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News and advancements in oncology from
The Sandra & Malcolm Berman Cancer Institute at GBMC
In this issue:
n Prostate Cancer
Treatment: Making
an Informed Decision
n Advancing
Medical Knowledge
Through Research
Winter 2009
A GBMC Publication • Winter 2009
A Message from the Director
Cancer Committee 2008
Dear friends:
Members shall be no less than seven in number and shall include
a representative from the Departments of Surgery, Gynecology,
Otolaryngology-Head and Neck Surgery, Internal Medicine,
Diagnostic Radiology, Radiation Oncology, Pathology and such
other members of the Medical Staff as deemed necessary to the
effective function of the committee.
A diagnosis of cancer is the beginning of a
long and difficult journey for any individual.
I am continually inspired by the incredible
strength and positive outlook so many of
our patients exhibit during one of the most
difficult times in their lives.
Chairman
Gary I. Cohen, MD
In recounting their experiences at GBMC’s
Cancer Institute, patients and families can’t
say enough about the medical excellence and
compassionate, comprehensive care that has made their journey with cancer
that much easier to bear. As you’ll read in this issue of Greater Oncology
Today, patient Debbie Fustig, a lung cancer survivor, states, “My entire
experience at GBMC was wonderful. Everyone I encountered was compassionate and supportive which made a tough time in my life less difficult.”
Head and neck cancer patient Cliff Feldheim recalls the tremendous
amount of support he and his family received during his treatment for
cancer of the tonsil, saying, “I never felt like a cancer patient. I felt like
a person who was surrounded by love.”
Patient testimonials such as Ms. Fustig’s and Mr. Feldheim’s inspired the
theme for this issue of Greater Oncology Today — multidisciplinary care.
You’ll read about some amazing individuals who beat tremendous odds
thanks to an environment of care that places emphasis on excellence,
compassion, patient satisfaction and teamwork. For it is this multidisciplinary and all-encompassing approach that makes a positive difference
in the lives of our patients every day. From diagnosis and treatment to the
ultimate goal of a life free of cancer, patients at GBMC’s Cancer Institute
become part of a team dedicated to reaching the finish line of the journey
with hope, grace and dignity.
Thank you for your continued support and best wishes for a healthy 2009.
American College of Surgery Co-Liaison
Daniel Dietrick, MD
Frank Rotolo, MD
Administration
Executive Director, Oncology Services
Brian E. McCagh, FACHE
Department of Medicine
Hematology: John A. Nesbitt, III, MD
Medical Oncology: Paul Celano, MD
Marshall Levine, MD
Palliative Care: Anthony Riley, MD
Primary Care: Sarah Whiteford, MD
Department of Surgery
General Surgery: Lauren A. Schnaper, MD
Gynecology: Francis Grumbine, MD
Thoracic Surgery: Neri Cohen, MD
Pathology
Nathan A. Dunsmore, MD
Pharmacy
Dolores Dixon, PharmD, MBA, RPh
Radiation Oncology
Robert Brookland, MD
Eva Zinreich, MD
Radiology
Lee Goodman, MD
Oncology Service Line
Medical Oncology/Cancer Center: Connie R. Herbold, CPC-I
Cancer Registry: Sharon McIntire, MA, CTR
Clinical Trials: Garnitha Ferguson, RN
Human Genetics Institute: Jessica Adcock, MS
Inpatient Oncology (Unit 45): Nicole Thompson, RN
Oncology Support Services: Donna Lewis, RN, MS, CPC
Community Outreach: Laura Chase, BS
Infusion Center: Dawn Stefanik, AA, MLT, RN, BSN, OCN
Quality Assurance: Susan Fowble, RN, MS
Radiation Oncology: Craig Randall, RTT
Spiritual Support: Joseph Hart, M.Div.
The Milton J. Dance, Jr. Center/Head and Neck Associates
Karen Ulmer, RN, CORLN
~
Greater Oncology Today is published semi-annually by the
Marketing and Communications Department of The Greater
Baltimore Medical Center, a private, non-profit healthcare provider.
Gary I. Cohen, MD
Medical Director
The Sandra & Malcolm Berman
Cancer Institute at GBMC
Questions and comments regarding Greater Oncology Today
articles should be submitted to [email protected]
Director of Marketing: Michael P. Hartnett
Publications Supervisor/Editor: Lisa J. Schwartz
Contributing Editor: Gary I. Cohen, MD
Contributing Writers: Karen Blum, Kevin Gault,
Judy Grillo, Jessica Schoeffield, Susan Walker
Design & Layout: Dave Pugh Design
Photography: Mimi Azrael, Tracey Brown
Printing: Schmitz Press
6701 North Charles Street
n
Baltimore, Maryland 21204
n
443.849.2000
n
www.gbmc.org
GBMC includes Greater Baltimore Medical Center, Gilchrist Hospice Care and GBMC Foundation.
TA B L E O F C O N T E N T S
2
5
W H AT ’ S N E W
6
R E S E A RCH
O N C O L O GY N U R S I N G
Three Women United
by One Disease
7
14
AREA HIGHLIGHT
Complete Range of
Treatment Options
for Prostate Cancer
8
OF NOTE...
10
O N C O L O GY
C A S E ST U DY
12
H E A D & N E CK
CANCER
18
2008
A N N UA L R E P O RT
24
O N C O L O GY
S U P P O RT
IN FOCUS...
GY N O N C O L O GY
Multidisciplinary Approach
Improves Ovarian Cancer
Patient Outcomes
16
AREA HIGHLIGHT
GI Cancer: Not
“Will I Live?” But “How?”
On the cover:
Dr. Ronald Tutrone,
Division Head of
Urology at GBMC
GREATER ONCOLOGY TODAY
~
Winter 2009
~
1
Barbara Raksin, RN, receives
a big hug from former breast
cancer patient, and friend,
Heidi Peach.
2
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GREATER ONCOLOGY TODAY
~
Winter 2009
ONCOLOGY NURSING
Three Women
United
by One Disease
Personal support completes the circle of care
for GBMC breast cancer patients
A
CANCER DIAGNOSIS CAN BE OVERWHELMING,
but for patients at GBMC the compassionate personal support and expert guidance
of Barbara Raksin, RN, clinical nurse and
staff member of the Sandra and Malcolm Berman
Comprehensive Breast Care Center, can ease the
journey. Ms. Raksin helps patients with the practical
side of treatment, from scheduling appointments and
understanding test results to providing links to support
services. Equally important, she provides much-needed
emotional support.
“I take the journey with each patient,” she explains. “The goal is to make
access to all of GBMC’s services seamless for the patient. Whatever their
question or need, I will help.”
Two of her first patients, whom she met 10 years ago, agree that having
Ms. Raksin in their corner made a tremendous difference for them.
“Barb is an angel on earth,” says Heidi Peach, who was diagnosed with
Stage III breast cancer at the age of 37. “She made sure all my needs were
met. She advocated on my behalf with doctors, arranged appointments
quickly and visited me every day when I was taking part in a stem cell
treatment clinical trial. She made sure my family and I had the social and
psychological support we needed. Just talking with her was uplifting.” k
GREATER ONCOLOGY TODAY
~
Winter 2009
~
3
Ten years later, all three
women continue to support
one another through life’s
many ups and downs. Heidi
Peach (pictured, left) calls
Ms. Raksin “an angel on
earth” and Valerie Waldman
(right) states that Barbara
is “still the foundation of
my support system.”
Valerie Waldman, who was diagnosed with breast cancer at age 44
around the same time as Ms. Peach, shares her feelings. “The support
Barb provided to me and continues to provide is phenomenal. She was
my navigator through the journey. Knowing she’s there whenever I need
support goes a long way toward making the experience more manageable.
