Download Fall/Winter 2014 - Allegheny Health Network

Gullet and Chest
Fall/Winter 2014
A Message from the Director
Blair A. Jobe, MD, FACS,
Director, Esophageal &
Thoracic Institute
Rodney J. Landreneau,
MD, Co-Director of the
Esophageal and Lung
Institute, Chief of the
Division of Thoracic
Surgery, and System
Director of Thoracic
Oncology
Welcome to the fall edition of
Gullet and Chest. We have had an
extremely active summer within
the Esophageal and Lung Institute
(ELI), and we have several exciting
pieces of news to share with you
in this edition. However, first and
foremost, it is with utmost pleasure
that we announce that Rodney
J. Landreneau, MD, has been
recruited to the Allegheny Health
Network family and will serve as the
Co-Director of the Esophageal and
Lung Institute, Chief of the Division
of Thoracic Surgery, and System
Director of Thoracic Oncology within
the Cancer Institute. Dr. Landreneau
comes to us from the Ochsner Health
System in New Orleans, where he
served as the Medical Director of the
Cancer Institute and Vice Chair of the
Department of Surgery. He brings to
ELI a long and distinguished career
of pioneering leadership, excellence
and innovation in thoracic surgery.
In addition to his unsurpassed clinical
talents, Dr. Landreneau is a highly
skilled clinical researcher and has
led or participated in national clinical trials throughout
his career within the American College of Surgeons
Oncology Group and the “Alliance” (CAL-GB, NCCTG,
ACOSOG) Cancer Cooperative Group. Prior to going to
New Orleans, Dr. Landreneau was a tenured professor
in the Department of Cardiothoracic Surgery at the
University of Pittsburgh, where he worked for more than
20 years. He has been prolific throughout his career and
published over 400 peer-reviewed manuscripts in the
field of thoracic oncology and esophageal diseases. Dr.
Landreneau brings passion, creativity and enthusiasm
to everything he does. Within the very near future, we
will be opening and enrolling into several additional
clinical trials in the field of esophageal and lung cancer,
leveraging the AHN’s newborn affiliation with the Johns
Hopkins Sidney Kimmel Comprehensive Cancer Center.
Dr. Landreneau is highly committed to the people of
Pennsylvania and tri-state area, and, although he hails
from Baton Rouge, Louisiana, he is a Pittsburgher at
heart. The leadership of the Esophageal and Lung
Institute believes that it is our absolute obligation to
bring every possible advantage to our patients afflicted
with esophageal and/or lung cancer. The arrival of Dr.
Landreneau bespeaks the commitment and support of
AHN to execute this vision.
In this issue of G&C, we cover the important issue of
Barrett’s esophageal adenocarcinoma. The incidence of
this form of esophageal cancer has increased at epidemic
proportions over the last three decades and the overall
survival — even after aggressive therapy — remains
unacceptably low. To put it simply, we must do better. We
believe that the answer lies in prevention, early detection
and a personalized approach for each patient. The
majority of those afflicted are diagnosed at a late stage
and this requires a coordinated and multidisciplinary team
of experts, which we have assembled within ELI. Our
experts are driven toward solutions through research and
innovation. This drive is bolstered on a daily basis by the
courage and indomitable spirit of our patients.
We sincerely appreciate the outpouring of confidence you
have shown in our program by entrusting us with your
patients. We will continue to deliver humanistic care one
patient (family) at a time. In the words of American writer
Ursula K. Le Guin, “It is above all by the imagination that
we achieve perception and compassion and hope.”
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Patient Perspective: My Journey with Esophageal Cancer
In February 2014, Pittsburgh resident Sara Duffett was told she had
esophageal cancer. For the past seven months, Sara has received
care at the Esophageal & Lung Institute. Here is her story.
Hospital. My ICU nurse was at my bed side whenever she saw
that I was in pain. She could see from the window when I was
in distress and was at my side before I could press the buzzer
for help.
Two months ago I danced with my eldest son at his wedding.
That doesn’t seem that unusual, except for the fact that I was
diagnosed with esophageal cancer in February 2014. It has
been quite a journey since February, but it hasn’t been as awful
of an experience as one would imagine. I have met the most
empathetic and caring people during my surgery, stay in the
hospital and throughout my chemo and radiation therapy.
Without them, I would have given up hope, but instead I am
very optimistic and enjoying my life.
