Cancer Care magazine Winter 18

care

CANCER

for anyone touched by cancer WINTER 2018

Back on the bike page 4

ALSO IN THIS ISSUE 14 ways to ease radiation therapy page 6 Lung cancer treatment options page 10 Will your health care proxy honor your wishes? page 13

Brought to you by the

Makeup tips help patients ‘look good, feel better’ page 16

What’s on the horizon regarding breast cancer treatment?

YOUR GUIDE

Medical providers at academic medical centers regularly attend lectures by experts Breast conservation was the theme of a second talk, delivered by surgeon Dennis Holmes, MD, the interim director of the Margie Petersen Breast Cancer Center in Santa Monica, Calif.

PREVENTING BREAST CANCER RECURRENCE and preserving the breast aer surgery were topics addressed recently in two research lectures at Upstate sponsored by the Carol M. Baldwin Breast Cancer Research Fund of CNY.

Holmes spoke about surgical innovations, not universally accepted, that he hopes will be less invasive, reduce the total radiation needed and lead to a better self-image and quality of life aer surgery.

Breast cancer can recur in up to 30 percent of women, even 20 years aer treatment, says Lewis Chodosh, MD, PhD, professor of cancer biology in the Perelman School of Medicine at the University of Pennsylvania.

ese methods could include:

Chodosh’s research has focused on detecting and attacking dormant cancer cells before they can reactivate. He hopes an antimalarial drug, now being tested, could neutralize these sleeper cells. “e dormancy window is a unique and valuable window of vulnerability, before patients actually relapse,” he said.

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intraoperative radiotherapy, or radiation beamed during a partial mastectomy operation. oncoplastic surgery, or cancer surgery done with breast preservation in mind. and cryoablation, or use of a freezing probe inserted into a tumor to kill cancer cells. ●

The National Stroke Association reports that African-Americans are twice as likely to die from stroke as Caucasians. The statistics are staggering — African-Americans are affected by stroke more often than any other group. Know your risk.

STROKE RISK FACTORS • HIGH BLOOD PRESSURE: It's the No.1 cause.

• DIABETES • MINI-STROKES (TIAS OR TRANSIENT ISCHEMIC ATTACKS)

• OBESITY

A STROKE IS A BRAIN EMERGENCY. IF YOU SUSPECT A STROKE, CALL 911 AND ASK FOR UPSTATE.

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CANCER CARE

• SMOKING: Increases risk by two to three times.

Comprehensive Stroke Center

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INSIDE

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Inside this issue CARING FOR PATIENTS

SHARING EXPERTISE

Riding again – He got cancer after his kidney transplant

page 4

14 ways Upstate helps patients get through radiation therapy

page 6

Building a TrueBeam

back cover

SEARCHING FOR CURES page 9

Experts lay out the options for lung cancer treatment

page 10

for anyone touched by cancer

WINTER 2018

CANCER CARE

UPSTATE CANCER CENTER

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications

DIRECTOR (INTERIM) Jeffrey Bogart, MD

Jim Howe Susan Keeter Amber Smith

DESIGNER

Susan Keeter

The Upstate Cancer Center provides the quarterly magazine Cancer Care for anyone touched by cancer. Send subscription requests and suggestions to magazine@upstate.edu and request additional copies by calling 315-464-4836.

Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.

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page 12

Will your health care proxy honor your wishes?

page 13

page 14

LIVING WITH CANCER

care

WRITERS

Joining forces with other cancer centers

A group offers a helping hand

CANCER

Amber Smith 315-464-4822 or smithamb@upstate.edu

page 12

MAKING A DIFFERENCE

Care for rare thyroid cancer requires vigilance

MANAGING EDITOR

Clinical trials get a boost

DEPUTY DIRECTOR (INTERIM) Gennady Bratslavsky, MD ASSOCIATE DIRECTOR FOR CLINICAL RESEARCH Stephen Graziano, MD ASSOCIATE DIRECTOR FOR BASIC AND TRANSLATIONAL RESEARCH Leszek Kotula, MD, PhD ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH Leslie J. Kohman, MD ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA

Recipe: Chicken nuggets for children and adults

page 15

Makeup tips help patients ‘look good, feel better’

page 16 .

On the cover: Chris Atwood, kidney transplant recipient and cancer survivor.

See story, page 4.

care

CANC ER

for anyone

touched

WINTER

Back on the bik e page 4

by cancer 2018

14 ways to ease radiati on therap y page 6

Lung cancer treatm ent option s page 10

PHOTO BY SUSAN KAHN Brought

Will your health care proxy honor your wishes ? page 13 to you by

the

Makeu p tips help patien ts ‘look good, feel better ’ page 16

The Upstate Cancer Center is part of Upstate Medical University in Syracuse, N.Y., one of 64 institutions that make up the State University of New York, the largest comprehensive university system in the United States.

Upstate Medical University is an academic medical center with four colleges, a robust biomedical research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s downtown and Community campuses, the Upstate Golisano Children’s Hospital and many outpatient facilities throughout Central New York — in addition to the Upstate Cancer Center, which is located at 750 E. Adams St., Syracuse, NY 13210.

CANCER CARE

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Riding again

CARING FOR PATIENTS

He bicycles despite kidney transplant, cancer diagnosis

BY AMBER SMITH

CHRIS ATWOOD OF MORAVIA has quite a few medical issues for a man of 59, but they don’t rattle him.

“I think that fixating and worrying about your health is bad for your health,” he says.

Atwood is a plumber and pipefitter and an avid bicyclist who underwent a kidney transplant in 2001. Twelve years later, he was diagnosed with lymphoma, a cancer caused by the anti-rejection drugs he had to take for his new kidney. e development of post-transplant lymphoproliferative disease, or PTLD, is a well-known potential complication.

Atwood’s response to the diagnosis was not typical.

“Great,” he said to the doctors and nurses who assembled to break the news. But it wasn’t a sarcastic great. Atwood was grateful. “Now I know what the problem is. Let’s fix it.”

His upbringing Perhaps the outlook Atwood has comes from growing up on a farm with five siblings, not a lot of money, and parents who were older.

His father, who would be 106 if he were alive today, grew up walking a plow behind horses. His mother did laundry with a washboard and clothesline. ey canned most of the food they would eat during the winter. From young ages, the kids had chores.