There should be an army of Barbs. I couldn’t have gotten through this
without her and she’s still the foundation of my support system.”
Ms. Raksin also introduced Ms. Peach to Ms. Waldman because they were
undergoing a similar multidisciplinary treatment regimen of chemotherapy,
radiation, and surgery as well as both taking part in a stem cell transplant
program at GBMC. “The side effects of treatment can be very intense, so
it’s good to be able to share your experiences with someone who understands first-hand what you’re going through,” notes Ms. Peach. The two
women continue to be in touch with each other and Ms. Raksin to this day.
The caregiver becomes the patient
Ms. Raksin says she was always in awe of how patients handled their
diagnosis and treatment and wondered, “Could I do what they do if I
had breast cancer?”
In 2004, she learned the answer to that question when she discovered
a lump in her breast during a self-exam and was diagnosed with breast
cancer. Her experiences, from diagnosis through chemotherapy, radiation,
surgery and recovery, have enriched the guidance she offers patients. “I tell
all my patients that I am a survivor and find that helps them relax because
they see I’m fine,” she says.
She notes it was difficult to share her diagnosis with Ms. Waldman and
Ms. Peach at first, but that their strong, ongoing bond and the way they
handled their cancer journey inspired her. “I’m very lucky to have relationships like this,” she adds. “We see each other in ways others don’t because
of our shared experience. It’s a lifelong bond.” n
4
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GREATER ONCOLOGY TODAY
~
Winter 2009
GBMC offers breast cancer
comprehensive care
GBMC’s Breast Care Center streamlines
the process of diagnosis, treatment and
recovery for patients by offering a wide
breadth of services in one convenient
location, including:
n
Risk assessment and genetic
counseling
n
Radiology/Digital mammography
n
Radiation oncology
n
Chemotherapy
n
Surgery
n
Social and psychological support
services
n
Lymphedema consultation and
treatment
n
The Boutique, a retail shop that
provides wigs, wig styling, scarves
and more
To learn more about breast cancer
services at GBMC, call the Sandra
and Malcolm Berman Comprehensive
Breast Care Center at 443-849-2600
or visit www.gbmc.org/cancer.
W H AT ’ S N E W
New Imaging Technology
Complements Digital Mammography
G
BMC’S SANDRA AND MALCOLM BERMAN
Comprehensive Breast Care Center is
the first center in the region to install
five new high definition, 5 MP digital
monitors that utilize the GE Centricity
PACS monitoring system and Dynamic
Imaging software to instantly retrieve and
view digital mammography images from all
sites of Advanced Radiology.
TM
The new system, which was made possible
by a generous grant to the Comprehensive
Breast Care Center, on behalf of the Board
of the Hospital for the Women of Maryland,
of Baltimore City, allows the Center’s
surgeons to instantly recall a patient’s
mammogram results in the exam room and
give them the ability to magnify and manipulate the images for optimal visualization.
All exam rooms are now equipped with the
monitors and imaging software in addition
to a physician office.
“This new PACS puts our center ahead of
the curve,” states Lauren Schnaper, MD,
Director of the Comprehensive Breast Care
Center, who uses the mammograms as
teaching tools for her patients, comparing
the previous year’s images with the current
year and explaining any changes that may
be seen in the breast tissue.
Patients who have mammograms performed
at Advanced Radiology, adjacent to the
Breast Care Center, have the images read by
a radiologist and then walk over to the breast
center. Here, their surgeon retrieves the
images instantly through the PACS system
in the privacy of the patient exam room.
“The high quality images projected by these
new monitors allow us to interpret, explain
and educate patients about the radiologist’s
reading, and help them in the decision
making process should cancer be detected,”
adds Dr. Schnaper. The new system can
recall images from CT, PET, MRI,
ultrasound and digital mammograms.
Saving More Lives with
Technology
Scott Maizel, MD, Director of the Breast
Cancer Risk Assessment Program, is thrilled
with the lifesaving implications the digital
mammography and new PACS technology
can offer patients. “The images on the
screen are so precise, we can
see a 2 mm tumor well before
it would ever be felt in a
physical exam or even picked
up using the previous generation of imaging equipment.”
Drs. Scott Maizel and
Lauren Schnaper with the
digital monitors that utilize
the GE Centricity PACS
monitoring system and
Dynamic Imaging software.
TM
He adds, “We dedicate a lot of
time to teaching our patients
about their breast health,
reviewing and comparing data
year after year. The new digital
mammography and monitors,
along with the specialized imaging software,
are an important part of this education. In
fact, this technology is the most important
tool we currently have to provide an early
diagnosis — and perhaps save more lives.” n
For more information, contact the Sandra & Malcolm Berman
Comprehensive Breast Care Center at 443-849-2600 or visit
www.gbmc.org/cancer.
GREATER ONCOLOGY TODAY
~
Winter 2009
~
5
RESEARCH
Advancing Medical Knowledge
Through
Research
The Cancer Institute
at GBMC presently
participates in
55 active clinical
trials for a wide
variety of cancers.
Since 1985, 1,700
patients have been
treated on close
to 500 clinical
trials at GBMC.
6
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GREATER ONCOLOGY TODAY
~
Winter 2009
E
VERY DAY, PATIENTS AND PHYSICIANS AT GBMC ARE
advancing medical knowledge of the best methods to
prevent and manage cancer. How? By participating in
national clinical trials that test the safety and effectiveness
of new treatments.
GBMC is the most active community hospital in the
Baltimore area and the state when it comes to clinical trials
participation, says Paul Celano, MD, Chief, Division of
Medical Oncology and the hospital’s director for clinical
trials. The Sandra & Malcolm Berman Cancer Institute at
GBMC presently participates in 55 active clinical trials for
a wide variety of cancers. Since 1985, 1,700 patients have
been treated on close to 500 clinical trials at GBMC.
GBMC physicians are active participants in trials organized
by pharmaceutical companies, national cooperative groups
including the Eastern Cooperative Oncology Group
(ECOG), Clinical Trials Support Unit (CTSU) and National
Surgical Adjuvant Breast and Bowel Project (NSABP), as well
as through The Johns Hopkins Hospital and the University
of Maryland Medical Center.
Most studies investigate the medical management of patients
with cancer, looking at radiation, chemotherapy, surgeries,
new medications or some combination, Dr. Celano says. But
the hospital also participates in trials aimed at the prevention
and detection of cancer.
“Our emphasis is multidisciplinary,” Dr. Celano says. The
TAILORx trial, for example, looks at ways to individualize
treatment for patients with early stage breast cancer. All
patients undergo surgery, then radiation. But investigators are
using a new gene-based test on an individual’s breast cancer to
determine whether patients are best suited to receive hormone
therapy alone versus hormones together with chemotherapy.
OF NOTE...
Other studies ongoing now include an
investigation of two different surgical
techniques in patients with non-small cell
lung cancer; a simple blood draw study to
develop a new method of detecting cancer
presence and monitor disease progression;
and a study of hormone and radiation
therapy in prostate cancer patients.
“GBMC is fortunate to have many patients
willing to participate in trials,” explains
Garnitha Ferguson, RN, clinical research
coordinator. During the past year alone,
267 patients were screened for clinical trials,
and 169 enrolled.
“The number one benefit is that it really
makes available to patients the most
advanced treatments for their cancer, in a
setting designed specifically for their type
and stage of disease,” Dr. Celano adds.
