Avera Cancer Institute Magazine - summer 2016 by Avera

Avera Cancer Institute High-Tech Care for Brain Tumors GAMMA KNIFE OFFERS NONSURGICAL PRECISION

UNEXPECTED

INTERRUPTION COLLEGE PLANS DIDNâ&#x20AC;&#x2122;T INCLUDE CANCER

GOING THE DISTANCE REMOVING BARRIERS TO BETTER CANCER CARE SUMMER 2016

DEAR READERS, Welcome to the latest edition of the Avera Cancer Institute magazine. Cancer can strike very unexpectedly – at any age. Yet we’re always happy to share stories of survivors who go on to live full, healthy lives. Just one example is Ty Eschenbaum, who today is sharing his insights to help patients in rural areas gain better access to cancer care. While our risk of certain cancers increases as we age, it’s important to be ever vigilant in listening to our own bodies, and work in partnership with our primary care provider. Prevention and early diagnosis are always our goals through regular screening. Medical science is constantly working to improve screening and hone screening recommendations.

ONE AVERA CANCER INSTITUTE. SIX REGIONAL CENTERS. Avera Cancer Institute Aberdeen 305 S. State St. Aberdeen, SD 57401 605-622-5000 Avera Cancer Institute Marshall 300 S. Bruce St. Marshall, MN 56258 507-537-9000

When the diagnosis is cancer, we at Avera strive to offer a seamless experience through the entire journey. This includes support and resources to help cope with the significant impact of cancer, from diagnosis through survivorship.

Avera Cancer Institute Mitchell 525 N. Foster Mitchell, SD 57301 605-995-5756

Through the latest cancer-fighting technology and science – like genomics – we’re working to provide patients with the best possible chance of a cure and/or remission, along with the highest quality of life as possible. Hopeful breakthroughs are happening all the time!

Avera Cancer Institute Sioux Falls 1000 E. 23rd St. Sioux Falls, SD 57105 605-322-3000

Immunotherapy and Gamma Knife® are just a couple of examples, covered in this issue. Other features include patient navigation, weight loss and cancer prevention, colon cancer prevention, and more.

Avera Cancer Institute Yankton 1115 W. Ninth St. Yankton, SD 57078 605-668-8000

Cutting-edge science is just one way that Avera does cancer care differently. There’s also the interconnectedness of Avera Cancer Institute – like between Aberdeen and Sioux Falls. We also care for you as a whole person – body, mind and spirit. Please visit Avera.org/cancer to learn more.

Avera St. Mary’s Hospital 801 E. Sioux Pierre, SD 57501 605-224-3100

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 Avera Foundations.

CONTENTS Avera Cancer Institute

SUMMER 2016

WHAT’S NEW

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

GAMMA KNIFE

Latest Technology for Brain Tumors........................................ 4

FAITH AND HUMOR

Friends Face Prostate Cancer Together ................................ 6

THOUGHTS ABOUT SURVIVORSHIP

From Survivors ...................................................................... 8

SUPPORT GROUPS

Finding Compassion and Understanding ............................... 9

HOPE AND PROMISE Avera Joins Worldwide Consortium ....................................... 10

CARE FOR THE WHOLE PERSON

Multidisciplinary Care for Pelvic Issues.................................. 12

MISSION OF HOPE AND HEALING

Don and Carmen Meyer Center of Excellence....................... 14

THE HELMSLEY CHARITABLE TRUST

Gift to Avera Cancer Institute Aberdeen................................. 17

UNEXPECTED INTERRUPTION

College Plans Didn’t Include Cancer ...................................... 19

IMMUNOTHERAPY

Boosting the Body’s Own Defenses....................................... 21

REMOVING BARRIERS

To Better Cancer Care............................................................. 22

CANCER NAVIGATION CENTER

24/7 Support for a 24/7 Disease............................................. 24

PREVENTING A DEADLY CANCER

Screening Tools for Colorectal Cancer.................................... 26

IMPROVING YOUR ODDS

How Weight Loss Lowers Your Risk ...................................... 28 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.

WHAT’S NEW ACROSS THE SYSTEM: Avera Cancer Institute Aberdeen

Avera Cancer Institute Marshall

EXPANDED MASSAGE PROGRAM

DIGNITY AND COMFORT

With the move to its new facility, Avera Cancer Institute Aberdeen offers an expanded therapeutic massage program for cancer patients. In the past, radiation oncology patients have been offered the opportunity to have one free 15-minute massage per week. The sale of cancer bracelets by the Avera St. Luke’s Hospital Foundation has made this benefit possible.

New robes are making radiation therapy a little more comfortable for patients at Avera Cancer Institute Marshall and other Avera Cancer Institute locations. Called dignity robes, they are designed to only expose what needs to be uncovered during treatment. They are especially beneficial to patients receiving radiation therapy for breast cancer who otherwise would be required to lie on the treatment table exposed from the waist up.

Massage therapy now has dedicated space in the new facility, and the program is expanding to include medical oncology patients. Therapeutic massage eases anxiety and stress, and also produces feelings of comfort and connection. “Many of our patients love it and get on the schedule every week,” said Lee Ann Tople, Director of Diagnostics. “It gives them something to look forward to, plus a little TLC.”

Hand-crafted by Avera volunteers, the robes have Velcro openings in the front and on the sides allowing more coverage than a traditional hospital gown. “The robes allow patients to stay covered as much as possible, but they don’t hinder our ability to administer treatment,” explained Angela Saporito, RT(T), Radiation Therapist, Avera Cancer Institute Marshall. “Anything we can do to reduce a patient’s stress level and help them feel more relaxed can contribute to them getting the best possible treatment.”

Avera Cancer Institute Yankton ENCOURAGING WELLNESS DURING CANCER CARE Research has shown that exercise can play a vital role in prevention, as well as recovery from a cancer diagnosis. Exercise helps patients maintain their strength and recover from physical treatment, but it also plays a role in mental and emotional well-being. At the Avera Sacred Heart Wellness Center, Avera Cancer Institute Yankton patients are eligible to have personal training programs, created just for them, and follow up with a trainer to meet their goals. To reap the greatest rewards of exercise, workouts should be consistent. This program offers the first month free, with the incentive of a reduced rate if participants exercise consistently each month.