Atwood had a newspaper route that he delivered by bicycle, pedaling 11 miles per day. He joined ROTC to help pay for college at Syracuse University. He majored in geography until the money ran out.

The transplant Atwood was born with a kidney problem, which was discovered during college. It was a valve problem that caused reflux. Bladder contents would backwash into the kidney, putting him at risk for infection.

It wasn’t a problem until February 1998. He recalls catching a cold, which he couldn’t shake. He ended up in the hospital undergoing blood tests. at’s when he learned he would eventually need a kidney transplant.

For three years, he followed doctor’s orders to eat no protein, no potassium and no phosphorus. e diet was difficult to follow, plus he was always tired.

Atwood continued working as a plumber/pipefitter, though. He said nothing about his condition at work. “I didn’t want any special treatment,” he says, “and I didn’t want to get fired.”

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Dillip Kittur, MD

Theresa Gentile, MD, PhD John Leggat, MD

On Valentine’s Day 2001, he got a phone call at 2:30 a.m.

A kidney was available for transplant. He le for Upstate University Hospital. His wife joined him aer she got the kids off to school. Atwood recalls that he was sore for a few days aer the surgery, completed by Dilip Kittur, MD. en one morning, he woke up feeling so much better. “at’s when I realized how sick I was before: how well I felt aerwards.”

Atwood never had to undergo dialysis for his kidney disease. He still appreciated the irony of his first assignment aer he returned to work with his new kidney: plumbing and pipefitting for a dialysis center on James Street in Syracuse.

The bike riding Since his days with a newspaper route, Atwood had been a bike rider. He’d take time to ride to Buffalo on occasion, or up to the Adirondacks. He took a break from riding when he became ill with kidney disease. en, four years aer his transplant, “I got this card from the Leukemia and Lymphoma Society’s Team in Training, out of the blue.” It was an invitation to raise money by training for and completing a 100-mile bike ride at Lake Tahoe.

Atwood decided to do it. He had a bike he was riding to try to get back in shape. Having a goal would help.

He did the Team in Training races for two years in a row. en he competed in the National Kidney Foundation’s Transplant Olympic games, held in Kentucky. He did not do well, but in 2008, when the games were held in Pittsburgh, Atwood says he was better prepared. He won two gold medals.

Today he rides between 2,000 and 3,000 miles per year.

He rode the Erie Canal from Buffalo to Albany. He has circumnavigated every Finger Lake. In 2017 he completed a quest to ride across every county in New York state. continued on page 5

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CARING FOR PATIENTS

Riding again

Transplant recipient and cancer survivor Chris Atwood bikes 2,000 to 3,000 miles per year.

PHOTO BY SUSAN KAHN

continued from page 4

The cancer

Atwood has lived with his donor kidney for almost 17 years, describing himself as “fit as a fiddle.”

Toward the end of summer 2013, he was plagued by coughing fits. He underwent some imaging scans and blood work, and a mass was discovered by accident. His kidney doctor, John Leggat, MD, told him it was cancer.

He set up an appointment with Teresa Gentile, MD, PhD, who oversaw Atwood’s cancer care.

CANCER CAN BE A COMPLICATION

People undergo organ transplants to extend their life expectancy and improve their quality of life. Kidney transplants, for instance, free many people who require kidney dialysis.

But taking medicine to suppress the immune system and protect the new organ raises a person’s risk of infections and the development of cancer. Transplant doctors tell patients about this risk before they have surgery. e risk of developing a type of skin cancer called squamous cell carcinoma increases a hundred fold for transplant recipients, according to the Skin Cancer Foundation. is is likely because of the suppression of the immune system, coupled with an interaction between the medication and the sun’s ultraviolet radiation. e cancer Chris Atwood developed is a lymphoma called PTLD, for post-transplant lymphoproliferative disorder.

“It’s related to the Epstein-Barr virus,” explains John Leggat, MD, Atwood’s kidney doctor. at’s the virus that causes mononucleosis. “Most people are exposed to the virus at some point. It tends to live in you, in lymphocytes (a type of white blood cell), and when you’re

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“She was a godsend,” Atwood says. For a while, he was quite sick. He underwent six cycles of chemotherapy three weeks apart, and then maintenance treatments aer that.

He lost his hair, but he had no negative side effects from the medicine.

His treatment concluded in March 2014. He still sees Gentile regularly. “I’m 100 percent in remission,” he says, “and I’m back to normal, living perfectly well.” at includes riding his bike.●

immunosuppressed it can cause those cells to proliferate abnormally.”

Leggat says doctors don’t screen for PTLD, but they regularly see transplant recipients for medical appointments. “When someone starts having odd symptoms, we will chase that down, because PTLD is always in the back of our minds.” e prognosis for someone with PTLD used to be poor.

Since the Food and Drug Administration approved rituximab in 2006, Leggat says treatment is generally successful.

Rituximab is a man-made antibody that triggers cell death by binding to a particular protein found on the surface of cells that are part of the immune system.

During treatment for the lymphoma, patients stop taking their immunosuppressant medication because rituximab suppresses the immune system. And aer treatment, the dosage of a patient’s immune-suppressing medication is lower than usual.

Leggat says “once a person survives this cancer, they don’t need so much immunosuppression.” ●

CANCER CARE

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Precision care

CARING FOR PATIENTS

Advances in radiation therapy minimize side effects

BY AMBER SMITH

THE FIRST VISIT with the radiation oncologist is usually where patients unload their fears.

In general, people may be more familiar with the negative image of radiation and somewhat unaware of its powers to help heal. So a good portion of that first visit is spent educating and assuaging fears, says Anna Shapiro, MD, associate professor of radiation oncology at Upstate.

Patients may or may not have had surgery or chemotherapy before they arrive for radiation oncology. But they have had time to think about their cancer diagnosis and what their body will now face.

Patients receive a general overview of what their treatments will be like at that first appointment, says radiation oncology resident Emily Daugherty, MD, “but it’s not a cookie-cutter treatment.

It’s very personalized.”

Radiation therapy technician Andrew Brown talks with a patient prior to treatment for prostate cancer.

