Download Winter 2014 - Glens Falls Hospital

The CR Wood Cancer Center at Glens Falls Hospital
Quarterly
Winter 2014
Issue No. 52
In seed-time learn,
in harvest teach,
in winter enjoy.
~William Blake
Cover Photo by Cate Howland, RN
Survivorship Stories
Life is Too Short to be Otherwise
By Christine Marra
I was diagnosed with Endometrial Sarcoma in 1986. It was found during a routine pelvic exam and I was devastated.
I have had four different surgeries including cryoablation which is when they
make a small hole in the skin and freeze the cancer spots on the liver. My cancer came back in April, 1991. I saw Dr. Piver at Roswell Park Cancer Institute
in Buffalo, a renowned gynecological oncologist in New York State. He went
in, cut out the cancer which was attached to the vein going down my leg and
then radiated the area. Dr. Piver put me on megace which curbed my cancer
until 1997 when he decided to take me off it.
I have had six different chemotherapies which have all extended my time on
earth. I am currently on a new chemotherapy that I started on December 1st. I
really appreciate the care I’m getting at Dana Farber Cancer Institute, because
if one type of chemotherapy isn’t working, they are not afraid to let someone
else try a different type of chemotherapy.
I have had wonderful support from my colleagues at North Warren Central Schools, my family and my husband’s family. Good friends and my sister Susan are always there for me to cheer me up and help me keep a
positive attitude. I have tried to always to remain optimistic. I find my students to be very uplifting every day,
and seeing them makes me glad to be alive.
Cancer has definitely changed my life, but I have beaten it for 28 years and counting, and am not ready to
give in yet. My oldest son got married last week, and it was so wonderful to be there with my family to enjoy
the event. My granddaughter is now three and I would like to dance at her wedding.
My grandmother lived to be 99 years old and that’s my goal in life. Until then I am going to enjoy every day to
the fullest, because no one knows how long they have. I would like people to think of me as upbeat and
happy, because life is too short to be otherwise.
Clinical Note: Endometrial Stromal Sarcoma is a rare cancer of the uterus. It develops within the supportive
connective tissue (stroma) of the endometrium. It accounts for 2-5% of all uterine cancers. Approximately 1 to
2 women out of 100,000 will be diagnosed with it. The average age at which it occurs is between 40-50 years.
Signs and symptoms of ESS are abnormally long or heavy periods, pelvic pain and swelling in the pelvis. If
you have any of these symptoms or are bleeding in between cycles or
after menopause you should bring it to the attention of your doctor.
Sources:
Puliyath, G., Nair, R. V., & Singh, S. (2010, Jan-Mar). Endometrial Stromal Sarcoma.
Indian Journal of Medical and Paediatric Oncology , 21-23.
Vann, M. (2009, February 18). What Is Endometrial Stromal Sarcoma? Retrieved
November 2014, from Everyday Health: http://www.everydayhealth.com/uterinecancer/endometrial-stromal-sarcoma.aspx
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Connections Quarterly
Food for Thought
Holiday Tips for Patients Undergoing Cancer Treatment
By Andrea Chowske, RD, CD-N
For most people, the holidays are associated with
memories that include food, perhaps sharing a
favorite dish or decorating cookies with loved
ones. However, during cancer treatment, the
thought of food can sometimes bring anxiety. Here
are a few suggestions that may help get you
through these occasions with less stress.
It is okay to tell people you aren’t up for your usual
celebration. If you typically host the party, think
about delegating tasks. People always want to
know what they can do so ask them to bring specific dishes or do certain tasks to lighten your load.
If you have a specialty dish that you always make,
focus on that one dish and let others take care of
the rest. If you aren’t up to cooking, pass along
the recipe to a loved one
for them to make. Offer to
do only what you think you
can manage for a holiday
celebration. If you’re not up
for too much celebration,
find a quiet place and settle in.
Keep your eyes open for
foods that you think you
will be able to tolerate. Eat
a little something before
you leave your house; try a
snack with some fiber and
protein to help keep you full in case there aren’t
many options for you. Start slow and take small
portions to avoid becoming too full. If it is a potluck dinner, look at it as an opportunity to try new
foods and flavors that might taste good to you.
If you are having physical symptoms such as nau-
sea, smell or taste changes, too much food at
once can be overwhelming. If the sight of food is
too much for you, grab a ginger ale or tea and
move out of the area where food is being prepared or served. Try chewing a mint gum or drinking a warm beverage to mask the smell of food.
The holidays are notorious for heavy foods which
can be overwhelming for a sensitive stomach. If
this is true for you, avoid anything with a cream
sauce, gravy or mayonnaise base and look for
baked or steamed items instead. If you feel that
your family’s usual sides will be too rich for you,
offer to bring some basic fruit or vegetable sides.
Foods like rice, potatoes, noodles and bread are
often well tolerated if they aren’t served in heavy
or rich sauces.
If your immune function is
weak due to treatment,
you need to be extra careful about food safety. It is
easy to lose track of how
long foods have been sitting out or if meat has
been cooked to a proper
internal temperature.
