Download Anne Katz, PhD, RN Monday April 11th 11:55am Helping families

Anne Katz, PhD, RN
Monday April 11th 11:55am
Helping families into and through survivorship
While many patients and their families welcome the end of the active phase of
treatment for breast cancer, transitioning out of the intense treatment phase and
into recovery and survivorship can be challenging. Cancer survivors and their
families are not always well prepared for what comes next and health care
providers have an important role to play in educating them about post-treatment
changes, physical and emotional, as well as anticipatory guidance related to
surveillance for recurrence.
The survivorship care plan should provide a road map for post-treatment care and issues however not
everyone receives the document and many patients forget that they have this piece of paper and what it
comprises. Some survivorship care plans do not adequately address the many psychosocial challenges
facing women after breast cancer including back to work issues, alterations to body image and sexuality,
as well as the changes posed by early or sudden ovarian failure. This session will highlight the key
messages that we should be providing to women in the immediate post-treatment phase as well as
health behaviors that women should integrate into their life after treatment is over.
Başak E. Dogan, MD
Tuesday April 12, 2016
Everything You Need to Know about Radioactive Seed Localization
Get off the Wire Addiction – Time to get started in RSL!
Radioactive I-125 seed localization (RSL) is a new breast lesion localization technique
which was developed as an alternative to pre-operative wire localization of nonpalpable breast lesions. A standard I-125 titanium seed with activities ranging 0.1000.300 mCi is implanted within targeted breast lesion. A handheld gamma probe optimized to 27keV is
then utilized by the surgeon to identify the lesion intraoperatively. Lesion removal is confirmed by
documenting counts in the specimen, with no residual counts in breast and/or subsequent specimen
radiography. Seeds can be placed up to 5 days prior to Surgery. This allows “uncoupling” of the radiology
and surgical schedule, as well as flexibility while timing placement. I-125 and Tc 99m are of different
Geiger counter peaks and can be individually distinguished with handheld Gamma detection probe if
concomitant sentinel lymph node biopsy is being performed.
Studies consistently show increased patient satisfaction, improved scheduling, shorter localization
procedure and OR times. Randomized controlled trials (RCT) and cohort studies report at least equal
success to imaging-guided needle localization (NL) for achieving negative surgical margins; some cohort
studies suggest improved negative margin and re-excision rates. Procedure is user friendly for the
radiologists and is a preferred method for non-palpable localization among surgeons.
One of the greatest barriers in implementation of RSL is the off-label use of I-125 brachytherapy seeds
for this procedure. While application for breast localization is vastly different, NRC rules and regulations
governing the process is the same as for its radiation therapy use. Another issue is the long half-life of I125 seeds rendering storage problematic, while dispensing carries liability after their use. After seed
insertions, patients carry minimal radioactivity, and while the full body dose from a single seed for the
purposes of localization is minimal, in the event it is not removed, dose needs to be calculated,
documented and reported to NRC. Lastly, there is a lack of trained individuals who are credentialed to
perform RSL procedure both in Radiology and Surgery communities. Implementation of RSL procedure is
a complex and multidisciplinary process that involves Radiology, Radiation Safety, Nuclear Medicine,
Surgery and Pathology departments. One or more authorized users must be determined, which are
responsible for proctoring other practitioners. Each practitioner is required to take an annual Radiation
Safety test, and adhere to a pre-developed protocol during insertion and removal. To ensure the safe
and appropriate use of the seeds, they must be tracked appropriately from ordering to retrieval and
return to the seed vendor. Special care must be taken to ensure none of the seeds are lost, all deployed
seeds are accounted for and transection of a seed during removal does not occur.
In my presentation entitled: “Get Off the Wire Addiction – Time To Get Started in RSL!” I will review the
legacy localization techniques and outcomes, explain in detail the documentation and framework
required for successful program development. I will address and illustrate our solutions to seed
selection, storage, dispensing and outline the key points of seed procedure planning and insertion by
the Radiologist, communication and reporting to the surgeon.
James A. Simon, MD, CCD, NCMP, IF, FACOG
Saturday April 9th 2:10pm Navigation/Survivorship Break out
Fertility Issues Facing Women with Breast Cancer
Decreased ovarian function following a breast cancer diagnosis results in
reduced fertility whether from a delay in childbearing during breast
cancer treatment or the adverse effects of adjuvant chemotherapy or
both. Approaches to assessing current fertility and ovarian follicular
“reserve” prior to definitive breast cancer therapy may facilitate more
realistic expectations of post-treatment fertility. Setting realistic goals can
go a long way to reducing anxiety and frustration. Current approaches to
preventing or minimizing the adverse effects of adjuvant chemotherapy on future ovarian function will
be reviewed. The brave new world of oocyte and embryo cryopreservation, ovarian transplantation, as
well as cutting edge treatments using the energy-producing mitochondria from egg precursor cells
(immature egg cells found in the protective lining of the ovaries) or mitochondria from younger more
fertile women to supplement the existing mitochondria to boost the older eggs’ energy levels for better
embryo development will be reviewed along with the inherent risks, benefits, and costs of these
procedures.
Sally Swift Joyce
Sunday April 10th 1:30pm in the Navigation Break Out
Camp Hope: An Escape from Cancer
At Northside Hospital-Atlanta, we call that Camp Hope.
Is it possible to give someone dealing with cancer a place to go to where
they can have a time of relaxation and fellowship with others and not
feel like a “PATIENT”?
Camp Hope is a place where people can relax, meet new friends, and learn ways to help take care of
themselves both physically and mentally surrounded by country air, two lakes, walking paths, a farm,
and much more. Campers relax and slow down, and find out that they can conquer more than they
thought they could.
With many different activities, campers find themselves opening up to many new things,
from drumming, to fishing, to storytelling, to dancing and more. Camp Hope is a fee-free, three-day
retreat for our patients giving them a rest from what they face every day and allowing them to just
breathe.
This session will explain how Camp Hope got started and how it has stayed successful for the past twelve
years. It may also give you pointers on how your hospital can start a similar program.