PHOTO BY RICHARD WHELSKY

"You just have to believe,” says Shapiro. “It’s not something you can see or feel or smell."

Shapiro says patients who recall parents or friends who received radiation therapy years ago are oen surprised to learn how much technology has advanced. Radiation is delivered much more precisely today, which means side effects are minimized.

e physicians, however, can watch the tumor shrink, treatment aer treatment, through advanced medical imaging.

Aer meeting with the patient, radiation oncologists, medical physicists and radiation therapists convene to determine where, precisely, to aim the radiation, and how best to avoid healthy tissues.

e first appointment for radiation oncology is like a rehearsal. Patients are fitted with immobilization structures that will help them assume the exact position for every treatment. ey see what treatments will be like.

Pretty much everyone asks about side effects, how the treatment schedule will affect the rest of their life and whether they will be radioactive. (e answer is no, unless they are receiving some forms of brachytherapy in which radioactive pellets are implanted in the body.)

Patients who require radiation to the head or neck have a special thermoplastic mask made that fits over their face. ese custom-made immobilization structures are stored near the TrueBeam radiotherapy system.

It doesn’t hurt. It’s like getting an X-ray, so the patient cannot tell whether it’s working.

Staying still is crucial. Radiation therapist Amanda Spence explains, “we’re treating to the 10th of a millimeter, so it’s continued on page 7 very precise.”

Look at the cancer-fighting TrueBeam, back cover

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CANCER CARE

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CARING FOR PATIENTS

Precision care

continued from page 6

14 UNIQUE WAYS UPSTATE HELPS PATIENTS THROUGH RADIATION THERAPY

Radiation therapy is an important part of treatment for many patients with a variety of cancers. e treatments oen take place every weekday for several weeks. Each visit is designed to be as easy as possible on patients.

WORRIED ABOUT MEMORY LOSS? NOW ACCEPTING NEW PATIENTS

What helps? l No-charge valet parking means patients can get in

and out of the Upstate Cancer Center quickly and without a lot of walking. l e routine of receiving treatment about the same

time every day, usually with the same technicians, adds some predictability to the unknown. l Friendships oen form between patients who

receive treatment at the same time of day. l Some patients derive comfort by praying during

treatment or holding rosary beads. l Just understanding the treatment plan offers relief

to many patients. Technicians are good at explaining what to expect. l Having directions to follow adds focus for some

patients. ose with prostate cancer may be asked to arrive with full bladders. ose with pancreatic cancer may be asked to fast, so their stomach is deflated during radiation. l Few patients turn down the offer of a warm

blanket. l Patients choose what type of music they want to

hear. l Patients pick the color of the lights in the room —

blue, orange, green, pink or a rotation. l Lots of thought went into the selection of tranquil

and interesting nature-themed artwork on the walls, designed to provide a calming distraction. l Anti-anxiety medications are available but rarely

If you or your loved one has concerns about memory loss, we can help. Our experts assess for dementia and Alzheimer’s disease in a caring environment with the patient and family members.

Our goals are to help: • extend self-sufficiency for as long as possible • preserve function • provide assessments such as memory or balance • develop a care plan that supports both the patient and caregiver.

FOR AN APPOINTMENT OR MORE INFORMATION, PLEASE CALL 315-464-5166.

Upstate is a New York State Center of Excellence for Alzheimer’s Disease.

It serves Central New York. www.upstate.edu/aging

required. l During the treatment, radiation therapists can

speak to the patient through an intercom.

Sometimes a spouse or loved one will speak encouraging words, too. l Radiation therapist Brian Goodrich describes the

general approach to patients: “We really just treat them like regular people.” l erapy dogs including Sebastian and Lumpy

spread cheer by making regular visits to the radiation therapy facilities. ●

winter 2018 l upstate.edu/cancer

Center of Excellence for Alzheimer’s Disease Upstate Specialty Services at Harrison Center Suite A, 550 Harrison Street Syracuse, NY 13202

Expertise . Compassion . Hope

CANCER CARE

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Look at the cancerfighting TrueBeam

CARING FOR PATIENTS

A precise installation for the newest technology continued from back cover

THE LARGEST PIECES OF THE TRUEBEAM machine, which weighs more than 9 tons when fully assembled, traveled in a tractor trailer from the Varian Medical Systems headquarters in Palo Alto, Calif. e truck arrived the weekend before anksgiving.

Getting the TrueBeam up and running required a lot more than simply plugging it in.

Most of the reconstruction work for the medical office building had to be completed before the TrueBeam arrived, said Jeff Buckman, practice administrator for the radiation oncology department. “Once the machine comes in, you don’t want to be stirring up dust.” e room that would hold the TrueBeam, called the “vault,” had to be prepared with radiation shielding, electrical conduits and a spot where the TrueBeam would be anchored to the ground.

Upstate’s team of radiation oncologists cares for patients in Oneida, Syracuse and Oswego. Left to right: Paul Aridgides, MD, Seung Shin Hahn, MD, Anna Shapiro, MD, Alexander Banashkevich, MD, Jeffrey Bogart, MD, Michael LaCombe, MD, and Michael Mix, MD PHOTO BY SUSAN KAHN

When the truck arrived, a 10-person rigging crew unloaded and positioned the TrueBeam inside the office, where it stands about 9 feet tall and 15 feet long. Its “arms” came from Switzerland. e generator that gives the arms their movement came from Canada. e “couch,” where patients lie during treatment, came from England.

Once Jones completed his installation of the TrueBeam, Upstate medical physicists Weidong Li and Sean Tanny and others did the commissioning, which means they input data, checked specifications and completed another set of measurements, working from a 165-page reference document.

So did the Varian installation engineer, Mike Jones of Liverpool, England. He arrived with cases of his own tools, digital volt meters, oscilloscopes and more. It was his job to introduce all the pieces of Upstate’s TrueBeam to one another through soware updates and a lengthy series of calibrations and tasks outlined in a notebook.

Working together, the engineer and medical physicists aligned the lasers and made sure the symmetry of the beams was adjusted. Also, the soware had to be integrated between the TrueBeam console and the computer server, which is located in Syracuse and shared with the TrueBeam at the Upstate Cancer Center headquarters.