Avoid any undercooked
foods such as homemade
eggnog, sushi, mayonnaise or desserts made
with raw eggs. If you’re unsure, don’t hesitate to
ask the chef or pass on that dish.
Reference:
http://www.cancer.org/cancer/news/expertvoices/
post/2012/12/03/holiday-eating-tips-if-youre-incancer-treatment.aspx
“Food is symbolic of love when words are inadequate.”
-Alan D. Wolfelt
Winter 2014
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Pharmacy Corner
Imbruvica® for Mantle Cell Lymphoma, Chronic Lymphocytic Lymphoma and Chronic
Lymphocytic Leukemia
By Beth Sponzo, RN, BS, OCN®
Imbruvica® (Ibrutininib) is a novel drug used to
treat relapse of mantle cell lymphoma, chronic
lymphocytic lymphoma or chronic lymphocytic leukemia with a 17p deletion. The term “17p deletion”
is shorthand to describe that an anomaly of the
short arm (p) of the 17th chromosome has occurred. Imbruvica® binds to BTK (Bruton's tyrosine kinase), an essential mediator of B cell signaling.
Chronic lymphocytic leukemia (CLL) is a cancer of
the white blood cells. The cancerous white blood
cells crowd out the healthy blood cells making it
harder for them to do their work. Mantle cell lymphoma (MCL) results from a malignant transformation of a B lymphocyte in the outer edge of a
lymph node follicle (the mantle zone).
Imbruvica® is an oral, once daily medication that
works by blocking an enzyme (BTK) that helps the
cancerous B cells multiply and survive.
Imbruvica is being studied alone and in combination with other treatments in several blood cancers
and approximately 3,700 patients have received
Imbruvica® in clinical trials conducted in 35 countries by more than 800 investigators around the
world. As of September 30, 2014, twelve Phase 3
trials have been initiated with Imbruvica® and fiftytwo trials are registered on www.clinicaltrials.gov.
The most commonly occurring adverse reactions
were thrombocytopenia (decrease in the platelets
increasing the risk for bleeding or bruising), diarrhea, neutropenia (decrease in the white blood
cells increasing the risk for infection), anemia, fatigue, musculoskeletal pain, upper respiratory tract
infection, nausea, constipation, rash and decreased appetite.
Targeted Cancer Therapy
Information from the National Cancer Institute
What are targeted cancer therapies?
Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression and spread of
cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs," "molecularly targeted
therapies," "precision medicines," or similar names.
Targeted therapies differ from standard chemotherapy in several ways:
Targeted therapies act on specific molecular targets that are associated with cancer, whereas most standard chemotherapies act on all rapidly dividing normal and cancerous cells.
Targeted therapies are deliberately chosen or designed to interact with their target, whereas many standard chemotherapies were identified because they kill cells.
Targeted therapies are often cytostatic (that is, they block tumor cell proliferation), whereas standard chemotherapy agents are cytotoxic (that is, they kill tumor cells).
Targeted therapies are currently the focus of much anticancer drug development. They are a cornerstone of
precision medicine, a form of medicine that uses information about a person’s genes and proteins to prevent,
diagnose and treat disease.
(Continued on page 7)
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Connections Quarterly
New Study at the CR Wood Cancer Center will Focus on
Metastatic Breast Cancer Patients
By Nannette Oberhelman
The MONALEESA-2
The CR Wood Cancer Center at Glens
Falls Hospital and Novartis Pharmaceuticals are sponsoring a clinical trial
called The MONALEESA-2 Trial
(Mammary Oncology: Assessment of
LEE011’s Efficacy and Safety:
CLEE011A2301).
LEE011 is a study drug that is being
investigated for the potential treatment
of different cancers. In the MONALEESA-2 study, LEE011 is being
studied specifically in the metastatic
breast cancer setting. LEE011 may be
taken by itself or together with other
cancer treatments, depending on the
type of study a patient is taking part of.
In this study, LEE011 (or a placebo) is
taken in combination with Letrozole for
the treatment of postmenopausal
women with hormone receptor positive,
HER2 negative, advanced breast cancer who received no prior therapy for
advanced disease. The patient may be
a newly diagnosed breast cancer with
a metastasis or have been found in
follow up for the first time to have a
metastatic site.
LEE011 belongs to a new class of drugs called CDK4/6 inhibitors. These drugs target proteins called cyclin-dependent
kinases (CDKs), which play an important role in the cell cycle,
a series of events that lead to cell growth through DNA duplication and cell division. CDK4/6 may be over-activated in
cancer, and drugs that block CDK4/6, like LEE011, may be
able to slow or stop cancer growth (see diagram).
When taking part in this clinical trial, the study drug (LEE011)
is provided at no charge. There is also a patient assistance
program to assist with co-pays, if needed. If you would like
more information about this trial, please call Beth Brundage,
RN, OCN at (518) 926-6644.
