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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 ~ 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 ~ 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 ~ 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 ~ 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 ~ 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 ~ 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 20 ~ G R E A T E R O N C O L O G Y T O D A Y ~ Winter 2009 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 ~ Winter 2009 ~ 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 ~ 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