Dr. Hiro visited me on the general floors three to four times a
day. He made sure everything was going well post-surgery and
removed all of my tubes and dressings. While I was taking a
walk one day, he joined me and we went to the window to see
the sunset. Being treated as a person and not a cancer patient
helped immensely in my recovery.
I also had a problem at home one day with my feeding tube.
I accidently cut the tube off late on a Friday evening. When I
called my doctors, they said they were going home for the day.
I knew Dr. Hoppo lived in my neighborhood, so I asked if he
could meet me somewhere. Instead he said he would come
to my house. Yes, my doctor made a house call! I am forever
grateful for these compassionate doctors. I will never forget the
care that I received while at West Penn Hospital and the doctors
that helped me through this process.
In November my father passed away and I began experiencing
problems with swallowing. I have never been a smoker or
drinker and had no acid reflux. The symptom of just having
trouble swallowing seemed insignificant to the G.I. doctor that
I visited, so I didn’t get an endoscopy until I couldn’t keep food
down. The doctor had planned to just stretch my esophagus
to allow me to swallow better. Instead, when I awoke from the
endoscopy, my doctor told me that I had a cancerous tumor in
the wall of my esophagus and needed a surgeon.
The third part of my journey was the chemotherapy and
radiation treatments. I received five weeks of daily radiation
while wearing the chemo pack every day. I did not experience
the severe side effects that they expected, but I did lose my
appetite and my hair. Losing my hair was not that traumatic,
but it did remind me daily that I have cancer. My radiation
oncologist, Dr. Russell Fuhrer, gave me some wonderful
advice. He said, “Don’t let cancer define you. It is just a bump in
the road but it isn’t who you are.” I loved that sentiment and it
reminds me to live each day to the fullest. Dr. Casey Moffa and
her nurse, Barbara, provided me with superior care as well. They
have accommodated me when scheduling appointments and
have adjusted my prescriptions to handle the nausea during
chemo. They have helped me and made me feel comfortable
every step of the way during chemotherapy.
Wow, what a blow to my husband and me! I immediately called
a doctor friend of mine at the Allegheny Health Network. She
referred me to Dr. Blair Jobe at the Esophageal & Lung Institute
and said to call him tomorrow. I called him on a Wednesday and
he gave me his cell phone number and said that he would see
me the following morning.
When you hear a diagnosis of cancer, there is nothing more
comforting than getting a quick response from your doctors.
Dr. Jobe and his practice, including Dr. Yoshihiro Komatsu
(Hiro) and Dr. Toshitaka Hoppo, have carried me through this
process with compassion and understanding.
After another endoscopy with Dr. Jobe, he set my individual
plan in motion. He told me we would take this in three steps
and not get into all of the problems until we needed to. The
first step of my individual plan was to prepare for surgery. I had
to see various doctors to evaluate my competency for surgery.
I saw a cardiologist (a pulmonary specialist) and was told that
I had to recover from the pneumonia I contracted from the
preliminary endoscopy. Eventually, all my tests came out great
and I was cleared for surgery.
I have finally finished all of my chemo treatments and radiation
therapy. It has been a hard fought journey. I will receive my PET
scan in October and we will find out if all of these treatments
have worked.
As I stated at the beginning of this article, it has not all been
a terrible journey. I am so appreciative of the caring people
that I have met along the way. My team of doctors and nurses
has been so friendly and competent during these last seven
months. I also have a wonderful family, group of neighbors, and
the school staff where I work that have been so supportive with
meals, cards, rides and their time. I am a very fortunate person
and plan to keep fighting. I was always a person that loved life
and took time each day to smell the roses and view the sunset. I
am remaining positive and enjoying this new life that has taught
me to appreciate every moment.
The second step of my plan was the surgery to remove my
esophagus and, hopefully, the cancerous tumor. The day of my
surgery, I asked Dr. Jobe how he was feeling. Ever the jokester,
he said he felt great except for the shaking in his hands. I loved
his response and felt comfort in his confidence.