New Year Re-registration
The New Year brings the need to re-register all Cancer Center patient accounts. It is necessary to verify your
personal information including address, telephone number and insurance information. It is also necessary to
have all of our patients sign a new treatment consent form and a new privacy form. Change of insurance often occurs at the beginning of the calendar year. It is critical that we have your correct information so that we
can accurately bill your insurance company.
We do ask that you bring your insurance card with you so that we can copy it for our records. If you
have a separate prescription card we will be making a copy of that as well.
Our Registration/Reception team is working hard to have paperwork prepared in advance to minimize delays
as you re-register for the New Year. Unfortunately, checking in at the reception desk may take a few minutes
longer than usual. We appreciate your understanding and apologize in advance for any inconvenience.
Winter 2014
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Call Us
Patty Godnick, RN, OCN® —Your Telephone Triage Nurse
When you call us during regular clinic hours (8:00 am to 4:00 pm weekdays) you will reach Patty Godnick, the
telephone triage nurse. Her phone number is 926-6620, the phone number that you are given to call if you
have any questions or problems.
When you call you will very likely need to leave a message as she is busy with other patients who have also
called. Patty would like to have the following information in the message to help
her assist you efficiently:
Your name, or the name of the person you are calling about (please spell the
last name)
Date of birth
Your doctor’s name (not the PA because they work with multiple doctors)
Your phone number (or where she can best get back to you)
The reason why you are calling
If you are calling for a medication refill, please also include:
The name of the pharmacy you use
The medication and the dose
You will need to allow 48 hours to have the medications refilled. It will be sent to
your pharmacy by e-mail (e-scribed). If it is a controlled medication, Patty or your
clinic staff will call you back as these are not allowed to be filled through the internet.
If you are having a medical problem, Patty or your clinic will try to call you back within 2 hours. Please be patient as Patty is taking calls on behalf of six oncologists and sometimes there are a lot of calls that come in
within a short period of time.
MyChart (the online site) allows 48 hours for a response. If you are having a medical problem that needs
prompt attention, it is better to call us and leave a message.
Many doctors return their calls (especially test and lab results) at the end of their clinic or at lunch time, so it
may be a few hours before they get back to you. You can let us know if it is okay for them to leave a message
with the results on your machine when you call.
If you call after hours and need a response, (evenings, nights, or weekends) please tell the answering service
to page the on-call doctor. No one is available to check messages during off hours so it will not be received
until the next business day.
Also, when you call and leave a message, please try to speak clearly without rushing. That will make it is easier for Patty to give you an appropriate response. Thank you for your understanding.
Holiday Celebration
The support group sponsored holiday
celebration was held on December 3rd,
2014. About 30 people enjoyed festivities, food and time to chat and catch up
with each other.
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Connections Quarterly
Targeted Cancer Therapy
(Continued from page 4)
Many targeted cancer therapies have been approved by the Food and Drug Administration
(FDA) to treat specific types of cancer. Others are
being studied in clinical trials (research studies
with people), and many more are in preclinical
testing (research studies with animals).
How are targets for targeted cancer therapies
identified?
The development of targeted therapies requires
the identification of good targets—that is, targets
that play a key role in cancer cell growth and survival. (It is for this reason that targeted therapies
are sometimes referred to as the product of
"rational" drug design.)
One approach to identify potential targets is to
compare the amounts of individual proteins in cancer cells with those in normal cells. Proteins that
are present in cancer cells but not normal cells or
that are more abundant in cancer cells would be
potential targets, especially if they are known to
be involved in cell growth or survival. An example
of such a differentially expressed target is the human epidermal growth factor receptor 2 protein
(HER-2). HER-2 is expressed at high levels on the
surface of some cancer cells. Several targeted
therapies are directed against HER-2, including
trastuzumab (Herceptin®), which is approved to
treat certain breast and stomach cancers that
overexpress HER-2.
Another approach is to determine whether cancer
cells produce mutant (altered) proteins that drive
cancer progression. For example, the cell growth
signaling protein BRAF is present in an altered
form (known as BRAF V600E) in many melanomas. Vemurafenib (Zelboraf®) targets this mutant
form of the BRAF protein and is approved to treat
patients with inoperable or metastatic melanoma
that contains this altered BRAF protein.
Researchers also look for abnormalities in chromosomes that are present in cancer cells but not
in normal cells. Sometimes these chromosome
abnormalities result in the creation of a fusion
gene (a gene that incorporates parts of two different genes) whose product, called a fusion protein,
may drive cancer development. Such fusion proWinter 2014
teins are potential targets for cancer therapies.
For example, imatinib mesylate (Gleevec®) targets the BCR-ABL fusion protein, which is made
from pieces of two genes that get joined together
in some leukemia cells and promotes the growth
of leukemic cells.
How are targeted therapies developed?
Once a candidate target has been identified, the
next step is to develop a therapy that affects the
target in a way that interferes with its ability to promote cancer cell growth or survival. For example,
a targeted therapy could reduce the activity of the
target or prevent it from binding to a receptor that
it normally activates, among other possible
mechanisms.