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Summer 2016

“No matter where patients happen to walk in the door across the Avera system, they have access to all resources offered by the Avera Cancer Institute’s six regional centers. When possible, we treat patients close to home, where they’re comfortable and near family and friends. When necessary, we refer them to other locations, such as Aberdeen, Marshall or Sioux Falls, to get the level of care needed for their specific case of cancer.” -Dave Kapaska, DO, administrative leader of the Avera cancer service line

Avera Cancer Institute Sioux Falls BEATING CANCER WITH JUST ONE DOSE Women over age 60 at Avera Cancer Institute are benefiting from an ongoing clinical trial with electron-based intraoperative radiation therapy (IORT) which shortens treatment from 30 days to a single day at the time of surgery. Women with certain cases of early-stage breast cancer can have lumpectomy, which removes the cancerous

Avera St. Mary’s Hospital in Pierre

lump yet preserves the breast tissue. At the time of surgery, a one-time radiation boost is delivered to prevent cancer recurrence, right at the tumor site. Avera is one of eight cancer centers in the U.S offering electron-based IORT in the treatment of breast cancer. Studies have shown that women over age 60 with small breast cancers have similar low rates of recurrence after single-dose IORT as women in the same age group who have six weeks of radiation. Now one year into the single-dose IORT study, 26 women have participated. “This means that once women are done with surgery, they are also done with treatment. They have a much shorter journey toward being a survivor and a thriver after breast cancer,” said Julie Reiland, MD, breast surgeon with Avera Medical Group Comprehensive Breast Care.

Avera Cancer Institute Mitchell

NEW CONVENIENT LOCATION FOR SURGICAL CARE

GREATER COMFORT DURING CHEMO

Surgery is often a key component of patients’ treatment plan throughout the cancer care journey. At Avera St. Mary’s Hospital in Pierre, a new location on the second floor is now open for pre-op and post-op visits with general surgeons, Brandt Becker, MD; Eldon Becker, MD; and Riley Lamb, MD. In addition to a welcoming care environment, the new location provides greater convenience and continuity of care.

Donors to the Avera Queen of Peace Foundation’s Cancer Care Fund have made a significant impact in the lives of cancer patients in Mitchell. Thanks to their donations, new, top-of-the-line chairs have been installed at Avera Cancer Institute Mitchell. These chairs provide the best possible comfort including in-chair massage, heat, and built-in tablets with Internet access. “In our communities, we understand how a caring gesture and a kind word can brighten the day for someone undergoing cancer treatment. Our donors have taken this sentiment one step further—giving generously of their dollars and making a real impact in the lives of cancer patients, bringing them comfort and strength,” said Tracy Pardy, Director of the Avera Queen of Peace Foundation. Summer 2016

Avera Cancer Institute

LATEST TECHNOLOGY FOR BRAIN TUMORS

Gamma Knife

Speech, emotion, vision, movement — and virtually all of the body’s vital functions begin in the brain. Because a brain tumor is a very serious condition, optimal treatment requires a multidisciplinary team and the right tools to treat the disease.

Avera Cancer Institute has built a team of neurosurgeons, radiation oncologists, medical oncologists and physicists to treat the entire spectrum of brain tumors. Treatment options have historically included surgery, external radiation and chemotherapy. Now, these options are greatly expanded by the addition of the Gamma Knife® at Avera Cancer Institute Sioux Falls. Gamma Knife was designed specifically to treat brain tumors and other brain conditions without surgery, but instead with stereotactic radiosurgery. “Primary treatment of most intracranial disease JAMES SIMON, MD is surgery,” said James Simon, RADIATION ONCOLOGIST MD, Radiation Oncologist with Avera Medical Group Radiation Oncology. “Unfortunately, not all tumors or cancerous lesions can be safely removed without causing long-term side effects to the brain. In these situations, an equally alternative therapy is critical.” Rather than a surgical incision, Gamma Knife targets 192 small beams of radiation on the tumor, with great precision and accuracy. It ablates, or removes the tumor or lesion, while causing minimal damage to surrounding normal tissue. “Gamma Knife has been the primary tool employed worldwide and is truly the gold standard for intracranial radiosurgery,” Simon said.

Gamma Knife has vast research and documentation available on its effectiveness in treating brain tumors. Benefits include: • Simplicity of treatment planning and delivery • Evidence of prolonged survival in patients with limited metastatic disease • Specialized design to treat brain disease • Treatment is completed in one session without an incision, with virtually no acute side effects

“Gamma Knife has been the primary tool employed worldwide and is truly the gold standard for intracranial radiosurgery.” - JAMES SIMON, MD

Cancer specialists work together to determine the best form of treatment based on the size, type and location of the tumor.

WISSAM ASFAHANI, MD NEUROSURGEON

Because radiosurgery can shrink the tumor to be nearly invisible, there are cases in which improving quality of life is the goal by managing the size of the tumor to minimize damage to brain functions, said Wissam Asfahani, MD, Neurosurgeon with Avera Medical Group Neurosurgery.

“With the Gamma Knife you’re able to control the disease as much as possible,” he said. In cases where cancer has spread to the brain, Gamma Knife might be part of the treatment plan, in addition to surgery or chemotherapy for the primary cancer. Gamma Knife can also be used to treat certain benign brain lesions, and is a good treatment for patients with facial pain due to trigeminal neuralgia (TN). When traditional surgery is not an option due to conditions such as heart disease, Gamma Knife offers an effective treatment without the risk of surgery, said Michael Peterson, MD, Radiation Oncologist with Avera Medical Group Radiation Oncology. “It’s a huge plus to have this tool available here in South Dakota, instead of patients having to drive long distances to take advantage of this technology,” Peterson said. “Having the Gamma Knife is a great addition to the care of our patients. We feel blessed to have the best radiosurgical technique available, right here in Sioux Falls,” Simon said.  Summer 2016

Avera Cancer Institute

FRIENDS FACE PROSTATE CANCER WITH FAITH AND HUMOR “You are never truly alone, with friends and neighbors. God was doing his part through all of this, as well. When you go through cancer treatment with a friend, you feel like there’s someone to share the burden with you.” - SKIP GLANZER

Avera Cancer Institute

Good friends Skip Glanzer and LeRoy Gross discovered they both had prostate cancer diagnosed in the same office, by the same doctor, on the same day — within the same hour. “When we went in for our yearly checkups, both of our blood tests showed high levels of PSA,” said Gross. “It took a day for the diagnosis to sink in, but when it did, I was ready to deal with it.” Prostate-specific antigen (PSA) is a protein produced by the prostate gland. Elevated levels in the blood may indicate disease. Growing up around the Huron area only 20 miles apart, the two have known each other most of their lives. (“Long enough,” commented Glanzer.) And now that friendship has seen them through prostate cancer treatment. In mid-November 2015, both men started their individual cancer treatment at Avera Cancer Institute Mitchell, where they found state-of-the-art technology and services close to home, including the new Elekta Infinity™ digital linear accelerator, under the care of Stephen Dick, MD, Radiation Oncologist.

