Avera Cancer Institute Magazine - fall 2017 by Avera

Avera Cancer Institute

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RADIATION THERAPY: WHATâ&#x20AC;&#x2122;S IT LIKE?

SOLVING THE PUZZLE OF

CANCER TREATMENT Be Your Own Advocate

DETERMINED TO BEAT BREAST CANCER FALL 2017

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DEAR READERS, Breast cancer is the most common type of cancer that women face, beyond non-melanoma skin cancers. It accounts for 30 percent of all cancers among women. Certainly, women are also at risk for lung cancer, colorectal cancer, uterine or ovarian cancer, but in much lower numbers. That’s why we focus many of the articles in our fall Avera Cancer Institute magazine on breast cancer. Avera’s breast cancer program really begins with your primary care provider – your family doctor. This is where important discussions take place, for example, are you scheduling regular mammograms as recommended? Are you feeling anything unusual or different? Avera Cancer Institute is one institute with six regional centers and over 40 outreach sites. In Pierre, we are constructing the Helmsley Center, home of the Avera Cancer Institute and a new medical office building. When completed in the fall of 2018, this beautiful new facility will offer a full range of cancer services in one location, including medical oncology and radiation oncology. We’re thankful to Rachel Hamburger of Gettysburg, S.D., for sharing her story, and why she chose to stay close to home and receive her cancer care in Pierre. Other topics in this issue cover the latest clinical trials, what it’s like to receive radiation therapy from a patient’s point of view, how to be your own advocate in cancer care, the latest ways to address the side effects of cancer care, and more. When the diagnosis is cancer, we at Avera strive to offer a seamless experience through the entire journey. Read to discover how Avera does cancer care differently – through the latest science, advanced technology, interconnectedness of the Avera system and compassionate care for the whole person – body, mind and spirit. Please visit Avera.org/breast to learn more.

ONE AVERA CANCER INSTITUTE. SIX REGIONAL CENTERS. Aberdeen 305 S. State St. Aberdeen, SD 57401 605-622-5000 Marshall 300 S. Bruce St. Marshall, MN 56258 507-537-9000 Mitchell 525 N. Foster Mitchell, SD 57301 605-995-5756 Pierre 801 E. Sioux Pierre, SD 57501 605-224-3100 Sioux Falls 1000 E. 23rd St. Sioux Falls, SD 57105 605-322-3000 Yankton 1115 W. Ninth St. Yankton, SD 57078 605-668-8850

Thanks for reading! In good health,

Tad Jacobs, DO Chief Medical Officer, Avera Medical Group

Several of the cancer programs and services you’re reading about are supported by generous donors from across the Avera system. To learn how you can help support local cancer patients through the Avera Cancer Institute, visit Avera.org and click on Donate to Avera.

CONTENTS Avera Cancer Institute

FALL 2017

WHAT’S NEW

Across The System.................................................................... 2

RADIATION ONCOLOGY Frequently Asked Questions...................................................... 4

CANCER NAVIGATION CENTER

An “Absolute Relief” for Ovarian Cancer Patient....................... 6

SOLVING THE PUZZLE

Of Cancer Treatment.................................................................. 8

PATIENT Q AND A............................................................... 11 WOMAN OF WILLPOWER Wife, Mom Is Determined to Beat Breast Cancer.................... 12

THOUGHTS ABOUT SURVIVORSHIP

From Survivors.......................................................................... 15

BE YOUR OWN ADVOCATE.............................................. 16 RELIEF FOR SIDE EFFECTS............................................. 18

BUILT UPON THE ROCK

Avera’s Mission in Cancer Care................................................. 21

Patient stories in this magazine describe the actual medical results of individual patients. These results may not be typical or expected for the disease type that is described, and all patients should not expect to experience similar results.

This magazine is published by Avera Health, sponsored by the Benedictine Sisters of Yankton, S.D., and Presentation Sisters of Aberdeen, S.D. Thanks to the leadership and heritage of faith of the Sisters, Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

WHAT’S NEW ACROSS THE SYSTEM: Sioux Falls

Marshall NEW CANCER CENTER DIRECTOR Jessica Moriarty, CNP, has been named Director of Avera Cancer Institute in Marshall. As a nurse practitioner, she is a local resource for oncology patients, which serves to complement and extend the care of both the medical oncology services provided by Mark Huber, MD, as well as radiation oncology services. Currently a team of highly qualified and board-certified providers including Barbara Schlager, MD; Kathleen Nordstrom, MD; James Simon, MD; and Leslie St. Royal provide day-to-day radiation oncology services. CESM: Marshall has used 3-D screening mammography for some time, but has added contrast enhanced spectral mammography (CESM), giving them a full array of leading-edge diagnostic tools, which also includes MRI, ultrasound-guided needle biopsies and stereotactic guided biopsies.