Most targeted therapies are either small molecules or monoclonal antibodies. Small-molecule
compounds are typically developed for targets that
are located inside the cell because such agents
are able to enter cells relatively easily. Monoclonal
antibodies are relatively large and generally cannot enter cells, so they are used only for targets
that are outside cells or on the cell surface.
Candidate small molecules are usually identified
in what are known as "high-throughput screens,"
in which the effects of thousands of test compounds on a specific target protein are examined.
Compounds that affect the target (sometimes
called "lead compounds") are then chemically
modified to produce numerous closely related versions of the lead compound. These related compounds are then tested to determine which are
most effective and have the fewest effects on nontarget molecules.
Monoclonal antibodies are developed by injecting
animals (usually mice) with purified target proteins, causing the animals to make many different
types of antibodies against the target. These antibodies are then tested to find the ones that bind
best to the target without binding to nontarget proteins.
Before monoclonal antibodies are used in humans, they are "humanized" by replacing as much
of the mouse antibody molecule as possible with
corresponding portions of human antibodies. Humanizing is necessary to prevent the human
(Continued on page 10)
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Support Services and Programs
For general questions about cancer or support services available, please call Oncology Resource Nurses: Vickie at 926-6639 or Paul at 926-6629.
Services for Individuals by Appointment
Care Management
For:
Continuing care needs, transportation and
financial concerns
Info:
Karen Cook , LMSW, OSW-C ~ 926-6619
Patient Financial/Insurance Assistance
For:
Referrals, prior authorizations, billing,
insurance questions
Info:
Michele Walker ~ 926-6637
Chemotherapy Education Class
For:
Individuals & family starting chemotherapy
Meets: Tuesdays at 4:00 P.M. ~ Cancer Center Library
or by appointment at your convenience
Info:
Vickie Yattaw, RN, BSN, OCN® ~ 926-6639
Paul Miller, RN, OCN® ~ 926-6629
Psychosocial Oncology
For:
Counseling for patients and/or their families
Info:
Gerry Florio, Ph.D. ~ 926-6529
Karen Cook , LMSW, OSW-C ~ 926-6619
Clinical Research
For:
Anyone interested in learning about clinical
trials
Info:
Beth Brundage, RN, OCN® ~ 926-6644
Genetics Counseling
For:
Anyone concerned about their personal or
family history of cancer
Info:
Charlene Schulz, MS, CGC ~ 926-6620
Nutrition Counseling
For:
Anyone interested in dietary counseling
Info:
Andrea Chowske, RD, CD-N ~ 926-2635
Pastoral Care
For:
Anyone interested in spiritual counseling
Info:
Please call 926-3531
Resource Nurses
For:
Individuals & family diagnosed with any cancer
Meets: By appointment or stop by
Info:
Vickie Yattaw, RN, BSN, OCN®~ 926-6639
Paul Miller, RN, OCN® ~ 926-6629
Spa Services at Cindy’s Healing Place
(Massage Therapy)
For:
Cancer patients during and after treatment
Meets: By appointment at Cindy’s Healing Place
Info:
Please call 926-6640
Uniquely You® Boutique & Salon
For:
Any cancer patient
Free wigs, hats & turbans, skin & hair care
Meets: By appointment on Tuesdays in the
C. R. Wood Cancer Center
Info:
Please call 926-6640
Special Programs (Pre-Registration Required)
CG Men’s Retreat
For:
Men living with and beyond cancer
Meets: One weekend each year in the Fall
Info:
Paul Miller, RN, OCN® ~ 926-6629
Cindy’s Retreat
For:
Women living with and beyond cancer
Meets: One weekend each Spring and Fall at
Silver Bay on Lake George
Info:
Karen Cook, LMSW ~ 926-6619
www.cindysretreat.org
Cindy’s Comfort Camp
For :
Children and teens ages 6-17 years who have
experienced the death or serious illness of a
parent or close relative
Meets: One weekend each Spring and Fall at the
Double “H” Hole in the Woods Ranch in Lake
Luzerne
Info:
926-6515 or www.cindysretreat.org
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Tobacco Cessation
Whether you’re thinking about quitting or
ready to quit, call the NYS Smokers’
Quitline for help and support.
1-866-NY-QUITS (1-866-697-8487)
Quit for Life
Stop Smoking Program
(Pre-Registration Required)
A 4 week program for anyone who would like to quit smoking
January 20, 27 & February 3, 10
Tuesday nights at 6:00 PM—7:00 PM
In the CR Wood Cancer Center Library
For information or to register please call Paul at 926-6629
Connections Quarterly
Support Groups and Events
These groups are open-ended and you may come as you wish.
You may want to call if you are new or you have not come for some time to make sure that the schedule or location has not changed.