Summer 2016

“It’s amazing how this equipment works: You lie on a table and the earth just rotates around you.” - LEROY GROSS

On-board imaging allows the physician to take CT scans or X-rays to guide treatment as needed. Because Glanzer and Gross each had more than 40 days of radiation treatment, they appreciated the quick one-hour drive to Mitchell. It was convenient, quick and hardly interrupted life at home. The self-described “grumpy old men” have left their mark on Avera Cancer Institute Mitchell and the people inside. They were grateful for the kindness and professionalism displayed by everyone — from the check-in staff to those who administered treatment. “The nurses and doctors have been excellent,” said Glanzer. “They’re going to miss us.” The jokesters and their shenanigans won’t be easily forgotten. Glanzer would find rocks in his hospital robe’s pockets, stealthily slipped there by Gross. As payback, Glanzer taped his buddy’s locker shut with electrical tape. Avera Cancer Institute Mitchell recently upgraded to the Elekta Infinity, which provides the capability and versatility to treat everything except for the most rare and complicated treatments. Specialized Elekta software allows physicians to build each patient’s treatment plan in advance, for precise delivery at any Avera location. When radiation therapy is the recommended treatment option, Elekta linear accelerators offer a faster, more precise method of treating cancer. Beams of radiation target the affected tissue with pinpoint accuracy, saving the surrounding healthy tissue and patient from unnecessary radiation.

“Our relationship has increased, going through cancer treatment together,” said Gross. “We talked through a lot of our trials and leaned on each other.” “He’s too short to hold up!” joked Glanzer, referring to Gross’ height. “And you’re too heavy!” Gross shot back. Laughs aside, the two urge men and women alike to make their health a priority and undergo the required screenings for prostate, breast and colon cancer. Nobody is immune to a cancer diagnosis. “I know another gentleman who was waiting for his test results to see if he had prostate cancer,” said Gross. “He was just blue in the face with worry, so I sat him down and gave him some encouragement: ‘You can do this.’” With cancer treatment in their rearview mirror, Glanzer and Gross greatly appreciate the prayers offered by their friends and family, as well as the spiritual heritage of Avera, embodied by its people. 

Summer 2016

Avera Cancer Institute

Thoughts about Survivorship – FROM SURVIVORS

“

Don’t worry about what’s in the future. You don’t know what the future is...

“

As a result of surviving, I would have to count myself as eternally grateful ...

Give your thoughts and fears to God. He’ll help carry you through. Look at the positive things that are still in your life. If the sun is shining, that might be the positive thing for the day; just look at it and appreciate it.” BECKY LANOUE TRACY, MINN. BREAST CANCER SURVIVOR

“

Cancer doesn’t just hit you. It hits your whole family...

Everybody is so supportive — all of my coworkers, family and friends. It has given me a deeper faith. God has a plan. I put it in his hands and let him do his magic.” LAVONNE LUELLMAN HURON, S.D. ESOPHAGEAL CANCER SURVIVOR

Survival was a matter of brilliant science, great medical care, lots of prayers and good old-fashioned luck, in equal portions. At this point, I’m more patient. I’m more grateful. Boredom is not in my vocabulary. Every day is interesting, educational, fun, relaxing.” BOB WILLCOCKSON YANKTON, S.D. PANCREATIC CANCER SURVIVOR

Avera Cancer Institute

Summer 2016

SUPPORT GROUPS FINDING COMPASSION AND UNDERSTANDING

hile cancer patients treasure a loving family, supportive friends and compassionate caregivers, there’s nothing quite like the understanding offered by someone who has traveled a similar journey. From time of diagnosis with cancer, patients can feel alone and bewildered, even if they have a strong network of family and friends, said Ben Solomon, MD, with Avera Medical Group Oncology & Hematology. Support groups – either during or after cancer care – allow people to find common ground and realize they are not alone. “Unless someone has walked in your shoes, you sometimes don’t feel like others really understand what you’re going through,” said Megan Gleich, MSW, Social Worker at Avera Cancer Institute Yankton. Each patient’s journey is different. “Patients do need to be careful about presuming that their experience will

be the same as others,” Solomon said. Yet hearing from others that there’s a “light at the end of the tunnel” is powerful. Support groups are an ideal setting to share joys, struggles and celebrations of key milestones. Support groups also offer practical advice and education. Support groups take different forms, for example, an open group that anyone can join at anytime, or a structured program. “Both are valuable for individuals at different times in their journey,” Gleich said.

Solomon says it’s healthier for patients to view treatment as an “ally” rather than an “enemy.” “It’s my experience that those who see their treatment in a positive light tend to tolerate treatment-associated side effects better. Maintaining a hopeful, positive outlook helps with coping with treatment as well as the disease.” After cancer care, it’s not unusual for patients to feel a little lost after they’re no longer in active treatment. “They are asking, ‘now what,’ and often have lingering fears of the cancer returning, or guilt at having survived cancer when others have not,” Gleich said.

The benefits are emotional, spiritual and even physical. “Stress affects the entire body. If you are carrying around extra stress, it can impact you on a physical level,” Gleich said. In addition, fellow support group members can provide encouragement to stay on top of appointments and medications, and persevere with the prescribed treatment regimen, even when it’s difficult.

For cancer survivors, it’s good to hear how others have returned to life after cancer. “There are no ‘shoulds’ as to how you should feel or respond along the cancer journey,” Gleich said. To learn more about cancer support groups, call the Avera Cancer Institute Navigation Center at 888-422-1410 or 605-322-3211. 

Summer 2016

Avera Cancer Institute

A time of

HOPE AND PROMISE AVERA JOINS WORLDWIDE CONSORTIUM TO TRANSFORM CANCER CARE

Avera Cancer Institute is the fifth medical institution in the United States to join the Worldwide Innovative Networking (WIN) Consortium. The WIN Consortium is a global network of leading academic, industry, insurance and non-profit research organizations working to make personalized cancer care a reality for patients worldwide. Avera joins prestigious medical institutions including Memorial Sloan-Kettering Cancer Center in New York, New York University Langone Medical Center, University of Texas MD Anderson Cancer Center and University of California San Diego Moores Cancer Center.

“In a similar way, every single cancer in every patient is entirely different. It’s driven by different genes, different composition and different signaling pathways. At Avera, we are in this transformative time of working with cancer patients and literally working out what is the exact genetic makeup of that tumor and matching it with therapies.”

