Christiana Care Cancer Update Spring 2013

Issue No. 27 / May 2013

cancer update In this issue Director’s Corner: The Last Piece of the Puzzle Screening Program Breaks Down Racial Barriers New Residency in Medical Physics Building Mental Health Programs for Cancer Survivors Safeguarding Patients’ Rights

Helen F. Graham Cancer Center pioneers clinical immersion program for engineering students I N A FIRST- OF - ITS - KIND PROGRAM IN THE NATION , cancer specialists at the Helen F. Graham Cancer Center are closing the gap between the real world and the classroom for tomorrow’s biomedical engineers.

“Our goal was to introduce future biomedical engineers to the problems that need solutions in today’s operating room,” said Surgical Oncologist Joseph Bennett, M.D., who led a four-week clinical immersion session in January 2013 for University of Delaware (UD) students.

“In just one month, the students came up with some very good ideas,” he said.

Eleven students took the course, offered in partnership with clinicians and professionals at Christiana Care, Nemours/ Alfred I. duPont Hospital for Children and the Infant Behavior Laboratory at UD’s Early Learning Center. The course challenged students to find potential solutions for unmet clinical needs.

“This unique clinical immersion session is a model for similar cooperative learning experiences,” said Nicholas J. Petrelli, M.D.,

Bank of America endowed medical director of the Helen F. Graham Cancer Center. (continued on back page)

Dr. Bennett demonstrates a procedure with University of Delaware students Anna Sung, left, and Madison DeFrank in the Virtual Education and Simulation Training Center.

DIRECTOR’S CORNER Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, lays out the pieces to a multifaceted Cancer Program.

The Last Piece of the Puzzle This year, the Friends of the Helen F. Graham Cancer Center celebrate their 10th anniversary. Thanks to the philanthropic efforts of these dedicated leaders, significant resources have been raised to support our program, and I am deeply grateful. We have also benefitted from the generosity of the Junior Board of Christiana Care, many community businesses, foundations and numerous individuals throughout our region. As a result, we have been able to raise the bar on cancer care for Delawareans in many ways: • Multidisciplinary disease site centers where patients meet their specialized cancer care team in one visit.

• The Ruth Ann Minner High-Risk Family Cancer Registry, made possible by a generous grant from AstraZeneca, offers statewide genetic counseling and gene testing, the ultimate in cancer prevention and early detection.

• An expanded cancer outreach program for the underserved.

• A premier National Cancer Institute and pharmaceutical clinical trials program, nurse navigators, pain and palliative care, wellness, social and psychology experts, research nurses and a Department of Radiation Oncology at the technological forefront.

2 Christiana Care Health System

One puzzle piece is still missing — adequate resources to secure the future of the Center for Translational Cancer Research (CTCR). This 7,000 square-foot, state-of-the-science laboratory, in the Graham Cancer Center’s West Pavilion, is unique to our community. The CTCR was founded on a strong infrastructure of collaboration between Graham Cancer Center clinicians and scientists at the University of Delaware, Delaware State University, the Wistar Institute in Philadelphia, the Nemours Research Institute/A.I. duPont Hospital for Children and the Kimmel Cancer Center at Thomas Jefferson University.

Our work is transforming the culture of cancer research into a powerhouse of multidisciplinary teams and a synthesis of ideas, technologies and research focused on the common goal of curing and preventing cancer. Our ultimate success requires time and no small sum of resources.

The CTCR offers the capability to conduct highly complex studies; to develop new diagnostics, drug products and new medical knowledge; to create jobs; to attract quality physicians; and to train tomorrow’s clinical investigators.

Exciting projects underway include researching colorectal cancer stem cells; mapping the pathways linked to cancer cell development; designing artificial

NICHOLAS J. PETRELLI, M.D.

salivary glands; and building nanofiber scaffolds to study breast cancer. Under the direction of Eric Kmiec, Ph.D., a Genome Customization Core within the CTCR will create customized cell lines for drug screening and analysis that better reflect genetic variances in our general population.

Completing the picture are the hardworking physicians, nurses and paramedical personnel who have tirelessly devoted their time and expertise to both inpatients and outpatients at Christiana Care. In concert with our patient care and prevention programs, a secure and vibrant CTCR will be a lasting legacy for our generous supporters — and a bright picture, indeed, for Delawareans who do not have to leave our state for their cancer care.

Successful colorectal cancer screening program breaks down racial barriers in Delaware Report by Stephen Grubbs, M.D., and Nora Katurakes, RN, featured in Journal of Clinical Oncology

D E L AWA R E ’ S

to eliminate the racial disparity in colon cancer between AfricanAmericans and whites is the focus of an article by lead co-author Stephen Grubbs, M.D., an oncologist at the Helen F. Graham Cancer Center, and Nora Katurakes, RN, MSN, OCN, Christiana Care’s manager of Community Outreach and Education. The article, “Eliminating Racial Disparities in Colorectal Cancer in the Real World: It Took a Village,” is featured in the April issue of the Journal of Clinical Oncology.