Discussion Groups
Activity Groups
ABC Support Group
(After Breast Cancer)
For:
Individuals with breast cancer
Meets: 4th Monday each month
6:00 P.M. ~ Cancer Center Waiting Room
Info:
Vickie Yattaw, RN, BSN, OCN® ~ 926-6639
Circle of Hope Knitting Group
For:
Cancer Survivors who want to learn to knit
and crochet. Teachers available
Meets: Wednesdays ~ 1:30 P.M. ~ Cancer Center
Library
Info:
Vickie Yattaw, RN, BSN, OCN® ~ 926-6639
Blood Cancer Support Group
(Leukemia & Lymphoma Society)
For:
Individuals & family diagnosed with
lymphoma, leukemia or multiple myeloma
Meets: 2nd Wednesday each month
6:00 P.M. ~ Cancer Center Library
Info:
Paul Miller, RN, OCN® ~ 926-6629
Healthy Steps©
For:
Gentle exercise for individuals with a cancer
diagnosis
Meets: Tuesdays at 10:00 am – Community Learning
Center (Side B)
Info:
Vickie Yattaw, RN, BSN, OCN® ~ 926-6639
Butt Kickers - Smoking Cessation Group
For:
Anyone who has, or is thinking about quitting
smoking
Meets: 3rd Wednesday each month
6:00 P.M. ~ Cancer Center Library
Info:
Paul Miller, RN, OCN® ~ 926-6629
Family Connections
For:
Families (parents, children or teens) facing
life after the loss of a loved one.
Meets: 2nd Thursday each month (3rd Thursday in
April) in Glens Falls or Saratoga (alternating)
Info:
Gerry Florio ~ 926-6528
[email protected]
Please let us know if you are coming so we can
have enough supplies available and food for
the family style meal that is included.
Prostate Cancer Awareness Group
For:
Men with prostate cancer and their families
Meets: 3rd Thursday each month
7:00 P.M. ~ Cancer Center Library
Info:
Paul Miller, RN, OCN® ~ 926-6629
Rays of Hope
For:
Women with ovarian cancer
Meets: 3rd Wednesday each month
4:00 P.M. ~ Cancer Center Library
Info:
Mary Davis ~ 656-9321
Carol Smith ~ 793-0565
Winter 2014
Tai Chi and Relaxation/Meditation
For:
Anyone interested
Meets: Monday afternoon at 3:30 P.M. and 5:30 P.M
Community Learning Center (Side B)
Info:
Paul Miller, RN, OCN® ~ 926-6629
Twisted Twirlers
For:
Individuals diagnosed with any cancer who
would like to join this Hall of Fame twirling
group
Meets: 11:30 A.M. ~ 1st and 3rd Tuesday each month
Community Learning Center (Side B)
Info:
Carol Newton ~ 854-9860
Ways of Seeing - Art Workshop
For:
Individuals & family diagnosed with any cancer
who want to enjoy the life affirming pleasures
of creating art
Meets: 2nd and 4th Tuesday each month at
11:30 A.M. in the Cancer Center Library
Info:
Paul Miller, RN, OCN® ~ 926-6629
Annual Survivors Events
(Pre-Registration Required)
Breast Cancer Survivor Luncheon
October, please call Vickie at 926-6639 for information
Spring Survivorship Celebration Breakfast
May 30, 2015, please call Paul at 926-6629
for information
9
Feature
Targeted Cancer Therapy
(Continued from page 7)
immune system from recognizing the monoclonal
antibody as "foreign" and destroying it before it
has a chance to bind to its target protein. Humanization is not an issue for small-molecule compounds because they are not typically recognized
by the body as foreign.
What types of targeted therapies are available?
Many different targeted therapies have been approved for use in cancer treatment. These therapies include hormone therapies, signal transduction inhibitors, gene expression modulators, apoptosis inducers, angiogenesis inhibitors, immunotherapies, and toxin delivery molecules.
Hormone therapies slow or stop the growth
of hormone-sensitive tumors, which require
certain hormones to grow. Hormone therapies
act by preventing the body from producing the
hormones or by interfering with the action of
the hormones. Hormone therapies have been
approved for both breast cancer and prostate
cancer.
Signal transduction inhibitors block the activities of molecules that participate in signal
transduction, the process by which a cell responds to signals from its environment. During
this process, once a cell has received a specific signal, the signal is relayed within the cell
through a series of biochemical reactions that
ultimately produce the appropriate response.
In some cancers, the malignant cells are
stimulated to divide continuously without being
prompted to do so by external growth factors.
Signal transduction inhibitors interfere with this
inappropriate signaling.
Gene expression modulators modify the
function of proteins that play a role in controlling gene expression.
Apoptosis inducers cause cancer cells to
undergo a process of controlled cell death
called apoptosis. Apoptosis is one method the
10
body uses to get rid of unneeded or abnormal
cells, but cancer cells have strategies to avoid
apoptosis. Apoptosis inducers can get around
these strategies to cause the death of cancer
cells.
Angiogenesis inhibitors block the growth of
new blood vessels to tumors (a process called
tumor angiogenesis). A blood supply is necessary for tumors to grow beyond a certain size
because blood provides the oxygen and nutrients that tumors need for continued growth.