Avera has three key approaches which also match the approaches taken by WIN. This includes:

“This is literally a transformative time in cancer care,” said Brian Leyland-Jones, MB BS, PhD, Vice President of the Avera Cancer Institute Center for Precision Oncology.

• Analyzing cancer in every available platform, for example, DNA, RNA and protein

“Every single person is different – each has a different face, different hands, different body – and that is because our individuality is driven by genomics,” Leyland-Jones said.

• Treating cancer aggressively and early

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• Using combinations of drugs that will close down all drivers of the patient’s particular tumor

[

As part of a global consortium, Avera Cancer Institute joins others around the world who have a shared goal: to translate personalized cancer medicine discoveries into standards of patient care.

To date, the approach in cancer care has been population medicine – treatments based on what has shown to be most effective for people with a certain type of cancer. In comparison, personalized medicine uses genomic analysis to discover the specific genetic drivers of a tumor, and target those drivers with treatment regimens. “Personalized medicine is a concept of giving the right drug at the right time for the right person,” said Vladimir Lazar, MD, PhD, founder and Chief Operating Officer of the WIN Consortium. “WIN was created with a goal to go beyond what is now possible. As a member of the WIN Consortium, Avera will be on the front line of this transition. Not only will this work benefit patients at Avera, it will benefit cancer patients throughout the world.” Leyland-Jones’ group has long-standing collaborations across the nation and world. Among the most recent are Foundation Medicine, based in Cambridge, Mass., and Epic Sciences, Inc., headquartered in San Diego, Calif.

]

“Cancer research and the search for a cure is a huge undertaking, and it will take worldwide collaboration to make it happen,” said Casey Williams, PharmD, Director of the Avera Cancer Institute Center for Precision Oncology. Genomics work at Avera to date is promising. Several patients with severe metastatic disease have been treated through this approach and no longer have any evidence of disease left. “We have seen patients with stage IV cancer who have had a complete response to treatment, giving them more time with loved ones and greater quality of life,” Williams said. “Together with WIN, our mission will be to transform cancer care. It will be to take patients with early disease and make it disappear. It will be to take patients with metastatic disease and give them multi-year remissions,” Leyland-Jones said. “For cancer patients, this is a time of enormous hope and promise.” 

Summer 2016

Avera Cancer Institute

Care for the Whole Person Rather than being defined by the type of cancer they have, patients are treated as a whole person at Avera. This often involves care by multiple specialists, for example, in the case of gynecologic cancer and urogynecologic issues.

MULTIDISCIPLINARY CARE FOR PELVIC ISSUES “Pelvic floor disorders are extremely common as women age, and the risk of gynecologic cancers increases with age, too,” said Matthew Barker, MD, fellowship-trained Urogynecologist. This can include pelvic organ prolapse, pelvic pain, painful intercourse, urinary incontinence or fecal incontinence. “In fact, over half of the women who present with gynecologic cancers also suffer from urinary incontinence just because of their age,” Barker added. Most often, both issues are happening at the same time and are not related. Yet gynecologic cancer and cancer treatment can be a risk factor for developing other genitourinary conditions.

MATTHEW BARKER, MD UROGYNECOLOGIST

The hysterectomy procedure itself does not cause loss of support of other pelvic structures, leading to pelvic organ prolapse. “This is a myth that has been debunked,” said Luis Rojas, MD, fellowship-trained Gynecologic Oncologist.

LUIS ROJAS, MD GYNECOLOGIC ONCOLOGIST

Avera Cancer Institute

“Rather, it’s most often a factor of losing natural estrogen which occurs when the ovaries are removed,” Rojas said. This hormonal change can impact the strength of pelvic supportive tissues, and in turn contribute to pelvic organ prolapse and other pelvic conditions, Rojas said.

Summer 2016

DAVID STARKS, MD GYNECOLOGIC ONCOLOGIST

Radiation for pelvic cancers is another factor in pelvic floor disorders, said David Starks,MD, fellowship-trained Gynecologic Oncologist. “Radiation changes the elasticity of those tissues. Due to decreased blood supply, the tissue becomes more fibrous.”

The most common side effect of pelvic radiation is sexual dysfunction, Starks said. If the vagina closes due to these changes, it is difficult if not impossible to reopen it. “The best approach is to be proactive, and this includes prescribing a vaginal dilator and watching the patient for two years after radiation,” Starks said. The two specialties of gynecologic oncology and urogynecology overlap in that gynecologic oncologists might become aware of pelvic floor disorders during the care of their patients. “And, I screen for gynecologic cancers that might be related to symptoms such as urinary incontinence,” Barker said. “For example, some of the symptoms of ovarian cancer are urinary complaints, including fullness, urgency, bloating and urinary hesitancy.” The three physicians work together in the care of women with these diagnoses. For example,

topical agents, oral medications and physical therapy can be prescribed to address symptoms such as urinary incontinence or pelvic pain, Barker said. Barker may join Rojas or Starks in a surgical procedure to correct pelvic organ prolapse at the same time as hysterectomy. Cancer patients treated with hormonal therapies can be impacted by genitourinary issues. “Due to their history of cancer, they cannot be treated like any other patient. There are special protocols for managing patients based on medical studies,” Rojas said. “We are becoming very successful at treating cancer,” Barker said. “So we are creating a whole population of survivors who go on to have other medical issues that impact their quality of life. Because most cancer survivors are age 50 or older, pelvic floor disorders are quite common.” Pelvic floor disorders are not life threatening, Barker said, but they definitely impact quality of life. “A woman with urinary incontinence may feel embarrassed, and feel hesitant to go to church, get-togethers and other social events because she is afraid of having an accident. We want to help all women – including cancer survivors – experience quality of life that includes the freedom to be with friends and family, travel and just enjoy life.” Summer 2016

Avera Cancer Institute

A MISSION OF

HOPE AND

THE DON AND CARMEN MEYER CENTER OF EXCELLENCE

ver the past 25 years, Avera St. Luke’s Hospital has provided cancer care services to the Aberdeen region. With the opening of its new home, Avera Cancer Institute Aberdeen is meeting the community’s growing need for cancer treatment and desire to receive that treatment close to home. “Our goal is to bring hope to the fight by providing excellent, comprehensive cancer care – for the mind, body and spirit – all in one place,” said Scott Lunzman, Director of Avera Medical Group in Aberdeen.