S U C C E S S F U L E F F O RT S

“The First State is the first state to show that they have eliminated a health disparity statewide.”

—STEPHEN GRUBBS, M.D.

“We demonstrated what can happen when the state’s entire health care community mobilizes toward a common goal,” said Dr. Grubbs, who is also a member

of the Delaware Cancer Consortium. “The First State is the first state to show that they have eliminated a health disparity statewide.”

Colorectal cancer is the third most common cancer in the U.S., but highly preventable with routine screening.

Using a multi-pronged approach, Christiana Care’s Helen F. Graham Cancer Center partnered with Delaware’s other hospitals, providers and state government to save lives from colorectal cancer, targeting the underserved at greatest risk. The state-run Screening for Life program and the Delaware Cancer Treatment Program helped cover the costs.

The findings show the percentage of colorectal cancer cases diagnosed at advanced and regional stages among African-Americans declined from 79 percent to 40 percent. Overall incidence rates per 100,000 also declined from 67 to 58 percent for African-Americans and whites, respectively in 2002 to 45 percent for both in 2009.

Nurse navigators at Christiana Care and other health systems recruited both insured and uninsured patients for cancer screening and coordination of care. From 2004 to 2011, the program provided more than 10,000 navigations and 5,000 colorectal cancer screenings.

Nora Katurakes, RN, MSN, OCN, manager of Community Outreach and Education, explains the benefits of colorectal cancer screening at a recent event.

Cancer Update 3

Radiation Oncology launches first allied health residency in medical physics T H E C H R I S T I A N A C A R E D E PA RT M E N T O F R A D I AT I O N O N C O L O G Y AT T H E H E L E N F. G R A H A M C A N C E R C E N T E R O F F E R S I T S F I R S T R E S I D E N C Y P R O G R A M I N M E D I C A L P H Y S I C S . The program is in collaboration with the Thomas Jefferson University Radiation Oncology Department Division of Medical Physics at the Kimmel Cancer Center in Philadelphia.

Dr. Mourtada and Dayee Jacob, senior medical physicist, work on a brachytherapy treatment plan.

The first candidate accepted into the new medical physics residency at Christiana Care is Allison Mitchell, who holds a master’s degree in medical physics from Duke University. She begins clinical rotations in July 2013, pending program certification by the Commission on Accreditation of Medical Physicists Educational Programs (CAMPEP), Inc. As a branch campus of Jefferson Medical College and an independent academic medical center, Christiana Care supports 13 residency programs. The new medical physics residency at the Helen F. Graham Cancer Center is the first for allied health professionals.

“Our ability to partner with Jefferson to offer accredited radiation oncology physics residency training strengthens our vision to provide quality education as well as excellent clinical practice to our community,” said Radiation Oncology’s Chief of Clinical Physics Firas Mourtada, MSE, Ph.D., D.ABR, who will serve as associate program director.

4 Christiana Care Health System

Innovative teaching model Medical physicists collaborate with radiation oncologists to help plan and supervise the delivery of complex radiation treatments for cancer patients. Using an innovative teaching model, Jefferson’s CAMPEPaccredited, two-year medical physics residency program will serve as the “hub,” offering courses for the residents on campus in Philadelphia with many sessions available online. The Helen F. Graham Cancer Center will be the “spoke” or affiliate, offering residents the opportunity to work alongside our radiation oncologists, medical physicists and dosimetrist using the latest radiation oncology technologies.

According to Dr. Mourtada, “With this training model, we maximize the complementary strengths of our two institutions.” For example, nationwide we are among the busiest for high-dose-rate brachytherapy for breast and gynecological cancers, low-dose-rate brachytherapy for prostate cancer, and the highly advanced Cyberknife robotic radiosurgery system, which is currently not available at Jefferson.

Graham Cancer Center models psychosocial program development for cancer centers across the country A S A N AT I O N A L C A N C E R I N S T I T U T E S E L E C T E D C O M M U N I T Y C A N C E R C E N T E R P R O G R A M ( N CCC P) , the Helen F. Graham Cancer Center is working with other centers — nationally — to build effective psychosocial programs for cancer survivors.

“We want to change the culture of thinking about mental health and how we communicate with cancer survivors to get them the help they need,” said Health Psychologist Scott D. Siegel, Ph.D.

Dr. Siegel led the NCCCP Survivorship & Palliative Care Subcommittee working group to develop a Cancer Psychosocial Care Matrix. Theresa Gillis, M.D., medical director of Oncology Pain and Symptom Management and Rehabilitation Services at the Graham Cancer Center, was in the working group and a co-author on its paper published online in Psycho-Oncology 2013.

