Banner MD Anderson Rounds - October 2013
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Transcript of Banner MD Anderson Rounds - October 2013
By Michelle TalsMa everson
W hen a patient suspects that
they might have breast
cancer, the wait for further
testing and an official diagnosis can be
agonizing. With this in mind, Banner
MD Anderson Cancer Center on the
Banner Gateway Campus, opened the
Undiagnosed Breast Clinic — a place
where women who suspect breast
cancer can get quick answers to some
of their most daunting questions.
Stephanie Byrum, M.D., F.A.C.S., a
general surgeon at Banner MD Ander-
son with special training in the treat-
ment of breast diseases, says that the
Undiagnosed Breast Clinic was modeled
after the benign breast clinic at MD
Anderson Cancer Center in Houston.
Providing resulTsByrum says the clinic is operated in
such a way that patients who might
have breast cancer get the answers
they need in as short a time as possible.
“A patient can get imaging done,
have a biopsy performed, get results,
and meet with physicians within a
24-hour turnaround,” Byrum says.
“Whatever the results, there is a sense
of relief knowing that either that they
are okay or that they have a treatment
plan in place.”
At the clinic, results and all consul-
tations needed for a treatment plan are
available to the patient by their second
appointment. Byrum adds that if the
OCTOBER 2012a PuBlicaTion For coMMuniTy Physicians
Banner MD Anderson Cancer Center patient Leaann Benzer, with her surgeon, Dr. Stephanie Byrum.
inside2 Center of Excellence3 Saving time, saving lives4 Palliative Program
5 Building a culture6 Defining ‘cutting edge’8 Meet Banner MD Anderson physicians
Undiagnosed Breast Clinic pioneers new level of care Provides rapid results — and relief — to women when they need it most
2 OCTOBER 2012 ROunDS
patient is diagnosed with cancer, they
are referred to the center’s Comprehen-
sive Breast Program.
TeaM aPProach“We [the physicians and staff members]
take a team approach; the Comprehen-
sive Breast Program has a strong team,
which is great for patients,” she says.
The Undiagnosed Breast Clinic,
which officially launched this past
April, is currently open one day a week.
Byrum says the clinic is off to a strong
start and she has ambitious hopes for
its future.
“Our goals with the Undiagnosed
Breast Clinic are to eventually have
daily operation, continue to have result
turnaround in 24 hours or less, and
ultimately serve more patients,” Byrum
says. “The quick service helps to relieve
that anxiety and provide relief. Every-
thing we do is about supporting the
patient.”
Leaann Benzer, the clinic’s first pa-
tient, says that she received same-day
results when she was tested for cancer.
Unfortunately, she was diagnosed with
early stage breast cancer and had to
undergo treatment. But, she believes
her expedited treatment helped to
relieve some of the tension and stress
of her condition.
“Nobody would choose to have
cancer, but as far as dealing with Ban-
ner MD Anderson, they were wonder-
ful,” Benzer recalls. “They were always
friendly and up-to-date… I know that
I’ve done everything I can do to fight
this disease.”
relieving anxieTyBenzer’s case exemplifies one of the
main missions of the clinic: to catch
any potential cancer in the earliest
possible stage, Byrum explains. She
adds that relieving some of that anxiety
patients may have about waiting to
find out their results is one of the
strong points of the program, too.
“To get their results quickly and,
if needed, have a treatment plan
established, lifts a weight off their
shoulders,” Byrum says.
To refer a patient to the Undiag-nosed Breast Clinic, call 480-256-3433.
A Center of Excellence
Once patients meet with a physician in the undiagnosed Breast Clinic, they are sent to the Women’s Imaging Center for appropriate testing. From diagnostic mammography and MRI to ultrasound and image-guided biopsies, this imaging center is second to none.
The center is designated as a Breast Imaging Center of Excellence by the American College of Radiology (ACR). This designation is awarded to breast imaging centers that achieve excellence in all of the ACR’s voluntary breast-imaging accreditation programs.
The accreditation certifies that Banner MD Anderson Cancer Center has achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs.