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Summer 2016

HEALING “This new center, along with our providers and staff, will give our community a new comfort and confidence level that they can receive world-class cancer treatment right at home.” - SCOTT LUNZMAN DIRECTOR OF AVERA MEDICAL GROUP IN ABERDEEN

The $14.5 million project includes a 27,500 square-foot facility located on the southeast wing of Avera St. Luke’s Hospital – more than doubling the size of the original institute. It features chemotherapy, radiation therapy, outpatient infusion services and the practices of Richard Conklin, MD, Medical Oncologist, and Troy Adolfson, MD, Radiation Oncologist. Upon arrival patients can take advantage of the new valet services. A reception desk, staffed full-time, provides a welcoming face along with immediate access to information. In the main lobby, the Meyer Wall introduces guests to the building’s namesake –Don and Carmen Meyer of Aberdeen, S.D. – and features memorabilia of the late Coach Don Meyer who received cancer treatment at Avera St. Luke’s. Nearby, a large screen television features photos and stories of local cancer survivors. A fireplace, comfortable seating areas, walls decorated with

“Don chose Avera St. Luke’s for his cancer treatment because it allowed us to stay close to home and still receive great care,” said Carmen. “Don and I loved, respected, and appreciated his doctors and nurses. When discussions began about the new cancer institute, Don was so excited that the staff would have a larger and more efficient facility to provide their excellent care.” PHOTO COURTESY OF NORTHERN STATE UNIVERSITY

Don and Carmen Meyer The late Don Meyer and his wife Carmen of Aberdeen, S.D. spent several years sharing about the expert cancer care and access to advanced technology and state-of-the-art treatment he received at the Avera Cancer Institute Aberdeen. Don, the winningest men’s basketball NCAA coach and former men’s basketball coach at Northern State University, was treated at Avera for cancer in his liver and small intestine.

Today, his legacy of excellence – whether on the basketball court or in cancer care – lives on through their generous support of the Don and Carmen Meyer Center of Excellence. “The center has great community support, including fundraising through Avera St. Luke’s Foundation,” said Scott Lunzman, Director of Avera Medical Group in Aberdeen. “To also have Don and Carmen Meyer’s support is huge. They’re faith-filled people, passionate about providing excellent care for our community. Providing excellent, compassionate care is our mission at Avera, so it’s a great partnership.”

Summer 2016

Avera Cancer Institute

Avera recognizes that cancer care is more than treating a disease. It’s caring for and recognizing each person as a whole – mind, body and spirit – through every stage of the cancer journey. While the building and technology are new, one thing that will remain is the expert and compassionate care each patient receives.

artwork from South Dakota artists, prayer room and nutrition center with free coffee and snacks for patients and guests invite them to rest and relax. There’s also a beautifully landscaped patio along the east side of the center to enjoy during the warmer months. The newly expanded infusion area includes 24 stations: 10 private, four semi-private and 10 open group stations, giving patients choice between receiving infusions privately or enjoying the camaraderie and support of other patients. Each chemotherapy bay features specially designed chairs that recline, heat and massage. With an in-house massage therapist, patients will also have access to free 10-15 minute massages. The radiation therapy area is equipped with the latest technology including the new, fully digital $3.4 million Elekta Infinity™ linear accelerator, which offers enhanced imaging and the capability for a full range of state-of-the-art radiation treatments. This equipment was made available through a grant from the Leona M. and Harry B. Helmsley Charitable Trust. In addition, the clinic area has tripled in size and now offers nine exam rooms. Avera Cancer Institute Aberdeen is one of six regional centers across the Avera system, allowing patients to seamlessly receive care at any Avera location.

“For example, if machine downtime should occur, we can provide a patient treatment at one of our regional Avera Cancer Institute facilities. They would receive the exact same treatment,” explained Lunzman. “It’s so important to be able to offer our patients the ability to continue care without missing any treatments.” In addition to the latest in cancer treatment technology, the center offers a wide variety of service enhancements including an in-house pharmacy and dedicated pharmacists, public education and screening programs, increased research and clinical trials, genetic counseling via telemedicine, nutritional counseling, financial counseling, social work, chaplain services and patient navigation.

“The new building is beautiful and the technology is incredible, but it’s really the people who make the center.” - SUSAN DEIBERT, RN, BSN NURSE MANAGER FOR MEDICAL ONCOLOGY

“Now that we can offer comprehensive cancer care one place, we have the opportunity to provide our patients with the best experience possible during a difficult time,”said Susan Deibert, RN, BSN, Nurse Manager for Medical Oncology. 

About the Helmsley Gift at Avera Cancer Institute Aberdeen Avera Cancer Institute Aberdeen is grateful for a generous grant of $3.4 million from The Leona M. and Harry B. Helmsley Charitable Trust to purchase a fully digital Elekta Infinity™ linear accelerator for its new home in the Don and Carmen Meyer Center of Excellence. By replacing out-of-date equipment installed in 2003, the new linear accelerator will allow Avera Cancer Institute Aberdeen to provide a full range of radiation oncology services that are tailored for each individual. The Elekta Infinity delivers precise beams of radiation to destroy cancer cells. The machine’s capabilities allow high treatment accuracy and optimal positioning, while also reducing radiation dosages. Motion management tools monitor and adjust for changing position of the tumor caused by motion of the body. Treatment planning software and on-board imaging provide for enhanced precision. Thanks to Avera’s collaboration with Elekta and the placement of Elekta machines at other Avera locations, radiation treatment is seamless between Avera locations, should a patient need care at another Avera Cancer Institute site.

Summer 2016

Avera Cancer Institute

Avera has been honored to receive millions of dollars in Helmsley grants for numerous projects. Examples include: • Elekta Infinity™ at Avera Cancer Institute Aberdeen The Leona M. and Harry B. Helmsley Charitable Trust supports nonprofits and other mission-aligned organizations in the U.S. and around the world in health, place-based initiatives, and education and human services. The Trust currently holds more than $5 billion in assets and has committed more than $1.5 billion since we began active grantmaking in 2008.

The Trust’s Rural Healthcare Program funds innovative projects that use information technologies to connect rural patients to emergency medical care, bring the latest medical therapies to patients in remote areas, and provide state-of-the-art training for rural hospitals and EMS personnel. To date, this program has awarded more than $278 million to organizations and initiatives in the upper Midwest states of North Dakota, South Dakota, Nebraska, Wyoming, Minnesota, Iowa and Montana.