A steel box the size of a refrigerator contains the brain of the TrueBeam, in a room down the hall from where patients are treated. Cables string out the back of the box.

Computer monitors sit on a countertop nearby, where radiation technicians observe patients during treatment. A chiller is mounted to the roof of the medical office so that the TrueBeam can be cooled by water.

One of Jones’ tasks was to set the TrueBeam’s “isocenter.” at’s the center point in space around which the sophisticated architecture of the machine rotates. It’s critically important, since radiation oncologists and medical physicists plan precision radiation treatments that depend on synchronized imaging, patient positioning, motion management, beam shaping and dose delivery. e isocenter is the reference point for everything.

All told, the active installation and commissioning process was about six weeks, not counting the pre-delivery preparations. Jan. 9 was the opening. ● HERE’S HOW IT WORKS FOR PATIENTS

ey are positioned exactly for each treatment, and their tumor is identified through advanced integrated image guidance. e TrueBeam delivers radiation through several beams at different angles and intensities — all directed at the tumor and usually lasting only a few minutes. Radiation is concentrated on the tumor, avoiding the healthy cells and tissue surrounding the tumor.

Such customized treatment minimizes side effects and provides hope for greater cure rates.

14 ways Upstate helps patients through radiation therapy. Page 6

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Ongoing battle

SEARCHING FOR CURES

Vigilance helps contain a rare, aggressive thyroid cancer

BY AMBER SMITH

THE MAN WAS IN HIS MID-50s in 2011 when he sought care for enlarged lymph nodes in the back of his neck. It was thyroid cancer.

receive weekly chemotherapy. Because he lived in the Binghamton area, he received treatment close to his home.

Surgeons in Binghamton removed his thyroid gland, and the man received radioactive iodine therapy aerward.

ree months aer he was done, another scan showed “near-complete resolution of metabolic activity in the thyroid bed and regional lymph node areas,” according to the journal article.

at typically is all the treatment that’s required.

But when the man returned six months later for a followup scan, more cancer showed up. at’s when he was referred to doctors at Upstate. He had more tissue removed from the le side of his neck. en six months aer that, cancer appeared again, and more tissue had to be removed from the right side.

As a patient at Syracuse’s only academic medical center, the man received expert care — while his physicians simultaneously learned and taught others about his unique type of thyroid cancer. ey wrote about his case in the journal Case Reports in Oncological Medicine to educate other physicians. e patient had an uncommon type of thyroid cancer, a “tall cell variant,” which grows and spreads rapidly, along with a genetic mutation that seems to make cancer more likely to grow and spread to other parts of the body.

It was 2014 when one of the man’s routine follow-up scans revealed cancer where his thyroid used to be. “At that time, he was symptomatic, with more fatigue and weight loss,” Abirami Sivapiragasam, MD, wrote in the journal. She’s an assistant professor of medicine at Upstate, specializing in hematology and oncology. e man underwent surgery to remove additional lymph nodes and tissue. From the medical laboratory, Upstate pathologist Joseph Fullmer, MD, PhD, discovered recurrent papillary thyroid carcinoma, the same cancer the man had before, but also another type of cancer called squamous cell carcinoma.

At this point, things were not adding up. e man had been treated successfully, but cancer kept coming back.

Fullmer sent samples and conferred with pathologists from Memorial Sloan Kettering Cancer Center in New York City for a second opinion. e physicians believe the man’s papillary cancer transformed into squamous cell cancer. His papillary cancer was particularly aggressive, and although it’s rare, “it can evolve into different types,” explained Alina Basnet, MBBS, one of the man’s Upstate doctors. ey decided the best treatment for the man would be six weeks of radiation therapy, during which time he would

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Sivapiragasam

e patient continues to be closely monitored.

Fullmer

His case is a good example of the benefit of collaboration when a patient has a complicated diagnosis or signs and symptoms that don’t add up. Bringing experts together produces a novel treatment plan. ●

Basnet

ABOUT THYROID CANCER l e butterfly-shaped thyroid gland is below the Adam’s

apple in the front of the neck. It has two main types of cells: follicular, which use iodine from the blood to make hormones that help regulate metabolism, and C cells, which make a hormone that helps the body use calcium. l Nearly three out of four cases are in women. l About 80 percent of thyroid cancers are papillary

carcinomas, which tend to grow slowly and to develop in only one lobe of the thyroid. Fewer than 10 percent of thyroid cancers are follicular. Medullary thyroid cancer, arising from the C cells, is the third most common, making up about 3 percent of thyroid cancers. l e most common subtypes of papillary cancer have a

good prognosis for treatment and outcome when found early. Some of the less common — including one called “tall cell variant” — grow and spread more quickly. l Treatment oen includes two or more of these options:

surgery, radioactive iodine treatment, thyroid hormone therapy, external beam radiation, chemotherapy or targeted therapy. l Most thyroid cancers can be cured, especially if they

have not spread to distant parts of the body. l In rare cases, a papillary thyroid cancer may be

aggressive and could possibly transform into another type of cancer, such as squamous cell carcinoma.

CANCER CARE

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Many options

SEARCHING FOR CURES

Caregiving team considers multiple factors in managing patients with lung cancer

BY AMBER SMITH

PEOPLE DIAGNOSED WITH LUNG CANCER a century ago had few options. e earliest surgical techniques, in the 1930s, involved cutting open a patient’s chest and removing an entire lung.

While that is sometimes still necessary today, surgeons are more apt to operate through tiny incisions to remove just a lobe, or a piece of a lobe. ey may also pair surgery with radiation therapy, or recommend radiation therapy instead of surgery.

Despite progress in diagnosis and treatment, lung cancer remains the most common cause of cancer death in both men and women.

Up to 85 percent of lung cancers are non-small cell lung cancers, which arise from a variety of lung cells. For patients with this diagnosis, optimal care comes from a collaborative multidisciplinary approach that includes thoracic surgeons, medical oncologists, radiation oncologists, pulmonologists and pathologists, according to an overview of lung cancer management written by a radiation oncologist and a thoracic surgeon from Upstate and published in the Journal of Oncology Practice in February 2017.

Jeffrey Bogart, MD Upstate chair of radiation oncology

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Multidisciplinary care is offered at most academic medical centers, including the Upstate Cancer Center.