Everything went very well and I received excellent care in the
Intensive Care Unit and on the general floors at West Penn
2
Esophageal Cancer: Disease Burden and Challenges Faced
Esophageal cancer is a lethal disease and is the sixth
leading cause of cancer deaths in the world. The majority
of esophageal cancer patients present with squamous cell
carcinoma or esophageal adenocarcinoma (EAC). Since
1970, there has been a 350 percent increase in the incidence
of EAC (www.nci.gov), with the preponderance (almost 500
percent increase) in white males over the age of 50. There are
approximately 15,000 new esophageal cancer diagnoses per
year in the United States, half of which are EAC. In particular,
EAC, has risen at an epidemic proportion in the western
hemisphere.
Chronic gastroesophageal reflux disease (GERD) initiates
the development of precancerous cellular changes in
the esophageal lining known as Barrett’s esophagus (BE).
Approximately, 20 million people suffer from chronic GERD in
the United States, of which an estimated 15 percent of cases
progress to BE.
EAC has known risk factors that include, but are not limited
to, being Caucasian, male, over age 50, having reflux disease,
obesity, length of BE, hiatal hernia and cigarette smoking.
Those diagnosed with BE then undergo lifetime endoscopic
surveillance to look for the development of malignancy.
Those with dysplasia undergo outpatient endoscopic
therapy to reduce the risk of cancer progression.
Endoscopic Image of Barrett’s esophagus
However, it is important to note that 95 percent of patients
who develop EAC have never undergone BE screening prior
to their cancer diagnosis. This makes the effectiveness of the
current endoscopic screening and surveillance programs
very challenging and almost akin to looking for a needle
in a haystack.
Continued on Page 4.
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to mask GERD symptoms while the
underlying injury mechanism continues
unabated. Overall, this results in
more than 50 percent of EAC patients
presenting initially with difficulty
swallowing secondary to obstruction
from the tumor representing more
advanced disease.
Unfortunately, because the esophagus
is a distensible organ, the majority
of patients who develop EAC do not
experience difficulty swallowing until
the tumor is advanced and the chances
for long-term survival are less likely.
Thus, EAC is associated with a poor
prognosis, with less than 15 patients out
of 100 living more than five years
from diagnoses.
This underscores the importance of
spending research dollars to improve
screening and surveillance methods,
identifying patients at risk of disease
progression and enhancing therapeutic
and minimally invasive surgical options
for treatment. The Esophageal and Lung Institute offers
approaches to diagnosis and therapy not available at other
institutions in the region.
Compounding the ineffectiveness of the current screening
and surveillance paradigm is the fact that up to 57 percent
of patients who develop EAC do not even report GERD
symptoms and have what is known as “silent reflux.”
This “silence” may be compounded by the liberal use of
over-the-counter acid suppressant medications that tend
You should consider endoscopic screening for
BE and EAC if you have:
• Commitment to anti-acid medication for more than
four years
• Difficulty swallowing
• Obesity (Body Mass Index >40) with symptoms
of reflux
• Chronic cough unexplained by any other disease
process
• A large hiatal hernia
• Regurgitation of fluid with changes in body position
• Blood in sputum
• Heartburn that resolves over time in the absence of
treatment with anti-acid medication
Endoscopic Image of esophageal cancer
4
Active Clinical Trials
Tech Talk n 12-036 Esophageal Tissue Bank
n 12-025 POEM Procedure for Achalasia
n 13-005 NIH-funded Pathways of Barrett’s
n 13-007 Barrett’s Esophagus Risk Consortium
n 13-018 Chronic Cough and GERD
n 13-035 Lung Tissue Bank
n 14-036 B-AMP Panel Serum Study for Esophageal
Adenocarcinoma
n 3545 Torax Medical Post Approval Study LINX Device
n 2271 NinePoint Medical NVLE registry
n 2272 Caris Tumor Profiling Registry
n Comparative Small Cell Lung Cancer Study
n CALGB Lung Cancer Tissue Bank
n CALGB 140503 Lobectomy v. Sublobar Resection
Unsedated Screening Endoscopy
Sedated endoscopy is the primary screening and surveillance
method for esophageal disease. It can be quite costly,
averaging about $3,000 per exam. Unsedated screening
endoscopy, otherwise known as unsedated transnasal or
small caliber endoscopy, does not require sedation and
can be performed in an in-office setting with a topical
anesthetic. This technology has been shown to provide
equivalent accuracy in detecting Barrett’s esophagus
with excellent patient tolerability. Unsedated transnasal
endoscopy is a feasible, safe and well-tolerated method to
screen for esophageal disease in a primary care population.