• Elekta Versa HD™ at Avera Cancer Institute Sioux Falls to expand radiation oncology services to include stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT) • Brachytherapy at Avera Cancer Institute Mitchell •

Electron-based intraoperative radiation therapy (IORT) in the treatment of early-stage breast cancer

• Digital mammography equipment at rural community hospitals and mobile digital mammography services • CT scanner replacement funding to rural hospitals

FOR MORE INFORMATION ON THE TRUST AND ITS PROGRAMS, PLEASE VISIT www.helmsleytrust.org

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• Northern Great Plains Oncology Network, of which Avera Cancer Institute is a founding member

UNEXPECTED INTERRUPTION STUDENT’S COLLEGE PLANS DIDN’T INCLUDE CANCER TREATMENT Any college student will tell you that it’s not all smooth sailing toward earning that coveted degree. There are “all nighters” spent preparing for difficult finals, plus thousands of words to write for term papers. But cancer? “That’s the last thing you’d expect,” said Nick Ries, a music major at Northern State University in Aberdeen. Yet for Nick, at age 19, the unexpected happened. “Usually you don’t think you might get cancer until you’re much older. It was a shock; I really couldn’t process it at first. I think my mom took it harder than I did.” Nick grew up on a farm outside of Watertown, and moved to Aberdeen after graduating from high school in 2013 to begin college. In August of 2014, when Nick went to the clinic with unexplained pain, his doctor found that one of his testicles was abnormally large. An ultrasound helped confirmed a diagnosis of cancer.

“IT PUT INTO PERSPECTIVE HOW INSIGNIFICANT MOST PROBLEMS ARE.” - NICK RIES

While testicular cancer is rare compared with other types of cancer, it is the most common cancer among American males ages 15 to 35. It is also a highly treatable and curable cancer. “Within a week I was in Sioux Falls and had it removed. Everything looked good at that point,” said Nick. While tests indicated the cancer had entered his blood stream, PET scans showed no signs of additional cancer growth. Treatment protocol outlined a choice between chemotherapy, surgery to remove lymph nodes located behind the major organs, or “active surveillance” with regular blood work, CT scans and X-rays. Just ready to start his sophomore year, Nick chose the third option. If testicular cancer does spread, it follows a predictable route through the lymph nodes upward to the lungs and then elsewhere. Everything looked great until August 2015, when a CT scan revealed a lymph node in his chest that was three times larger than normal. At that point, Nick began a treatment plan of four rounds of chemotherapy. This meant having infusions every day, Monday through Friday, from 8 a.m.-3 p.m. for one week, and then having three weeks off until the next

Avera Cancer Institute

round. It also meant missing a full week of school during the chemotherapy weeks, plus the nausea and hair loss that came along with it. He finished his chemo in October. Nick didn’t lose his hair until the second round, when it came out in clumps while washing his hair in the shower. “Shortly thereafter my friend buzzed my hair, which was quite an adjustment after having a nice, full head of hair.” Nick credits supportive family, friends and professors for getting through the fall semester successfully – with all A’s. “While I had to miss class, I did a lot of homework during chemo and could do a lot of work online,” he said. Despite his high grades, Nick is quick to tell you that the fall semester was “rough.” “Some days it was really hard to keep a positive attitude. I was so tired and so sick of it,” he said. “It helped to try to keep a normal routine, and I had the best support system from my family, friends and professors.” Nick continued to live in a house with his four roommates throughout his treatment at Avera Cancer Institute Aberdeen. “It was great being able to get my treatment right in Aberdeen. Otherwise, I’m not sure what I would have done. Having the Avera Cancer Institute available in Aberdeen meant I could stay in school.” As a result, Nick is still on track with his music major as a 21-year-old junior. He’d like to be a high school or middle school band director, and someday pursue a master’s and possible doctoral degree, and teach at the college level. “Future plans are always in motion,” he said. Nick plays trumpet and also sings as part of his activities at Northern State. He is president of Northern State’s chapter of Phi Mu Alpha music fraternity, which has a tradition of singing at nursing homes and the cancer center. This group also graced listeners at Avera Cancer Institute Aberdeen’s grand opening on Jan. 21. “Most of us realize what the gift of music means for people,” he said. Having been on the patient side, this performance was especially meaningful for Nick. Even though Nick missed four full weeks of classes, cancer treatment was a learning experience that he’ll carry with him for life. 

Summer 2016

IMMUNOTHERAPY

Boosting the Body’s Own Defenses Against Cancer The immune system is your body’s fortress against germs and foreign bodies — even cancer. But sometimes the immune system needs a little help. An innovative treatment option called immunotherapy does just that by helping the immune system to better detect and kill cancer cells.

SREEKANTH DONEPUDI MD, MPH ONCOLOGIST

“Immunotherapy is almost like waking up your own immune system. With that help, the immune system can recognize the cancer cells and kill them.”

Because cancer occurs when cells become altered, the immune system can have a harder time detecting them as foreign — the cancer cells are essentially able to evade the immune system. Sometimes the immune system is suppressed by cancer cells or the response just isn’t strong enough to kill the cells. The therapy uses substances made from living organisms to help the immune system recognize cancer cells and create a stronger response to destroy them. While immunotherapy is not as common as chemotherapy, radiation or surgery, it is becoming an important tool for certain types of cancer, including lung, melanoma and more recently, renal cancer. Most people probably don’t realize immunotherapy has a more than century-old history, but it also is in the midst of a major growth and development stage. As research continues its uses continue to grow.

“This is an exciting part of oncology. Eventually we’ll have more therapies for more types of tumors,” said Sreekanth Donepudi, MD, MPH, Oncologist at Avera St. Mary’s Hospital in Pierre.

There are two common types of cancer immunotherapy: • Man-made versions of immune system proteins — these can be designed to attack a very specific part of a cancer cell. • Drugs that wake up the immune system to help it recognize and attack cancer cells.

Patients typically receive medication every two to three weeks through an IV. Immunotherapy can be a good option for patients who are not well enough for more traditional treatments such as chemotherapy. While there is typically no hair loss, nausea or vomiting, patients sometimes experience skin rashes and thyroid problems. “The good thing about immunotherapy is that side effects are often more tolerable than with chemotherapy,” Donepudi said. “This is really exciting for patients who are struggling to find new options.” 

Summer 2016

Avera Cancer Institute

REMOVING BARRIERS TO BETTER CANCER CARE “I think it made me a totally different person. It gave me an entirely new outlook on life for the positive.” - TY ESCHENBAUM

TY ESCHENBAUM, HIS GRANDFATHER ARNOLD WIENK, AND AUCTIONEER SETH WEISHAAR WORK DURING THE FEMALE AUCTION SALE IN SEPTEMBER 2014 AT THE WIENK CHAROLAIS RANCH.

There are many great things about living in a rural area.

He also runs the Ty Eschenbaum Foundation, which provides college scholarships to youth cancer survivors in South Dakota.