It means experts from several medical backgrounds confer together about what’s best for each patient.

In deciding what to recommend, they consider the tumor’s size and location, its cellular makeup and the patient’s condition and desires. is era holds many options.

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SEARCHING FOR CURES

Radiation therapy options

Lung surgery options

STEREOTACTIC BODY RADIOTHERAPY

LOBECTOMY

high-dose radiation precisely targets the tumor, requiring fewer treatments than traditional external beam radiation.

the surgeon removes the lobe containing the tumor; the right lung has three lobes, and the le has two.

BRACHYTHERAPY

radioactive material is placed inside the body, so that radiation can be delivered to a specific area.

the surgeon removes the tumor without removing excessive amounts of healthy lung tissue in this technically demanding procedure.

ABLATIVE TECHNIQUES

WIDE WEDGE RESECTION

relying on advanced imaging, a thin, needlelike probe goes through the skin and into a tumor near the outer edge of the lung, and then high-energy radio waves heat the tumor to destroy cancer cells.

the surgeon removes a triangle-shaped slice of tissue containing the tumor and a small amount of healthy tissue around it.

FRACTIONATED RADIOTHERAPY

Upstate has the only robotic thoracic surgery program in the region, providing advanced, minimally invasive options.

a technique in which the total radiation dose is divided into multiple small doses that are dispensed over several days to reduce toxic effects on healthy cells.

ANATOMIC SEGMENTECTOMY

ROBOTIC SURGERY

Best care comes from team Radiation oncologist Jeffrey Bogart, MD, and thoracic surgeon Jason Wallen, MD, explain in their article that the standard therapy for patients with an early-stage lung cancer is to remove the affected lobe through minimally invasive surgery.

Minimally invasive surgery is preferred because patients recover more quickly, have their chest tubes removed sooner aer surgery and require fewer days of hospitalization. Also, their survival rates four years later are higher than for those who undergo surgery in which their chest is cut open.

Doctors want to determine if survival and the risk of cancer recurrence is the same when they remove just a portion of the lobe, rather than the entire lobe.

Studies underway in the United States and Japan focus on which procedure is best for patients with lung masses that are smaller than 2 centimeters (.78 inches) in diameter.

●

Additional research since the mid-1990s has compared treatment options for patients who are at high risk for lung surgery — including those who smoke, have other health problems or are older than 60.

Especially for these patients, the best way of treating lung cancer may mean removing just a wedge or a section of a lobe, perhaps combined with or followed by some type of radiation therapy. Or, it may mean undergoing stereotactic radiotherapy instead of surgery.

With so many options to consider, and so much ongoing research, patients with a lung cancer diagnosis get the best care at an academic medical center, as it offers a team approach. ●

Jason Wallen, MD Upstate chief of thoracic surgery PHOTOS BY SUSAN KAHN

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CANCER CARE

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St. Baldrick’s money to boost clinical trials

SHARING EXPERTISE

UPSTATE IS ONE OF 39 INSTITUTIONS nationwide selected to share $2.2 million in grant money from the St. Baldrick’s Foundation to advance patient access to clinical trials.

Having access to clinical trials is vital to the treatment of childhood cancers. Nearly 80 percent of childhood cancer patients at Upstate are enrolled in a clinical trial, a number consistent with national trends. e main St. Baldrick’s fundraisers are events in which men, women and children raise money by pledging to have their heads shaved. Kitty Hoynes hosted 530 “shavees” in 2017, and the Syracuse pub raised the most money in the country — more than $540,000 — for the second year in a row.

Melanie Comito, MD, chief of pediatric hematology/ oncology and professor of pediatrics at the Upstate Golisano Children’s Hospital, is appreciative of the St. Baldrick’s support and says it helps toward the long-term goal of curing all children with cancer.’With the new grant,

St. Baldrick’s Day in Syracuse raises money for the cure of childhood cancer.

Participants are shown at Kitty Hoynes in Syracuse on April 2, 2017. Last year more than 530 people had their locks shaved off in honor of cancer survivors and those who have passed away.

PHOTO BY DENNIS NETT | SYRACUSE.COM

she says, “we are able to adequately staff our clinical research program, making it possible to provide the most up-to-date care to the children and teenagers in our region.” ●

Peer experts share best practices THE UPSTATE CANCER CENTER has joined the Association of American Cancer Institutes, an organization dedicated to reducing the burden of cancer by enhancing the impact of North America’s leading academic cancer centers. e association, based in Pittsburgh, is made up of National Cancer Institute-designated centers and academic-based cancer research programs that receive NCI support.

“Membership in this organization is another distinguishing feature of the Upstate Cancer Center, as it

recognizes our expertise in various areas, from our faculty to our research to our patient care,” said Interim Director Jeffrey Bogart, MD, professor and chair of the department of radiation oncology.

A key element of the association’s mission is to assist the centers in keeping pace with the changing landscape in science, technology and health care. is is done by gathering and sharing best practices among cancer centers and providing a forum for members to address common challenges. e association also educates policymakers about the important role cancer centers play in advancing cancer discovery. ●

Experts on many cancer topics

6 a.m. & 9 p.m.

SUNDAYS ON WRVO

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89.9 & 90.3 FM

Listen anytime on www.healthlinkonair.org or find us on iTunes

upstate.edu/cancer l winter 2018

Ethics consult

SHARING EXPERTISE

Will your health care proxy honor your wishes?

THOMAS CURRAN, MD, and Robert Olick, JD, PhD, are hospital ethics consultants and members of Upstate’s bioethics and humanities faculty. ey provide advice to patients and families who find themselves in ethically charged situations surrounding care at Upstate University Hospital. Disagreements having to do with end-of-life care are one of the most common reasons for a consult.

“When the patient has mental capacity, there’s no argument. Patients are allowed to make what you could consider to be bad decisions if they have capacity. It’s when they lose capacity and you have to figure out ‘what would this patient want?’ where it gets muddy,” says Curran.

He and Olick tell about a muddy situation: A 63-year-old woman arrived at the emergency department with sudden respiratory failure. She had lung cancer that was so advanced she had to be placed on a breathing machine. Chemotherapy was not an option. Her diagnosis wasn’t a surprise; the woman had known for 10 months about a mass in her lung and ignored treatment recommendations.