Banner MD Anderson Cancer Center’s Breast Center is now fully accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy. Banner MD Anderson Cancer Center is proud to be the first Banner Health facility in Arizona to acquire the Breast Imaging Center of Excellence accreditation and is proud to be among an elite group of breast imaging centers that have achieved this designation. The Breast Imaging Center of Excellence designation reflects the importance we place on providing the highest quality of care to our patients.
Refer a patient to the Women’s Imaging Center by calling 480-543-6900.
Leaann Benzer’s breast cancer was caught in the early stages thanks to Banner MD Anderson Cancer Center’s undiagnosed Breast Clinic.
BannerMDAnderson.com 3
By Brian sodoMa
A patient walks into the Suspicion
of Cancer Clinic at Banner MD
Anderson Cancer Center in
Gilbert with back pain and a doctor’s
referral. Within a few hours a malignant
tumor on his lumbar spine is diagnosed
and an appointment is made with an
oncologist to begin treatment.
If only it could always be this easy.
Dr. Nikunj Doshi, division chief of
internal medicine at Banner MD Ander-
son, knows all too well that often times
an accurate cancer diagnosis can mean
jumping from one specialist to another,
eating up precious time and bringing
added frustration to patients.
“When you’re sick the last thing you
want to do is travel to different places
and then wait for those places to com-
municate with each other,” Doshi says.
The Suspicion of Cancer Clinic works
to alleviate this by offering a multi-
disciplinary, research-driven approach
that houses numerous needed specialties
under one roof to help deliver an accurate
and timely cancer malignancy diagnosis.
Saving time saves livesSuspicion of Cancer Clinic brings faster, more accurate results
With cardiologists, pulmonologists,
endocrinologists, nephrologists, neu-
rologists, gastroenterologists, oncolo-
gists, hematologists, radiologists and
surgeons all working in one place, many
minds can weigh in on each case, help-
ing to eliminate obvious non-factors
and zero in on the real problem.
“Our goal is to minimize unnecessary
intervention and expedite the clinical di-
agnosis,” Doshi says. “We want to know
‘Is this a malignancy or just noise?’”
More complicated cases are referred
to a tumor board that meets every Tues-
day and Thursday. The group of special-
ists then comes to a consensus for either
further testing or treatment, Doshi says.
Open for one year, Doshi hopes
the Suspicion of Cancer Clinic can be
a resource for local physicians helping
their patients find an accurate cancer
diagnosis in an efficient and timely
manner. The site takes both physician
and self-referrals.
To make a referral to the suspicion of Cancer Clinic, call 480-256-3433 or go to www.bannermdanderson. com/physicians.
New clinical trials spur new treatment, growth
By sTePhanie conner
At Banner MD Anderson Cancer Center, a growing clinical trials pro-gram is helping patients today and in the future.
“Research is an integral component of our organization. In addition to seeing patients, we are a knowledge development organization,” says Lee Seabrooke, M.A., MBA, the Center’s director of research. “It’s important to align the knowledge we develop with the problems we’re trying to solve.”
The clinical trials program currently offers phase II and III drug trials. Four trials — including those for pancreatic cancer, colorectal cancer, breast can-cer and chronic lymphocytic leukemia — are actively enrolling patients. And that’s just the beginning, which is an impressive start in just one year.
“In addition, we have a growing pipeline of about 18 trials that will be offered in the near future,” Seabrooke says. Those trials will explore thera-pies for metastatic melanoma, ovarian cancer, bladder cancer and more.
“Although the research organization is small at this point, it’s in a continu-ous growth mode,” Seabrooke adds. “Over time, we expect to have a very robust enterprise.”
Banner MD Anderson Cancer Center has been officially accepted into the national Cancer Institute’s (nCI) Southwest Oncology Group (SWOG) and Gynecology Oncology Group (GOG) as an affiliate of The university of Texas MD Anderson Cancer Center in Houston, TX. The SWOG and GOG memberships represent major steps for the research program at Banner MD Anderson that will provide additional access for our patients to new and innovative therapies within nCI sponsored clinical trials.
Dr. nikunj Doshi
4 OCTOBER 2012 ROunDS
By deBra gelBarT
The Palliative Care program at
Banner MD Anderson Cancer
Center is much more than keep-
ing patients comfortable.