“As a member of the NCCCP, we share a common goal of improving cancer care for our patients in their home communities,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center. “Collaborating to develop better tools to facilitate better care and modeling best practices from our own experiences are important elements of this successful partnership that will benefit the entire national community of cancer centers.”

Roadmap for improvement According to Dr. Siegel, national practice guidelines emphasize the importance of providing distress screening for cancer survivors, improving communication between providers and patients, and offering interventions or referrals for mental health and social services.

However, he acknowledges that guidance about how to make the vision a reality among cancer centers with diverse capabilities and resources is limited.

“The matrix can help community cancer centers evaluate their own programs and provide measureable milestones to close any gaps to care,” he said. This roadmap can be a conduit to more comprehensive psychosocial services for patients at individual centers, especially within the context of changing Commission on Cancer accreditation standards.

Dr. Siegel counsels a patient at the Helen F. Graham Cancer Center.

NEW STUDY EXAMINES SURVIVORS’ FEAR OF RECURRENCE A two-year grant from the National Cancer Institute supports Dr. Siegel’s research in collaboration with the University of Delaware’s Professor Jean-Philippe Laurenceau, Ph.D., which studies fear of recurrence in breast cancer patients and their spouses or partners. “From our prior research, we know fear of recurrence is common, at times debilitating, and under-recognized problem facing survivors,” Dr. Siegel said.

In this new study, the investigators examine factors that exacerbate and attenuate fear of recurrence and its emotional toll on family members as well. Their clinical findings potentially will enhance standards of care for cancer survivors.

Cancer Update 5

Institutional Review Board safeguards patient rights in cancer clinical trials A T 23

P E R C E N T , Christiana Care’s Helen F. Graham Cancer Center has one of the highest patient accrual rates for cancer clinical trials in the U.S., far above the national average of 5 percent.

The Christiana Care Institutional Review Board (IRB) represents the interests of patients who participate in cancer clinical trials and safeguards their rights and welfare. The IRB also ensures compliance with all federal and state regulatory requirements and ethical principles and reports to the Quality and Safety Committee of the Christiana Care Board of Directors.

Twenty members, volunteers from multiple medical disciplines and the community, serve on one of two IRB committees chaired by Gary Johnson, Ph.D., and Steven Kushner, M.D. All research that involves human subjects or their data at Christiana Care must be approved by the IRB. According to IRB Director Jerry Castellano, Pharm.D., CIP, cancer research trials

constitute a significant percentage of the IRB workload. The Christiana Care IRB also reviews and approves cancer research trials for protocols conducted at hospital affiliates of Christiana Care's Community Clinical Oncology Program (CCOP) at the Helen F. Graham Cancer Center.

THE IRB TEAM, FROM LEFT: Sonia Martinez-Colon, executive assistant; Jerry Castellano, BS, Pharm.D, CIP, corporate director; Lauren Pigeon, CPhT, administrative assistant II; Janet Leary-Prowse, MSEd, CIP, research education specialist; Heidi Derr, CIP, regulatory affairs and auditing specialist; and Judy Hutt, administrative assistant.

Meet our new team members Beverly Cusano, MHA, joined

Christiana Care as director of Radiation Oncology in August 2012. She replaces former director William Holden, MBA, RN, RT, (T), (R), who is now Vice President

of the Helen F. Graham Cancer Center.

As director, Ms. Cusano has oversight for all Radiation Oncology operations at the Graham Cancer Center and Christiana Hospital as well as at satellites in Elkton, Md., and North Wilmington, Del. She has extensive experience in health care administration, having worked most recently (2009-2012) as director of Radiation Oncology for Baptist Memorial Hospital in Memphis, Tenn. Her background as a radiation therapist, coupled with her master’s degree in health administration, gives her a patient-centric perspective of the radiation therapy process.

6 Christiana Care Health System

Cardiothoracic Surgeon Brian T. Nam, M.D., joined the Thoracic/Esophageal Cancers multidisciplinary team at the Helen F. Graham Cancer Center following fellowship training in his specialty at the University of Wisconsin, Madison. He received his medical degree from the University of Minnesota and competed residency training in general surgery at the Mayo Clinic in 2010.

Dr. Nam specializes in minimally invasive treatments for esophageal and lung cancers including videoassisted thoracic surgery and minimally invasive esophagectomy. His research includes using “fast track” standardized protocols to promote faster recovery and shorter hospital stays.

This just in The Helen F. Graham Cancer Center’s Care Management Team won the American Psychological Association’s (APA) Psychologically Healthy Workplace Award 2013, for creating a healthy, high-performance work environment. The team is also an APA Best Practices honoree for employee growth and development. Christiana Care is only the fourth hospital system ever to win the national award and is one of only four employers in North America to receive the award this year.