REACHING LATINO COMMUNITY The hiring of Latino Community Health Coordinator Belen Madrigal will help Avera Cancer Institute reach more area Spanish-speaking women who need breast health education, screening and cancer care. The addition of Madrigal means the Hispanic community in the Sioux Falls region now has a full-time, dedicated breast health resource. GAMMA KNIFE: Sioux Falls also has begun to diversify the use of its Gamma Knife® technology by treating non-malignant diagnoses such as acoustic neuromas, trigeminal neuralgias and arterial venous malformations. Gamma Knife was designed to treat brain tumors without a surgical incision through 192 highly focused beams of radiation. It can be used to treat cancerous brain tumors and benign brain lesions with great precision and accuracy while reducing the possible damage to nearby healthy tissue. HELMSLEY CHALLENGE IS ON PACE

Pierre

The Avera St. Mary’s Foundation continues its Helmsley Center fundraising with a goal of $300,000 in donations prior to Feb. 1, 2018. Every dollar donated to the Helmsley Center Challenge is matched. The planned fall 2018 opening date is still on target. Thanks to the construction of the Helmsley Center, supported by grant funding of up to $10 million from The Leona M. and Harry B. Helmsley Charitable Trust, Avera Cancer Institute in Pierre will offer radiation therapy, meeting a long-time community need. To learn more go to AveraStMarysFoundation.org CESM: Pierre has added contrast enhanced spectral mammography (CESM), an imaging tool that helps evaluate abnormal findings from mammography or other breast imaging.

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Fall 2017

Aberdeen

Yankton CANCER SUPPORT GROUP GETS CREATIVE

A Cancer Support Group is a meaningful addition to the cancer care offered in Aberdeen. Avera social worker Jeny Barnes, along with therapist Becky Ellingson share a wide range of efforts – from conversation to art – with cancer patients, families and other supporters. The group entered a collaborative art project in the Brown County Fair, winning a purple ribbon. Judges commented, “Wow, this is beyond words. Such great detail put into one piece. No one part is greater than the whole.” This led to developing art kits for patients, for which the Avera St. Luke’s Foundation provided financial support. CESM: Aberdeen has added contrast enhanced spectral mammography (CESM), an imaging tool that helps evaluate abnormal findings from mammography or other breast imaging.

Mitchell PROTECTION IN PROSTATE TREATMENT Avera physicians in Mitchell are using the SpaceOAR System, and it allows them to provide prostate cancer radiation treatment with less risk of rectal injury during procedures. SpaceOAR is a hydrogel spacer that is inserted behind the prostate and in front of the anterior rectal wall. It reduces the chance of radiation damage to the rectum when administering high-dose radiotherapy for treatment of prostate cancer. The body reabsorbs the spacer about three months after physicians place it.

UPGRADE TO ELEKTA INFINITY Avera Cancer Institute in Yankton welcomed a truckload of technology on Sept. 13, as it began the six-week installation process of a new Elekta Infinity™ linear accelerator. This cancer-fighting radiation therapy technology, which took 10 hours to unload and put in place, will be ready for use in December for patients in need of external-beam radiation treatment. All Avera Cancer Institute linear accelerators are “beam matched” which means when needed, a patient’s plan of care can seamlessly transfer from one site to another. This allows patients to avoid issues or delays in case one location has machine downtime. In those particular situations, another site can provide the exact same treatment with no interruption. While the linear accelerator is being replaced, Yankton patients in need of radiation therapy services are being cared for at Avera Cancer Institute in Mitchell.

In the SpaceOAR name, the capital OAR stands for “organ at risk.” Physicians Xenofon Papadopoulos, MD, Avera Medical Group Urology, and Stephen J. Dick, MD, Avera Cancer Institute in Mitchell, have treated nearly a dozen patients with the SpaceOAR device. Also in Mitchell, Avera Cancer Institute welcomed Johannes Ritter, PhD, who will serve as the new physicist. Physicists help physicians and dosimetrists develop dosage and treatment plans for cancer patients. Fall 2017

Avera Cancer Institute

RADIATION ONCOLOGY

TOTALLY NORMAL, FREQUENTLY ASKED QUESTIONS

You’ve heard of family medicine and scheduled an appointment for your children with their pediatrician. You can rattle off a few things a cardiologist could do for you and your family. But if you’ve been diagnosed with cancer, your oncologist may refer you to radiation oncology.

So, what happens there? Avera Medical Group radiation oncologists Michael Peterson, MD, of Yankton, and Stephen Dick, MD, MPH, of Mitchell, answer commonly asked questions about what you can expect during radiation treatments.

MICHAEL PETERSON, MD, RADIATION ONCOLOGIST

“Radiation oncology is the treatment of medical conditions, typically cancer, with ionizing radiation to either cure the cancer, or improve the patient’s condition or quality of life,” said Peterson. Radiation oncology is utilized to treat practically any cancer — breast, lung, brain, prostate, rectal, lymphoma, kidney, bone and more. For the most part, there are two types of radiation:

STEPHEN DICK, MD, MPH, RADIATION ONCOLOGIST

• External beam therapy – In the most common form of radiation therapy, high energy beams of X-rays and electrons are delivered to the tumor in a way that best spares nearby healthy tissues from receiving high doses of radiation. • Brachytherapy – During brachytherapy, radioactive materials are placed into or near the affected tissue to kill cancer cells. While this approach is less common, it can be very useful to treat a number of cancers including prostate cancer and vaginal cancer.

What should I do to prepare for treatment? Learn as much as possible about radiation oncology from your physician, reputable online sources and publications from organizations like the American Cancer Society — pros and cons, side effects, expected results, etc. “Bring your findings into your appointment; the radiation oncologist will compare this information to your situation,” said Peterson. Preparation also happens outside of the doctor’s office. Set up a feasible plan with your employer that takes into consideration your responsibilities at work. Most employers will be more than willing to accommodate your health care needs when both parties make thoughtful planning a priority.