This specialty has only been board-
recognized as a separate discipline
since 2008. After 2012, physicians in
other disciplines who sit for the board
exam in palliative medicine will be
required to complete a fellowship in
palliative medicine specifically. “This
is not end-of-life care and it’s not
hospice,” said Kerry Tobias, D.O., who
completed her residency and is board
certified in palliative medicine and
pain management as well as directs
the Palliative Care program at Ban-
ner MD Anderson. “I don’t manage a
cancer patient’s diagnosis; I manage
the patient’s symptoms as much as
possible regardless of the reasons for
those symptoms.”
Patients suffering from significant
nausea, constipation, pain, shortness
of breath or weakness — among other
symptoms — can benefit from a pallia-
tive medicine physician’s care, said To-
bias, who completed her residency in
physical medicine and rehabilitation.
PaTienTs BeneFiTPalliative care is not just for current can-
cer patients or terminal patients, she em-
phasized. “A cancer survivor can suffer
from residual neuropathy, for example,
or fatigue,” she said. “My job is to allevi-
ate those symptoms or make it easier for
that patient to cope with them.”
Typically in the past, cancer pa-
tients in treatment and suffering side
other specialist at the cancer center. But
they must have a current or past cancer
diagnosis; carry participating health
insurance; and permit forwarding of
their medical records from their current
or previous treating physician.
“Our goal is to ensure the highest
quality of life for cancer patients un-
dergoing treatment or those who have
completed treatment and for cancer
survivors who have residual symptoms,
by optimizing pain management and
by alleviating or reducing the severity
of other symptoms,” Tobias said.
A patient’s physician (including a primary care provider) can refer a patient to the Palliative Care program by calling 480-256-3433.
effects looked to their oncologist to
address treatment of those side effects.
But palliative medicine makes it possi-
ble for the oncologist to focus solely or
primarily on treatment of the diagnosis
and on additional medical issues that
arise. The palliative medicine physi-
cian develops a regimen of treatment
modalities to reduce the severity of the
patient’s symptoms. Treatment may in-
clude medications, pain management
applications and recommendations for
low-grade aerobic exercise, Tobias said.
QualiFy For carePalliative Care program patients are
not required to be under the care of a
Banner MD Anderson oncologist or any
Palliative Program alleviates symptoms, provides comfort Banner MD Anderson Cancer Center model is not ‘end of life’ care
Kerry Tobias, D.O.
BannerMDAnderson.com 5
The past year
has been an
exciting one
— one filled with
great pride.
I always tell
people that when
you build some-
thing from the
ground up, it’s not
for the faint of
heart. It took a lot of hard work and
a bit of faith to open a brand new
cancer center. And in just our first
year, we’ve had a lot of opportunities
to celebrate.
Together, we’ve opened a beauti-
ful facility. We’ve built a culture of ex-
cellence and professionalism. We’ve
hired the very best physicians and
staff. We’ve established a compre-
hensive breast cancer program and
are developing other comprehensive
programs. We’ve recently opened
four clinical trials with 18 more in
the pipeline. We’ve established our-
selves in the community as experts
in our field, and we’ve seen more
than 3,500 patients.
And that’s just in our first year.
I’m also proud of our efforts to
integrate with The University of
Texas MD Anderson Cancer Cen-
ter in Houston. We have seamlessly
integrated our computer systems, we
communicate with their staff regu-
larly, and we communicate regularly
with our colleagues to continue our
evolution and growth.
What we have built in the past
year is a cancer center that
brings together
oncology
experts in medication therapy, ra-
diation, surgery, imaging, pharmacy,
psychology, physical therapy, nutri-
tion and more to provide superior
multidisciplinary care.
When I came here a year and
a half ago, our building was under
construction. And after just one year,
we’re exploring expansion opportuni-
ties. In fact, we have already begun
the installation of a third linear
accelerator to meet the increasing
need for radiation treatments. This is
a tremendous accomplishment for a
center as young as ours, and I believe
the best is yet to come.
Thank you for your continued support. As always, please contact me if you have any questions about Banner Md Anderson Cancer Center
or referring a patient. i can be reached at 480-256-3335.