GBMC patients have had access to a variety
of new medications long before formal FDA
approval solely because of clinical trials,
states Dr. Celano. Examples include bevacizumab, a drug that inhibits tumor growth
by blocking the formation of new blood
vessels, and lapatinib, which deprives tumor
cells of signals needed to grow. Participation
in trials has also helped GBMC physicians
find better ways to treat patients, including
the use of medications that block estrogen
production, called aromatase inhibitors, in
patients with breast cancers.
“The thing I tell patients about trial
participation is that it really gives them
access to many more options in managing
their treatment,” Dr. Celano says. n
For more information on clinical
trials at GBMC, visit gbmc.org/
cancer/clintrials or contact Susan
Murphy, RN, oncology nurse
coordinator or Mindy Shifflett,
the American Cancer Society patient
navigator, at 443-849-3706. To search
a database of ongoing clinical trials,
see www.clinicaltrials.gov.
“Fight Back Express”
Visits GBMC To Fight Cancer
T
HE AMERICAN CANCER SOCIETY ’S
“Fight Back Express,” a bus that
served as a “rolling petition,” made
a stop on the GBMC campus on June
4, 2008. The bus, shrink-wrapped in
the American Cancer Society logo, was
adorned with thousands of signatures
and messages in support of its grassroots
cancer awareness campaign.
During GBMC’s stop, cancer survivors,
current patients, oncology staff
members and others braved the rain
to add their personal messages to the
“rolling petition” in memory of someone who lost their battle or in
recognition of someone fighting the disease.
The American Cancer Society’s Cancer Action Network sponsored
the “Fight Back Express,” which travels across the 48 continental
United States through Election Day in an effort to make cancer a
higher national priority by educating the public, lawmakers, candidates and the media about the importance of government’s role in
defeating cancer. The bus carried a mobile message that Americans
have the power to fight cancer through their voices and their votes. n
Laura Chase Honored for Volunteerism
by the American Cancer Society
L
AURA CHASE, COMMUNITY OUTREACH SPECIALIST IN THE CANCER
Institute, was a recipient of the Sunrise Award, a prestigious volunteerism award offered
annually by the American
Cancer Society. The award is
given on both the state and
national levels for outstanding
commitment and service to
the Look Good, Feel Better®
(LGFB) program. Laura, who
facilitates GBMC’s Look
Left to right: Linda Stoltenberg,
Look Good Feel Better volunteer
Good…Feel Better program,
& cosmetologist; Laura Chase,
was one of 12 recipients of
Community Outreach Specialist;
the state award from the
Alison Ressler, American Cancer
South Atlantic Division of
Society; Mindy Shifflett, Oncology
the ACS. n
Support Program Consultant
GREATER ONCOLOGY TODAY
~
Winter 2009
~
7
IN FOCUS...GYN ONCOLOGY
Multidisciplinary Approach Improves
Ovarian Cancer Patient Outcomes
A
CCORDING TO THE AMERICAN CANCER
Society, ovarian cancer is the fifthleading cause of cancer deaths in
women in the United States. This is a
statistic that GBMC oncologists Francis C.
Grumbine, MD, Division Head of Gynecologic Oncology, and Paul Celano, MD,
Division Head of Medical Oncology, hope
to change by utilizing the intensive procedure of intraperitoneal (IP) chemotherapy
as the standard of care for women suffering
from Stage III ovarian cancer.
The disease frequently spreads to the
abdominal cavity, and from there it can
move to other vital organs. Whereas
intravenous (IV) chemotherapy fights
cancerous cells through a patient’s bloodstream, IP chemotherapy is advantageous
because it delivers medication directly into
the abdominal lining, or peritoneum, and
then gets absorbed intravenously as well.
Dr. Celano explains, “IP chemotherapy
allows us to provide higher concentrations
of the drugs cisplatin and paclitaxel that can
then remain active in the area for a longer
period of time.” The IP drugs target cancer
cells in the abdomen, the primary site of
involvement, while IV drugs attack cells that
may have spread elsewhere in the body.
“Administration of the chemotherapy agents
takes place via catheter and port, which are
implanted under the skin during or after
debulking surgery, known as cytoreduction,”
adds Dr. Grumbine, who recommends the
intensive treatment for approximately 25
percent of his patients.
8
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GREATER ONCOLOGY TODAY
~
Winter 2009
Linda Zook (right) and Pat Richman (left), who befriended one
another during their intensive treatment for ovarian cancer, take
a moment to enjoy a stop in the GBMC Boutique.
Expert Care Team Sees Patients Through Intensive Treatment
Linda Zook sought treatment from Dr. Grumbine and the
multidisciplinary team at GBMC’s Cancer Institute when
she was diagnosed with Stage III-C ovarian cancer in July
2007 at the age of 54. Dr. Grumbine performed her radical
surgery, including cytoreduction, and Dr. Celano managed
her four-and-a-half month long IP chemotherapy regimen.
“I’m fortunate to have had such an expert care team,” she
states. “I am still recovering my strength a year later, but
my physicians, infusion therapists, nurses and the oncology
support staff did everything they could for me.”
Patient Pat Richman went through her IP chemotherapy
process with Drs. Grumbine and Celano at about the same
time as Ms. Zook. Both women, who became friends
through their shared experience, still exhibit some
neurological side effects as a result of completing their
rigorous treatments, but are grateful to be alive.
The physicians note that side effects from IP chemotherapy
are unfortunately more severe than those caused by IV
The Boutique
chemotherapy alone. These can include nausea, vomiting
and abdominal pain, possible bowel obstructions, as well as
neurologic problems. In fact, some patients are unable to
complete their chemotherapy courses due to the side effects.
However, a recent National Cancer Institute study confirms
that patients who embark on the six-course regimen gain
about 16 months in their median survival time and a better
relapse-free survival rate compared to those who received
IV-only.
Dr. Grumbine notes, “Because of the aggressive nature of
the disease and the intensity of this treatment, it is crucial
for ovarian cancer patients to be treated and followed by a
gynecological oncologist and a team of oncology specialists
to help ensure a more favorable outcome.”
VVV
VVVV
VVV
VVVV
VVV
Ms. Richman confirms, “It was not an easy treatment to
endure, but I would do it again without hesitation.” n
To learn more about gynecological cancer and
treatment options, visit www.gbmc.org/cancer.
Helping women look good and feel great about themselves…
Sometimes it’s the small things that
can make a woman undergoing cancer
treatment feel better… a great-fitting
wig, a touch of blush on the cheeks and
a little extra pampering.
That’s just what they’ll find at GBMC’s
Boutique, where the primary focus is on
the special needs of women with cancer,
alopecia and specialized skin care conditions resulting from scars, burns or laser
treatments. The Boutique offers wigs and
wig fittings, scarves and hats for hair loss,
breast fittings (bras and prosthetics),
products for skin care and overall image
consultation.
The Boutique’s cosmetologist, Linda
Kurgan, puts great emphasis on helping
patients look good and feel well. Other
services provided include shampoos, haircuts,
styling, manicures and waxing services.
Next time your patient needs that little extra
pampering, send her to The Boutique.
Hours of Operation: Monday-Friday, 8:30 a.m. - 5:00 p.m. Gift certificates
are available. All services are by appointment only. Call 443-849-8700
or e-mail Lynne Caddick, Boutique Manager, at [email protected].
GREATER ONCOLOGY TODAY
~
Winter 2009
~
9
ONCOLOGY CASE STUDY
Comprehensive Approach
to Lung Cancer Changes
a Patient’s Life
D
EBBIE FUSTING WAS NEVER SICK A DAY IN HER LIFE. SO WHEN A ROUTINE
pre-operative chest X-ray for elective surgery showed a small, suspicious
spot on her lung, she was stunned. “I’m a very lucky woman,” she says.
