission on Cancer: •

UMass Memorial Medical Center: Three-Year Accreditation & Six Commendations

National Accreditation Program for Breast Centers (NAPBC) •

UMass Memorial Medical Center, Comprehensive Breast Center

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Foundation for the Accreditation of Cellular Therapy (FACT) •

UMass Memorial Medical Center: Bone and Blood Marrow Transplant Program

European Society for Medical Oncology (ESMO) •

UMass Memorial Medical Center: Designated Center of Integrated Oncology and Palliative Care

A Far-reaching Network of Community Cancer Care UMass Memorial Health Care offers a broad-reaching network of cancer care in the MetroWest and Central Massachusetts communities. It is our goal is to provide our patients with expert, personalized, patient-centered, high-value cancer care and services in a location that is close to home.

Our Community Hospitals: At UMass Memorial – Marlborough Hospital, we offer our patients convenient, compassionate cancer care close to home, in a new patient-focused facility. Here you will find infusion services and radiation therapy featuring the latest 4-D imaging. A team approach to your treatment features multidisciplinary care from many specialists, plus access to some of the most promising clinical trials and research studies, and links to specialized cancer programs such as genetic testing, bone marrow transplant, surgical oncology and more.

At UMass Memorial – HealthAlliance Hospital, the Simonds-Sinon Cancer Center offers comprehensive, personalized cancer care locally. With services such as medical oncology, radiation therapy featuring the True Beam patient system, a complementary care center with mind-body interventions such as Reiki and massage therapy, a patient navigator program, plus access to more advanced treatments and clinical trials, the Simonds-Sinon Cancer Center is a beacon of hope for residents in the greater North Central Massachusetts region. The center has achieved accreditation from the American College of Surgeons Commission on Cancer and is designated as a Community Cancer Program.

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Patients and families trust UMass Memorial Medical Center as the region’s leading academic medical center, committed to improving the health of our communities in Central Massachusetts. With our partner, the University of Massachusetts Medical School, we are committed to excellence in primary and specialty care, community service, teaching and research. The Medical Center offers advanced technology and support services for patients and families, providing the region with specialists renowned for their expertise in caring for adults and children. Visit www.umassmemorial.org. General information: 508-334-1000

UMass Memorial Health Care is the largest not-for-profit health care system in Central Massachusetts with more than 12,000 employees and 1,700 physicians, many of whom are members of UMass Memorial Medical Group. Our member hospitals and entities include UMass Memorial – Clinton Hospital, UMass Memorial – HealthAlliance Hospital, UMass Memorial – Marlborough Hospital, UMass Memorial Medical Center and UMass Memorial – Community Healthlink, our behavioral health agency. With our teaching and research partner, the University of Massachusetts Medical School, our extensive primary care network and our cancer, diabetes, heart and vascular, orthopedic and surgery programs, UMass Memorial delivers safe, high-quality and compassionate care. Visit www. umassmemorialhealthcare.org.

To find a physician in your community, call 855-UMASS-MD (855-862-7763).

Clinton Hospital 201 Highland Street, Clinton, MA Simonds-Sinon Regional Cancer Center HealthAlliance Hospital - Burbank Campus 275 Nichols Road, Fitchburg, MA UMass Memorial Cancer Center at Marlborough Hospital 157 Union Street, Marlborough, MA UMass Memorial Medical Center Hahnemann Campus 281 Lincoln Street, Worcester, MA Memorial Campus 119 Belmont Street, Worcester, MA University Campus Ambulatory Care Center 55 Lake Avenue North, Worcester, MA HOPE Line – 866-597-HOPE (4673) www.umassmemorial.org/cancer 05/17