Building a culture of excellence at Banner MD Anderson Cancer CenterBy dr. edgardo rivera, Medical direcTor
6 OCTOBER 2012 ROunDS
By Brian sodoMa
For a long time, a radiologist’s
work seemed to only be as-
sociated with imaging. But in
the past decade, advances in imaging
technology combined with other tools
have helped to create actual treatments
that are extending lives and minimiz-
ing side effects for cancer patients.
Dr. Andrew Price, an interven-
tional radiologist with Banner MD
Anderson Cancer Center, sees radio-
embolization — or “Y-90” — treat-
ment for metastatic and primary liver
cancers as the biggest game changer
in his field of late.
radioeMBolizaTionRadioembolization uses a small
catheter inserted through the groin
to deliver tiny beads loaded with the
radioactive isotope, yttrium-90, or
Y-90, directly into the feeding arteries
of a tumor. This selective approach
delivers a high dose of radiation
directly into the arteries of tumor
cells, while minimizing the impact
on surrounding normal liver tissue.
The outpatient procedure is generally
well tolerated and associated with
minimal side effects. It can often lead
to a dramatic improvement in tumor
burden, Price explained.
“It has been shown to improve
quality of life and prolong survival,
giving hope to those patients with ad-
vanced liver cancer,” Price says.
Finding Y-90’s place in a treat-
ment plan is still being investigated.
In many cases, a patient has failed
several rounds of chemotherapy
defining ‘cutting edge’
Dr. Andrew Price
BannerMDAnderson.com 7
before trying Y-90. But more evidence
is surfacing that indicates using the
treatment earlier in a program may
produce better results.
TrueBeaM linear acceleraTorRadiation oncology has also seen
significant advances through the years,
and there may be no greater example
of these strides than some of the state-
of-the-art technology found at Banner
MD Anderson Cancer Center.
Dr. Emily Grade, a radiation on-
cologist at the center, said the site’s
state-of-the-art Varian TrueBeam linear
accelerators are one of her best options
for better pinpointing treatments and
minimizing side effects when treating
cancer. The image-guided radiation
therapy (IGRT) system uses 3D and 4D
technology to give Grade the ability to
effectively locate tumors on the move.
“Tumors in the body don’t just
stay still. They can move daily by a few
millimeters or more in one direction or
another,” Grade says.
Once the tumor is effectively
tracked, the machine’s state-of-the-
art collimators allow Grade to shape
the treatment field almost perfectly to
within a millimeter of the tumor. Past
technologies, she explained, didn’t
have the contouring ability that the
newer machines have that now allow
her to be more exact with where in the
body she can deliver the treatments.
“The whole goal is to treat only the
tumor and avoid the normal tissues,”
Grade added. “As we get better technol-
ogy we can go higher with our doses.
Often, the higher the dose, the better
the cure rate.”
sTereoTacTic Body radiaTion TheraPySpecialists at Banner MD Anderson
also use Stereotactic Body Radia-
tion Therapy (SBRT), which uses a
specific coordinate system to more
exactly localize a tumor in cases like
lung, spine, brain and other can-
cers. Image-guided HDR (High-Dose
Rate) Brachytherapy is also used in a
dedicated Brachytherapy suite. This
method of treatment uses a radioac-
tive source placed in the target, such
as a breast or for a gynecologic tumor
and delivers a high dose in a short-
ened time precisely. This approach
allows some patients to receive treat-
ment for breast cancer in one week
rather than six weeks.
The multi-disciplinary team
environment also complements the
state-of-the-art technology found at
Banner MD Anderson, Grade added.
Specialists housed under one roof meet
regularly to discuss and make treat-
ment decisions for cases. This collabo-
ration also decreases travel time and
frustration for patients.
“We meet and talk about all the cases
collaboratively and this provides the best
care for patients. It’s one of the big rea-
sons I chose to come here,” Grade says.