Because of her condition, her lucidity waned. e woman’s ability to make decisions would come and go.

When she was lucid, she indicated she wanted to go home to die in peace.

When she was not lucid, the person she had selected as her health care proxy, her husband, insisted that she wanted life-sustaining measures.

Sometimes when she was lucid and her husband was present, the woman would defer to him.

winter 2018 l upstate.edu/cancer

So the ethicists sought to get family members and caregivers in the same room at the same time, when the woman was lucid, to discuss her wishes. ey talked about how she neglected to seek care for 10 months, and how that may have foreshadowed the type of care she really wanted. “e principle is to respect patient autonomy,” says Curran.

Olick points out that “it’s also important to understand the husband’s role as health care proxy only has force if she lacks capacity.

“It’s her wishes that control what happens. He doesn’t have authority to override that.”

In the end, the woman died in the hospital before things could be settled.

Curran says the situation illustrates the importance of choosing a proxy who will respect your wishes. “In this case, she appeared to have done a poor job of selecting a health care proxy because he appeared to be acting in opposition to her wishes.” ● ENSURING YOUR END-OF-LIFE WISHES ARE FOLLOWED:

1. It takes foresight and courage to confront the future possibilities of your mortality — and to be open about that with the people who care about you most.

2. Carefully choose a proxy (someone who will speak on your behalf if you are incapacitated) who will be able to bear the burdens of the decisions that may be placed on him or her.

3. In addition to completing the proper paperwork, conversations are important. Consider looping in multiple family members or loved ones, plus your doctor.

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Group offers helping hand to cancer patients in need

MAKING A DIFFERENCE

BY JIM HOWE

CENTRAL NEW YORK CANCER PATIENTS facing money problems can get some help from a foundation dedicated to a young Rome, N.Y., native who died of a rare and aggressive cancer.

Everything from help with travel expenses to arranging a final holiday meal for a dying patient and her family has been paid for with grants of up to $300 per patient from the Joseph Michael Chubbuck Foundation, based in Rome. ose grants total about $43,000 and include help to roughly a hundred patients a year, as well as donations to several of Central New York’s treatment centers, such as $1,000 for a special chair in a treatment room at Upstate Golisano Children’s Hospital. e foundation helps residents of Onondaga, Oneida, Madison and Herkimer counties and honors the memory of Joseph Michael Chubbuck, who was diagnosed with a rare, aggressive and unidentifiable form of cancer at age 21 in March 2012, while a student at Utica College and member of the Army National Guard. e cancer, discovered during an emergency appendectomy, held a genetic mutation commonly found in a rare, incurable type of sarcoma. He underwent major surgeries and aggressive chemotherapy treatments at various cancer centers around the country and died in August 2013 at age 22.

Before his death, he asked his family to start a charity to help others facing cancer. e foundation was launched and began helping cancer patients in January 2015.

Joseph Michael Chubbuck with his dog, Shadow, in May 2011. Shadow was battling cancer at the time this photo was taken and died in 2012, while Chubbuck was in an intensive care unit fighting his own cancer.

e aid is oen arranged through a medical social worker, such as Chevelle JonesMoore of Upstate, who says the foundation money has helped numerous patients at the Upstate Cancer Center and the children’s hospital. “ey are very consistent, they are faithful, they are dependable, they are flexible, and they are willing to hear what you have to say, so they can figure out how they can accommodate your needs,” Jones-Moore says of the foundation.

Barbara Chubbuck, Joseph’s mother and the foundation’s vice president, says, “When an individual is fighting cancer, they shouldn’t have to worry about how their monthly bills are going to get paid. Knowing that the foundation can help ease the financial burden of these patients, even a little, makes me feel good. I know it is what my son wanted.”

Grateful for expert care

For more about the foundation, including how to apply for help, go to its website, www.thejmcf.org, which also offers general information and advice for cancer patients. ●

AT AGE 2, CARTER HERGERT STARTED WALKING AS IF HE WERE DIZZY, and that proved to be a symptom of a rare, aggressive brain tumor with a poor prognosis.

Treatment — surgery to remove the orange-sized tumor, five months of chemotherapy and three autologous stem cell transplants — was successful, but intensive and debilitating.

His mother, Kathleen, “basically lived” at the Upstate Golisano Children’s Hospital with Carter. His father, Jeremy, took a leave from work to be with them daily at the hospital.

Carter’s older brother, Evan, stayed with relatives.

Aer completing treatment, it took a year for Carter to regain his strength. Today, thankfully, Carter is a busy first-grade student at Auburn’s Seward Elementary School.

He loves riding his bike and playing computer games.

Carter Hergert, 6, of Auburn.

Carter’s parents are grateful for his team — neurosurgeon Zulma Tovar-Spinoza, MD; oncologist Irene Cherrick, MD; gastroenterologist Manoochehr Karjoo, MD; surgeon Tamer Ahmed, MD; professor of pediatrics Henry Roane, PhD; case manager Heather Kadey and others — who they describe as “kind, loving and supportive.”

PHOTO BY ROBERT MESCAVAGE

To donate to programs that benefit patients like Carter, contact the Upstate Foundation at upstatefoundation.org or 315-464-4416. ● 14

CANCER CARE

upstate.edu/cancer l winter 2018

LIVING WITH CANCER

Crunchy ‘Oven-Fried’ Chicken Nuggets is recipe from “e Great American Eat-Right Cookbook” is a healthful rendition of chicken nuggets – and likely to appeal to kids and adults. e coating adds crunch, while keeping the meat tender and moist.

Preparation takes less than a half hour, and this recipe serves four.

Chef ’s tip: Line your baking sheet with aluminum foil or parchment paper to speed cleanup.

Preparation 1. Preheat the oven to 400 degrees. Place a cooling rack on a rimmed baking sheet.

2. In a food processor, pulse the Melba toast until pieces are about ⅛ inch in size, with some smaller and larger pieces. Don’t over-process. Add oil and pulse once or twice, or until crumbs are just moistened. (You can also use a rolling pin or a meat mallet to crush the toasts by hand in a zip-top bag. en mix the oil and crumbs together in a bowl.) Transfer crumbs to a plate.