“I had no symptoms and no reason to believe something was wrong.”
Her diagnosis and treatment moved rapidly at GBMC, where she was
referred to pulmonologist Mitchell Schwartz, MD, for further tests
including a CT scan and a bronchoscopic biopsy that returned nondiagnostic results. In light of those inconclusive results, Dr. Schwartz
immediately sent Ms. Fusting to see Neri Cohen, MD, PhD, Head of
Thoracic Surgery at GBMC.
“I was impressed with how swiftly the process moved from diagnosis to
treatment,” Ms. Fusting adds. “I had my chest X-ray on August 17, 2005,
bronchoscopy on August 29, saw Dr. Cohen on September 9, completed
additional tests by September 13 and had my surgery September 21. I feel
that early detection and the speed with which I moved through the process
made a real difference.”
A former longtime smoker, Ms. Fusting, who was 53 at the time, had quit
a year before. A routine pre-op CXR revealed a 5 cm right lung mass.
Chest CT confirmed a spiculated mass in the right upper lobe. A PET
scan showed the mass to be hypermetabolic — highly suggestive of cancer
— without evidence of additional local or distant disease. Further pathologic
examination of lymph nodes by mediastinoscopy found no evidence of
advanced disease. Her breathing capacity was excellent at 75 to 85 percent
predicted for someone her age, race, sex and size.
Neri Cohen, MD, Ph.D.
During Dr. Cohen’s minimally invasive resection of the tumor, however,
additional lymph nodes were discovered to be microscopically involved with tumor. The tumor
was determined to be Stage III, crossing the fissure between the middle and upper lobes of
the lung, which were both removed during the procedure. Ms. Fusting completed the routine
post-operative clinical guideline and was discharged home on the third post-operative day.
After surgery, Ms. Fusting recovered as expected and began radiation therapy (33 treatments)
and six cycles of chemotherapy three weeks after surgery. “I didn’t know what to expect, but
in a sense, going in for the treatments at GBMC was almost comforting. The people were so
supportive and always available to answer questions,” she says.
10 ~ G R E A T E R O N C O L O G Y T O D A Y
~
Winter 2009
Patient and Medical Team Committed to the Fight
Ms. Fusting found the six weeks of radiation taxing. But the support of the nurses and
physicians at GBMC and her own unwavering commitment to doing all she could to beat
lung cancer helped her complete all 33 radiation treatments. “She took it in stride,” notes
Dr. Cohen. “She was adamant about not letting her treatment interfere with living her life. If a
patient can tolerate it, multimodality treatment is the best we can offer patients with advanced
stage disease, but less than two thirds of people can complete the full course of therapy as
Ms. Fusting did. Using minimally invasive surgical techniques clearly increases the likelihood
of patients being able to start and complete the multimodality therapy without interruption or
reduction in expected doses.”
It’s been nearly three years since she was diagnosed with lung cancer and Debbie Fusting
continues to be healthy with no recurrence of the disease and no breathing problems.
Dr. Neri Cohen followed her every three months for the first two years and now sees her
every six months. She also sees GBMC medical oncologist Robert Donegan, MD, who
oversees her medical care, every four months.
“When people hear they have cancer and they Google it, they find such bad, bad news.
But I hope my experience shows that even though it’s a rough road, not everything is bleak
or ends badly,” Ms. Fusting concludes. “My entire experience at GBMC was wonderful.
Everyone I encountered was compassionate and supportive which made a tough time in my
life less difficult.” n
‘‘I didn’t know what
to expect, but in
a sense, going in
for treatment at
GBMC was almost
comforting.’’
For more information about lung cancer visit www.gbmc.org/cancer.
Participation in
Clinical Trials Provides
Patient with Chance
to Impact the Future
As a result of the Cancer Institute’s keen
focus on research, Ms. Fusting took part
in the American College of Surgeons
Oncology Group (ACOSOG) Z4031
clinical trial during her treatment.
A sample of her tumor was sent to
researchers at Duke University who
are performing genomic and proteomic
testing on a range of tumors to pinpoint
abnormal cells that could lead to the
development of a blood test that could
identify lung cancer in its earliest stages.
GREATER ONCOLOGY TODAY
~
Winter 2009
~
11
HEAD & NECK CANCER
Chief of Staff, and Medical Director, Milton
J. Dance, Jr., Head and Neck Center.
The Dance Center
A Team
of Experts
Who
Surround
You with
Love
C
LIFF FELDHEIM IS GOING TO CELEBRATE
his 50th birthday again this year. Just
one month after reaching this milestone
in September 2007, he was hit by a car
while helping a truck accident
victim. Prior to this, Mr. Feldheim had not
required medical attention since college. As
a surveyor for a mapping company, he works
outdoors most of the time, is fairly active,
and has never been a drinker or a smoker.
Two months after the accident, he was
bothered by a swollen tonsil that would not
go away so he sought medical advice again.
While a series of examinations and biopsies
showed negative results for cancer, the lump
in Mr. Feldheim’s neck kept getting larger.
He jokes that he “just started falling apart
when he hit 50.”
Diagnosis Confirmed
(top) The multidisciplinary
team at the Dance Center
12 ~ G R E A T E R O N C O L O G Y T O D A Y
Mr. Feldheim was then seen by
Otolaryngologist/Head and Neck
Surgeon Mark Williams, MD, who
presented his case to the Milton J. Dance,
Jr., Head and Neck Center Tumor Board,
and subsequently diagnosed Mr. Feldheim
with T2N3Mo squamous cell carcinoma
of the tonsil. “The Tumor Board exists to
provide each patient with a thorough,
multidisciplinary review and detailed input
from the entire team to create the best
possible treatment plan,” explains
John R. Saunders, Jr., MD, MBA, FACS,
~
Winter 2009
Comprised of specialists in head and neck
surgery, otolaryngology, radiation and medical oncology, oral pathology-oral medicine,
maxillofacial prosthodontics and radiology,
the Tumor Board also includes the Dance
Center’s nursing, social work, speechlanguage pathology, nutrition and clinical
research team. “These experts bring new
research findings, experience and a very high
level of clinical expertise to each meeting,”
says Barbara Messing, MA, CCC-SLP,
BRS-S, Clinical Director of the Dance
Center. “Based upon the initial work-up and
testing, along with input from the Tumor
Board specialists, treatment with combined
radiation and chemotherapy was recommended for Mr. Feldheim,” she adds.
Treatment Coupled with
Personal Care
“From the first day we arrived at the Dance
Center, I felt like we had a team of people
that were there just for my wife, Erica, and
me,” says Mr. Feldheim. “I never felt like a
cancer patient. I felt like a person who was
surrounded by love.”
The Feldheims credit “a large part of the
positive outcome” to the extensive support
services that both Mr. Feldheim and his
wife received. They praise Dorothy Gold,
LCSW-C, OSW-C, Senior Oncology Social
Worker, with getting them past being “shellshocked” by what was happening and what
was still to come. “Dorothy gave us clear
direction in terms of what we could expect
along the way, and how this would affect
our lives beyond the treatment side effects
that I had to endure,” says Mr. Feldheim.
Everyone “gently offered help,” he recalls.
Karen Ulmer, BSN, RN, CORLN,
Otolaryngology Nurse Specialist, helped
prepare him for the treatment process and
potential post-treatment side effects.
“Knowing in advance that I wasn’t the first
person to experience this and
that there were ways to help
me recover took away a lot of
the fear.”