How long does treatment last? Treatment plans vary from patient to patient. An individual treatment session can last from just a few minutes to more than a half hour. As for how often and for how long you may need radiation, it can range from a single treatment all the way to five days a week for eight weeks.

What should I wear? Comfortable street clothes work fine during your radiation session. Think zip-up sweatshirts, sweatpants or roomy T-shirts. “Depending on where the machine needs access to your body, clothes should be easy to remove,” said Dick. Staff may offer a hospital gown or Dignity Robe to make this process simpler.

What do I hear during the radiation session? For the most part, treatment is a noiseless experience. Yet, for your enjoyment, staff may play music from your favorite genre or artist while you receive treatment. “I’ve heard everything from classical to country to hard rock; it’s whatever makes the experience more comfortable for you,” said Peterson.

What side effects might I experience? Will you help me manage these symptoms? “Side effects from radiation therapy depend on the part of the body that is being treated,” said Dick. A common symptom is fatigue. There may be hair loss if radiation therapy is directed to a part of the body that grows hair. Likewise, there may be nausea if the stomach or abdomen are treated. “Sometimes, exposed skin during radiation may become irritated, resembling a sunburn,” Dick said. This “radiation sunburn” is acute dermatitis. Your skin may become red, feel tender to the touch, and peel. Talk to your physician if you discover any skin irritation. Steroid cream and various soaks are available to relieve itchy areas and tenderness. You don’t have to live with radiation side effects, whether physical or emotional. Always speak up if something just doesn’t seem right or you’re feeling depressed or anxious. One final note: If you are undergoing external beam radiation therapy, you will not become radioactive and your body will not pose a radiation hazard to loved ones around you.

Fall 2017

Avera Cancer Institute

CANCER NAVIGATION CENTER AN “ABSOLUTE RELIEF” FOR WOMAN FIGHTING OVARIAN CANCER

n one summer, everything changed for Lennox, S.D., native Brittany Bisdorf.

She graduated from college. Her boyfriend proposed to her and they made plans to create a life in a city 14 hours away from home in Sault Ste. Marie, Mich. They started planning their wedding. And she received a diagnosis from her doctor: ovarian cancer. For the first four years of her journey, she received care two hours away from home. But in time, she needed to look elsewhere for continued, targeted chemotherapy.

Brittany Bisdorf pictured with her mom, Jill Adams, above, and husband, Mark, right.

A single phone call changed everything. “I knew I needed help on several levels,” Bisdorf said. “I called the Avera Cancer Institute Navigation Center and it absolutely relieved my stress. I called and they

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Fall 2017

Center team began their work, she no longer felt overwhelmed.

David Starks, MD, and Luis Rojas, MD, provide expert care in the subspecialty of gynecologic oncology in Sioux Falls.

did the rest.” Earlier, Bisdorf had reached out to various Midwest sites, but her mother in Sioux Falls encouraged her to consider Avera. “I was trying to do all that and go through treatment,” said Bisdorf. “When I transferred to Avera, the navigator took all that off my plate.” Before she reached Sioux Falls, Avera Medical Group gynecologic oncologist Luis Rojas, MD, and his team were preparing for Bisdorf ’s arrival.

“When I came to Sioux Falls, I went right to the emergency room due to complications, and the team was ready. I was already on their radar,” she said. “I had a complete support system: doctors, nurses, social worker, dietitians – everything I needed.” In the face of ovarian cancer, Bisdorf was also trying to “do it all” and cover the bases of insurance, medical bills and research. Once the Avera Cancer Institute Navigation

“Now I feel all aspects of this disease are being treated,” Bisdorf said. “No matter what I face, I know I can make a single call and have issues addressed. My mom can call with her questions or to get help. There’s no logistics or recordkeeping or transfer work I have to worry about.” The Navigation Center is much more than a call center. “They know and remember me,” she said. “If you need help, reach out to them.” Brittany passed away peacefully on Nov. 27, 2017, after a five-year courageous battle with ovarian cancer. In her memory, her family and care team honor her by sharing her story.

The Navigation Center can be reached 24/7 at 855-853-4398.

CANCER SUBSPECIALTY CARE SETS AVERA APART

Rojas said that approach applies to any patient who needs care. “They can be from Pierre, Redfield, Aberdeen – it doesn’t matter,” Rojas said. “We can marshal resources from multiple entities and bring them together to benefit the patient.”

Avera’s depth of subspecialty care includes fields like gynecologic oncology.

David Starks, MD, gynecologist oncologist who practices with Rojas, said it’s all about approach. “Ours tends to be patient-centered and hands-on, which helps many of our patients as all their needs are met in one place,” he said. “We serve those patients across many subspecialties – surgery, medical oncology, radiation oncology – and we manage our patients and the complications they might face. They benefit by having a home for all their care. Everyone in our clinic is dedicated to treating their cancer.”

“At Avera, our coordinated subspecialty care and the seamless nature of our integration as a cancer institute is the beauty of our system. Patients have a more complete experience and better quality of care, from diagnosis through the entire scope of treatment.” - LUIS ROJAS, MD, AVERA MEDICAL GROUP GYNECOLOGIC ONCOLOGIST

Fall 2017

Avera Cancer Institute

SOLVING THE PUZZLE OF

CANCER TREATMENT Genomics, Clinical Trials Keep Avera on the Leading Edge Cancer treatment is like a puzzle. As cancer grows and changes over time so do the types of treatment that work best. It’s your cancer team’s job to match the best treatment to your cancer at a certain snapshot in time.