Additionally, unsedated endoscopy costs approximately
$400 per exam, eliminates anesthesia risks and saves time for
patients and their families. Overall, this procedure can enable
more people to undergo potentially lifesaving screening at a
reduced cost.
n Ultrasonography Eval. of Esophageal Cancer
n CALGB 80803 PET Scan of Esophageal Cancer
n Early Diagnoses of Pulmonary Nodules
New Team Members
The Esophageal & Lung Institute happily welcomes:
n Megan Heit: Clinical Research Coordinator. Megan joins
the team with a background in biology and program
management as a previous employee of UPMC.
n Steve Choe, MD: Minimally Invasive Surgical Fellow.
Steve completed his general surgical residency at Drexel
University and will be working alongside the institute
surgical team during the next year training in minimally
invasive esophageal surgery. A Californian, Dr. Choe
received degrees from UCLA, Fullerton, and Drexel
universities.
Our Mission
n Amit Shetty BS, MS:
Research Fellow. Amit joins the
team after completing a master’s degree in physiology
from Georgetown University. A Pittsburgh native, Amit
received his bachelor’s degree from the University of
Notre Dame and previously worked at the University of
Pittsburgh Cancer Institute.
To provide patient-centered and cutting-edge clinical
care for diseases of the esophagus and chest in a
compassionate, effective, and user-friendly fashion,
employing a coordinated network of clinics which serve
the patients of western Pennsylvania, surrounding
states and the nation.
Gullet and Chest is published by the Esophageal and
Lung Institute. Please send all questions and comments
to Emily Lloyd, Editor, [email protected] or call
412.578.1343.
5
Expert Care for Esophageal Cancer
Clinical scenario: A man in his late fifties with a 15-year
history of GERD and a hiatal hernia visits his primary care
physician’s office. The patient says he is having problems
swallowing and has lost 10 pounds. Furthermore, the patient
states that he has been having episodes of regurgitation
of foamy saliva and thought that it represented worsening
symptoms of GERD.
The construct of the Esophageal & Lung Institute is unique
in that providers deliver long-term and seamless care
throughout the entire course of the treatment and recovery
while maintaining detailed communication with the patient’s
referring and primary care physicians. Surgeons work
closely with medical and radiation oncologists to plan the
most effective treatment strategies. Multiple specialists, at
one hospital, can see patients on the same day. Molecular
profiling is routinely performed on esophageal tumors to
best select chemotherapeutic treatment options to target
vulnerabilities of a given individual’s cancer.
The doctor reviews his medical history and performs a
physical examination. The man is referred to an endoscopist
where he is scheduled for an upper endoscopy. During
the procedure, the physician notices long-segment
Barrett’s esophagus with nodularity and a mass in the
end of the man’s esophagus. The mass is biopsied and
after confirmatory tests, the diagnosis is esophageal
adenocarcinoma in a field of Barrett’s esophagus with
multifocal high-grade dysplasia. Now what?
For those with Barrett’s esophagus or early stage cancer,
physicians within the institute are the region’s leaders
in endoscopic esophageal preserving techniques, using
radiofrequency ablation, cryoablation, endoscopic mucosal
resection and endoscopic submucosal dissection (pictured
above) to remove cancerous areas from the inside of the
esophagus and stomach. These procedures are performed
on an outpatient basis and do not require surgical incisions
on the skin.
The Esophageal & Lung Institute offers the highest quality
and most specialized care for individuals diagnosed with
esophageal cancer in the region. Individuals receive an
initial consultation with one of the institute’s disease-based
specialists to outline the best possible treatment plan.
Patients are guided through the variety of options currently
available to overcome the disease. Patients first undergo
clinical staging, which dictates the treatment strategy. Most
often, clinical staging can be performed on the same day or
within days of the initial consultation. This involves imaging
and endoscopic ultrasound of the diseased esophagus and
surrounding lymph nodes.
For more advanced cases, individuals may need to have
the affected area of the esophagus removed entirely.
The institute’s surgeons are national leaders in the field
of minimally invasive esophagectomy — a combined
laparoscopic (abdomen) and thoracoscopic (chest) procedure
for removal of the esophagus. This procedure only requires
5 and 10mm incisions that lead to less pain, faster healing
times and likely less morbidity than the same procedure
performed through large incisions.
Continued on Page 7.