Just ask Ty Eschenbaum, 28, who grew up on a farm a few miles north of Lake Preston. His family owns Wienk Charolais, a fourth-generation seedstock cattle operation.

Ty is drawing upon both his experience as a cancer survivor and his understanding of rural communities as part of his work on the Avera Rural Cancer Advisory Board.

“Like most that love rural America, I enjoy knowing people in your community on a first-name basis, growing up with a small class of the same kids from kindergarten through high school, and being part of a community that really looks out for each other,” he said.

It’s a new forum in which 22 stakeholders are sharing their insights and input, through a project funded by a $200,000 Community Innovation Grant from the Bush Foundation. Avera will use their valuable insights to better understand the barriers to cancer treatment, how to remove them and how to change the course of care delivery.

But when it comes to accessing cancer care, distance can be an obstacle to receiving care. That was the case 13 years ago when Ty, as a high school freshman, was diagnosed with acute lymphoblastic leukemia. Ty estimates he missed about 35 percent of classes from his sophomore through his senior year as he traveled to receive treatment at Avera Cancer Institute Sioux Falls and Mayo Clinic in Rochester, Minn. He took summer classes and still graduated with a 4.0 grade-point average and was valedictorian in his class. That tenacity helped him through a difficult cancer journey, and led him to where he is today. Ty works for the South Dakota Department of Agriculture’s agriculture development team, where he recruits companies to South Dakota and helps existing companies expand.

Ty and the other members of the group tackle issues that Ty experienced firsthand, such as traveling to receive cancer care. His family often made the 90-mile drive to Sioux Falls for Ty to receive care. “It was everything — every checkup, every round of chemo and spinal tap. If we could go home and sleep in our bed after each treatment, we would drive for three hours versus staying at someone’s house.” It’s an all-too common experience for cancer patients living in rural communities. Ty and others say it will take innovative solutions like Avera eCARE™ to combat the issues of distance and limited access to treatments and facilities. “It really is such a unique issue in South Dakota because of how far we are from health care centers,” he said. Summer 2016

Avera Cancer Institute

Members gather to have conversations about how to best assist people in getting the help they need, when they need it. The group also focuses on challenges beyond distance, including what Ty calls the “agricultural mindset.” It’s that tendency of many farmers and ranchers to put their livestock first. “They make sure their livestock are warm and bedded before they take care of themselves. Trying to get them to come in for yearly checkups and to take it easy — it’s hard.”

CANCER NAVIGATION CENTER

Midwesterners also tend to do things on their own, which can be difficult when families are dealing with a serious illness. “By and large, they’re not used to needing anyone, not having to reach out to anyone. A lot of folks don’t want to talk about it,” he said. The Rural Cancer Advisory Board has discussed setting up a mentor network for cancer patients to talk with someone who has been through cancer treatment. Another idea is to raise awareness for the informal support programs that are common in many small communities. “It’s the unspoken things we do in a small community. They are a group of people in our church that drive people who have chemo treatments. Every time someone comes down with a sickness in Lake Preston we do a benefit,” Ty said. The board wants to look into letting patients know about those formal and informal assistance programs. “How do we get patients aware of them? How do we modify the programs to meet their situation?” With the help of individuals like Ty, who has been through cancer treatment and heard from many others about their experiences, the board is working to provide innovative solutions for better cancer care. 

Avera Cancer Institute

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24/7 support for a 24/7 disease Reasons for calling the Avera Cancer Institute Navigation Center can range from managing symptoms, to finding resources for emotional support, to getting help for loved ones impacted by a cancer diagnosis. Anyone can call the Navigation Center – they do not need to be an Avera patient.

“ I wish I would have known that...” That’s exactly what Avera caregivers don’t want to hear from patients after they have completed their cancer journey.

JAMIE ARENS AVERA CANCER INSTITUTE NAVIGATION CENTER DIRECTOR

“We want to connect all patients with all the helpful resources, education, experts and services we can to help make their cancer care journey successful,” said Jamie Arens, Director of the new Avera Cancer Institute Navigation Center.

Navigation Center calls are answered 24/7, with navigation services provided by registered nurses and social workers. For several years, Avera has had disease-specific navigators who come alongside cancer patients throughout their care journey, from diagnosis to survivorship. This service expands navigation, making it available across the entire Avera footprint. “This offers an added layer of support to connect people to the help they need in their moment of need,” Arens said. This community-based model connects people to resources closest to home, for example, support groups, transportation resources or physician outreach clinics. “Our focus is really that rural population who might feel isolated,” Arens said.

NAVIGATION CENTER Calls answered 24/7 605-322-3211 888-422-1410

The Navigation Center is physically located on the first floor of the Prairie Center in Sioux Falls. It’s a call center, but it’s also set up to help anyone who walks in seeking assistance. The Avera Cancer Institute chaplain, dietitian and American Cancer Society navigator have offices in the same location, bringing several supportive services together in one location for better accessibility and collaboration. “Our goals are to overcome barriers to care, reduce burdens of cancer and improve access to quality care as we connect people back to resources that are close to home,” Arens said. 

PREVENTING

ONE OF AMERICA’S DEADLIEST

CANCERS

Colorectal cancer claims 50,000 lives annually in the United States, and nearly 135,000 people are diagnosed with this disease each year.

STEVEN CONDRON, MD, GASTROENTEROLOGIST

However, screening early and regularly – whether you’re at higher risk or not – enables physicians to find colon cancer in its earliest stages, when it is most treatable. Even better, the removal of pre-cancerous polyps can prevent cancer from ever developing in the first place.

“For the general population, we advise getting screened by age 50,” said Steven Condron, MD, Gastroenterologist with Avera Medical Group Gastroenterology. “Each person is unique, so your physician may recommend a different schedule.”

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Based on your medical history, sedation needs and personal sensitivity, you and your doctor will also choose which test is best for you from among these options:

COLONOSCOPY “Because of its sensitivity to detecting abnormal growths and thorough examination of the colon, a colonoscopy is the best screening for colon cancer,” said Condron. “It’s the gold standard.” For the patient’s comfort, a sedative is given before inserting a long, thin tube into the rectum. During the colonoscopy, the gastroenterologist can remove polyps immediately as well as take biopsies of any suspicious lesions.

FIT KIT If a patient isn’t comfortable with or is unable to undergo colonoscopy for medical reasons, a FIT kit is recommended. This take-home test allows you to collect stool hygienically, and then return it to the clinic for lab testing. “A patient with negative results can repeat the process every year,” said Condron. “With positive results, this patient will need more in-depth testing with a colonoscopy.”