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Fall 2017

That’s done in part by analyzing your DNA. But research is only just beginning to pinpoint which treatment therapies work best for each newly discovered mutation. That is what the experts at Avera Cancer Institute Center for Precision Oncology and Avera Research Institute in Sioux Falls are focused on as they create the infrastructure to develop Phase 1 trials for patients. In fact, scientists at Avera are researching drug combinations for specific cancer mutations that could one day become standard of care through clinical trials done right here at Avera.

“There are infinite combinations of genetic changes that can occur with cancer but not an infinite number of drugs to treat it.” - CASEY WILLIAMS, PHARMD, DIRECTOR OF THE AVERA CANCER INSTITUTE CENTER FOR PRECISION ONCOLOGY

‘Infinite Combinations’ “The only way to truly make a maximum impact in cancer is to combine new and existing therapies and limit the ability of cancer to grow and change,” said Casey Williams, PharmD, Director of the Avera Center for Precision Oncology. Genomic medicine helps guide care by sequencing the patient’s cancer DNA to determine the specific cancer mutations. This allows the Avera Center for Precision Oncology – led by Brian Leyland-Jones, MB BS, PhD, and Williams – to work with the rest of the patient’s care team to determine the best types of treatment. “Research has allowed us to understand that tumors change over time and to match this growth to individual treatments,” said Richard Conklin, MD, oncologist and hematologist in Aberdeen, who has offered clinical trials to area patients for more than 20 years. “We also have leading experts in genomics and translational research to help us with more advanced therapies. Only a small percent of cancer centers in the country even have that capability.”

BRIAN LEYLAND-JONES MB BS, PHD, VICE PRESIDENT OF THE AVERA CENTER FOR PRECISION ONCOLOGY

CASEY WILLIAMS, PHARMD, DIRECTOR OF THE AVERA CENTER FOR PRECISION ONCOLOGY

RICHARD CONKLIN, MD, ONCOLOGIST AND HEMATOLOGIST

Innovating Our Own Path To further that goal, Williams and the physicians of Avera Cancer Institute recently developed the first two investigator-initiated Phase 1 drug therapy trials at Avera. These trials were approved by the U.S. Food and Drug Administration and the respective pharmaceutical companies to move forward with patients to test the safety and efficacy of the new drug combinations. This is in addition to the standard portfolio of clinical trials in which Avera participates but did not develop – some of which are early phase. Few health systems outside of the 69 National Cancer Institute designated cancer centers develop and/or participate in Phase 1 trials because of the lack of necessary infrastructure and expertise. Williams and his colleagues are working with various types of cancers at all stages of treatment. Treatment becomes more complicated in later stages because the cancer has had more opportunity to grow and change. That’s why Avera research investigators are developing multi-drug combinations that can block multiple paths to limit growth of specific cancer mutations. The team will continue to develop and open Phase 1 trials at Avera to offer therapies not otherwise available to patients in our region or possibly anywhere. The more of these combinations that can be created and proven to be safe and effective, the more successfully cancer can be treated without recurrence.

Fall 2017

Avera Cancer Institute

“We’re building a basket of studies,” Williams said. “We want the oncologists to be able to order genomic sequencing, and then use that genomic information to decide whether that patient may benefit from any of the available studies and treatment regimens.”

CANCER CLINICAL TRIALS —

MYTHS DEBUNKED ials al tr c i n i ble Cl aila ent. v a only eatm are ncer tr ca for

MYTH

Genomics and Risk

Long-term, the goal is to investigate ways to categorize genomic information from patients from high to low risk so patients can get the right level of treatment according to their needs. It’s a change in focus from which drug works better – A or B – to a more patient-focused approach. “Our goal is to reduce the toxicity for those who don’t need it and maximize therapy for those who do need it to avoid recurrence down the road,” Williams said.

MYTH:

When it come s to can ce treatme nt, clinic r al trials ar eo offered nly a last alte s a rnative .

MYTH:

t I migh a e ceiv only re “sugar or , o b in place enroll I if ” l, pil ia al tr l. a clinic

What’s Happening Now Here’s a rundown of some of the innovative clinical trials and research happening at Avera. A Blood Test to Detect Multiple Cancers

Reduced Whole Breast Radiation

Researchers are working to develop a blood test that could detect many different types of cancers in early stages when a cure is possible. GRAIL is currently in the research stage with a goal of getting 10,000 blood samples from healthy volunteers, and Avera Cancer Institute is a participant in this study.

Electron-based intraoperative radiation therapy (IORT) targets the cancer with a high dose of radiation during surgery to remove your tumor. The benefits include fewer treatments and side effects. In this region, this trial is only available to breast cancer patients at Avera.

FACT: Clinical trials are available across the spectrum of cancer care – from prevention and screening to diagnosis and treatment.

FACT: Clinical trials are available for all situations. No matter what stage of cancer treatment you are in, clinical trials may offer more effective options for specific circumstances than the current standard of care. That’s why your Avera cancer care team will determine whether or not you may be eligible to participate in a clinical trial from the onset. If so, it’ll be included as one of your treatment options.