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surgical approach used at the Esophageal & Lung Institute
(versus the comparison group), which is theoretically more
aggressive in removing all lymph nodes in the region of the
cancer.
The outcomes of esophagectomy within the Esophageal and
Lung Institute are outstanding and compare favorably to that
of national and regional numbers. The most recent series of
100 consecutive esophagectomy cases has yielded outcomes
consistent or superior to national standards in most postoperative complication categories (see graph below). Of
these 100 patients who underwent esophagectomy, 70
underwent the procedure for EAC and had short hospital
stays and excellent survival on short term follow-up. The
higher pneumonia rates in this series likely reflect the
Throughout their treatment and recovery, patients have
access to real-time counseling from institute-dedicated
dieticians, speech pathologists and palliative care experts
who improve an overall sense of well-being. The team works
alongside the patient and family throughout the course of
their cancer treatment in order to coordinate efforts and
provide the best possible outcomes.
7
Case Study: Use of NVLE to target biopsies, increase diagnostic
yield and decrease sampling error
Upper Endoscopy with Narrow Band Imaging
The traditional approach for evaluating a patient with
Barrett’s esophagus (BE) is to obtain random biopsies from
the field of endoscopically apparent BE. Unfortunately, this
approach sets the stage for missing dysplasia and early
cancer as only a very small proportion of the field is sampled
with very small biopsy forceps. The Esophageal and Lung
Institute is the only program in the region that offers optical
coherence tomography (volumetric laser endomicroscopy
or NVLE) for its patients with BE. This technology enables
directed biopsies by using real-time microscopic imaging to
pinpoint the location of diseased tissue.
Long segment Barrett’s esophagus with the longest lesion
measuring 5 cm in length was identified. The surface of the
esophageal lining appeared flat and no significant nodularity
was identified using the standard white light endoscope and
narrow band imaging.
NVLE
Circumferential images of the esophagus were taken using
the volumetric laser endomicroscopy (NVLE). Multiple
Barrett’s glands were identified using NVLE at 38.5cm
from incisors that were not initially apparent using white
light endoscopy. A second area of Barrett’s esophagus was
scanned using NVLE but did not show suspicious glands.
The Patient
The patient is a 51-year-old male with a long history of GERD.
He has been on proton pump inhibitors (medication) for
over five years which helps his heartburn. He has undergone
upper endoscopy by a different physician several times
before. His last upper endoscopy was in 2011 which reported
long segment Barrett’s esophagus with lesions measuring
8cm in length. Serial biopsies had revealed abnormal tissue
(intestinal metaplasia) without dysplasia. We performed
upper endoscopy with NVLE to evaluate the current status of
his long segment Barrett’s esophagus.
EMR and Serial Biopsy
Based off of NVLE imaging, endoscopic mucosal resection
(EMR) was performed on the suspicious region of Barrett’s
esophagus. This EMR sample removed a larger amount of
tissue compared to biopsies. Random biopsies were obtained
from other areas and all tissue was sent to pathology for
analysis.
Pathology Outcomes
The EMR specimen showed
intestinal metaplasia with
focal low-grade dysplasia.
Random biopsy specimens
showed intestinal metaplasia
without dysplasia.
Future Treatment Plan
The NVLE-guided tissue
acquisition and the lesions of
dysplasia were successfully
removed during endoscopy
through EMR. Radio
frequency ablation (RFA) is
planned to remove and treat
the remaining Barrett’s tissue.
Anti-reflux surgery may also
be scheduled in order to
eliminate the patient’s GERD
and prevent further damage
caused by recurrent acid
reflux.
8
Genetic profiling in a model of metastatic esophageal cancer:
Using research models to gain insight into the mechanisms
of metastasis
MicroRNAs constitute a recently discovered class of genetic
fragments that play a key role in gene regulation. In cancer
models they control the “mutated” genes central to tumor
development, invasion and spread. By using a molecular
profiling technology on rat esophageal cancer specimens,
the Esophageal & Lung Institute research team further
identified a unique set of microRNAs that predict advanced
esophageal adenocarcinoma that will likely spread to other
organs within the animal.
This unique microRNA signature could eventually be used
in clinical care to predict survival, identify patients at risk
of developing metastatic disease, and, most importantly,
guide selection of molecular targets for new therapies
for each individual patient. As an example, this predictive
microRNA signature can potentially dictate selection of a
more aggressive chemotherapy regimen for patients likely
to develop metastasis and save metastasis-unlikely patients
from the unnecessary cytotoxic effects where surgery alone
will be effective. This work was presented at the Annual
Meeting of American College of Surgeons, San Francisco in
October, 2014.