Cancer Care Management previously won the Delaware Psychological Association’s state-level Psychologically Healthy Workplace Award, qualifying for APA award nomination.

Among the 100 top hospitals with “Great Oncology Programs,” Christiana Care and the Helen F. Graham Cancer Center rank among the best for clinical accolades, quality care and contributions to the field of oncology, according to Becker’s Hospital Review.

Congratulations to Radiation Oncology’s Chief of Clinical Physics Firas Mourtada, MSE., Ph.D., D.ABR, who is the newly elected treasurer and member of the Board of Directors of the American Brachytherapy Society, 2014-2016.

Helping Hands for Breast Health at the Helen F. Graham Cancer Center won a one-year, $50,000 grant from the Avon Breast Health Outreach Program. Now in its 12th year of Avon funding, the program has reached more than 8,000 New Castle County area women and referred them for low-cost or free mammograms and clinical breast exams in their own communities.

Members from Cancer Care Management accepted the award at APA’s 8th Annual Psychologically Healthy Workplace Award Ceremony on March 9 in Washington, DC.

Christiana Care’s Chief of Thoracic Surgery Thomas L Bauer, M.D., is the 2013 president of the Philadelphia Academy of Surgery, the oldest surgical society in the U.S. Dr. Bauer, who sees patients at the Helen F. Graham Cancer Center, is a National Institutes of Health-funded clinical trials principal investigator, working to advance the treatment of lung and esophageal cancer.

Society of Surgical Oncology’s “Great Debates” featured Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, versus Mitchell C. Posner, M.D., chief of general surgery and surgical oncology from the University of Chicago, during the society’s 66th Annual Cancer Symposium, on March 9. Their topic: “Surgery Alone Versus Surgery Plus Chemotherapy for Resectable Colorectal Liver Metastases.” Dr. Petrelli argued in favor of surgery alone; Dr. Posner argued in favor of both surgery and chemotherapy.

“The real crux of the matter here is surgical resection and avoiding the toxicity and the cost of these agents, which have absolutely no impact on overall survival as shown by prospective randomized trials,” Dr. Petrelli said during the debate.

Treatment at the Graham Cancer Center is based on national guidelines and tailored to what is most appropriate for each individual patient, whether it is surgery alone or in combination with chemotherapy.

Cancer Update 7

Non-Profit Org. US Postage

PAID Wilmington, DE Permit No. 357

P.O. Box 1668 Wilmington, Delaware 19899 www.christianacare.org

One of the original 14 cancer centers in the nation selected for the National Cancer Institute Community Cancer Centers Program.

Helen F. Graham Cancer Center pioneers clinical immersion program for engineering students (continued from front)

“What better way to allow biomedical engineering students to think outside the box than to place them in a health care environment to benefit patient treatment?”

Operating room becomes classroom The Graham Cancer Center hosted UD juniors Madison DeFrank and Anna Sung, who shadowed 10 different specialists and gained exposure to surgical oncology techniques, medical devices and instrumentation in the operating room. Their mission was to observe, identify and develop potential solutions to some of cancer surgery’s most intricate and pressing technical challenges.

The students presented their ideas to participating faculty and industry sponsors at the Nemours/A.I. duPont Hospital for Children on Jan. 31 during a poster session funded by the Delaware Health Sciences Alliance. Proposed innovations included a biodegradable suture delivery system, a waterproof sealant to close incisions, a “belly cam” to view

the inner abdomen, an automated “twitch” monitor for patients under anesthesia and a pill-sized camera for taking pictures inside the digestive tract. Several students are eager to transform their ideas into formal senior design projects next year.

Jill Higginson, Ph.D., associate director of UD’s Biomedical

Engineering Program, conceived the idea for the course and secured the student placements with the help of David Martin, Ph.D., Karl Bõer Chair of UD’s Department of Materials Science and Engineering.

Christiana Care participating specialists included surgeons, Thomas Bauer, M.D., Michael Conway, M.D., Raafat Abdel-Misih, M.D., Michael Peters, M.D., Bhaskar Rao, M.D., and Jeffery Zern, M.D.; gynecologic oncologist Mark Cadungog, M.D.; vascular and interventional radiologist Mark Garcia, M.D and cardiologist Michael Stillabower, M.D.

F EATU R E D E MP L OY E E

Virginia Loos Executive Assistant “Part of my job is making sure the Graham Cancer Center is a safe and inviting environment for everyone who walks through our doors. Above all, I’m here to provide direct support to the physicians and nurses so they can stay focused on what’s most important – our patients.”

Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit www.christianacare.org/donors.

Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2013. All rights reserved.

13CANC57