FACT: If you enroll in a cancer treatment clinical trial, you’ll always receive at least the gold standard of care. Any investigational drugs or placebos that are part of the study are added to the standard of care regimen – not as a replacement for the standard of care.

The First Trial with WIN

Phase 1 Trials at Avera

The SPRING clinical trial is through the Worldwide Innovative Networking (WIN) Consortium. This trial is meant to provide better treatments for metastatic non-small cell lung cancer, which is often detected at an advanced stage, by using a three-drug protocol. The SPRING trial will be a Phase 1 study to explore the safety of the drug combination and determine the optimal doses. Benjamin Solomon, MD, is the co-principal investigator for this trial.

The Avera Cancer Institute Center for Precision Oncology developed its first of many Phase 1 trials, which were recently approved to move forward. The research to pinpoint the optimal multiple-drug protocols for these trials was done right here at Avera and will only be available at the Avera Cancer Institute. These trials are using multi-drug protocols for various solid tumors, including breast and ovarian. Trials for blood cancers like leukemia and lymphoma are also in preparation.

These trials areInstitute availableFall for2017 specific types of cancer. Learn more at Avera.org/cancer-trials Avera Cancer 12

Q&A

PATIENT

While a cancer diagnosis raises lots of questions, we want to help you fully understand your options.

What are some of the other diagnostic tools available? Contrast-enhanced spectral mammography (CESM) and Videssa® Breast blood test are both used in combination with mammography. CESM is used with a mammogram to get a better look at abnormal areas and is particularly helpful for women who have dense breasts. We use a contrast dye that enhances the abnormal tissue. It’s more sensitive than the standard mammography and helpful to get a clear picture of the extent of the cancer without the need for MRI. Videssa Breast is a new blood test that is used through the High Risk Breast Cancer and Prevention Clinic, when mammography and ultrasounds are inconclusive. It looks for specific protein biomarkers that point to cancer and is nearly 99 percent effective in proving a patient does not have cancer. We want to biopsy people who are likely to have cancer but we’d like to avoid biopsy when lumps are benign, when possible.

BY TRICIA MERRIGAN, MD, FACS AVERA MEDICAL GROUP COMPREHENSIVE BREAST CARE, SIOUX FALLS

What is the difference between a screening and diagnostic tool? Screening mammograms occur as recommended to periodically view the breast tissue for earliest detection. Screenings are performed annually after age 40 when there are no symptoms. If you or your provider detect a lump or change on mammography, a diagnostic mammogram is ordered and may include additional views. Concerning areas may also necessitate the use of other diagnostic tools such as ultrasound, contrast-enhanced spectral mammography (CESM), or breast MRI.

What is electron-based intraoperative radiation therapy? During lumpectomy surgery to remove the tumor, electron-based IORT provides a high dose of radiation to the tumor site. Depending on your age and type of cancer you may be eligible for single dose, which doesn’t necessitate a follow-up of whole-breast radiation after surgery. Some women still may need an additional three weeks of whole-breast radiation. This therapy is proving effective and is a great option for women who want to limit radiation and avoid mastectomy. Fall 2017

Avera Cancer Institute

A Woman with

Willpower

WIFE AND MOM STAYS DETERMINED TO BEAT BREAST CANCER Upon hearing a diagnosis of breast cancer, Rachel Hamburger didn’t feel shocked, scared, angry or sad. “I was annoyed,” said the Gettysburg, S.D., mother of six, home daycare operator and wife of the county sheriff. “Our lives are so busy – I didn’t have time to be sick.”

Rachel and Curt Hamburger are pictured with their six sons.

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Fall 2017

Her diagnosis of triple negative breast cancer came after feeling a lump that didn’t go away and seemed to get larger. Triple negative is a more aggressive form of breast cancer and it doesn’t respond as well to treatment. At her age of 42, she had a 3 percent chance of getting breast cancer, and of that 3 percent, her chances of having triple negative cancer were 20 to 25 percent. She remembered looking at her husband, Curt, and thinking, “Of course I would have that kind. It couldn’t be easy.”

Along with annoyance, she also felt her natural trait of stubbornness rise to the surface. Rachel is the mother of six sons – two in college, one in high school and three in grade school. “My littlest is 6 and he’s too little to be without his mama, and in fact I know it would be a tremendous setback for all of my boys if something happened to me. I’m too stubborn to let that happen.” Rachel says she can be a “difficult patient” because of that stubborn streak. But when it came to her treatment plan outlined by Sreekanth Donepudi, MD, Avera Medical Group oncologist in Pierre, she wanted to follow it to the letter. “I trust my doctor. He’s super smart, he’s got the training and he sees cancer patients every day.” Her case was also presented to the Breast Conference in Sioux Falls, where multiple specialists had opportunity to share their recommendations. That trust made Rachel totally fine with an emerging treatment plan that called for chemotherapy and immunotherapy before surgery, rather than the traditional plan of drug treatment after surgery. Now finished with her initial phase of chemotherapy, Rachel is undergoing chemo immunotherapy, and the next phase of her treatment will be a mastectomy to remove the affected breast along with reconstruction during the same surgery. She has opted to have all her cancer care close to home in Pierre. “One thing that attracted me to Pierre was that my doctor was willing to go outside of the box when treating my cancer. He didn’t settle for the norm. I asked him if it was your wife, daughter or mom, what would you recommend for her.” She remembers that Donepudi sat back, crossed his arms and said, “she would do chemo first.” “So I said, OK, let’s do that.”