Over the last decade, advances in molecular profiling
technology have resulted in a survival benefit and improved
patient quality of life for several well-studied cancer types
such as breast, colon and lung. Unfortunately, with EAC,
which is an understudied and underfunded cancer, this goal
has not yet been realized and is reflected by very low patient
survival rates. Therefore, in order to bring benefit to EAC
patients there is a profound need to develop representative
esophageal cancer animal models to study cancer behavior,
cellular changes central to disease progression and to test
new drug therapies.
Helpful Links for Patients
with Esophageal Cancer
The animal model employed by researchers at the
Esophageal & Lung Institute results in the free flow of
stomach acid and bile juices into the esophagus leading to
the development of EAC within seven months. This mimics
the human esophageal cancer molecular progression. To
date, the major criticism of this model has been that, unlike
human EAC, no metastatic disease has been shown in these
rodents. However, in a recent study, the institute research
team was able to confirm distant metastasis in the model
using fluorescent labeled metastatic and epithelial markers,
hence establishing their esophageal origin. This research
finding opens the door to the utilization of this model for the
study of mechanisms of EAC metastasis.
Esophageal Cancer Action Network - http://www.ecan.org
NCCN Guidelines for EAC - http://www.nccn.org/patients/
guidelines/esophageal/index.html#20
Esophageal Cancer Education Foundation - http://www.
fightec.org
Association of Online Cancer Resources - http://www.acor.
org
National Cancer Institute - http://www.cancer.gov
Esophageal Cancer Awareness Association - http://www.
ecaware.org
Barrett’s Esophagus - http://digestive.niddk.nih.gov/
ddiseases/pubs/barretts/index.aspx
9
Support for those
with Cancer
Contact Us
To schedule an appointment: Call 724.260.7300
or visit www.ahn.org.
The Esophageal & Lung Institute strives to provide the
most convenient and reliable cancer support for those
immediately affected by the disease. Immediate clinic visits
are offered to all patients with a new diagnosis of esophageal
cancer where patients and families are supported through
the process by trained nurse navigators.
To make a donation: Call 412.578.4427
or visit www.wphfoundation.org.
For overnight lodging: Family House: for out-of-town
patients and their families traveling to any AHN location who
require overnight lodging, visit www.familyhouse.org/.
For individuals who travel long distances to seek treatment,
the Family House offers affordable accommodations
and is located in close proximity to West Penn Hospital
in Pittsburgh, Pa. Patients and families are provided with
housing and shuttle transportation to and from the hospital,
as well as many activities. For more information on pricing or
to book a room, please call 412.647.7777.
For clinical trial enrollment: Call 412.578.1343
Locations Served
The Allegheny Health Network offers emotional support
and has a variety of resources to help those with cancer and
their loved ones through their cancer journey. Support group
meetings occur the second Tuesday of every month, from
7:00 to 8:30 p.m. at Jefferson Hospital in Jefferson Hills, Pa.
Other meetings will soon be available at West Penn Hospital
and the Wexford Health + Wellness Pavillion, located in
Wexford, Pa. Registration is easily accessible by calling
412.622.1212. For more information and a comprehensive
schedule of other general support groups, please visit
https://www.ahn.org/events/.
Whether it is finding an affordable and convenient place
to stay or learning more about the disease and treatment
options, the Esophageal & Lung Institute, as part of the
Allegheny Health Network, pledges to provide a supportive
environment for those affected by cancer.