Treatments that interfere with angiogenesis
may block tumor growth. Some targeted therapies that inhibit angiogenesis interfere with the
action of vascular endothelial growth factor
(VEGF), a substance that stimulates new
blood vessel formation. Other angiogenesis
inhibitors target other molecules that stimulate
new blood vessel growth.
Immunotherapies trigger the immune system
to destroy cancer cells. Some immunotherapies are monoclonal antibodies that recognize
specific molecules on the surface of cancer
cells. Binding of the monoclonal antibody to
the target molecule results in the immune destruction of cells that express that target molecule. Other monoclonal antibodies bind to certain immune cells to help these cells better kill
cancer cells.
Monoclonal antibodies that deliver toxic
molecules can cause the death of cancer
cells specifically. Once the antibody has bound
to its target cell, the toxic molecule that is
linked to the antibody—such as a radioactive
substance or a poisonous chemical—is taken
up by the cell, ultimately killing that cell. The
toxin will not affect cells that lack the target for
the antibody—i.e., the vast majority of cells in
the body.
Cancer vaccines and gene therapy are
sometimes considered targeted therapies because they interfere with the growth of specific
cancer cells.
How is it determined whether a patient is a
candidate for targeted therapy?
Connections Quarterly
For some types of cancer, most patients with that
cancer will have an appropriate target for a particular targeted therapy and thus will be candidates to be treated with that therapy. CML is an
example: most patients have the BCR-ABL fusion
gene. For other cancer types, however, a patient’s
tumor tissue must be tested to determine whether
or not an appropriate target is present. The use of
a targeted therapy may be restricted to patients
whose tumor has a specific gene mutation that
codes for the target; patients who do not have the
mutation would not be candidates because the
therapy would have nothing to target.
Sometimes, a patient is a candidate for a targeted
therapy only if he or she meets specific criteria (for
example, their cancer did not respond to other
therapies, has spread, or is inoperable). These
criteria are set by the FDA when it approves a
specific targeted therapy.
What are the limitations of targeted cancer
therapies?
Targeted therapies do have some limitations. One
is that cancer cells can become resistant to them.
Resistance can occur in two ways: the target itself
changes through mutation so that the targeted
therapy no longer interacts well with it, and/or the
tumor finds a new pathway to achieve tumor
growth that does not depend on the target.
For this reason, targeted therapies may work best
in combination. For example, a recent study found
that using two therapies that target different parts
of the cell signaling pathway that is altered in
melanoma by the BRAF V600E mutation slowed
the development of resistance and disease progression to a greater extent than using just one
targeted therapy.
Another approach is to use a targeted therapy in
combination with one or more traditional chemotherapy drugs. For example, the targeted therapy
trastuzumab (Herceptin®) has been used in combination with docetaxel, a traditional chemotherapy drug, to treat women with metastatic breast
cancer that overexpresses the protein HER2/neu.
Another limitation of targeted therapy at present is
that drugs for some identified targets are difficult
Winter 2014
to develop because of the target’s structure and/or
the way its function is regulated in the cell. One
example is Ras, a signaling protein that is mutated
in as many as one-quarter of all cancers (and in
the majority of certain cancer types, such as pancreatic cancer). To date, it has not been possible
to develop inhibitors of Ras signaling with existing
drug development technologies. However, promising new approaches are offering hope that this
limitation can soon be overcome.
What are the side effects of targeted cancer
therapies?
Scientists had expected that targeted cancer
therapies would be less toxic than traditional chemotherapy drugs because cancer cells are more
dependent on the targets than are normal cells.
However, targeted cancer therapies can have
substantial side effects.
The most common side effects seen with targeted
therapies are diarrhea and liver problems, such as
hepatitis and elevated liver enzymes. Other side
effects seen with targeted therapies include:
Skin problems (acneiform rash, dry skin, nail
changes, hair depigmentation)
Problems with blood clotting and wound healing
High blood pressure
Gastrointestinal perforation (a rare side effect
of some targeted therapies)
Certain side effects of some targeted therapies
have been linked to better patient outcomes. For
example, patients who develop acneiform rash
(skin eruptions that resemble acne) while being
treated with the signal transduction inhibitors erlotinib (Tarceva®) or gefitinib (Iressa®), both of
which target the epidermal growth factor receptor,
have tended to respond better to these drugs than
patients who do not develop the rash Similarly,
patients who develop high blood pressure while
being treated with the angiogenesis inhibitor
bevacizumab generally have had better outcomes.
Source:
http://www.cancer.gov/cancertopics/factsheet/
Therapy/targeted
11
Your Cancer Care Team
Andrea Chowske, RD, CD-N — Nutrition Services
Andrea has been with our Oncology Team for nearly six months as a Registered Dietician. Andrea received her Bachelor’s degree in Food and Nutrition from SUNY Plattsburgh. She also completed her dietetic internship at Sage Graduate School. Andrea
worked at Southampton Hospital in Long Island for three years; two years as a Clinical
Dietician and one year as the Clinical Nutrition Manager.