Rachel with her husband, Curt (above), and talking with Sreekanth Donepudi, MD (left).

she needs, as well as a group of good girlfriends. “They check in on me or come and take the boys for me.” That includes her family practitioner, Connie Belford, CNP, in Gettysburg, who will give her a needed pep talk if she gives into feeling sorry for herself. “You get over that. I’m stubborn and the people around me are just as stubborn,” Rachel said. “I just don’t stop having the willpower to keep moving and keep living.”

The plan’s success to date is giving Rachel and her family a lot of hope. “My tumor was 6 cm when I started treatment, and my latest ultrasound showed it had shrunk to 1.9 cm.” Also, Donepudi could no longer feel the tumor in an exam. “I think he was more excited than I was.” “I have to say that chemo was hard. I was tired, sore and weak.” She said these effects were scary for her family. “It wasn’t normal for me to be sleeping during the day, for dad to be doing laundry rather than mom, or for me to not get up to cook supper.” She remembers feeling so weak she couldn’t hold her water bottle or even her phone. However, her stubborn nature helped with the nausea. “I was too stubborn to throw up. I hate

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Fall 2017

to throw up. So whenever I would

feel sick, I would go find a little something salty to eat to stave it off.”

“All my care here in Pierre has been awesome. They know me when I walk in. The nurses who take care of me are very warm and help me feel comfortable. I love that.”

One of the hardest aspects for Rachel was losing her hair, and gaining back the “baby weight” she had worked so hard to lose. “They don’t tell you that it hurts when your hair starts to fall out.” Rachel started her own blog to share such details of her journey with other women who might have to go through the same things. The weight gain was due to taking steroids. “But the hair will grow back and the swelling is just water weight. I will get through it – it’s just the actual getting through it that’s hard.” She credits her family for being there with the encouragement

- RACHEL HAMBURGER

Thoughts about Survivorship – From Survivors

“

This will be quite a journey that I’ve taken, but then after all, isn’t life one big journey?”

THERESA SCHUTT BREAST CANCER SURVIVOR MILLTOWN, S.D.

“ JOLINDA GRAY ANAL CANCER SURVIVOR VERMILLION, S.D.

“

JENNA TREVOR BREAST CANCER SURVIVOR ABERDEEN, S.D.

Once the initial shock of my diagnosis had settled, I knew I had to have a plan for how I was going to get through the surgeries, treatments and recovery. With the support of my husband Matthew, and knowing I had a strategy to face what was coming next got me through some of the toughest times.”

Life is not normal when you’re going through cancer treatment. It makes you realize that you really aren’t in control of a whole lot. You take one day at a time. Each day was a new challenge. I tried to keep my sense of humor and a belief that tomorrow would be a better day. Everybody kept telling me I was strong and tough, but I didn’t feel very tough at the time. However, I guess I was.” Fall 2017

Avera Cancer Institute

BE YOUR OWN

ADVOCATE W H Y PAT I E N T S A R E A K E Y M E M B E R O F T H E C A N C E R C A R E T E A M

There are many members of the cancer care team, from medical oncologists to surgeons, radiation oncologists, navigators, nurses and the list goes on. Yet one of the most important team members is the patient.

“The cancer care team will always advocate for our patients. Yet it’s important for patients to advocate for themselves, too. The more people who are striving toward the best possible outcomes, the better.” - JESS MORIARTY, CNP, DIRECTOR OF AVERA CANCER INSTITUTE IN MARSHALL

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Becky Johnson of Aberdeen enjoys an art session with her daughter, Athena.

“As cancer caregivers, we encourage patients to seek out information, to become educated through reputable sources and websites, and ask plenty of questions,” said Susan Deibert, RN, BSN, Nurse Manager for Medical Oncology at Avera Cancer Institute in Aberdeen. Becky Johnson of Aberdeen was identified as being high risk for breast cancer. During breast MRI –

a special test often recommended for women at high risk – a lump was discovered in her left breast, which turned out to be stage II breast cancer. Because of her status as high risk, and as the mother of two active kids, ages 10 and 16, “we wanted to treat it aggressively,” said Johnson, who opted for a double mastectomy followed by chemotherapy and radiation.

“My husband and I were good readers, looking up and reading clinical studies from medical journals. And then we would approach our doctor based on what we found, saying, ‘OK, you’re telling me this, here’s my question as to what I read,’” Johnson said. “You really do have a lot of choices,” Johnson said. For example, she’s choosing to wait five years before having reconstruction surgery to make sure all the cancer is gone. “Not everyone would choose what I did, but it’s my choice.” Mike Sperl of Florence, Minn., had an incident at a swimming pool where he hit the bottom a little hard, and then the area around his lower lung began to hurt. “I was feeling more and more fatigued.” While a blood clot was suspected at first, he eventually was diagnosed with stage IV liver cancer. Sperl was not ready to accept that his only option was to buy more time through chemotherapy treatments. He and his wife, Heather, faced their situation with a positive attitude – an attitude that they were going to win. “We wanted to beat this thing.” Sperl has advocated for himself by learning about his diagnosis, learning about cancer drugs, seeking second opinions, working with his health insurance carrier to ensure treatments were covered, and working with patient advocates. For both Johnson and Sperl, the choice of where to receive cancer care was important to them.