3. In a bowl, beat egg. Add mustard, oregano, salt and garlic powder and beat to combine. Dip chicken in egg mixture, then in crumbs, pressing to coat all sides of the meat. Place on the rack.

4. Bake for 15 minutes, or until cooked through.

Ingredients 10 whole-grain or classic Melba toasts (2 pouches) 1 tablespoon canola oil 1 egg 1 teaspoon Dijon mustard ¼ teaspoon salt ¼ teaspoon dried oregano ¼ teaspoon garlic powder 1 pound boneless, skinless chicken breasts, cut into 2-inch “nuggets”

Nutritional information per serving: 230 calories 8 grams fat 120 milligrams cholesterol 335 milligrams sodium 10 grams carbohydrate 1 gram fiber 27 grams protein

SOURCE: AMERICAN CANCER SOCIETY WEBSITE

Syracuse University Head Football Coach Dino Babers, front row, second from left, visited the Upstate campus to appear in a television spot for the Upstate Cancer Center. With Babers are members of the Upstate Cancer Center team, including Jeffrey Bogart, MD, front row, right, professor and chair of radiation oncology and the center’s interim director.

winter 2018 l upstate.edu/cancer

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LIVING WITH CANCER iN THE KNOW

Teens ‘Look Good’ and ‘Feel Better’

Taylor Way, 15, experiments with makeup during a “Look Good Feel Better” session at the Upstate Cancer Center. With her are Amanda Wilson, 16, and Julia Nguyen, 16.

PHOTOS BY SUSAN KAHN

BY SUSAN KEETER

“IT WAS AS IF SHE WAS TRYING TO DISAPPEAR inside her clothes,” explains nurse Kristen omas, remembering hot summer days when a teenage cancer patient showed up for appointments hidden under a woolen ski cap and layers of heavy clothing.

When omas overheard that patient confess that dealing with her changed appearance was harder than coping with cancer, omas knew she had to do something. Melanie Comito, MD, chief of Upstate’s Waters Center for Children’s Cancer and Blood Disorders, guided omas to the American Cancer Society’s “Look Good Feel Better” program. It is a national program that teaches beauty techniques to people with cancer to help them manage appearance-related side effects of cancer treatment. omas and Molly Napier, nurse manager of the pediatric outpatient unit, applied for the Upstate Cancer Center to become the first “Look Good Feel Better” site for teens in New York state.

On Oct. 23, patients Artesia Gjoncari, Julia Nguyen, Taylor Way and Amanda Wilson gathered in a conference room at the cancer center. Licensed cosmetologists Maria Ascrizzi and Angela McBride greeted each of the young women with a gi bag of cosmetics donated by companies including Estee Lauder, Smashbox and Burt’s Bees. Ascrizzi 16

CANCER CARE

and McBride offered step-by-step instruction on everything from wearing turbans to drawing naturallooking eyebrows.

e room was quiet at first, and two girls sat alone. But, thanks to experimenting with eye shadow and wig brushes, the girls started talking and laughing, comparing makeup tips and gulping down so drinks and snacks.

“It’s not just about makeup, it’s about making connections with other teens in a fun environment,” explains omas.

“Cancer treatment can be isolating.”

“Side effects can take a big toll. Patients lose confidence,” notes Stephanie D’Amico of the American Cancer Society. “is program is transformative.”

Ascrizzi and McBride have been volunteering with “Look Good Feel Better” for adults since 1989, but this was their first experience working with teens with cancer. Ascrizzi, a 20-plus year cancer survivor, says that they are motivated by the opportunity to give back in a nontraditional way.

Upstate plans to offer the teen program several times a year. While the goal is to keep the sessions small and intimate, “Look Good Feel Better for Teens” at Upstate will be open to any teenager with cancer in New York state.

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LIVING WITH CANCER

Meet the young women from ‘Look Good Feel Better’:

Artesia Gjoncari, 20, of Syracuse

Julia Nguyen, 16, of Camillus

Taylor Way, 15, of Cuyler

Amanda Wilson, 16, of Tully

Diagnosis: osteosarcoma

Diagnosis: primary mediastinal large B-cell lymphoma

Diagnosis: Ewing’s sarcoma

Diagnosis: non-Hodgkin lymphoma

Symptoms: hip pain

Symptoms: chest pain

Physicians: Philip Monteleone, MD, and Paul Aridgides, MD

Physicians: Andrea Dvorak, MD

Symptoms: knee pain Physicians: Timothy Damron, MD, and Philip Monteleone, MD Treatment: chemotherapy, surgery and physical therapy Her thoughts: “It was a shock when my waist-length, curly hair fell out two weeks aer I started chemotherapy. At the session, I learned how to do my eyebrows and how to tie scarves.”

Symptoms: swelling in face, not feeling well Physicians: Irene Cherrick, MD Treatment: chemotherapy Her thoughts: “I’d never used makeup before, so it was all new, and fun. I liked learning about wearing a scarf with a prom dress when you have a chest port.”

Treatment: chemotherapy and radiation Her thoughts: “It was nice to learn about makeup, especially eye shadow. But when I lost my hair, I decided there was no need to wear a scarf or wig. is is who I am now.”

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Her thoughts: “I spent a lot of time playing with makeup and watching how-to videos when I was in the hospital. e session added to my knowledge, especially about good sanitary practices. You can’t have fake nails when you’re in treatment because of bacteria.” continued on page 18

How to participate Are you a teenager or adult with cancer interested in a “Look Good Feel Better” session? In the Syracuse area, sessions are offered at the Upstate Cancer Center (teens and adults) and the East Syracuse office of the American Cancer Society (adults only). Contact the Upstate Cancer Center, 800-464-HOPE (4673), or the American Cancer Society at cancer.org or 800-227-2345.

Treatment: chemotherapy

Are you a licensed cosmetologist interested in becoming a “Look Good Feel Better” volunteer?

Contact the American Cancer Society.

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LIVING WITH CANCER iN THE KNOW

‘Look Good’ and ‘Feel Better’

Tips from the cosmetologists

Losing your hair?

No eyelashes?

Some cancer patients, like Taylor Way, are comfortable showing their bald heads when chemotherapy or radiation have caused hair loss. If that’s not for you, there are wigs, hats and turbans for your head and makeup solutions to camouflage the loss of eyelashes and eyebrows.