Mr. Feldheim did experience
weak facial and throat muscles
that created swallowing and
speech problems so he worked
with Melissa Walker, MS,
CCC-SLP, on range of movement exercises to regain and
maintain the muscle strength he
needed. This was complemented
by nutritional counseling with
Keri L. Culton, RD, LDN,
CNSD, who helped him to
expand his food choices, eating
schedule and caloric intake to
support his recovery.
The Feldheims also participated
in the Dance Center Patient and
Family Support Group. “If you
haven’t gone through this, it’s
simply impossible to understand,
so having this group was both
enlightening and consoling,” says
Mrs. Feldheim. She recalls group
members telling her husband
how good he looked and how
surprising it was to see him
already out and about in such
a short period of time. “We’re
positive people and full of faith,”
Mrs. Feldheim adds, “but hearing this from people who knew,
who had been there, meant
everything.”
Mr. Feldheim says that his recovery was “excellent” and he has
returned to work. In their spare
time, he and his wife are planning his “next” 50th birthday. n
Head and Neck Program
Enters Next Phase
K
NOWN NATIONALLY FOR ITS PATIENT-ORIENTED, MULTIDISCIPLINARY CARE OF
cancer and non-cancer patients, the Milton J. Dance Jr., Head and Neck
Center has relocated to a new 10,000-square-foot suite on the fourth floor of
Physicians Pavilion West on the GBMC campus. This uniquely-designed space
comfortably houses the staff and equipment necessary to deliver the latest advances
in diagnostic, treatment, research and support services that ensure comprehensive,
specialized patient care.
“As the diagnosis and treatment methods of head and neck disorders have
continued to evolve, so has the growth of our professional staff, services and
capabilities to serve patients,” says John R. Saunders, Jr., MD, MBA, FACS,
Chief of Staff and Medical Director of the Dance Center. “Today, our integrated
approach combines the disciplines of surgery, oncology, speech-language pathology,
nursing, nutrition, social work and other allied health professionals to offer
coordinated patient-centered care.”
The Dance Center addresses head and neck cancer patients’ physical and emotional
needs through a wide range of programs and services to improve patients’ quality
of life. Exceptional care is offered through counseling and education for patients
and family members, head and neck cancer tumor board meetings, interdisciplinary
patient care conferences, discharge planning and home health care coordination,
patient and family support groups, and more. Speech pathology services also
provide the highest level of clinical expertise for non-cancer patients with speechlanguage, swallowing and
feeding, voice and cognitivecommunications disorders.
On-site, Johns Hopkins Head &
Neck Surgery at GBMC works
hand-in-hand with the multidisciplinary team of professionals
at the Dance Center to offer
expertise in organ preservation,
microvascular and laryngeal
surgery, minimally invasive
techniques, voice rehabilitation
and research-based clinical trials.
Drs. Joseph Califano (left) and Patrick Ha
The Dance Center has also
collaborate on a patient case.
expanded its voice program in
collaboration with Johns Hopkins to manage all types of laryngeal voice
problems including benign andmalignant lesions, neurological disorders and
vocal dysfunction due to behavioral causes. n
For information on the
Dance Center and Head and
Neck services at GBMC, call
443-849-2087 or visit
www.gbmc.org/cancer.
GREATER ONCOLOGY TODAY
~
Winter 2009
~
13
AREA HIGHLIGHT
Dr. Robert Brookland holds
a cartridge containing 15
radioactive seeds, which
will be implanted into a
patient’s prostate.
14 ~ G R E A T E R O N C O L O G Y T O D A Y
~
Winter 2009
According to Dr. Ronald
Tutrone, patients considering
treatment options for prostate
cancer need to make an
informed decision with
their surgeon and radiation
oncologist.
P
ROSTATE CANCER AFFECTS MORE THAN
two million men in the U.S. and,
10 years ago, at the age of 63, Cecil
County resident Charles Ham became one
of those men. When a routine screening
found his PSA level had increased to 9.4,
he was referred to Ronald Tutrone, Jr., MD,
GBMC’s Divison Head of Urology, for
further assessment. “If it were not for the
thorough and direct approach Dr. Tutrone
took to treating my cancer, I might not be
here today,” says Mr. Ham.
Dr. Tutrone performed a trans-rectal ultrasound guided needle biopsy with sectional
mapping of the prostate that uncovered
Stage T1C prostate cancer. A CAT scan
found no evidence the disease had spread
beyond the prostate.
“Mr. Ham had several treatment options,”
notes Dr. Tutrone. “Because he had a
Gleason scale score of seven, watchful
waiting was not recommended, but he did
have the choice of radical prostatectomy,
external beam radiation, hormonal therapy
and brachytherapy. Both surgery and
radiation have equivalent 15-year cancer-free
survival rates, so Mr. Ham chose radiation
because it was the path with the least risk
of post-treament urinary incontinence and
sexual dysfunction.”
Mr. Ham underwent brachytherapy preceded by hormonal treatment with Lupron.
Brachytherapy involves placing a series of
needles in the perineum while the patient is
under anesthesia in the operating room.
Small radioactive pellets are introduced
through the needles into the prostate. The
location and number of the pellets is guided
by images provided via a trans-rectal probe.
“No treatment does a better job of confining
the radiation dose to the prostate and of
preserving potency,” explains Robert
Brookland, MD, Chairman of the
Department of Radiation Oncology at
GBMC, who performed Mr. Ham’s
procedure in concert with Dr. Tutrone.
The advantages of brachytherapy include
the minimally invasive nature of the
procedure, the convenience of a one-time
treatment, and the ability to perform the
procedure on an outpatient basis.
Brachytherapy side effects include about
two months of increased urinary urgency
and frequency and the need to avoid close
contact with others for about four months.
One potential disadvantage is that the seeds
can migrate a few millimeters over time. A
new technology, however, virtually eliminates
that problem by linking the seeds together.
“Using this technology to prevent seed
migration has not added any time to the
procedure, which usually takes about an
hour and a half,” says Alan Geringer, MD,
a surgical urologist who practices at GBMC.
Ten years after his treatment, Mr. Ham
remains cancer-free with a PSA level of
0.5. He sees Dr. Tutrone once a year for
a PSA check.
“Choosing a prostate cancer treatment
is a very individual decision,” adds
Dr. Tutrone. “Patients need to
understand the options and make
an informed decision with their
surgeon and radiation oncologist.” n
For more information about
urological services for prostate
cancer or about radiation
oncology at GBMC, visit
www.gbmc.org/cancer.
New treatments
give patients
more choices
Since Charles Ham
underwent treatment for
prostate cancer 10 years
ago, a number of new
treatments have been
developed, including:
n
Robotically-assisted
surgery
n
A computer program
that uses real-time
rectal ultrasound data
to provide images
that allow ideal placement and dosage of
brachytherapy pellets
n
The use of a shortacting isotope of
Cesium, which has
a faster fall off of
side effects, for
brachytherapy
n
There is also an
ultra-sensitive PSA
test in development
that would advance
early detection
GREATER ONCOLOGY TODAY
~
Winter 2009
~
15
AREA HIGHLIGHT
T
HE NATIONAL
cancer institute
estimates that
nearly 150,000 new cases of colorectal cancer will be reported in the United States in 2008,
making it one of the most common cancers among men and women of all ages and races.
Thanks to the prevalence of early detection screenings and a number of surgical options,
however, the disease is also highly treatable, even curable. Thus, for many patients newly
diagnosed with colorectal cancer, the question is no longer “Will I live?” but “How will I live?”