Allegheny General
Hospital
320 East North Avenue
Pittsburgh, PA  15212
Peters Township Health +
Wellness Pavilion
160 Gallery Drive
McMurray, PA  15317
Bethel Park Health +
Wellness Pavilion
1000 Higbee Road
Bethel Park, PA 15102
Uniontown
97 Delaware Avenue
Suite 103
Uniontown, PA 15401
Canonsburg Hospital
100 Medical Boulevard,
Canonsburg, PA  15317
West Penn Hospital
4800 Friendship Avenue
Pittsburgh, PA  15224
Forbes Hospital
2570 Haymaker Road,
Monroeville, PA  15146
Wexford Health +
Wellness Pavilion
12311 Perry Highway
Wexford, PA  15090
New Castle
3124 Wilmington Road
Suite 203
New Castle, PA 16105
10
Meet Your Care Team
Lana Y. Schumacher, MD, MS,
FACS, is an accomplished thoracic
surgeon specializing in thoracic surgical
oncology and minimally invasive/robotic
thoracic surgery. She is an Assistant
Professor of Cardiothoracic Surgery
at Temple University and is boardcertified with both the American Board
of Thoracic Surgery and the American
Board of Surgery. She has a special interest in thoracic
oncology and focuses on innovative minimally invasive and
robotic approaches to lung and esophageal surgery. Her
research interests include specialized treatments for lung and
esophageal cancers, lung cancer screening, and participation
in national clinical trials.
in 1975 and worked there for years. She later became a
Senior Professional Nurse and a Certified Gastroenterology
Registered Nurse (CGRN). As a nurse educator and preceptor
for professional development, Joan has helped to improve
knowledge, skills and critical thinking to ensure best
practices and positive patient outcomes in the specialty.
Ms. Schrenker served as a unit representative to the
hospital Professional Practice Council. She participated
in the development of a comprehensive orientation and
preceptor program for other nursing units regarding
the care of patients undergoing GI specialty procedures.
Joan also coordinated the development of a nursing staff
competency assessment programs that included peer review
and self-evaluation processes as well as ongoing continuing
education programs and opportunities for nursing career
development.
Dr. Schumacher received her medical degree at the
University of California of Los Angeles (UCLA) School of
Medicine and both her Bachelor of Science and Master of
Science degrees from the University of Southern California.
She completed her surgical internship and residency at
Stanford University Hospital and subsequently completed
her Cardiothoracic Fellowship at the University of Pittsburgh
Medical Center (UPMC). During her surgical training, she also
carried out a research fellowship supported by the National
Institute of Health in Immunotherapy for Cancer. She further
spent fellowship training at the Memorial Sloan Kettering
Cancer Center (New York, NY).
As the years progressed, Joan found a special niche
in diseases of the esophagus. In 2012, Joan joined the
Esophageal and Lung Institute under the direction of Dr.
Blair Jobe. Currently, Joan coordinates and performs many
diagnostic testing such as high resolution esophageal
manometry and pH reflux testing as well as related patient/
family education. Results of these procedures assist in the
treatment of patients using state-of-the-art critical therapies.
With her wealth of knowledge and experience, Joan serves as
a resource for staff education for the multidisciplinary team
members of the Esophageal and Lung Institute at Allegheny
Health Network.
Dr. Schumacher is an active member in the Society of
Thoracic Surgeons, Women in Thoracic Surgery, General
Thoracic Surgery Club and a Fellow of the American College
of Surgery. She was awarded the Outstanding Researcher
Award at Stanford University in 2008. She has also received
numerous teaching awards, the most prestigious being
the Arnold P. Gold Foundation Award for Humanism and
Excellence in Teaching Award in 2008.
Donna Snyder has been employed at
the Esophageal and Lung Institute since
March of 2013, after having worked
for over 20 years in primary care for
West Penn Allegheny Health System
(now Allegheny Health Network).
Donna acts as the institute’s scheduler
where she often is tasked with juggling
operating room schedules, clinic visits
and esophageal testing appointments for the institute’s
various sites. In addition to scheduling, Donna seeks out
authorizations from insurance providers for surgeries and
procedures and is frequently the voice patients hear when
calling the institute at 724.260.7300. Donna particularly
enjoys the face-to-face interactions with patients and
being able to help them receive the care they need. She
strives to do her best every day and has learned a great deal
while working with the talented surgeons and staff at the
Esophageal & Lung Institute.
Within Allegheny Health Network, Dr. Schumacher sees
patients and performs thoracic surgery at Allegheny General
Hospital, West Penn Hospital, Forbes Regional Hospital and
Allegheny Valley Hospital.
Joan Schrenker RN, CGRN, has
practiced nursing for many years in a
variety of roles. After graduating from
Shadyside Hospital School of Nursing in
1971, Joan worked in the Intensive Care
Unit and began learning the specialty
of gastroenterology. She was the nurse
member of the team that developed the
inaugural GI Lab at Shadyside Hospital
11
4800 Friendship Avenue, Suite 242
Pittsburgh, PA  15224
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