CT COLONOGRAPHY Also known as a virtual colonoscopy, a CT colonography aims X-rays around the body and captures multiple crosssectional images of the colon. Software reconstructs the patient’s colon on a screen, allowing the radiologist to “drive” through the colon and look for polyps. Minimally invasive, the CT colonography doesn’t require a sedative. However, a tube inserted into the rectum gently pumps air to expand the bowels. Like colonscopy, this test requires colon prep the day before the exam. Also, if any polyps or lesions are detected, the patient needs to undergo colonoscopy as well.

THE 80/18 INITIATIVE Regardless of which screening you choose, just get screened! In 2014, the National Colorectal Cancer Roundtable began a nationwide project to get 80 percent of adults 50 years or older screened for colon cancer by 2018. “To boost the number of screenings in our region, we’ve visited local

organizations promoting our Flu/ FIT campaign,” said Alicia Sanborn, Director of Avera Gastroenterology. “While offering flu shots to people, we educate them on colon cancer and offer a FIT kit.”

COVERAGE Before setting up a colorectal screening, make sure you understand your insurance coverage. “Call your insurance carrier directly to verify how screening options are covered,” advised Preston Renshaw, MD, Chief Medical Officer at Avera Health Plans. Typically, a patient’s initial screening is completely covered by insurance. “When the patient can follow the standard timeline for colorectal screenings, their procedure should be completely covered by their insurance,” said Renshaw. If abnormalities are present or if biopsies are taken to a pathology lab, coverage may change. Further diagnostic tests are subject to deductible and coinsurance, depending on your insurance plan. If you are at higher risk for colorectal cancer, and need earlier or more frequent screenings, you should check with your insurance carrier to see how this is covered. CT colonography may be covered by insurance as a screening option based on medical issues that prevent the other tests. It is important to check with your insurance carrier anytime you have coverage concerns. Take our FREE, online colon cancer health risk assessment to learn your risk of colorectal cancer. Visit Avera.org/colon to learn more. 

COLORECTAL CANCER RISK FACTORS • Having a personal or family history of precancerous colon polyps or colon cancer • Being age 50 or older, age 45 or older if African American • Being overweight • Smoking • Having ulcerative colitis or Crohn’s colitis (IBD)

GENERAL SCREENING GUIDELINES Colonoscopy – once every 10 years FIT kit – once every year CT colonography – once every 5 years People at high risk for developing colon cancer should be tested more often. Source: UpToDate, Inc.

IMPROVING YOUR ODDS How Weight Loss Can Lower Your Risk for Cancer

Among the myriad benefits of maintaining a healthy weight, it may also reduce your risk of several types of cancer.

One of the leading theories on why obesity leads to increased cancer is because individuals who are overweight have higher levels of hormones in their bloodstream, because fat cells produce estrogen.

Research has shown for awhile that obesity lowers life expectancy by contributing to diabetes, high blood pressure, heart disease and stroke. More recently, ties between obesity and cancer have become evident.

The connection between obesity and breast cancer is particularly striking, says Amy Krie, MD, Breast Medical Oncologist with Avera Medical Group Oncology & Hematology.

DAVID BASEL, MD AVERA MEDICAL GROUP VICE PRESIDENT OF CLINICAL QUALITY

“There is a well established link between obesity and an increased risk of cancer, especially certain cancer types including esophageal, breast, pancreas, colorectal, endometrial, kidney, thyroid and gallbladder,” said David Basel, MD, Avera Medical Group Vice President of Clinical Quality.

Obesity can increase risk as much as 30 to 40 percent for some cancers, Basel said. “The strongest is esophageal and endometrial,” Basel said. With more than one-third of Americans being overweight, the obesity epidemic across the U.S. is only getting worse.

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“Another reason we think that obesity leads to cancer is that there are higher insulin levels in obese individuals,” Basel said. Higher insulin levels can cause inflammation and also prevent cancer cells from dying.

Research shows: • Obese women are 30 to 50 percent more likely to develop breast cancer than women of a healthy weight. • Women who walk 30 minutes per day lower their rate of breast cancer by 20 percent. •

Women who gain 20 to 30 pounds after age 18 are 40 percent more likely to develop breast cancer than those women who stay within five pounds. Women who gain 70 pounds double their risk of breast cancer.

Research shows that breast cancer survivors who do not gain weight after their diagnosis and maintain a healthy weight are less likely to have a recurrence of breast cancer.

AMY KRIE, MD BREAST MEDICAL ONCOLOGIST

“Certainly, the connection between obesity and cancer is one we’re still unraveling,” Krie said. “In order for a cancer cell to grow, it needs to have the right microenvironment. If your microenvironment is healthy, it is harder for cancer cells to set up shop.” For weight loss to last, it needs to be a lifestyle change. “Commit to a lifestyle change of healthier eating habits, increasing fruits and vegetables and decreasing carbohydrates. Exercise is the No. 1 key. That in itself can have an effect on decreasing your cancer risk separate from obesity,” Basel said. Aim for 30 minutes of moderate exercise five times a week, which are the recommended guidelines from the Centers for Disease Control and Prevention. If you can fit in more, that’s even better. “Exercise lowers estrogen and insulin levels, decreases inflammation, relieves stress and improves your immune system,” Krie said. “Exercise is the single most important thing a woman can do to modify her risk.”

Exercise Recommendations

Adult s need at least: 30 minutes of moderate intensity aerobic activity (such as walking quickly or riding a bike) five times a week

or 75 minutes per week of vigorous-intensity aerobic activity (such as running)

an equivalent mix of moderateand vigorous-intensity aerobic activityand muscle-strengthening activities on two or more days a week that work all major muscle groups

Source: Centers for Disease Control and Prevention

THE DIFFERENCE IS...

Participation in national and international research.

At Avera Cancer Institute, our patients inspire us to offer more effective treatment options through partnerships, research and innovative technology while maintaining our long-standing focus on the whole patient — mind, body and spirit.

That’s cancer care done differently. That’s Avera.

1 of 5 medical institutions in the U.S. participating in the Worldwide Innovative Networking Consortium — a global network of research organizations developing personalized cancer care for patients. The largest cancer care team in the region. Offering Gamma Knife technology, the most trusted nonsurgical solution for treating brain disorders. Offering the region’s only 24/7 navigation call center devoted to helping cancer patients. The region’s only bone marrow transplant program. A comprehensive approach to treatment that encompasses spiritual and restorative services, with the belief that a mind at peace can help the body heal.

Call anytime for cancer-related guidance and support: 888-422-1410 Learn more at Avera.org/cancer 16-ACAI-0057