Cut your hair and save a lock

If your doctor says that you are likely to lose your hair during treatment, consider cutting it short before you begin to lose it. Save a lock of hair, so you can match the color if you decide to get a wig.

If your hair has not been colored or permed, and you need to cut off at least 6 inches, consider donating it to a nonprofit organization that makes wigs for people with medical hair loss.

Scarves and Turbans

Use cotton, not silky fabrics, which will slip on your head.

Make Your Own Turban

Avoid using false eyelashes with adhesive. e glue may cause skin damage and infection.

No eyebrows?

Draw eyebrows

2

To fill in a thinning brow or re-create an entire eyebrow:

2. Hold the pencil straight against your nose, parallel to the inside corner of your eye. Draw a dot just above the brow bone.

3 is is where your eyebrow should begin.

1. Use any all-cotton T-shirt.

Cut straight across the shirt just under the sleeves.

2. Take the bottom portion of the shirt (the “tube”) and center it on your forehead at your hairline.

3. Holding each side of the “tube” at the back of your head, cross the piece of fabric in the right hand over the le, creating a figure 8.

4. With the fabric crossed, pull the lower half of the figure 8 from the back of your head to the front, creating a headband.

5. Tuck any extra fabric under the twisted band.

3

Create the illusion of lashes by using a finetip eyeliner to draw a series of dots at the edge of your upper and lower lids. ese will look like eyelashes when someone looks at you directly. Want a bolder look? Use an eyeliner pencil. Apply a thin long line across the upper and lower lids. Smudge for a soer look.

1. Find the brow bone with your fingertip. Use an eyebrow pencil.

1

You can make a turban out of a T-shirt.

2

continued from page 17

4

5

3. Looking straight ahead, place the pencil parallel to the outside edge of your iris (the colored part of your eye.)

Place a dot where the highest point of the brow line should be.

4. Place the pencil diagonally from the bottom corner of your nose, past the corner of your eye, and draw a dot on your brow bone. Make sure the outer edge of the brow is not lower than the inside.

4

5. Once the dots are placed, connect them with into a brow line with feathery strokes of color. Make the brow fuller on the inside (near your nose).

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LIVING WITH CANCER

Wigs

Wigs are made of either synthetic material or human hair.

Most are made with more hair than is needed, so they can be cut and styled.

A turban or wide headband worn with a wig camouflages the hairline and makes the wig look more natural.

Wig care

Avoid using standard hairbrushes. ey can stretch and damage the hair on the wig. Use a wide brush with loose bristles. ink reverse when brushing your wig. Start at the ends and work up.

Changes in your skin?

Concealer

Dark circles under your eyes, redness and discoloration can occur during cancer treatment. To camouflage skin changes, use a concealer that matches your skin color.

Apply dots at areas that you wish to correct, then blot or lightly pat using your finger or a sponge.

Moisturizer, sunscreen, perfumes, etc.

Don’t use hair dryers, crimpers or curling irons on wigs.

With chemotherapy — Moisturizer and sunscreen are important because chemotherapy can cause skin to become dry and more sensitive to sun.

Don’t cook, grill or shower in a wig. Avoid steam heat from clothes dryers and microwaves. e wig will frizz or melt.

With radiation — Don’t use cosmetics, perfumes or deodorants on treated areas without checking with your physician. Avoid exposing treated areas to the sun.

Wash your wig every week or two. Fill a sink with water and add a few drops of clear dish soap. Submerge the wig and swish it around. Drain the sink and refill it with clear water. Submerge the wig in the clear water to wash out the soap. Wrap the wig in a towel. Avoid scrubbing, which causes frizz. Dry your wig on a shower head or a bottle, not a wig stand. (e stand will stretch the wig.)

1

3

Done with chemotherapy?

Get new makeup aer you are finished with treatments.

Dispose of the makeup you used while you were in treatment. It will have absorbed the chemotherapy medication when it touched your skin.

5

4

2

Got a chest port?

ILLUSTRATIONS BY SUSAN KEETER

Create a scarf with a rosette If you’d like to wear something with a low-cut neckline, get an extra large (one yard) square silky scarf that complements your outfit (For example, a red scarf for a black dress). It’s a great solution for a prom dress or other formal attire.

1. Fold the scarf diagonally in half to create a triangle.

2. Knot the two long points together into a tight knot.

3. Put the knot over your le wrist.

— With your le hand, hold the point of the bottom layer of the scarf.

4. Hold the point of the top layer of the scarf in your right hand and pull the two points, creating a rosette.

— en, take the opposite ends and tie them together, so the scarf looks like a sling.

— Hang the knotted area of the scarf over your arm.

— Grasp the untied/knotted points of the scarf with the same hand.

— With the opposite hand, hold the piece of scarf closest to you. Pull your arm through, and it will create a knot.

5. Drape the scarf over your shoulder.

— Use a safety pin or decorative brooch to hold the scarf in place on the back of your dress or on your bra strap.

ADAPTED FROM “LOOK GOOD FEEL BETTER.”

winter 2018 l upstate.edu/cancer

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19

750 East Adams Street l Syracuse, NY 13210

Look at the cancer-fighting TrueBeam UPClose

BY AMBER SMITH

WORKERS IN CALIFORNIA, SWITZERLAND, England and Canada built the precision cancer-fighting technology that occupies Upstate Radiation Oncology at the newly renovated Oneida office.

17.4340218 39.39mcanfieldsk

Pieces of the TrueBeam Radiotherapy System are put together only aer they are all delivered to the medical office where patients will go for care — in this case, 605 Seneca St., off of Route 5 in Oneida.

TrueBeam provides state-of-the-art radiotherapy and radiosurgery, and its new location in Oneida is convenient to cancer patients east of Syracuse. Already in use at the Upstate Cancer Center in Syracuse and another satellite office in Oswego, the TrueBeam can be used for many types of tumors, including tumors that are hard to reach surgically. TrueBeam is particularly well suited for treating tumors that move, such as lung, liver and pancreas cancer, as well as cancers in critical locations, such as prostate cancer, breast cancer, colorectal cancer, gynecologic cancer and brain tumors.

Continued on page 8