An increasingly common surgery that is used to treat colorectal cancers staged between T1 and
T3 helps surgeons to address both questions. Ultralow anterior resection with coloanal anastomosis (pull-through) is a technique in which the surgeon removes the rectum and attaches
the colon directly to the anus. A colon pouch, to restore the rectum’s reservoir capability,
may be created between the colon and anal canal by fashioning a neo-rectum from the patient’s
own colon, thereby improving the patient’s quality of life by decreasing the number of stools
per day. This procedure ensures that cancerous and surrounding tissues in the rectum are
destroyed, while the patient’s sphincter muscles are preserved so that the bowels can be
eliminated more normally.
Depending on the stage of the cancer, chemotherapy and radiation may be administered to
shrink the tumor before surgery takes place. George Apostolides, MD, FACS, FASCRS,
Division Head of Colon and Rectal Surgery and Colorectal Fellowship Program Director at
GBMC, also notes, “During the six- to eight-week recovery period, most patients will have a
temporary ileostomy diverting stool away from the surgical site and allowing the pouch to
heal.” Although anterior resection with coloanal pull-through is not for every patient —
Dr. Apostolides cautions that those with weak sphincter muscle control or metastatic
cancers are not good candidates — it provides a realistic solution for many others.
Recurrent Cancer No Longer Life-Limiting
When 62-year-old Carolyn Yohn was diagnosed with very early (stage Tis) colorectal
cancer in February of 2008, it wasn’t for the first time. A wife and mother of three,
the Pennsylvania resident is a breast cancer survivor who was initially diagnosed with
colorectal cancer four years ago. With her recurrent cancer in a lower position and
scar tissue in her GI tract from previous cancer treatments, Ms. Yohn faced a second
surgery that, years ago, would likely have resulted in a permanent colostomy.
Dr. Apostolides performed her ultralow anterior resection of the recurrent rectal cancer
with coloanal pull-through in June 2008. “Preserving the sphincter offers patients a
better quality of life post-operatively,” he states. “It allows regular bowel function, which
gives patients the freedom to live life as normal.”
16 ~ G R E A T E R O N C O L O G Y T O D A Y
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Winter 2009
After 10-Year Battle, Patient Still Feels “Lucky”
And normal sounds good to Ms. Yohn. For her, the past 10 years have been anything but
ordinary. “I have been through three different cancer surgeries at GBMC, fortunately with the
most talented and compassionate care team I could find,” she says. Before being referred to
Dr. Apostolides, she was treated by Lauren Schnaper, MD, FACS, for stage T3 breast cancer
in 2000 and by Joel Turner, MD, FACS, for stage 2 (T3 N0 M0) colorectal cancer in 2004.
Ms. Yohn notes that she feels lucky to have received the quality of treatment that she did.
“Everyone, from the surgeons to the nurses, conveyed a sense of hope, which gave me and my
family great comfort,” she remembers.
Two months following her surgery with Dr. Apostolides, her ileostomy was removed and
closed and she is successfully eliminating waste on her own. “This procedure has done so much
for me,” says Ms. Yohn. “I cannot thank Dr. Apostolides and the
entire staff enough for the quality of care they provided.
They gave me my life back.” n
For more information on GI cancer,
visit www.gbmc.org/cancer.
Dr. George Apostolides
performs an ultralow
anterior resection with
coloanal pull-through to
treat rectal cancer.
GREATER ONCOLOGY TODAY
~
Winter 2009
~
17
2008 ANNUAL REPORT
Greater Baltimore Medical Center
Sandra & Malcolm Berman Cancer Institute
Cancer Registry Report
T
he Cancer Data Management System/
Cancer Registry collects data on all types
of cancer diagnosed or treated in an
institution and is one of the four major
components of an approved cancer program.
From the reference or starting date of
January 1, 1990, through December 31,
2007, GBMC’s Cancer Registry has
abstracted into its database the demographic, diagnostic, staging, treatment and
follow-up information on 34,584 cancer
cases. To ensure accurate survival statistics,
the Registry is required to follow these
patients annually. GBMC’s follow-up rate
is 97 percent.
All data are reported quarterly to the
Maryland Cancer Registry (MCR), which is
part of the Maryland Department of Health
and Mental Hygiene, and annually to the
National Cancer Database (NCDB), the
data management system for hospitals and
programs approved by the Commission on
Cancer. Co-sponsored by the American
Cancer Society and the American College
of Surgeons, the NCDB uses submitted
data for comparative studies that evaluate
oncology care and provides a Benchmark
Summary of Cancer Care and Survival in
the United States. The Cancer Committee
at the Greater Baltimore Medical Center
authorized our facility’s 2006 data
submission to the NCDB, which included
site and stage data, to be posted to the
American Cancer Society (ACS) web site
(www.cancer.org). This Facility Information
Profile System (FIPS) allows patients to view
18 ~ G R E A T E R O N C O L O G Y T O D A Y
~
Winter 2009
the types of cancers diagnosed and treated
at a particular facility and can help patients
make more educated decisions about their
cancer care.
The MCR uses data to evaluate incidence
rates for the entire state, and compares data
by region and county; they also participate
in national studies. In addition to required
reporting, the Cancer Registry at GBMC
provides data for physician studies and
educational conferences. The Maryland
Cancer Registry, the National Cancer
Database and the Greater Baltimore Medical
Center and its Sandra & Malcolm Berman
Cancer Institute support websites.
One part-time and three full-time
Certified Tumor Registrars and a part-time
follow-up clerk staff the Cancer Registry
at GBMC. For additional information,
call 443-849-8063.
Analysis
The Cancer Registry accessioned 2,018 cases
during calendar year 2007. Of these, 1,918
were analytic cases — those patients who
were initially diagnosed at GBMC and/or
received all or part of their first course of
treatment at GBMC. The 100 non-analytic
cases were initially diagnosed and treated
at other facilities before referral to GBMC
for additional treatment for recurrent disease
or were initially diagnosed or treated at
GBMC prior to January 1,1990. Many
of these non-analytic patients chose to be
treated in one of the many clinical trials
available at GBMC.
2008 ANNUAL REPORT
In addition, the Cancer Registry reported
12 patients with benign brain and central
nervous system (CNS) tumors to the MCR.
Beginning in January 2004, all hospital
registries in the United States were required
to collect data on both malignant and
non-malignant CNS tumors and follow
these patients for their lifetime. These
patients are part of the Central Brain Tumor
Registry of the United States (CBTRUS).
In 2007, the average age at diagnosis for
males at GBMC was 64.9 years; for females,
it was 60.5 years.
The racial distribution of cases includes
83.9% Caucasian, 14.8% African-American,
1% Asian and 0.3% other. While 52.5%
of patients diagnosed or treated at GBMC
live in Baltimore County and 18.7% live in
Baltimore City, patients come from 18 other
Maryland counties, Pennsylvania, Delaware,
and other states for treatment.
Site Distribution
Breast cancer continues to be the most
frequently diagnosed and/or treated cancer
at GBMC, with 527 analytic cases. The
second most common cancer at GBMC is
prostate with 221 analytics, followed by
lung (160 analytics), colon/rectum (153
analytics) and thyroid (79 analytics).
(Tables 1 and 2)
The American Cancer Society’s Surveillance
Research estimated that 26,390 new cancer
cases would be diagnosed in Maryland in
2007. That same year, GBMC diagnosed
and/or treated an increased number of
cancers of the prostate (221 compared to
205 in 2006) and esophagus (12 compared
to 9 in 2006). In addition, the total number
of head and neck cancers seen at GBMC
increased from 183 in 2006 to 203 in 2007.