Andrea and her husband, Nick have an eighteen month old son, Levi. They also have two
cats. She enjoys hiking, cooking, reading, knitting, hanging out with her family and playing with her son.
Leigh Kenyon, RN — Medical Oncology
Leigh is working in the Hematology/Oncology Clinic. She received her Associate’s degree
in Nursing from SUNY Adirondack in 2008 and graduated from SUNY Delhi with her
Bachelor’s degree in Nursing in May, 2014. Leigh worked for the last six years on the
medical/surgical (in-patient) unit on Tower 3.
Leigh and her husband Jake have two sons, Brady, two years, and Jace, four months
old. They reside in Queensbury. She enjoys vacations in warm places, spending time
with her boys and her husband, swimming in their new pool and running. Leigh plans on running a 15K this
coming summer.
Elizabeth (Lisa) Haase, RN — Medical Oncology
Elizabeth has recently joined the oncology team in the treatment center. She received her
Bachelor’s of Science degree in Nursing from Oregon Health and Science University in
2013. She was an inpatient nurse on a hematology/oncology/bone marrow transplant
floor at Doernsbecher Children’s Hospital.
Lisa and her husband Brett have two daughters, Carlie, thirteen and Lauren, ten years
old. They also have two dogs, Bleu and Belle. Lisa enjoys reading, spending time with
her family, baking and cooking. They recently moved to Wilton, New York from the state of Washington.
Nicole Molinero, RN — Medical Oncology
Nicole is with the Hematology/Oncology clinic. She received her Associate’s degree in
Nursing at SUNY Adirondack. Nicole is currently pursuing her Bachelor’s of Science degree in Nursing at Capella University. She has previously worked at St. Mary’s Hospital in
Troy. She completed her internship on the inpatient oncology floor at St. Peter’s Health
Partners. She has also worked at Community Work and Independence (CWI) as a Registered Nurse Health Services Specialist.
Nicole has been married for 6 ½ years to her husband Neil. They have one child, Anthony, who is almost
three years old. Nicole enjoys spending time with her family.
12
Connections Quarterly
Brittany Mason — Referral Specialist
Brittany has recently joined the Oncology Team as a Referral Specialist in the Medical Records Department. Her previous experience includes two years as a receptionist at Hand
to Hand Occupational Therapy and three years as a receptionist for the Vascular Group.
Brittany was recently married to Mark, and her first wedding anniversary is in December.
She enjoys kayaking, golfing and gardening. She and her husband care for their seventeen chickens, honey bees, three cats and their dog Harper.
Melissa Collins — Referral Specialist
Melissa works with the Oncology Team in the Medical Records Department. She studied
Business Administration at SUNY Adirondack . Melissa received a Certificate in Secretarial Science at SUNY Adirondack as well. Melissa worked as a lead receptionist at Hudson
Headwaters Health Network for three and a half years. Prior to this, she worked at Glens
Falls Hospital for eight years as a Case Management Coordinator and as a Department
Secretary.
Melissa and her husband, Dean, have two daughters; Emily, twelve years old and Katelyn, eight. They also
have a dog, Tye, who is fourteen years old. She enjoys spending time with family and watching her girls play
basketball. Melissa participated in Relay for Life with her team “Hair Creations.”
Serena Cosey — Referral Specialist
Serena recently joined the Cancer Center Medical Records department as a Referral Specialist. She is a graduate of Hudson Falls High School in 2001. Serena received her certification in Medical Billing and Coding.
Serena lives with her husband, Benjamin and eleven week old daughter, Sahara Lonna, in
Hudson Falls. She and her husband purchased their home this past August. She enjoys
kayaking, canoeing, bow target practice, and hiking.
Noel Harding — Medical Oncology Informaticist, Cancer Center
Noel has joined our team as an Oncology Informaticist. He received his Bachelor’s degree in Medical Technology at SUNY Upstate Medical Center and his Master’s of Science
degree in Health Services Administration at New School University. He was an Application Support Analyst with Dignity Health supporting software applications for a forty hospital system. Noel started working at Glens Falls Hospital in 1984. He held a variety of positions in the laboratory including Hematology/Blood Bank Supervisor, Technical Manager
and Administrative Director. Throughout his lab experience, information technology has always been a large
part of his responsibilities.
Noel is married to Michele, formally a Registered Nurse in the Catheter Lab. She is currently a Nurse Practitioner with Fort Edward Internal Medicine. Noel has two sons, one who lives locally and is married, and the
other who lives in Colorado. He also has a grandson, Oliver, who is fifteen months old. Noel’s interests and
hobbies include running, hiking, camping, kayaking, gardening and making wooden toys for his grandson. He
also enjoys his winter vacations in the Caribbean.