Dr. Andrew Price
PRESORTED STD
U.S. POSTAGE
PAID
LONG BEACH, CA
PERMIT NO.1677
Introducing Banner MD Anderson Physicians
HEMATOLOGy & MEDICAL OnCOLOGy SECTIOn
Tomislav Dragovich, MD, PhD, Section ChiefDigestive tract cancers including colorectal, esophageal, stomach, pancreatic, hepatobiliary
Gorgun Akpek, MD, MHSDirector of Stem Cell Transplantation and Cellular Therapy program
Shakeela Bahadur, MDLung, colorectal, breast cancers
Mary Cianfrocca, DOBreast Cancer Program Director
Jade Homsi, MDMelanoma, sarcoma, immunotherapy
H. uwe Klueppelberg, MD, PhDMultiple myeloma and other plasma cell disorders, lymphomas, myelodysplastic syndrome, brain cancers, head and neck cancers, thoracic cancers
Edgardo Rivera, MD, Medical DirectorBreast cancer
Kerry Tobias, DOPain management, palliative medicine, physical medicine, rehabilitation
Bryan Wong, MDGenitourinary cancers
OnCOLOGy SuRGERy SECTIOn
Stephanie Byrum, MDBreast surgery
Al Chen, MDGeneral surgery
Randall Craft, MDFull spectrum of both implant-based and autologous breast reconstruction, comprehensive plastic and reconstructive options for all areas of the body
Mark Gimbel, MDMelanoma, sarcoma, cancer of the stomach, small bowel, colon and rectum, thyroid, pancreas, liver, breast, and other rare cancers
Christine Landry, MDPancreatic cancer, carcinoid tumors, thyroid cancer, adrenal tumors, parathyroid tumors, melanoma, sarcoma, gastrointestinal cancers, breast cancer, liver tumors
Matthew Schlumbrecht, MD, MPHGynecologic oncology; gestational trophoblastic disease; a variety of surgical techniques including radical abdominopelvic exploration and minimally invasive procedures.
Rob Schuster, MDGeneral surgery
Thomas Shellenberger, MD Recurrent thyroid cancers, cancers of the oral cavity, oropharynx, and larynx, salivary gland cancers, advanced skin cancers and melanoma of the head and neck, complications from treatment of head and neck cancer.
Diljeet Singh, MDProgram Director, Gynecologic
Oncology; Program Director, Cancer Prevention & Integrative Medicine
Benny Tan, MDPlastic and reconstruction surgeonBreast cancer reconstruction and most forms of cancer reconstruction
Judith K. Wolf, MD, Section ChiefGynecologic oncology
RADIATIOn OnCOLOGy SECTIOn
Matthew Callister, MD, Section ChiefGastrointestinal, skin, sarcomas, and head and neck cancers
Emily Grade, MDBreast treatment including partial breast brachytherapy, prostate brachytherapy, gynecological and thyroid cancers
Terence Roberts, MD, JDBrain, lung and prostate tumors; stereotactic radiosurgery; partial breast brachytherapy
DIAGnOSTIC IMAGInG SECTIOn
Donald Schomer, MD, Section Chief, CAQ neuroradiologyOncologic diseases of the brain, spine, head and neck
John Chang, MD, PhDAdvanced magnetic resonance and computerized tomography imaging of gastrointestinal and genitourinary systems; imaging guided biopsies
Vilert Loving, MDBreast imaging and intervention
Harvinder Maan, MD, CAQ neuroradiologyDirector of neuroradiology neuroradiology and interventional spine procedures
Rizvan Mirza, MDAbdominal and pelvic magnetic resonance imaging
Susan Passalaqua, MDDirector of nuclear Medicine and Molecular Imaging Oncologic imaging, nuclear medicine, radiology, PET/CT
Andrew Price, MD, CAQ Interventional RadiologyInterventional radiology, including percutaneous tumor ablation, chemoembolization, and radioembolization
David Russell, MD, FACPBreast imaging and intervention
CRITICAL CARE SECTIOn
Shiva Birdi, MD, Section ChiefJijo John, MDDeven S. Kothari, MDDean Prater, MDRavindra Gudavalli, MD
InTERnAL MEDICInE SECTIOn
nikunj Doshi, DO, Section ChiefInternal medicine
David Edwards, MDInternal medicine
Ronald Servi, DOPulmonary medicine
PATHOLOGy SECTIOn
Kevin McCabe, DOSection Chief
Banner MD Anderson Cancer Center physicians are highly specialized in their fields
of expertise. Below is a listing of physicians currently on our full time staff. Physicians
continue to join Banner MD Anderson, so this list will continue to evolve.
To make a referral to a physician on our staff, please call 480-256-3433. To contact a member of medical staff, call 480-256-6444 and ask for the physician to be paged.