Gynecological cancers increased from 194 to
246. The number of lymphomas diagnosed
and/or treated at GBMC increased from
66 to 78. k
Table 1
n
GBMC Site Distribution
Primary Site
Total
Cases
n
All Cases 2007
NonAnalytic Analytic
Male
Female
338
317
21
299
39
232
221
11
232
0
Renal
44
42
2
24
20
Bladder
50
43
7
31
19
Other GU
12
11
1
12
0
BREAST
545
527
18
6
539
GASTROINTESTINAL
265
253
12
118
147
Esophagus
13
12
1
11
2
Stomach
20
19
1
10
10
159
153
6
66
93
Anal
20
19
1
8
12
Pancreas
27
24
3
11
16
Other GI
26
26
0
12
14
258
246
12
0
258
Cervix Uteri
92
90
2
0
92
Corpus Uteri
84
80
4
0
84
Ovary
44
42
2
0
44
Other Gyn
38
34
4
0
38
213
203
10
103
110
Oral Cavity
35
32
3
16
19
Pharynx
38
38
0
26
12
Salivary Gland
13
13
0
6
7
Larynx
34
31
3
24
10
Thyroid
83
79
4
24
59
Other Head & Neck
10
10
0
7
3
164
160
4
88
76
LYMPH NODES
59
53
6
28
31
BONE MARROW
49
43
6
23
26
SKIN*
64
56
8
32
32
5
5
0
3
2
CNS
14
13
1
10
4
OTHER
16
15
1
9
7
UNKNOWN PRIMARY
28
27
1
14
14
2,018
1,918
100
733
1,285
GENITOURINARY
Prostate
Colon/Rectum
GYNECOLOGIC
HEAD AND NECK
LUNG
SOFT TISSUE SARCOMA
ALL SITES TOTAL
*Skin — Excludes basal/squamous skin cancers
Source: GBMC Cancer Registry Database
GREATER ONCOLOGY TODAY
~
Winter 2009
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19
2008 ANNUAL REPORT
Table 2 n GBMC Site Distribution by Sex 2007
Based on 1.918 Analytic Cases
Table 3 n AJCC Stage at Diagnosis 2007
Based on 1,918 Analytic Cases
Males
35.0%
693 (36%)
Females
Melanoma
16 (2.3)
Melanoma
22 (1.8)
Oral
37 (5.3)
Oral
25 (2.0)
Lung
83 (12.0)
Pancreas
8 (1.2)
Stomach
7 (1.0)
Prostate
Leukemia &
Lymphoma
All Other
51
Breast
522 (42.6)
Lung
72 (5.9)
Pancreas
15 (1.2)
30.0%
26.1%
25.0%
23.5%
20.0%
Colon/Rectum 61 (8.8)
Urinary
1,225 (64%)
Colon/Rectum 89
(7.4)
(7.3)
Ovary
40 (3.3)
Uterus
153 (12.5)
Urinary
34 (2.8)
Leukemia &
Lymphoma
50 (4.1)
14.0%
15.0%
11.5%
13.8%
11.1%
10.0%
221 (31.9)
46 (6.6)
163 (23.5)
All Other
5.0%
203 (16.6)
0.0%
© 1997, Onco, Inc. – Numbers based on ACS All Sites distribution
Stage
0
Stage
1
Stage
2
Stage
3
Stage Unstageable
4
Source: GBMC Cancer Registry – 1,918 analytic cases
Staging
To help the physician evaluate the patient’s disease at diagnosis, estimate prognosis, guide
treatment, evaluate therapy and access the results of early cancer detection, the American Joint
Committee on Cancer (AJCC) has established a TNM Staging Classification based on the
premise that cancers of similar sites and histologies share similar patterns of growth and
extension. In the TNM staging system, T relates to extent of the primary tumor, N relates to
lymph node involvement and M indicates the presence of distant metastases. The combination
of the TNM provides a stage group classification of Stage 0, 1, 2, 3, 4, or unstageable. Cancers
may be unstageable because no AJCC staging classification exists for the site. For example,
leukemias, unknown primaries and primary brain tumors cannot be staged using the AJCC
criteria. Also, patients may be unstageable because they choose to forego treatment or further
testing needed to determine the appropriate stage. At diagnosis, 11.5% of GBMC’s 1,918
analytic cases were Stage 0 (in situ), the earliest stage tumors. In general, the survival rates for
in-situ cancers are higher than for those of invasive cancers. Of the invasive cancers, 26.1%
were Stage 1; 23.5% were Stage 2; 14% were Stage 3; 11.1% were Stage 4; and 13.8% had
no AJCC stage for the site or were unstageable. (Table 3) n
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2008 ANNUAL REPORT
Focus: Carcinoma of the Tonsil
I
n 2007, head and neck cancer
was the fifth most common cancer
with incidence of 780,000 new
cases a year worldwide and an estimated
45,000 new cases in the United States. The
incidence rate is more than twice as high in
men as in women.
Using Cancer Registry data for GBMC,
we evaluated patients with advanced stage
cancer of the tonsil for the period 19962002 and compared the results with the
National Cancer Data Base (NCDB). The
majority of our patients were Stage III and
IV (53 patients). Twelve patients were Stage
I and II. The incidence ratio of men/
women was 50/16 (75.8 percent / 24.2
percent) and corresponds to the national
numbers. (Table 1)
Compared to current cases (15 patients in
2007), the age distribution has changed
slightly since the studied period (1996-2002)
with a shift to younger age in 2007. (Table 2)
The five-year survival of patients treated at
GBMC during 1996 -2002 compares favorably with the National Cancer Data Base.
(Table 3) The five-year survival for Stage III
was 85.7 percent versus 63.4 percent and for
Stage IV patients it was 62.2 percent versus
51.7 percent (GBMC / NCDB). (Figure 1)
The treatment for tonsil cancer in this study
period was surgery for early stage cancer.
For advanced stage, surgery was followed by
post-operative radiation therapy with very
few patients receiving post-operative
chemotherapy. (Tables 3a, 3b)
Since 2000, the treatment of tonsil cancer
has changed. For patients with advanced
oropharyngeal cancer that includes the base
of tongue and the tonsillar fossa, treatment
involves organ preservation using radiation
therapy and chemotherapy. Surgery is then
applicable for residual disease.
At GBMC, for advanced nodal involvement
(N2-3 patients), we use hyper-fractionated
By Eva Zinreich, MD
radiation therapy and chemotherapy,
followed by neck dissection. Our results
with a median follow-up of 27 months
showed a survival rate of 83 percent, and
the disease-free survival was 78 percent.
We found at surgery that 20 percent of
our patients still harbor microscopic disease
in the neck nodes, thus the need for neck
dissection.
To facilitate this multi-modal treatment, we
have instituted a multidisciplinary approach.
A dedicated head and neck group is in place
and includes: head and neck surgeons,
radiation and medical oncologists, speech
pathologists, social workers, dieticians,
nurses and a specialized orthodontist.
All members have a major impact in the
therapeutic decision-making, keeping in
mind that prolonging longevity, maintaining
quality of life with least side effects and
preventing complications are the objectives.
Multi-modal treatment in advanced head
and neck cancer emerged as the standard
of care for these patients. The newest technology affords improved local control and
reduces the side effects and complications.
Newer radiation techniques such as IMRT
reduced the occurrence of local toxicities
such as xerostomia, and therefore improved
the quality of life in our patients. Our
intention is to help develop and rapidly
adopt treatment advances to provide the
highest quality of care and best quality of
life for our referred patient population.
While alcohol and tobacco abuse are known
risk factors, the presence of the HPV virus
in pre-treatment biopsies may also be a
factor that may influence the chosen type
of treatment and expected response.