Winter 2014
13
CG
Men’s Retreat
A weekend of reflection, relaxation and
real-life guidance for women living with
and beyond cancer
An open invitation to any women
with a diagnosis of cancer
Please join us for a weekend retreat
located at Silver Bay Conference Center
on the beautiful shores of
Lake George, New York
The C.G. Men’s Retreat was held on November 14th 16th at the Christ the King Spiritual Life Center in Greenwich, New York. Bright, albeit cold weather accompanied
the ten men who attended. This year, the themes for discussion were finding meaning, looking at decision making
and how our attitudes affect the process. Relaxation techniques, massage, great food and in depth discussions
were enjoyed along with free time for informal discussion
and camaraderie.
April 24th — 26th, 2015
For more information contact:
Karen Cook, LMSW
926-6619
[email protected]
FREE SKIN CANCER SCREENING — PREVENT. DETECT. LIVE.
Skin cancer is the most common of all cancers. It accounts for nearly half of all cancers in the United States.
Melanoma, the most serious type, has seen an incidence increase of more than 2000% since the 1930’s.
Unfortunately, one person dies of melanoma every hour.
SATURDAY, April 18, 2015
9:00 AM TO 12:00 PM
C.R. WOOD CANCER CENTER, 1ST FLOOR, PRUYN PAVILION, AT GLENS FALLS HOSPITAL
APPOINTMENTS NEEDED. CALL TO SCHEDULE: 926.6640
For more information or to register, please call 926.6640. Space is limited, so register early!
Sponsored by:
14
Connections Quarterly
About US
Clinical Research at the C.R. Wood Cancer Center at Glens Falls Hospital
If you have been diagnosed with cancer, you may want to talk to your physician about taking part in a clinical trial. Clinical trials may offer treatment options for patients with cancer that are not otherwise available.
• If you have just found out that you have cancer, the time to think about a clinical trial is before you make a treatment decision. Talk with your doctor about all your options including a clinical trial.
Other clinical trials are looking for people who have already been treated for their cancer.
• If you have already had one or more forms of cancer treatment and are looking for a new treatment option, there
may still be a clinical trial for you to think about.
Please call our research office at 518.926.6644 or 926.6701 for more information about clinical trials available at Glens
Falls Hospital or visit our website at www.glensfallshospital.org/CRWood-Cancer-Center/clinical-research/clinicalresearch.cfm.
You may also want to visit the National Cancer Institute website for other clinical trials at www.cancer.gov/clinicaltrials.
Cancer Services Program (CSP)
Men and women who are uninsured, meet eligibility criteria
and are in need of treatment for breast, cervical, colorectal or
prostate cancer, may be eligible for full Medicaid coverage
through the Medicaid Cancer Treatment Program. Coverage is
arranged through the Cancer Services Program Case Manager and will last for the entire treatment period.
These eligibility guidelines are more generous than local counties’ departments of social services. So if you’ve been denied in the past please don’t let that stop you from applying again through the Cancer Services Program.
Glens Falls Hospital provides a New York State Department of Health Cancer Services Program grant that funds breast,
cervical and colorectal cancer screenings and follow-up testing at no cost for uninsured women and men. If you or someone you love is without health insurance, call today at:1.800.882.0121 or 518.926.6570.
Connections Editorial Board
Connections is published quarterly by
Joan Carpenter, CSP
The Charles R. Wood Cancer Center at Glens Falls Hospital, 102 Park
Street, Glens Falls, NY 12801. Phone: 518.926.6640, Fax: 518.926.6643
Andrea Chowske, RD, CD-N
Kelle Engel, RN, BSN, OCN®
Melissa Engwer, RN
Katy Maloy
Paul Miller, RN, OCN®
Andrew Morrison, RN
Connections is available online: www.glensfallshospital.org
The information in this newsletter is for educational purposes only and is not
intended to be used as medical advice. Please consult your physician for
questions regarding your treatment.
Nannette Oberhelman, CCRP
If you are unable to view us on the internet and would like to receive
Beth Sponzo, RN, BS, OCN®
Connections at home, please call, write or e-mail the editor:
Suzannah Virgil, Secretary
Paul Miller, RN, OCN® 926.6629 C.R. Wood Cancer Center, Glens Falls
Hospital Glens Falls, NY 12801. e-mail: [email protected]
Ruth Whitney, RN, OCN®
Donna Winchell, RN, BSN, OCN®
Vickie Yattaw, RN, BSN, OCN®
Winter 2014
Please let us know if you wish to be removed from our mailing list.
15
Staff were adorned with spooky and not so spooky costumes for Halloween, 2014.
Inside Connections
Life is Too Short to be Otherwise
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Imbruvica® for Mantle Cell Lymphoma,
Chronic Lymphocytic Lymphoma and Chronic Lymphocytic Leukemia
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Targeted Cancer Therapy
Holiday Tips for Patients Undergoing Cancer Treatment
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New Study at the CR Wood Cancer Center will Focus on
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New Year Re-registration
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Patty Godnick, RN, OCN® —Your Telephone Triage Nurse
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Holiday Celebration
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Support Services
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8-9
Your Cancer Care Team
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12-13
CG Men’s Retreat
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Cindy’s Retreat
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Free Skin Cancer Screening .
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Clinical Research at the CR Wood Cancer Center .
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Cancer Services Program (CSP)
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