Mike Sperl, center, is surrounded by support from his wife, Heather (left of Mike), and family.

“We have a wonderful cancer center in Aberdeen. I wanted to be mom and be home around my kids, and participate in their activities as much as possible. I had an amazing cancer care team here,” Johnson said. Sperl has received his chemotherapy infusions close to home at Avera Cancer Institute in Marshall. Most recently, he’s undergone genomic testing at the Avera Cancer Institute Center for Precision Oncology. Through genomic testing, a chemo drug was identified that will hopefully be more effective against the primary cancer in his body. In working with the patient advocate at the Center for Precision Oncology, Sperl was able to get his testing covered through programs offered by collaborating genomic testing companies. “The Avera Cancer Institute team in Marshall has been fantastic. If I call and say I have an insurance issue, or need my biopsy results sent somewhere, they get it taken care of right away. I have a lot of faith in them. I’m not one to sit around and wait for results, I’m one to pick up the phone and make some calls,” Sperl said. Although patients can advocate for themselves, the support of family and friends can’t be underestimated. Sperl has been a local firefighter for several years, and this summer, a benefit was held for him in Tyler, Minn. “We’re like family,” he said. “Usually, I’ve been the one doing benefits to raise money for others. We’ve learned to accept help graciously, because this is going to be a long road.”

Fall 2017

Avera Cancer Institute

Relief for Side Effects Dealing with side effects of powerful treatments like chemotherapy is often a major aspect of having cancer. For some, side effects cause more symptoms than the cancer itself.

Avera Cancer Institute

Fall 2017

Out of concern for caring for the whole person, Avera Cancer Institute offers services to address side effects as well as treatment for cancer. Preventing Hair Loss “A vast majority of chemotherapy treatments result in temporary hair loss, and for some patients, this side effect can be particularly traumatic,” said Amy Krie, MD, breast cancer oncologist with Avera Medical Group in Sioux Falls. “A key reason for this is physical appearance. Hair loss sends the message to everyone that you have cancer.” Avera’s wig program offers a free wig to any woman who AMY KRIE, MD, will lose her hair during cancer BREAST CANCER ONCOLOGIST treatment. But now there’s a new treatment that can minimize hair loss. It’s called the DigniCap® Scalp Cooling System, and Avera Cancer Institute was the first center within seven states across the Upper Midwest to offer it. Beginning with getting their hair wet, patients wear caps that are tight around the scalp and also cool the scalp to around 37 degrees F. The cap is worn during chemo treatments and then for three hours afterward. Scalp cooling prevents circulation of the chemo drugs to the hair cells. “At Avera, all of the patients who have tried scalp cooling to date have successfully kept over 50 percent of their hair by the end of chemotherapy treatments, and most kept 75 to 90 percent of their hair,” Krie said. “We’re excited to see that this treatment has been so effective. It’s great to be able to offer this option to patients who dread losing their hair.”

Elva Connelly was proud to be the first Avera patient to use the DigniCap to avoid hair loss during chemotherapy.

Sexual Side Effects Two common cancers among women, breast and uterine, are estrogen dependent, and treatments decrease the body’s estrogen level to prevent a recurrence.

MATTHEW BARKER, MD, UROGYNECOLOGIST

“Whether or not a woman is at the age of menopause, these treatments cause menopausal changes, including vaginal dryness and painful intercourse, as well as recurrent urinary tract or vaginal infections,” said Matthew Barker, MD, Avera Medical Group urogynecologist in Sioux Falls.

“Women have so much to go through, they usually don’t even talk about sexual side effects,” he said. Treatments such as hormonal therapy, physical therapy, lubrication and counseling can help. “The exciting new thing is treatment with a fractional CO2 laser, which is similar to lasers for dermatology and hair removal,” Barker said. Treatment with this laser changes the lining of the vagina to create a premenopausal state of the skin for women to help with dryness. This treatment takes only a few minutes,

with no anesthesia or recovery time. “It’s very effective, especially for women who can’t tolerate estrogen,” Barker said. Three treatments are delivered six weeks apart, followed up by yearly maintenance treatments if needed. To learn more about Avera’s Sexual Medicine Program, call 605-322-6700 or 866-996-6980.

Natural Therapies Avera Medical Group Integrative Medicine in Sioux Falls offers non-drug services that help alleviate and even prevent many common side effects of cancer treatment, such as constipation or diarrhea, depression and anxiety, difficulty sleeping, fatigue, hot flashes, nausea, numbness or tingling (neuropathy), muscle aches or headaches, sinus congestion and more. Acupuncture: Research has shown that 80 percent of cancer patients experience positive results when using acupuncture. This ancient healing practice uses sterilized, hair-thin needles gently placed at strategic places in the skin to stimulate the body’s natural healing process.

DAWN FLICKEMA, MD, INTEGRATIVE MEDICINE

“The nice thing about acupuncture is that it’s not another medicine or chemical to put into your body – it’s completely natural. It also has the potential to treat a number of symptoms all at once and many patients find their appointments relaxing,” says Dawn Flickema, MD, Avera Medical Group Integrative Medicine specialist. Aromatherapy: Sally Williams, DO, Avera Medical Group Integrative Medicine specialist, said use of essential oils are especially popular for treating nausea, anxiety, sleep issues and even hot flashes.