The aim is to be able to predict tumor
behavior and the potential for metastasis.
Understanding these issues will shape the
appropriate selection of optimal therapy. n
GREATER ONCOLOGY TODAY
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Winter 2009
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21
2008 ANNUAL REPORT
Table 1
n
Tonsillar Cancer
n
Comparison of AJCC Staging
100%
GBMC (2007) N = 15
GBMC (1996-2002) N = 66
90%
80%
68.2%
70%
60%
46.7%
50%
40%
33.3%
30%
20%
13.3%
12.1%
0.0% 1.5%
0%
12.1%
6.7%
6.1%
10%
0.0%
0.0%
Stage 1
Stage 0
Stage 2
Stage 3
Stage 4
Unknown
Source: GBMC Cancer Registry
Table 2
n
Tonsillar Cancer
n
Age at Diagnosis
33.3%
35.0%
30.0%
GBMC (1996-2002) N = 66
GBMC (2007) N = 15
28.8%
26.7%
25.8%
25.0%
20.0%
20.0%
16.7%
15.0%
15.2%
13.3%
10.0%
6.7%
5.0%
1.5%
0.0%
7.6%
3.0%
0.0%
20 -29
0.0%
30 -39
40 -49
50 -59
Source: GBMC Cancer Registry
22 ~ G R E A T E R O N C O L O G Y T O D A Y
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Winter 2009
60 -69
70 -79
80 -89
2008 ANNUAL REPORT
Table 3a
Treatment Combinations
n
n
Tonsillar Cancer at GBMC
n
25.0%
Surgery alone
GBMC (1996-2002) N = 8
0.0%
GBMC (2007) N = 5
50.0%
Surgery/Rad
Stage 3
0.0%
Surgery/Chemo 0.0%
0.0%
0.0%
0.0%
Radiation/Chemo
80.0%
12.5%
Surg/Rad/Chemo
20.0%
Other comb 0.0%
0.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Source: GBMC Cancer Registry
Table 3b
n
Treatment Combinations
Surgery alone
Tonsillar Cancer at GBMC
n
Stage 4
6.7%
0.0%
2.2%
Radiation only
0.0%
2.2%
Chemo only
0.0%
Surgery/Rad
0.0%
2.2%
Surgery/Chemo
0.0%
Radiation/Chemo
Surg/Rad/Chemo
n
GBMC (1996-2002) N = 45
GBMC (2007) N = 7
66.7%
11.1%
71.4%
4.4%
28.6%
Other comb 0.0%
0.0%
4.4%
No tx
0.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Source: GBMC Cancer Registry
Figure 1
Stage 1 GBMC
Stage 1 NCDB
Stage 2 GBMC
Stage 2 NCDB
Stage 3 GBMC
Stage 3 NCDB
Stage 4 GBMC
Stage 4 NCDB
5 Year Observed Survival Rate
GBMC (1996-2002) NCDB (1998-2000)
Stage 1 N = 8
38%
N = 445 65.8%
Stage 2 N = 4
75%
N = 893
67.9%
Stage 3 N = 8 85.7%
N = 1793 63.4%
Stage 4 N = 45 62.2%
N = 4539 51.7%
Data from the NCDB/Commission on Cancer 2008
Five-Year Survival
n
n
Tonsillar Cancer at GBMC 1996-2002
120%
100%
80%
60%
40%
20%
0%
1
2
3
Years of Survival
4
GREATER ONCOLOGY TODAY
5
~
Winter 2009
~
23
ONCOLOGY SUPPORT
Collaborative Partnerships
Offer an Extra Helping Hand
I
cancer patients face many other challenges
when battling the disease. GBMC’s
Oncology Support Services team connects
them with organizations that help shoulder
the burden.
“We think of support in the broad sense
of the word,” explains Donna Lewis, RN,
Manager, Oncology Support Services. “We
don’t focus on one type of service; we provide a wide range of free services, including
enlisting the help of organizations that specialize in making our patients’ lives easier.”
A Caring Network
Oncology Support Services matches patients
with these organizations:
n
n
n
24 ~ G R E A T E R O N C O L O G Y T O D A Y
ACS’s Patient Resource Navigator at
GBMC helps patients and caregivers find
resources that help them cope with their
illness.
N ADDITION TO DIFFICULT TREATMENTS,
Catastrophic Health Planners (CHP), a
local not-for-profit organization, provides
free financial and legal counseling for
families facing a catastrophic health
event. The organization was founded by
a cancer survivor who recognized firsthand that patients and families need
one organization that could address
many needs.
Us TOO, a national prostate-cancer
support and education group, serves
prostate-cancer survivors and their
families by providing timely, reliable
information that helps them make
informed choices about detection and
treatment.
The “Look Good, Feel Better®” program
from the American Cancer Society
(ACS) helps women undergoing cancer
treatment cope with appearance-related
side effects of treatment. In addition, the
~
Winter 2009
n
The Red Devils, a local organization for
breast-cancer patients, provides help with
transportation, meals, shopping and
babysitting.
Many Patient Benefits
“The services provided by these
organizations benefit patients greatly,”
adds Ms. Lewis. “Certain organizations
help patients get medications if they can’t
afford them and others help provide funds
for transportation for treatments. And, with
the counseling offered at GBMC, they can
become less anxious and more comfortable
with their treatments.”
Lynda Streckfus, a patient who has been
diagnosed with colon cancer, attests to
the help that these organizations provide:
“GBMC’s Oncology Support Services took
a tremendous burden from my shoulders.
The program put me in touch with people
who gave me financial advice. They also
connected me with a social worker any time
I needed someone to talk to. And they
helped me find counseling for my children.
It’s wonderful knowing that all I have to do
is call Support Services and I’ll get the help
I need.” n
For more information on GBMC’s
Oncology Support Services and
the collaborative partners that work
with GBMC patients and families,
contact 443-849-2961 or visit
www.gbmc.org/cancer.
Oncology Support Groups and Classes*
“Us Too” Prostate Cancer Support Group
Assembling the first Monday of every month, 20 to 30 participants meet from 7:00 - 9:00 p.m.,
discussing educational topics and personal experiences. Facilitator: Michele Better, LCSW-C.
For more information call 443-849-2961. Registration required.
Look Good, Feel Better¨
Sponsored by the American Cancer Society, this program helps women undergoing cancer
treatments cope with the appearance-related side effects of rehabilitation therapies, such as hair
loss and changes in complexion. Meetings are held the first and third Monday of every month
from 2:00 - 4:00 p.m. Facilitated by Laura Chase, Community Outreach Specialist. For more
information call 443-849-2037. Registration required.
Patient/Family Head and Neck Cancer Support Group
This support group is composed of newly diagnosed and long-time survivors of head and neck
cancer. Meeting the third Tuesday of every month from 7:00 - 8:30 p.m., participants share
feelings associated with their diagnosis. Facilitators: Dorothy Gold, LCSW-C; Karen Ulmer,
RN, MS, CORLN. For more information call 443-849-2087.
Laryngectomee Interest Group
This group provides news and information relevant to people who have had a laryngectomy.
Participants also have the opportunity to share their experiences and practice voicing. Meetings
are on the first Tuesday of every month from 12:00 - 1:00 p.m. Facilitators: Barbara Messing,
MA, CCC-SLP, BRS-S and Melissa Walker, MS, CCC-SLP. For more information call
443-849-2087.
* There is no charge for any of the above listed support groups and classes.
Non-Profit Org
U.S. Postage
6701 N. Charles Street
Baltimore, MD 21204
PAID
Permit No. 4406
Baltimore, MD