SALLY WILLIAMS, DO, INTEGRATIVE MEDICINE

“Essential oils are pleasant and convenient to use,” adds Flickema. “For example, if you’re experiencing nausea, you can pull it out of your pocket or purse and use it right away.” Fall 2017

Avera Cancer Institute

For the safest and best use of aromatherapy, it’s important to only inhale – not ingest – essential oils. “Your most efficient uptake of essential oil is by smelling it. It’s absorbed more readily that way to stimulate the different parts of your brain,” says Flickema. Mind Body Classes: Gentle movement techniques can be helpful for treating neuropathy and improving balance. “It can also help reduce stress and pain and improve sleep,” Williams said. A Singing Bowls Relaxation and Meditation class is also available. Cancer patients may also benefit from: • Guidance on supplements • Health coaching and nutrition consultations • Massage therapy Integrative therapies provide the relief many people need to continue with cancer treatments as scheduled, Flickema said. “We’ve found that it helps a lot of people be able to finish or avoid delays in their treatment, which is a great benefit.” To learn more about integrative medicine therapies, schedule a consultation by calling 605-322-3241.

Nutrition Nausea and loss of appetite is a common side effect of chemotherapy, although some patients are affected by symptoms like constipation or diarrhea. “We want patients to maintain their weight during cancer treatment, and that means getting plenty of good healthy food,” said Nancy Miller, Registered Dietitian for Avera Cancer Institute in Mitchell. If needed, patients may benefit from incorporating more calories through smoothies or supplements. Dietitians are available at all Avera Cancer Institute locations to consult with patients about their diet during cancer treatment. Often it’s the smell – rather than the taste – of food that brings on nausea. “I tell patients to plan ahead and prepare meals in advance on days when they’re feeling good, or have someone else do the cooking.” Cancer treatment is not the time to diet to lose weight. “If patients have a good appetite, we advise them to eat three meals a day with healthy snacks in between with plenty of fruits, vegetables, low-fat dairy and protein. Keeping hydrated by drinking plenty of water is also important,” Miller said. 

Avera Cancer Institute

Fall 2017

BUILT

UPON THE ROCK: AVERA’S MISSION AS FOUNDATION FOR CANCER CARE At Avera Cancer Institute, elite professional medical teams, state-of-the-art technology and an array of services to treat a patient as a whole person – all are built upon a rock-solid foundation of faith.

The people who are on individual cancer journeys are not just seeking radiation therapy, talented surgeons and clinicians or unique genomic medical research. “They are asking big questions – they are facing life and death realities and they are hoping and trusting that God will surround them with peace and mercy,” said Rev. Laurel Buwalda, Avera Cancer Institute chaplain in Sioux Falls. “I may have the title of chaplain, but I am certainly not the only minister in our facility. On any given day, you will find our physicians and staff praying with patients, or encouraging them. Our mission gives us room to infuse God’s grace into all our interactions.” This idea encompasses all employees and approaches. “We are there to lean on when the difficult questions arise, and while we may not always have the answers, we can be present to validate their story of pain and courage,” Buwalda said.

“I don’t know why the Lord has allowed the burden of cancer, but I encourage people to live into the mystery of all that God is, to claim God’s faithfulness as our reality, no matter what we face.” - REV. LAUREL BUWALDA, AVERA CANCER INSTITUTE CHAPLAIN

Marshall-based Avera chemotherapy infusion nurse Deb Baumann, RN, finds frequent connections with patients through faith. She prays for her patients and nurtures relationships. “I enjoy getting to know my patients and developing close connections,” she said. “I’m happy to be able to offer them support and compassion during what can be a stressful time. I look at it like this: I’m one of God’s tools. He is using me to help get patients to the best they can be.”

Luis Rojas, MD, Avera Medical Group gynecologic oncologist in Sioux Falls, said the Avera mission lives daily in the interactions between professionals like him and the patients they serve. “I have been here for 10 years, and what fills me up and keeps me here is the fact that our mission is real. We do not pay it lip service; we live it every day. That sentiment is widely shared among all who work here,” said Rojas. “We treat every patient like we’d want our loved ones to be treated. Many cases are difficult, or require tremendous work. But we bring it back to that first question: Within the science, is my plan the same approach I would take with my wife? If it’s not, we start over. “That approach pretty much intertwines with the Avera mission and we just keep on trying, keep on looking for ways to achieve better outcomes, with faith at the heart of every effort.” Fall 2016

Avera Cancer Institute

It’s happening now.

A blood test that can help diagnose breast cancer in combination with mammography – only at Avera.

Treatment plans created with insight from

30 breast cancer experts. Breast cancer treatment plans created after analyzing your DNA for improved response rates*.

ANSWERS to your breast cancer questions 24/7 through our Navigation Center — at no charge. Availability of clinical trials, which create more options for breast cancer treatments today and in the future.

Radiation during breast cancer surgery to decrease the need for more treatments later — only at Avera.

Advanced surgical approaches for breast cancer reconstruction so you can

look and feel your best.

3-D

imaging for the earliest possible detection of breast cancer.

Learn more at Avera.org/breast or call 855-853-4398.

Saturday, May 12, 2018 Join us for the 30th anniversary of the Avera Race Against Breast Cancer

Consult with your insurance plan for coverage. *Value of sequencing-guided treatment for patients with advanced malignancies. 2016 ASCO Annual Meeting, (suppl; abstr TPS6632) 17-ACAI-7809